Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · May 2008
Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies--consensus recommendations.
Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures, and patient demographics. Clinicians can benefit from ongoing guidance on products, tailoring treatments to individual patients, treating multiple facial areas, and using combinations of products and ways to optimize outcomes. ⋯ Optimal outcomes in facial aesthetics require in-depth knowledge of facial aging and anatomy, an appreciation that rejuvenation is a three-dimensional process involving muscle control, volume restoration, and recontouring, and thorough knowledge of properties and techniques specific to each product in the armamentarium.
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Plast. Reconstr. Surg. · Apr 2008
Osteoplastic thumb ray restoration with or without secondary toe transfer for reconstruction of opposable basic hand function.
Mutilating hand injuries result in bone and soft-tissue defects. Osteocutaneous flaps can be used for osteoplastic thumb ray reconstruction as a definitive procedure or followed by toe transfer. ⋯ Osteoplastic thumb ray reconstruction followed by osteotomies or sensate flap transfers can yield satisfactory results for some patients. Optimal functional outcomes are achieved when osteoplastic thumb ray reconstruction is followed by toe transfer.
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Plast. Reconstr. Surg. · Apr 2008
ReviewMOC-PS(SM) CME article: management considerations in the treatment of craniosynostosis.
After studying this article, the participant should be able to: 1. Recognize the anatomical characteristics of the individual forms of craniosynostosis. 2. Differentiate deformational plagiocephaly from craniosynostosis. 3. Identify the pros and cons of individual types of craniosynostosis operations (i.e., endoscopic craniectomy and open cranioplasty procedures). 4. Understand risks of operative procedure versus the natural history of untreated craniosynostosis. ⋯ The term "craniosynostosis" refers to the premature fusion of one or more cranial vault sutures and its associated skull deformities. The pattern of skull deformities for each of the sutures (metopic, coronal, sagittal, and lambdoid) is characteristic from patient to patient, although variable in the degree of severity. The skull pattern is predictable in that restriction of growth occurs in a plane perpendicular to the plane of the fused vault suture, and compensatory changes occur frequently, parallel to it. When skull deformities are recognized with midfacial and extremity deformities, often the craniosynostosis is referred to as syndromic, implying a genetic basis for the skeletal maldevelopment. Indications for surgery relate to benefits in changing the shape of the skull toward normal and potentially avoiding brain maldevelopment. Brain injury is presumed to be related to local or regional increases in intracranial pressure. A broad range of surgical options to treat craniosynostosis exist, from strip craniectomy to comprehensive, or whole vault, cranioplasty. The optimal surgical timing for these approaches must balance both the desire for early intervention to reduce the effects of bone restriction on brain growth and the ability of a child to withstand the rigors of surgery. Complications of surgery include blood loss, bone defects, and scalp scarring. The most common, significant, postoperative complication, however, is incomplete correction of the skull deformity. Infection in nonsyndromic synostosis surgery is rare. Team management and longitudinal follow-through will aid in determining efficacy and safety of the available surgical approaches.
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Plast. Reconstr. Surg. · Mar 2008
Randomized Controlled TrialA prospective, randomized, double-blind, controlled trial of continuous local anesthetic infusion in cosmetic breast augmentation.
Narcotic pain medications are a significant component of most postoperative pain control regimens. Although they are usually effective, they produce several untoward side effects and sometimes provide inadequate analgesia. The continuous infusion of local anesthetic agents (via pain pump) has been used to supplement narcotic analgesics after various surgical procedures. The purpose of this study was to examine the effectiveness of the pain pump after cosmetic breast augmentation. ⋯ The pain pump appears to provide breast augmentation patients marginal improvement in pain control, although this advantage did not reach statistical significance in this study. The benefit, if real, also appears to wane over the first postoperative week.