Annals of plastic surgery
-
A system is presented for the application of tie-over dressings. Following skin grafting, the graft is secured with a tie-over dressing covered with a sheath of 3-way stretch fabric. The fabric is secured with the aid of staples. This system is easy to apply and is useful for securing grafts in otherwise difficult anatomic locations.
-
Annals of plastic surgery · Feb 2005
Transfusion-free pediatric burn surgery: techniques and strategies.
More than 1.3 million children sustain burns each year, resulting in 40,000 admissions and more than 3000 pediatric deaths. Pediatric burn surgery has been described as excessively bloody. Strategies to reduce intraoperative blood loss include the use of topical thrombin and epinephrine, extremity tourniquets, acute normovolemic hemodilution, and hypotensive anesthesia. ⋯ There was a single mortality secondary to systemic inflammatory response syndrome and acute respiratory distress syndrome. After the proposed pediatric burn treatment protocol, intraoperative blood loss requiring transfusion can be minimized or eliminated. Large TBSA burns must be surveilled for burn wound anemia that may ultimately require blood transfusion.
-
Annals of plastic surgery · Jan 2005
ReviewSternal nonunion: a review of current treatments and a new method of rigid fixation.
Sternal nonunion as the result of cardiac intervention or trauma remains a morbid condition with serious sequelae. Patients often report pain with breathing, coughing, and/or movement. The authors present 6 patients that were diagnosed with sterile sternal nonunion after cardiac procedure (4) or trauma (2). ⋯ There was no incidence of subsequent infection. Pain completely resolved in all patients. All wounds healed to completion, and bone healing was assessed clinically with the absence of instability and pain and follow-up chest radiographs.
-
Annals of plastic surgery · Jan 2005
Comparative StudyConsecutive versus simultaneous bilateral carpal tunnel release.
Many patients have symptoms of bilateral carpal tunnel syndrome and require surgical release of both hands. Despite the intuitive savings to both the patient and the institution of simultaneous carpal tunnel release, many surgeons choose to repair one hand at a time under the assumption that the morbidity and disability following surgery, such as pain and hand incapacity, would be too great if both hands were repaired simultaneously. We reviewed the charts of 108 patients who underwent bilateral carpal tunnel release to ascertain information on both the relative costs and morbidities of the 2 approaches; mean follow-up time was 2.6 years. ⋯ All 11 patients in the consecutive group were satisfied with the results of their surgery and would do it again (P = 0.21 and 0.03, respectively). On the basis of these findings, we conclude first, the overall costs associated with simultaneous release are considerably less than consecutive bilateral release, and second, the disability following simultaneous bilateral carpal tunnel release is no greater than that following consecutive bilateral release. We, therefore, recommend simultaneous bilateral carpal tunnel release in patients who have bilateral carpal tunnel syndrome.
-
Annals of plastic surgery · Jan 2005
Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers.
Microsurgical operations of the hand are common procedures of reconstructive surgeons. Sympathetic blockade of the vessels provides increased blood flow to the injured extremity, which increases the success rate of the surgery. Moreover, postoperative pain management can be performed with continuous blockade of the nerves. ⋯ Pain was scored by visual analog scale every 4 hours postoperatively. Continuous brachial plexus blockade was found to be effective in both sympathetic blockade and postoperative pain management. Continuous brachial plexus blockade must be considered when microvascular anastomosis is performed at the upper extremity, especially at the digital vessels, which are very susceptible to vasospasm.