Annals of plastic surgery
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Annals of plastic surgery · Feb 2014
Greater occipital nerve excision for occipital neuralgia refractory to nerve decompression.
Patients who undergo occipital nerve decompression for treatment of migraine headaches due to occipital neuralgia have already exhausted medical options for treatment. When surgical decompression fails, it is unknown how best to help these patients. We examine our experience performing greater occipital nerve (GON) excision for pain relief in this select, refractory group of patients. ⋯ Excision of the GON is a valid option for pain relief in patients with occipital headaches refractory to both medical treatment and surgical decompression. Potential risks include failure in patients with cervicogenic headache and hypersensitivity of the denervated area. To provide the best outcome to these patients who have failed all previous medical and surgical treatments, a multidisciplinary team approach remains critical.
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Annals of plastic surgery · Feb 2014
Lower extremity free flap outcomes using an anastomotic venous coupler device.
Venous anastomosis is one of the most challenging technical aspects of microsurgery. Recently, it has been expedited by the use of an anastomotic coupler device in multiple reconstructive venues. However, there are few studies in the literature evaluating the use of the coupler in lower extremity reconstruction. We present one of the largest series to date examining the use of the venous coupler in microsurgical reconstruction of the lower extremity. ⋯ The use of the venous coupler device in lower extremity reconstruction can be performed with a high degree of success. The potential of the venous coupler for reduced operative time, more efficient anastomoses with decreased ischemia, and reduced thrombotic rates represents potential benefits of this important tool.
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Annals of plastic surgery · Feb 2014
A cost-effective and simple electronic solution to communication with patients with tracheostomy in a burns and intensive care setting.
Ventilated patients in ITU (intensive treatment unit) tend to be challenging to communicate with, especially patients who are being weaned. These patients usually have tracheostomy in situ and use means such as writing or letter boards to communicate. The situation becomes complex in patient groups that have burn injuries with bulky dressings and restricted upper limb function. We demonstrate a low cost, easy to use, potentially disposable system that can display words on any television screen via patient input device for such patient groups. ⋯ This device is a self-contained, cost-effective, simple, and open-source system that can be used effectively to bridge the communication gap with significant potential for patient care globally.
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Annals of plastic surgery · Jan 2014
Randomized Controlled Trial Comparative StudyThe effect of reusable versus disposable draping material on infection rates in implant-based breast reconstruction: a prospective randomized trial.
Clinical infection remains a significant problem in implant-based breast reconstruction and is a physical and emotional strain to the breast reconstruction patient. Bacterial strikethrough of draping and gown material is a likely source of infection. Strategies to reduce infection in implant-based breast reconstruction are essential to improve patient outcomes. ⋯ Disposable draping material is superior to a reusable draping system in the prevention of clinical infection within the immediate postoperative period. This study did not demonstrate a clear link between intraoperative culture data and the development of clinical infection. A completely disposable gown and draping system is recommended during implant-based breast reconstruction.
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Annals of plastic surgery · Jan 2014
Early postoperative outcomes associated with the anterolateral thigh flap in Gustilo IIIB fractures of the lower extremity.
A core concept in plastic surgery has been the replacement of "like-with-like" tissue. Applying this concept to the lower extremity, the anterolateral thigh (ALT) perforator flap has become a frequently used free flap for restoration of soft tissue defects involving the distal lower extremity. The objective of this study was to evaluate the rate of early postoperative complications associated with the ALT perforator free flap for coverage of high-energy traumatic open fractures of the lower extremity (Gustilo IIIB) and explore related patient risk factors. ⋯ In this retrospective review, those patients who had a positive history of tobacco use at the time of injury and those with risk factors for atherosclerosis had a significantly increased risk of flap complications. Although this is not surprising given the vasoconstrictive effects of nicotine and the impaired blood flow to the lower extremity in patients with atherosclerosis, this study will allow the surgeon to better counsel patients who have a history of tobacco use through complex reconstruction of the lower extremity. This analysis is a preliminary investigation into the safety and efficacy of the ALT fasciocutaneous or adipocutaneous flap to reconstruct high-energy open fractures of the lower extremity.