Annals of plastic surgery
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Annals of plastic surgery · Jul 1997
Randomized Controlled Trial Clinical TrialClinical features and outcome of patients admitted to the intensive care unit after plastic surgical procedures: implications for cost reduction and quality of care.
Recent interest in cutting cost and improving utilization and delivery of perioperative services has prompted surgeons to identify patient populations that would benefit from care in an intensive care unit as opposed to intermediate or standard care. The purpose of this study was to evaluate patients admitted to the surgical intensive care unit (SICU) after major plastic/reconstructive surgical procedures in order to determine appropriate perioperative management strategies for these patients. We reviewed retrospectively the data from 2,805 consecutive admissions to the SICU between 1990 and 1996. ⋯ Based on severity of illness scoring and eventual mortality, patients admitted to our SICU after major reconstructive surgery were selected appropriately for that setting. In contrast, the patients who stayed in the PACU for perioperative monitoring did not require life-supporting therapy and, therefore, were overmonitored. Care could be provided in a specialized unit with dedicated nursing specifically trained for that purpose.
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Annals of plastic surgery · Jun 1997
Case ReportsSubcutaneous metallic mercury injection: early, massive excision.
The case of a patient who injected 10 cc of metallic mercury subcutaneously into his left forearm through multiple punctures in an attempt at suicide is presented. Diagnosis was made by plain radiography of his left forearm, which exhibited redness, edema, and tenderness on the third day postinjection. Early excision of all affected subcutaneous tissues including metallic mercury deposits was performed on the fifth day postinjection. ⋯ The patient was free of toxic symptoms and mercury embolism. The local, aseptic lytic property of metallic mercury, which could cause severe damage to vital structures, was observed perioperatively. Early diagnosis and early, massive excision of mercury deposits in affected tissues is the important treatment modality in these rare cases.
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Annals of plastic surgery · May 1997
Randomized Controlled Trial Clinical TrialA controlled, randomized, double-blind study of ketorolac for postoperative analgesia after plastic surgery.
The present study was designed to evaluate the efficacy and safety of ketorolac compared with metamizol (Nolotil) in the control of pain after plastic surgery. Almost no literature exists on postoperative pain control in this specialty. A multiple-dose, randomized, double-blind study of parallel design was carried out. ⋯ Ketorolac and metamizol were found to be equally safe and effective in reducing postoperative pain after plastic surgery. It should be noted that 52% of patients in the ketorolac group and 48% in the metamizol group considered their postoperative analgesia to be very good. Nevertheless, for surgical procedures or for patients in whom postoperative hematoma formation is a particular concern, ketorolac probably should not be used.
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Annals of plastic surgery · May 1997
Case ReportsAneurysm of the radial artery following blunt trauma to the wrist.
Aneurysms involving the distal radial artery are rare lesions which are usually secondary to penetrating trauma or iatrogenic injury. Blunt trauma is an extremely uncommon cause. ⋯ Excision of the aneurysm is recommended. The decision to ligate or reconstruct the radial artery remains controversial.
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Ischemic time (the time between the interruption and reestablishment of blood supply) was reviewed for 700 free flaps used for breast or head and neck reconstruction. Flaps that failed had a mean ischemic time of 111.64 minutes, while flaps that survived had a mean ischemic time of 91.25 minutes. The difference was not statistically significant (p = 0.189). ⋯ Flap survival was also similar when 75 minutes and 120 minutes were used to segregate the longer and shorter ischemic time groups. When 180 minutes was used to segregate the groups, there was a slight trend toward more flap loss in the group with longer ischemic time, but the difference was not significant. We conclude that ischemic time is irrelevant to flap survival, provided that ischemia is not prolonged past 3 hours or to the point where the no-reflow phenomenon occurs.