Clinics in plastic surgery
-
In summary, many surgical procedures may be safely and comfortably performed utilizing regional anesthesia if only a few guidelines are followed as to choice and usage of local anesthetics. The success of a regional block will always be dependent upon correct needle placement by an experienced physician with good technical skills. However, the safety of the patient is not solely a function of experience. ⋯ Plastic surgery is recognized as a specialty that frequently utilizes local anesthetics for office and outpatient procedures. The manner in which these drugs are used or abused determines their clinical reputation as well as that of the physician. It is important to promote a correct understanding of local anesthetic compounds, not only among ourselves as physicians, but also among our patients, who are becoming ever more knowledgeable of medical practice as time goes on.
-
Regional anesthesia in the head and neck area is a common and effective tool for the plastic surgeon. For short procedures, it offers the advantages of convenience and comfort to the patient. In many procedures, in addition, it offers advantages to the plastic surgeon over general anesthesia. ⋯ An attempt was made, however, to indicate one or two successful methods for each type of commonly used block so that when studied and practiced it can be expected to yield consistent results. Some repetition has been unavoidable because the intent has been to provide a relatively self-contained section for each block so that it may be as a reference without having to read the entire article. It is hoped that frequent practice will result in effective local and regional anesthesia in the head and neck area.
-
The authors' philosophy in performing labial reconstruction has evolved from unsatisfactory results using classic procedures. Such results prompted attempts with procedures that are both more cosmetic and functional and that give greater emphasis to the restoration of the oral sphincter.
-
The past decade has witnessed many changes in the basic concepts and understanding of breast cancer. The classic radical mastectomy, which prevailed for almost 100 years, has given way to a less aggressive surgical approach that aims to provide a better quality of life without compromising survival. Modified radical mastectomy, simple mastectomy, and breast-conserving local excision are discussed.
-
Successful clinical management of symptomatic neuromas continues to present a challenge to the responsible surgeon. It is unexplained why some patients with neuromas are completely asymptomatic while others exhibit debilitating symptoms. Prevention of neuromas is paramount with precise attention to severed nerves following amputations and other surgical procedures. ⋯ Sympathetic blockade with guanethidine may be beneficial in some patients. When necessary, surgical excision of the neuroma along with a combination of funiculectomy, epineurial sleeve suture ligation, and silicone capping offers the best chance for eradication. In intractable or recurrent cases and following careful patient selection, neuroma excision followed by nerve grafting combined with sympathetic blockade using guanethidine can be successful in a significant number of cases.