Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Apr 1998
Case ReportsReconstruction for palmar skin defects of the digits and hand using plantar dermal grafting.
The plantar skin is considered suitable for skin grafting onto the volar aspect of the digits and hand. However, this method is not widely used because it is associated with problems at the donor site. To solve these problems, a new method was developed in which two different layers of the plantar skin are harvested from the same site. ⋯ Reconstruction was performed for 17 patients using this method, involving digit-only reconstruction in 8 patients, and wider reconstruction in the other 9. Excellent color and texture match of the graft and donor sites were obtained with no noticeable marginal scarring, and the durability of the skin was satisfactory. This method was useful for skin grafting to the digits and palms with minimal sacrifice to the donor site.
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Regional blocking techniques as noted in dentistry, anesthesia, and anatomy texts may result in inconsistent and imperfect analgesia when needed for facial aesthetic surgery. The advent of laser facial surgery and more complicated aesthetic facial procedures has thus increased the demand for anesthesia support. ⋯ This sequence of bilateral blocks will routinely provide profound full facial anesthesia. Certain groupings of blocks are effective for perioral or periorbital laser surgery.
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Plast. Reconstr. Surg. · Mar 1998
Comparative StudyA new evaluation system to predict the sequelae of late obstetric brachial plexus palsy.
Obstetric brachial plexus palsy has two distinct categories: (1) early obstetric brachial plexus palsy (or obstetric brachial plexus palsy in an infant) and (2) late obstetric brachial plexus palsy with deformity (or obstetric brachial plexus palsy in a child). Both early and late obstetric brachial plexus palsy lack a uniform evaluation system, and this makes correlation between them difficult. Clinical evaluation of obstetric brachial plexus palsy in infants is difficult, but in children it is easier. ⋯ The Klumpke score gives points for lower plexus functions including wrist extension, wrist flexion, metacarpophalangeal joint extension, interphalangeal joint extension, finger flexion, thumb adduction, and thumb abduction. The aims of this evaluation system are to determine the relationships between early and late obstetric brachial plexus palsy, to predict the progressive changes that take place with aging, and to propose the possible operation procedures to reconstruct. However, this evaluation system may differ by time and may not be suitable for comparisons between pre- and postreconstruction.
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Plast. Reconstr. Surg. · Feb 1998
Randomized Controlled Trial Clinical TrialThe effects of hyaluronidase on the efficacy and on the pain of administration of 1% lidocaine.
Despite current clinical practice, there is no objective evidence to demonstrate the efficacy or pain on injection when hyaluronidase is added to lidocaine as an anesthetic combination for local anesthesia. To evaluate the usefulness of hyaluronidase added to lidocaine in affecting pain on injection and effectiveness of local anesthesia, a prospective, randomized, double blind study comparing 1% lidocaine preparations with and without hyaluronidase (15 U/cc) was conducted. A paired experiment was done with each subject receiving both treatments. ⋯ In addition, the hyaluronidase additive significantly decreases the amount of tissue distortion (p < 0.0001) without decreasing the efficacy of anesthetic action (p = 0.01). However, adding hyaluronidase to 1% lidocaine significantly increased the pain on injection (p = 0.0002). The injections of small amounts of hyaluronidase-containing solutions in this experiment did not produce any visible effects at 5 to 7 days after injection; however, the effect of hyaluronidase upon wound healing was not studied.