The American surgeon
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The American surgeon · Oct 1982
Case ReportsSecondary burn reconstruction: recent advances with microvascular free flaps, regional flaps, and specialized grafts.
A representative series of cases are presented which demonstrate secondary reconstructive plastic surgery procedures for the burn victim utilizing microvascular free flaps, regional flaps, and specialized skin grafts. The unstable burn scar of the lower extremity could be managed either by a microvascular free-flap transfer, a muscle transfer, a myocutaneous flap transfer, or a reverse dermis graft, or overgrafting. In the present day, there are many treatment modalities available to us. ⋯ Both microvascular surgeons participate in the multiple anastomoses that are required. A microvascular laboratory is essential to the success of a microvascular team, and constant practice is mandatory to maintain and enhance these precision skills. The primary burn surgeon ideally must always keep in mind ways to minimize functional and aesthetic deformity and to continue to improve the quality of life of the burn victim.
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A severely debilitating anaphylactic reaction occurred in a diabetic when protamine was injected following carotid endarterectomy. The patient had been taking neutral protein Hagedorn (NPH) insulin for several months. ⋯ This applies to diabetics, certain blood donors, and previous cardiac surgery patients. Skin testing and specific premedications may be indicated to avoid disastrous consequences.