British journal of plastic surgery
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Randomized Controlled Trial Clinical Trial
Randomised control trial of pH buffered lignocaine with adrenaline in outpatient operations.
Bicarbonate buffering of local anaesthetics is known to significantly decrease the pain of their administration and yet few practising surgeons do so. A double-blind randomised cross-over clinical trial was conducted to confirm the practicality and efficacy of bicarbonate buffering of lignocaine with adrenaline in the setting of a busy local anaesthetic operating theatre. 40 patients received either buffered or control local anaesthetic solutions in equivalent sites on opposite sides of the body. ⋯ The mean pain score for the buffered solution was significantly lower than the control solution (3.06 vs 4.34, P = 0.002). Bicarbonate buffering of lignocaine with adrenaline is effective, inexpensive and simple; its widespread use should be encouraged.
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Case Reports
Versatility of modified planimetric Z-plasties in the treatment of scar with contracture.
The planimetric Z-plasty proposed by Roggendorf provides elongation by excision of a pair of triangular pieces of tissue. The application of planimetric Z-plasties has been modified by making the vertical angle flexible, and making them continuous in the same or in opposite directions. Continuous planimetric Z-plasties in the same direction elongate an oblique contracture in the longitudinal direction. ⋯ Both techniques partially reduce unsightly scarring. Furthermore, they can be used in combination with V-Y-plasties. These modifications permit rational planing of the treatment of complicated scars with contracture.
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We have performed C7 spinal nerve transfer to treat root injury of the brachial plexus since 1989. Out of a total of 43 patients, 21 have been followed up for at least 2 years. Evaluation of the effect of C7 transection included clinical examination, intraoperative C7 stimulation, LIDO Workset machine and electrophysiological studies to test C7 innervated muscles, and histochemical analysis of the anterior and posterior division of the upper trunk using acetylcholinesterase stain. ⋯ We also found that intraoperative C7 stimulation was a useful predictor of possible post-transection morbidity. Subclinical deficits, detected by the LIDO workset machine and by electro-physiological studies, were quite common. Histochemical analysis revealed that the posterior division of C7 had more motor fibres than the anterior division.
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The concept that end-to-side nerve coaptation can induce collateral sprouting was recently reintroduced by Viterbo. However, other authors have reported conflicting results with this technique of nerve repair. The current paper studies some of the variables affecting axonal regeneration following end-to-side repair. ⋯ The silicone tube contained soft tissue which was firmly attached to the side of the nerve and this was called the Attached Soft Tissue Segment (ASTS). Histological and electron microscopic examination showed no evidence of any nerve regeneration within the ASTS. The failure to demonstrate collateral sprouting within the ASTS may be explained by the absence of Schwann cells in the transplanted silicone tubes.
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Editorial Historical Article
The 50th anniversary of the British Journal of Plastic Surgery.