Annals of plastic surgery
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Annals of plastic surgery · Sep 2011
Prediction of mortality in patients with major burns: clinical and biochemical factors.
The plasma electric charge, in addition to clinical factors, was considered to improve the prediction of mortality in patients with major burns. ⋯ [Na(+)], [HCO(3)(-)] (bicarbonate), and [Cl(-)] are the ions contributing the most to the plasma charge equilibrium in patients with major burns; a loss of 50% of plasma proteins in the first 48 hours is equivalent to the loss of 1 mmol/L of HCO(3)(-). Moreover, the consideration of plasma biochemical parameters in the first 48 hours may improve the mortality predictive equation of mortality for burned victims.
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Annals of plastic surgery · Sep 2011
Nonincisional osteotomy for gradual lengthening by callus distraction in the hand and foot.
Gradual lengthening by distraction osteogenesis is widely used for brachydactyly. The most frequent postoperative complaint of the patients treated with this method is the appearance of the scar caused by the skin incision for the osteotomy, which is an integral technique of distraction osteogenesis. A nonincisional approach to osteotomy would reduce the dorsal scarring. ⋯ Of 14 digits, 13 digits achieved the target length and sufficient bone consolidation and 1 digit showed early consolidation. There was no case in which complications occurred because of the drilling. Nonincisional osteotomy for callus distraction in the hand and foot reduced dorsal longitudinal scarring and achieved good cosmetic results as compared with an ordinary osteotomy involving skin incision.
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Annals of plastic surgery · Aug 2011
Comparative StudyLocating perforator vessels by dynamic infrared imaging and flow Doppler with no thermal cold challenge.
Dynamic Infrared Imaging (DIRI) is a noninvasive technique that precisely analyzes the infrared radiation of any object. We used this technique to locate the dominant perforator vessels in flap surgery in conjunction with conventional Doppler. ⋯ DIRI produces a skin thermographic map of perforator vessels and their perfusion area. Handheld Doppler locates perforators at the aponeurotic level. Their combination increases safety in the planning of perforator flap surgery.
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Annals of plastic surgery · Jul 2011
Evaluation of prophylactic anticoagulation, deep venous thrombosis, and heparin-induced thrombocytopenia in 21 burn centers in Germany, Austria, and Switzerland.
Heparin-induced thrombocytopenia (HIT) is a life-threatening complication in intensive care settings. The timely diagnosis and management of HIT are challenging, and the incidences of HIT and deep venous thrombosis (DVT) may be related to prophylactic anticoagulation standards in burn units. We therefore evaluated, using a questionnaire, prophylactic anticoagulation, HIT management, and incidences of DVT and HIT in burn centers located in the German-speaking part of Europe. ⋯ Burn centers using low molecular weight heparin (LMWH) subcutaneous for all patients had a low rate of DVT (0.9%) and significantly lower rates of HIT (0.2%) relative to all other centers (P < 0.05). The highest rates of HIT (2.7%) and DVT (3.8%) were found in burn centers administering unfractionated heparin intravenous. While current HIT guidelines do not specify the administration of unfractionated heparin or LMWH for burn patients, these data warrant controlled prospective studies to confirm the advantage of LMWH administration in burn patients.
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Annals of plastic surgery · Jun 2011
Protective effect of human recombinant copper-zinc superoxide dismutase on zone of stasis survival in burns in rats.
Superoxide dismutase, acting as a scavenger of oxygen free radicals, has shown mixed results in increasing burn wound survival. Originally, we demonstrated that human recombinant copper-zinc superoxide dismutase (Hr-CuZnSOD) could increase the survival of failing ischemic flaps in a rat model. Because of the possible similar pathophysiology of tissue ischemia in flaps and the zone of stasis in burns, we conducted a later study using 2 groups of rats with standardized intermediate burns, to ascertain whether Hr-CuZnSOD could increase zone of stasis survival in rats. ⋯ We used 2 groups of rats, one of which received prophylactic treatments with Hr-CuZnSOD before the induction of standardized intermediate burns. Results showed that preburn Hr-CuZnSOD also failed to improve zone of stasis survival in burns. Further studies are needed to adequately understand the effect of oxygen free radicals in burn wound pathophysiology and to determine whether Hr-CuZnSOD has a role in the clinical management of burns or should be abandoned.