Annals of plastic surgery
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Annals of plastic surgery · Mar 2009
Infection risk from the use of continuous local-anesthetic infusion pain pumps in aesthetic and reconstructive abdominal procedures.
Postoperative pain control after abdominal procedures can be an area of significant concern. Continuous local-anesthetic infusion pain pumps have been clearly documented in recent literature to provide effective early postoperative pain control, in addition to other benefits. Our goal was to evaluate any increase in the risk of infection with the use of pain pumps with aesthetic and reconstructive abdominal procedures. ⋯ Fifty-nine patients did not receive a pain pump, and 2 of those patients (3.3%) developed an infection. Overall, 1.3% (2 of 159) of patients in our study developed a postoperative infection. There is no increase in the risk of postoperative infection with the use of continuous local-anesthetic infusion pain pumps used after aesthetic and reconstructive abdominal procedures.
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In this study we present the first experimental vascularized penile allogenic transplantation model in the rat. In group 1 (n = 6), the vascular anatomy of the male rat perineal region was determined. In 12 Lewis rats of group 2 (n = 24), the penile composite graft was transplanted as isotransplant by microvascular anastomosis of the pedicle of the penis to the saphenous vessels and in another 12 Lewis rats of group 2, penile composite graft was transplanted without vascular anastomosis. ⋯ Direct observation, somatosensory evoked potential test, histologic examination and microangiography were used to assess the viability of the transplants. All vascularized isotransplants and allotransplants survived over 200 days (still under observation) whereas all the nonvascularized grafts were necrosed at 7 days posttransplant. In this study the new penile allograft transplantation model in the rat was developed and a new method of blood supply to a vascularized composite tissue with directly artery-to-corpus spongiosum anastomosis was introduced.
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Annals of plastic surgery · Feb 2009
Nasal reconstruction after severe facial burns using a local turndown flap.
Reconstruction of the nose after severe burn injury is a challenging problem. There are usually associated facial burns, which limits the availability of local flaps. Reconstruction with unburned distant tissue is often not appropriate because of the resulting mismatch in color and texture. ⋯ Even in patients with subtotal nasal amputation and complete absence of cartilaginous support, the opportunistic use of scar tissue can restore nasal tip projection and alar lobule architecture without cartilage grafting. The resulting nasal reconstruction blends well into the surrounding facial appearance. This simple technique has been remarkably successful in this selected group of patients with challenging nasal deformities.
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Annals of plastic surgery · Jan 2009
Randomized Controlled TrialEfficacy of pocket irrigation with bupivacaine and ketorolac in breast augmentation: a randomized controlled trial.
Breast augmentation is the most common cosmetic surgery procedure performed in the United States. The optimal approach to postoperative pain management in these patients, however, has yet to be determined. The objective of this study was to investigate the efficacy of pocket irrigation with bupivacaine and ketorolac in reducing pain, narcotic use, and methocarbamol use following subpectoral breast augmentation. ⋯ This study suggests that pocket irrigation with bupivacaine and ketorolac can significantly decrease patient-reported pain in the early postoperative period following subpectoral augmentation. It also demonstrates, however, that there is an increased requirement for narcotics between 1-3 days after surgery. These findings suggest that intraoperative administration of analgesics into the implant pocket may thus facilitate an early postoperative recovery; yet, patients should be advised that they might require more pain medication at home for the first few days.