Annals of plastic surgery
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Since antiquity, clinicians have observed that maggots can provide debridement of necrotic wounds, but the therapeutic use has declined since the advent of aseptic wound management and antibiotics. In certain difficult wounds, the use of maggots for debridement may have a role. ⋯ The mechanism of wound debridement by maggots includes the secretion of proteolytic enzymes and antibacterial substances. A case of infestation of a necrotic wound in a patient with cancer of the head and neck is presented including the entomological identification and description of the maggots.
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Annals of plastic surgery · Apr 1988
Is topical application of epinephrine at skin graft donor sites during halothane anesthesia safe?
Topical epinephrine is useful in controlling the bleeding of skin graft donor sites. However, the use of exogenous epinephrine during halothane anesthetization increases the risk of cardiac arrhythmias. This study shows that there is no significant increase in plasma epinephrine levels after topical administration of up to 80 cc of 1:500,000 epinephrine, suggesting that the use of this dose in conjunction with halothane anesthesia is safe.
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Annals of plastic surgery · Mar 1988
Case ReportsFasciocutaneous flap closure of a grade III lower third tibial fracture: an alternative to free flap coverage.
We present a patient who sustained a close-range shotgun wound resulting in a grade III fracture of the lower tibia. The wound was debrided on several occasions and, on day 4, was closed with a flexor digitorum muscle and pedicled fasciocutaneous flap. ⋯ Occasionally a fasciocutaneous flap may be available to facilitate wound closure and spare the patient a lengthy procedure and distant donor site. The established principles of compound tibial coverage must be adhered to when choosing a local fasciocutaneous flap.
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Annals of plastic surgery · Feb 1988
Case ReportsMedial arm fasciocutaneous island flap coverage of an electrical burn of the upper extremity.
Deep tissue necrosis following debridement of electrical injuries can be so severe that amputation of the limb is often necessary. To preserve function and partially devitalized structures, and to lessen the necessity for amputation, several debridements followed by coverage with a vascularized fasciocutaneous flap can be advantageous. ⋯ An angiography revealed that the ulnar collateral artery was not occluded, and thus it was used in the flap with successful results. The donor defect was closed primarily and did not require a skin graft.
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Annals of plastic surgery · Dec 1987
Case ReportsUvulopalatopharyngoplasty as a treatment of obstructive sleep apnea precipitated by uvular prolapse.
Two patients are discussed in whom obstructive sleep apnea was precipitated by uvular prolapse into the larynx and successfully treated by uvulopalatopharyngoplasty. Although tracheostomy has been the definitive treatment for obstructive sleep apnea, uvulopalatopharyngoplasty has also been used as an alternative surgical procedure. However, indications for its successful use have not been clearly defined. Our experience illustrates that the surgical approach to obstructive sleep apnea is dependent on a thorough diagnostic evaluation that includes a sleep history, head and neck examination, hypnopolygraphic recording and, if indicated, nocturnal fiberoptic endoscopy.