British journal of plastic surgery
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Case Reports
Fascial flaps based on perforators for reconstruction of defects in the distal forearm.
Twenty fascial flaps were used in the reconstruction of defects in the distal forearm, wrist and hand in 18 patients over a 2-year period. In 16 patients the fascial flaps were based on a single fascial feeding vessel or 'perforator' arising from the anterior interosseous artery and/or ulnar artery when the radial artery had been used as the donor vessel in free flap reconstruction elsewhere in the body. There was no loss of any fascial flap in the study. The use of fascial flaps based on fascial feeders of the anterior interosseous and ulnar arteries extends the range of fascial flaps that can be raised in the forearm for reconstruction of defects in the distal forearm, wrist and hand.
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Correction of prominent ears is a commonly performed operation, not without complications. We present a retrospective analysis of the results of 122 operations for correction of prominent ears performed in the 12 months from April 1995 to March 1996, and the results of a patient questionnaire. ⋯ Complication rates appear to be highest for unsupervised SHOs. Head bandages are particularly likely to fall off in boys under 7 years of age.
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Paediatric burn surgery may be associated with significant blood loss and postoperative pain. To investigate methods of reducing these symptoms, we studied a prospective series of 29 children with small to medium sized burns. Presurgically both the burn wound and split skin graft donor sites were injected with a 1:500,000 adrenaline solution, to which bupivicaine had been added. ⋯ Four patients required parenteral analgesia, two in the immediate postoperative period and two at first dressing change. In all other patients pain was controlled with oral analgesia alone. Mean graft take in our series was 95%, indicating that this technique does not compromise burn depth assessment, nor impair graft survival.
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Colour shift in tattoo pigment is a recognised complication of laser tattoo treatment. We report our experience over the past 4 years in treating 275 patients, with a total of 323 professional tattoos. ⋯ We found brown and white/flesh coloured pigments to be significantly more likely to change colour compared to red and that the chance of certain colours shifting related to the age of the tattoo. We outline our management of this problem and discuss the results of continued treatment.
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Randomized Controlled Trial Clinical Trial
The efficacy of bupivacaine with adrenaline in reducing pain and bleeding associated with breast reduction: a prospective trial.
In a randomised, double-blind, placebo-controlled trial, the effect of preoperative local anaesthesia vasoconstrictor infiltration on peri- and postoperative bleeding and postoperative pain was evaluated in 24 consecutive patients undergoing breast reduction. After the induction of general anaesthesia, one breast was infiltrated with a solution of bupivacaine with adrenaline and the other with the same amount of normal saline solution simultaneously. The perioperative blood loss was calculated by weighing swabs, and postoperative drainage was measured at 3, 24 and 48 h by using suction drains. ⋯ At 6, 10 and 24 h, pain tended to be less on the local anaesthetic side, but this did not reach statistical significance. No major complications were seen. Our results confirm a beneficial effect of bupivacaine with adrenaline on peri- and postoperative bleeding as well as in the early postoperative phase of pain.