Annals of plastic surgery
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Annals of plastic surgery · Jul 2019
Comparative StudyComparison of Costs and Outcomes for In-Office and Operating Room Excision of Nonmelanoma Skin Cancer.
With increasing health care expenses and limited resources, it is important to evaluate potential means of reducing cost while maintaining efficacy and safety. The purpose of our study was to compare the cost and outcomes of surgical excision of nonmelanoma skin cancer (NMSC) in the operating room versus an outpatient procedure clinic. ⋯ Excellent oncologic outcomes were achieved for both operating room and procedure clinic excision. Excision in the operating room excision was significantly more expensive than in the procedure clinic. Excision in a procedure clinic offers an opportunity to reduce costs while maintaining quality care.
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Annals of plastic surgery · Jun 2019
Meta AnalysisHematoma Risks of Nonsteroidal Anti-inflammatory Drugs Used in Plastic Surgery Procedures: A Systematic Review and Meta-analysis.
The opioid crisis in America has sparked a shift toward a multimodality perioperative pain regimen. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the perioperative period decreases opioid consumption and increases efficacy. However, many plastic surgeons avoid their use because of antiplatelet effects. The purpose of this article is to systematically review the plastic surgery literature to assess the risk of intraoperative or postoperative bleeding and hematoma formation. ⋯ Nonsteroidal anti-inflammatory drugs significantly improve pain control and decrease opioid use when used in plastic surgery. The majority of evidence in plastic surgery does not support an increased incidence of bleeding/hematoma with the use of perioperative NSAIDs.
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Annals of plastic surgery · May 2019
Observational StudyManagement of Major Burns in 37 Casualties of a Colored Powder Explosion: Experience of the Linkou Burn Center in Taiwan.
On June 27, 2015, a colored powder explosion occurred in Taiwan. As a result, 499 people were injured, and over 200 people were in critical condition because of severe burns. Forty-nine casualties were transported to the Chang Gung Memorial Hospital. ⋯ We share our experience in managing 37 major burn patients in a colored powder explosion to improve the holistic care in modern mass burn casualties. Aggressive early debridement and skin grafting reduced hospital stay and costs.
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Annals of plastic surgery · Apr 2019
ReviewLymphedema Incidence After Axillary Lymph Node Dissection: Quantifying the Impact of Radiation and the Lymphatic Microsurgical Preventive Healing Approach.
Axillary surgery and radiotherapy are important aspects of breast cancer treatment associated with development of lymphedema. Studies demonstrate that Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) may greatly reduce the incidence of lymphedema in high-risk groups. The objective of this study is to summarize the evidence relating lymphedema incidence to axillary lymph node dissection (ALND), regional lymph node radiation (RLNR) therapy, and LYMPHA. ⋯ Axillary lymph node dissection and RLNR are important interventions to obtain regional control for many patients but were found to constitute an increased risk of development of lymphedema. Our findings support that LYMPHA, a preventive surgical technique, may reduce the risk of breast cancer-related lymphedema in high-risk patients.
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Annals of plastic surgery · Apr 2019
The Incidence of Snow Blower-Related Injuries to the Hand in the United States.
Snow blowers represent a highly preventable and increasingly common mechanism of hand injury. This study examines current safety features and their impact on decreasing the incidence of snow blower-related injuries. ⋯ The incidence of snow blower injuries increased from 2001 to 2016. Unlike with other power tools, Consumer Product Safety Commission-mandated guidelines for safer operation and improvements in equipment have not been successful in producing a decrease in the incidence of snow blower injuries to the upper extremity. Based on this, further equipment modifications are necessary and should be aimed at preventing operators from placing their hand into the exit chute while the machine is still running. Physicians should take an active role in their practice as well as in their professional societies to educate and counsel patients to prevent further injury.