Annals of plastic surgery
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Annals of plastic surgery · Apr 2018
Factors Associated With Late Surgical Cancellations in Pediatric Plastic and Oral Surgery.
Surgical cancellations that occur within 1 day of the procedure (ie, late cancellations) disrupt the efficiency of the operating room. The aim of the present study was to identify the factors associated with late cancellations in a tertiary pediatric surgical practice. ⋯ In our study, most late surgical cancellations were preventable or possibly preventable. The timing of the cancellation is important because those that occur near the scheduled procedure time disallow adequate and timely redistribution of operating room resources and personnel. Analyzing and addressing the preventable and possibly preventable causes outlined in this study will significantly improve efficiency and patient access.
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Annals of plastic surgery · Apr 2018
Literacy Analysis of Spanish Online Resources for Breast Reconstruction.
Health literacy studies indicate that literacy skills are linked to access to information and health outcomes, potentially contributing to health disparities. In the United States, minority and immigrant populations are more likely to have lower literacy skills than are other population groups. The aim of this study is to evaluate web-based health information prepared in Spanish for Hispanic women considering breast reconstruction surgery. ⋯ Available breast reconstruction online resources for the Spanish-speaking population are rated too high for readability. Suitability, understandability, and cultural sensitivity scores are adequate; however, actionability scores are low, indicating potential areas for improvement. These findings demonstrate an opportunity to correct disparities in the literature on breast reconstruction for the Spanish-speaking population.
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Annals of plastic surgery · Mar 2018
Reconstruction of Defects in the Weight-Bearing Plantar Area Using the Innervated Free Medial Plantar (Instep) Flap.
Defects in the weight-bearing heel or forefoot are commonly derived from chronic wounds, acute trauma, or tumor excision. Reconstruction of such defects pose a significant challenge to provide a flap that is stable, durable, and sensate. Several flaps have been described for reconstruction of plantar defects, but recurrent ulcerations and/or the need of additional procedures are common. This article provides the approach and outcomes of innervated free medial plantar flap for weight-bearing plantar defects reconstruction. ⋯ The innervated medial plantar flap is an excellent solution for treatment of medium-to-large defects in the weight-bearing heel or forefoot. It provides glabrous skin that is stable, durable, and sensate. The long-term results are good, with no patient afflicted by recurrent ulceration during the follow-up time.
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Annals of plastic surgery · Mar 2018
ReviewVolume Resuscitation in Patients With High-Voltage Electrical Injuries.
Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. ⋯ Mannitol and bicarbonates are available but have limited support in the literature. High-voltage electrical injury patients often develop acute kidney injury requiring dialysis and have increased risks of chronic kidney disease and mortality. Continuous venovenous hemofiltration is a well-supported adjunct to clear the myoglobin load that hemodialysis cannot from circulation.
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Annals of plastic surgery · Feb 2018
Goal-Directed Fluid Resuscitation Protocol Based on Arterial Waveform Analysis of Major Burn Patients in a Mass Burn Casualty.
Adequate fluid titration during the initial resuscitation period of major burn patients is crucial. This study aimed to evaluate the feasibility and efficacy of a goal-directed fluid resuscitation protocol that used hourly urine output plus the arterial waveform analysis FloTrac (Edwards LifeSciences, Irvine, Calif) system for major burns to avoid fluid overload. ⋯ The SVV-based goal-directed fluid resuscitation protocol leads to less unnecessary fluid administration during the early resuscitation phase. Clinicians can efficaciously manage the dynamic body fluid changes in major burn patients under the guidance of the protocol.