British journal of plastic surgery
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The ability to assess viability of tissues by monitoring changes in oxygenation and perfusion during harvesting and following transfer of free and pedicled flaps is potentially important in reconstructive surgery. Rapid detection of a critical change in tissue oxygenation could enable earlier and more successful surgical intervention when such problems arise. In this study near infra-red spectroscopy (NIRS) was used to assess changes in tissue oxygenation, haemoglobin oxygenation and blood volume in a porcine prefabricated myocutaneous flap model in response to pedicle manipulations. ⋯ It can accurately identify different types of problems with the pedicle vessels. In addition its predictive capabilities would allow assessment of flaps buried deep to the skin. This monitor is excellent for surgical and intensive care unit monitoring since it is unaffected by light, portable and is extremely easy to use.
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Comparative Study Clinical Trial Controlled Clinical Trial
Prevention of painful neuromas by epineural ligatures, flaps and grafts.
Neuroma formation at the proximal end of a divided nerve is a common problem in peripheral nerve surgery. Forty-eight nerve endings in 23 patients with traumatic or post-elective surgery amputation stumps were capped with either an epineural ligature, epineural flaps or an epineural graft. ⋯ The mean VAS scores were 5.18 for epineural ligatures, 4.25 for epineural flaps and 2.06 for epineural grafts. Epineural grafts were significantly more effective in preventing neuroma pain (ANOVA: F = 11.4, P < 0.05).
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Comparative Study Clinical Trial Controlled Clinical Trial
Absorbable skin graft staples: a clinical trial using Graftac-X.
Skin stapling devices are a quick, effective method for securing skin grafts in burns patients. Removal of staples can be painful, often requiring a general anaesthetic. This problem has led to the recent development of absorbable staples which extrude with time. ⋯ Infection and excess scarring at tack sites were assessed at one month. A statistically significant difference was not found between either group. In our hands absorbable skin staples have proven to be a reliable method of securing skin grafts.
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Randomized Controlled Trial Comparative Study Clinical Trial
The use of pH adjusted lignocaine in controlling operative pain in the day surgery unit: a prospective, randomised trial.
We report the results of a randomised, case matched, controlled, double blind study on 40 patients undergoing correction of their prominent ears, comparing efficacy of pH adjusted lignocaine to lignocaine alone in controlling operative pain. Each patient received commercial lignocaine in one ear and the same preparation reconstituted with 1 ml of 8.4% sodium bicarbonate in the other ear according to our randomisation protocol. 30 patients were studied to compare the difference between the buffered and commercial preparation infiltrated at room temperature. ⋯ Buffered lignocaine imparts a significant reduction in pain on infiltration, compared to the commercial preparation at both room and body temperature. Both preparations were equally effective in obliterating pain during the operation itself.
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Case Reports
The distally based superficial sural flap for reconstruction of the lower leg and foot.
We describe our experience with the use of distally based superficial sural flaps for coverage of defects in the lower leg and foot in 21 patients. In 18 patients the flap was successfully transferred, in 2 cases partial necrosis of the flap occurred and 1 flap failed completely. ⋯ The advantages of this flap are: easy and quick dissection, hence saving operating time, minimal morbidity of donor site and preservation of major arteries of the leg. Although the flap was described as reliable for covering defects around the ankle joint, we have been able to cover defects of the dorsum of the foot distally and up to the mid-third of the tibia proximally.