Annals of plastic surgery
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Annals of plastic surgery · Sep 2005
Comparative Study Clinical TrialLevobupivacaine versus ropivacaine infiltration analgesia for mastopexy: a comparative study of 2 long-acting anesthetic drugs in infiltrative anesthesia for mastopexy.
A prospective double-blind study was conducted to compare the analgesic properties of levobupivacaine and ropivacaine in a bilaterally symmetrical mastopexy model. Both of these 2 long-acting local anesthetic amides are associated with lower cardiac and central nervous system toxicity than racemic bupivacaine, a widely used agent for long-lasting perioperative analgesia in esthetic procedures. In this study, each of the 18 patients undergoing bilateral mastopexy under conscious sedation received preoperative infiltration with levobupivacaine in 1 breast and equal volume of ropivacaine in the other. ⋯ Both anesthetics provided satisfactory analgesia for at least 10 hours, but constantly low pain scores were recorded for levobupivacaine for 10 hours postoperatively, whereas for ropivacaine only for 6 hours. At 12 hours, 66% of patients needed oral analgesia for pain in the ropivacaine-infiltrated breast. It is concluded that levobupivacaine is more effective for local infiltrative analgesia in mastopexy than ropivacaine, providing longer-lasting postoperative analgesia.
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Immediate breast reconstruction (IBR) is considered as a safe procedure nowadays, and it can be proposed in the majority of patients requiring a mastectomy. In fact, recent studies have demonstrated that immediate breast reconstruction is not detrimental also to patients with locally advanced breast cancers. However, IBR should be reevaluated in case of locally advanced breast cancer requiring high-dose chemotherapy (HDCT). The aim of this study is to evaluate both the risk of chemotherapy delay due to surgical complications and the risk of late surgical complications related to the association with HDCT. We considered 3 series of 23, 67, and 15 patients requiring a mastectomy at the European Institute of Oncology in Milan. After mastectomy, these groups respectively received an IBR and HDCT, an IBR and conventional chemotherapy, and only HDCT with no IBR. ⋯ We did not observe any delay for the administration of high-dose chemotherapy after mastectomy with IBR surgery. The complication rate before HDCT is similar to the complication rates published in the literature. On the contrary, we observed a higher rate of infections (13% versus 0%, P = 0,014) after HDCT than after conventional CT, which can be related to the association with high-dose chemotherapy, inducing a decrease of the immune defenses. These results seems to demonstrate that the association of IBR with HDCT is not detrimental to patients from the oncological point of view, but the impact of HDCT on the reconstruction is more negative. Further studies are needed to verify if this risk exists, although lower, in the association with conventional CT. However, a careful evaluation of the risk of infections should be considered preoperatively, and perioperative contaminations should be carefully prevented.
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Annals of plastic surgery · Aug 2005
Duplex ultrasound imaging in free transverse rectus abdominis muscle, deep inferior epigastric artery perforator, and superior gluteal artery perforator flaps: early and long-term comparison of perfusion changes in free flaps following breast reconstruction.
Our objective was to assess the hemodynamic differences in free DIEP (deep inferior epigastric artery perforator flap), S-GAP (superior gluteal artery perforator flap) flaps versus TRAM (transverse rectus abdominis muscle) flaps and to analyze any perfusion change due to perforator dissection (study 1). To examine the hypothesis as to whether flap perfusion is maintained through the pedicle (study 2), we also compared short- and long-term DIEP flap perfusion. ⋯ The minimum perfusion requirement is easily satisfied in musculocutaneus and free perforator flaps. In the long term, DIEP flap perfusion increases 13%, which assumes that DIEP flap perfusion is maintained on the pedicle.
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Annals of plastic surgery · Jun 2005
Improved ankyloglossia correction with four-flap Z-frenuloplasty.
Ankyloglossia, or tongue-tie, is the result of a short, tight, lingual frenulum causing tethering of the tongue tip. Although most cases resolve or are asymptomatic, some patients develop articulation problems and other concerns related to poor tongue-tip mobility. In this study, we evaluated the treatment of patients greater than 3 years of age with persistent articulation problems related to ankyloglossia (n = 16). ⋯ In contrast, with the horizontal-to-vertical frenuloplasty, only 40% showed 1 order of improvement in speech, and 60% had no change in articulation. Frenulum length and tongue protrusion gained 11.2 +/- 4.15 mm (98% increase) and 13.2 +/- 2.6 mm (P = 0.0003), respectively. Our data indicated that the 4-flap Z-frenuloplasty was superior to the horizontal to vertical frenuloplasty with respect to tongue lengthening, protrusion, and articulation improvement for patients with symptomatic ankyloglossia.
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Annals of plastic surgery · Jun 2005
Case ReportsReconstruction of traumatic transposition of the penis and scrotum and associated complex open abdominoperineal pelvic deformity with free innervated tensor fascia latae osteomyocutaneous flap.
Guidelines for the repair of full-thickness defects of the lower abdominal wall have been established. However, lower abdominal defects associated with traumatic bladder herniation and pubic symphyseal diastasis or bony loss have not been addressed. Poor abdominal wall contour, protuberance, and recurrent hernias are likely when there is discontinuity of the midline pelvis in association with full-thickness lower abdominal defects and visceral herniation. We devised an operation that would not only restore bony continuity by providing a vascularized bone flap but also simultaneously maintain the integrity of the attachment of the tensor fascia latae muscle to the iliac crest and reestablish musculofascial continuity.