Scand J Plast Recons
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Ten patients, eight of whom were paraplegic, have had ischial pressure ulcers treated by skin expansion. Skin expanders 680 ml in size were inserted subcutaneously on the posterior aspect of the thigh. ⋯ After a few weeks the patients were able to undergo a programme of rehabilitation that included sitting with the expanded flaps. No ulcers recurred during a median follow-up of 12 months (range 8-34).
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Scand J Plast Recons · Jan 1992
Reinnervation of muscles in rats after repair of transsected sciatic nerves with Y-shaped and X-shaped silicone tubes. Muscle reinnervation after nerve repair.
Reinnervation of the gastrocnemius and anterior tibial muscles was assessed by measurements of tetanic force after repair of sciatic nerves with Y-shaped or X-shaped silicone tubes in rats. The transsected proximal stump of either the tibial or the peroneal fascicle was introduced into the opening of a Y-shaped silicone tube, or both fascicles were introduced into an X-shaped tube. The distal tibial and peroneal fascicles were inserted into the distal outlets of the tubes leaving a gap of 4 mm between proximal and distal stumps. ⋯ Recovery was lower in the X-shaped tubes, amounting to about 75%. Contractions evoked by misrouted fibres were similar (roughly 40%) in both models. We conclude that motor axons preferentially, but not exclusively, selected a path to reinnervate their original target muscle.
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Scand J Plast Recons · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialBilateral infraorbital block with 0.5% bupivacaine as post-operative analgesia following cheiloplasty in children.
Various studies have shown that bupivacaine nerve blocks provide prolonged post-operative analgesia. We studied the efficacy of a 0.5% bupivacaine infraorbital nerve block as post-operative analgesia in a random, prospective, double blind manner in children undergoing cleft lip repair. Following the induction of anesthesia with ketamine 2-4 mg/kg im, 60 patients, aged 2-13 years, ASA I and II were equally divided: Group A received 1-1.5 ml bupivacaine, 0.5% with 1:200,000 epinephrine; Group B received 1-1.5 ml saline injected into the vicinity of the infraorbital foramina. ⋯ Group A required no other analgesic whereas a total of 17 patients in Group B required analgesic medication starting at four hours post-operatively, (p less than 0.001). Both the nurses and the parents confirmed that those who received infraorbital block were more comfortable than those who did not. One-way analysis of variance indicates that the mean scores for both groups differs significantly at all levels of comparison, (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Scand J Plast Recons · Jan 1991
Nerve function and structure beneath and distal to a pneumatic tourniquet applied to rabbit hindlimbs.
Neurophysiologic and neuropathologic changes were studied in rabbit hindlimbs after 2 hours of pneumatic tourniquet application with either 350 mmHg (n = 18) or 1,000 mmHg (n = 6) cuff inflation pressure. The toe spread reflex was decreased in 66% and absent in 33% of limbs 2 days after 350 mmHg compression, and was absent in all limbs after 1,000 mmHg compression. Compound motor action potential amplitudes (CMAPs), recorded from the abductor hallucis muscle, were significantly decreased with sciatic nerve stimulation 1 hour after 350 mmHg compression. ⋯ Severe fiber damage and nodal obliteration were noted after 1,000 mmHg tourniquet compression. Although nodal invagination is probably not a significant pathogenic mechanism at clinically relevant tourniquet pressures and durations, functional abnormalities were induced by 2 hour, 350 mmHg tourniquet compression. Such changes probably correlate with clinical electromyographic abnormalities and delayed post-operative recovery following 'routine' extremity surgery using pneumatic tourniquets.
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A case of subungual keratoacanthoma in a 64-year-old man with psoriasis is described. Important differential diagnoses are squamous cell carcinoma and epidermoid cyst. The treatment recommended is local removal. Follow up should be prolonged, as recurrence has been reported more than two years after primary operation.