Annals of plastic surgery
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Annals of plastic surgery · Dec 2008
Snowblower injuries to the hand: epidemiology, patterns of injury, and strategies for prevention.
Snowblowers injure approximately 5000 people a year and can cause devastating hand injuries. Even with added safety measures and warnings on modern snowblowers, hand injuries are still occurring at an alarming rate. We have reviewed our series of snowblower-related hand injuries to elucidate the epidemiology, patterns of injury, and strategies for prevention. ⋯ Operator inexperience, low operator intelligence, and excessive alcohol consumption do not seem to contribute to injury. Instead, significant experience, older machines, short durations of use before injury, characteristic weather patterns, and underlying misperceptions about snowblower design and function typically set the stage for injury. Injuries may be prevented in the future by improving snowblower design and/or by making brief public service announcements.
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Annals of plastic surgery · Nov 2008
A challenging problem that concerns the aesthetic surgeon: postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) are among the most common adverse events in the postoperative period. This is especially disastrous in aesthetic surgery; it may cause hematoma, wound dehiscence, and patient dissatisfaction. The purpose of this study was to evaluate the incidence of PONV after aesthetic surgery procedures, and to determine the risk factors for PONV. ⋯ Risk factors for PONV must be questioned preoperatively. Patients with risk factors are good candidates for prophylaxis. As a result of the effective prevention of PONV, postoperative patient comfort and satisfaction should be more improved.
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Annals of plastic surgery · Oct 2008
Case ReportsResurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications, technical refinements, outcomes, and long-term neurosensory recovery.
Volar-oblique injuries of the thumb pulp are particularly disabling. Many methods have been described to treat these injuries and provide return of sensibility. The conventional cross finger flap is an established technique and is well suited for intermediate-sized partial pulp losses. ⋯ The last patient (DASH score, 61.67) complained of hypersensitivity and cold intolerance that affected his work. The conventional cross finger flap provides reliable coverage for volar-oblique hemipulp losses of the thumb, with patients regaining at least protective sensibility in the long term. The proximal and middle phalanges of both the index and long fingers may serve as donor sites, allowing the surgeon to best select skin cover based on defect size and options in finger positioning.
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Annals of plastic surgery · Oct 2008
Successful truncated osteomyelitis treatment for chronic osteomyelitis secondary to pressure ulcers in spinal cord injury patients.
Time-tested treatments for chronic osteomyelitis involve prolonged courses of costly antibiotic treatment. Although such treatment remains unquestioned in acute osteomyelitis, it is an excessive regiment for chronic osteomyelitis. With appropriate surgical debridement and careful operative care, antibiotic treatment can be truncated in diagnoses of chronic osteomyelitis. ⋯ The acute osteomyelitis group incurred longer hospital stays, greater incidence of wound breakdown, and statistically significantly greater ulcer recurrence (78.6 days, 13.2% and 17.0%, respectively). In cases of pressure ulcer management with bony involvement, bone pathologic diagnosis of chronic osteomyelitis allows for a shorter antibiotic course with better results when the offending tissue has been adequately debrided and closed with viable tissue flap coverage, than simple long-term (4-6 weeks) antibiotic treatment. Because of the extreme contaminated nature of these wounds, if such therapy works in these patients, it may be applicable to chronic osteomyelitis in more varied contaminated surgical cases involving bone.