Annals of plastic surgery
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Annals of plastic surgery · Apr 2004
Clinical experience with linezolid in conjunction with wound coverage techniques for skin and soft-tissue infections and postoperative osteomyelitis.
Gram-positive organisms are emerging as possibly the most important nosocomial pathogens during the past decade. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection in the postoperative patient. Burn victims are at high risk for developing vancomycin-resistant Enterococcus (VRE) and other multidrug-resistant microbial infections as a result of the immunocompromising effects of burn injury, prolonged intensive care unit stays, and broad-spectrum antibiotic therapy. ⋯ For infections of wound coverage, the clinical success rate was 83.3%. In conclusion, linezolid was an effective antibiotic for the treatment of S. aureus (including MRSA) and VRE infections in conjunction with wound coverage techniques. In addition, linezolid offers the option of treating these infections with an oral agent that is 100% bioavailable.
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Annals of plastic surgery · Apr 2004
Case ReportsThin split-thickness toenail bed grafts for avulsed nail bed defects.
Avulsed defect of a fingernail bed is a common injury in acute hand trauma. Insufficient management for this type of nail bed avulsion often leads to an irregular and nonadherent nail. ⋯ The end results of this technique were excellent and no deformities occurred in the graft donor area. Thin split-thickness toenail bed graft is a good choice for the treatment of acute nail bed avulsion.
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This study compared the combined iliac and ulnar forearm flaps with the osteomusculocutaneous fibular free flap for mandibular reconstruction. A retrospective study of 40 patients who had oromandibular reconstruction was performed, of whom 23 patients had a combined iliac crest without skin and ulnar forearm free flap. Seventeen patients had an osteomusculocutaneous free fibular flap. ⋯ It appears that within this study population the free osteomusculocutaneous fibular flap had fewer local complications and a higher flap survival rate than the combined iliac/ulnar forearm flaps. Overall functional outcome was also improved. The use of the double flap may be appropriate in massive oromandibular defects, but may be less appropriate in more modest functional reconstructions of mandibular defects.
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Annals of plastic surgery · Jan 2004
Randomized Controlled Trial Clinical TrialThe single-fascicle method of nerve grafting.
In this study a single-fascicle technique for neural deficits repair was evaluated using a rat sciatic nerve model. Twenty-four Lewis rats were divided into 4 groups: group 1, 1.5-cm deficit without repair; group 2, conventional autograft; group 3, large-fascicle autograft; and group 4, small-fascicle autograft. Nerve regeneration was evaluated by pin-prick and toe-spread tests. ⋯ Histology revealed a significantly higher number of axons and myelin thickness in the small-fascicle (2.8 +/- 0.4 x 10(3) axons, 4.22 +/- 0.41 microm) and large-fascicle (5.1 +/- 1.7 x 10(3) axons, 4.62 +/- 0.28 microm) groups compared with the conventional autograft group (2.1 +/- 0.3 x 10(3) axons, 2.93 +/- 0.20 microm). The small-fascicle group had a significantly greater mean axon area (58.59 +/- 15.81 microm2) than the large-fascicle group (29.66 +/- 12.67 microm2) and the conventional group (25.35 +/- 7.52 microm2). In this study, peripheral nerve repair using a single-fascicle graft resulted in faster functional recovery and better morphometric outcome compared with conventional nerve repair.
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Annals of plastic surgery · Dec 2003
Randomized Controlled Trial Clinical TrialEffect of steroids on edema, ecchymosis, and intraoperative bleeding in rhinoplasty.
A double-blind, randomized study was designed to determine the efficacy of dexamethasone in decreasing periorbital edema and ecchymosis after rhinoplasty. Sixty rhinoplasty patients undergoing hump resection and lateral osteotomy were included in the study and were divided into 6 groups: group 1 (n = 10), single dose of 8 mg intravenous (IV) dexamethasone 1 hour before the operation; group 2 (n = 10), single dose of 8 mg IV dexamethasone at the beginning of the operation; group 3 (n = 10), 3 doses of 8 mg IV dexamethasone 1 hour before the operation, and 24 and 48 hours after the operation; group 4 (n = 10), 3 doses of 8 mg IV dexamethasone at the beginning of the operation, and 24 and 48 hour after the operation; group 5 (n = 10), 3 doses of 8 mg IV dexamethasone immediately after the operation, and 24 and 48 hours after the operation; group 6 (n = 10), control, no dexamethasone administration before or after the operation. Intraoperative blood loss was recorded for each patient. ⋯ There was no significant difference between groups on day 10. In conclusion, if the first dose is given before osteotomy, triple-dose steroid application is the best bet for decreasing postoperative edema and ecchymosis. None of the patients had any complications related to the use of dexamethasone.