Annals of plastic surgery
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Annals of plastic surgery · May 2010
Does voltage predict return to work and neuropsychiatric sequelae following electrical burn injury?
Voltage has historically guided the acute management and long-term prognosis of physical morbidity in electrical injury patients; however, few large studies exist that include neuropsychiatric morbidity in final outcome analysis. This review compares high (>1000 V) to low (<1000 V) voltage injuries, focusing on return to work and neuropsychiatric sequelae following electrical burn injury. Patients with electrical injuries admitted to the University of North Carolina Jaycee Burn Center between 2000 and 2005 were prospectively entered into a trauma database, then retrospectively reviewed. ⋯ Final impairment ratings for the high and low voltage groups were 17.5% and 5.3%, respectively. Electrical injuries often incur severe morbidity despite relatively small burn size and/or low voltage. When comparing high and low voltage injuries, similarities in endpoints such as neuropsychiatric sequelae, the need for late reconstruction, and failure to return to work challenge previous notions that voltage predicts outcome.
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Annals of plastic surgery · May 2010
The treatment of gustilo grade IIIB tibia fractures with application of antibiotic spacer, flap, and sequential distraction osteogenesis.
Gustilo grade III (GIII) B-C open tibia shaft fractures have a wide spectrum of injury to the bone and soft tissues. At the severe end of the spectrum are GIII B tibia fractures that combine segmental bone loss with soft tissue injuries which require flap reconstruction. These complex injuries can be treated combining circular tensioned wire fixation and distraction histiogenesis with flap reconstruction. ⋯ Eighteen of 19 fractures were reconstructed with union and no deep infection or osteomyelitis. One fracture had a hypertrophic nonunion in a noncompliant patient. The use of antibiotic spacers and flaps to construct a soft tissue tunnel combined with distraction histiogenesis is an effective technique to salvage complex GIII B tibia fractures with segmental bone loss.
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Annals of plastic surgery · Apr 2010
Expanded retroauricular skin and fascial flap in congenital microtia reconstruction.
The aim of this article is to report the application of expanding retroauricular skin fascia flap, and autogenous costal cartilage for congenital microtia reconstruction. Microtia reconstruction was generally completed in 3 surgical stages. In the first surgical stage, a 50 or 80 mL kidney-shaped tissue expander was inserted subcutaneously in the retroauricular mastoid region. ⋯ Expanded retroauricular skin flap combined with fascial flap can cover the different size and height of cartilage ear framework in single surgical stage. At the same time, on the basis of structure stability and contour reality of cartilage framework, we can achieve fine structure and erect stability of constructed auricle. This method affords ideal results in microtia reconstruction.
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Annals of plastic surgery · Apr 2010
Case ReportsMicrosurgical reconstruction for canalicular laceration using Monostent and Mini-Monoka.
Many surgical techniques are available for repairing a lacerated canaliculus, such as, Worst pigtail probing, and monocanalicular or bicanalicular procedures involving silicone intubation. Despite this, controversy still exists regarding the best surgical method in terms of subjective and objective outcomes. We report the experience of microscopic canalicular repair using monocanalicular stents; Monostent (Eagle Vision Inc., Memphis, TN) and Mini-Monoka stents (FCI Ophthalmics, Marshfield Hills, MA) and compare these 2 products. ⋯ However, in one case, a Mini-Monoka stent (FCI Ophthalmics) was repeatedly extruded or clogged internally and replaced by Monostent (Eagle Vision Inc.). Although the latter had a larger conduit diameter, it was more flexible and had potentially folded on itself in the lacrimal sac, thus, obstructing flow in this case. Microscopic canalicular reconstruction using a Monostent (Eagle Vision Inc.) or Mini-Monoka stent (FCI Ophthalmics) offers a safe, effective, and straightforward means of acute lacrimal system injury treatment.