Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Apr 1993
Comparative StudyEfficacy of epidural anesthesia in free flaps to the lower extremity.
Epidural anesthesia is an effective means of providing pain control and chemical sympathectomy at the spinal nerve root level. The purpose of this study is to compare the efficacy of the combination of epidural and general anesthesia to general anesthesia alone in patients undergoing free flaps to the lower extremity. A retrospective review of 35 consecutive patients (36 operations) from November of 1988 to November of 1990 undergoing free tissue transfer to the lower extremity was undertaken. ⋯ These included three microvascular complications (15 percent). There were significantly fewer patients with postoperative atelectatic fevers in the epidural group versus the nonepidural group. In this consecutive series of patients, epidural supplementation of general anesthesia for free flaps to the lower extremity was associated with uniformly successful flap survival and a lower rate of microvascular complications compared to general anesthesia alone.
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Plast. Reconstr. Surg. · Mar 1993
Cosmetic reconstruction of the mons veneris and lower abdominal wall by skin expansion as the last stage of the surgical treatment of bladder exstrophy: a report of three cases.
The results of the correction of the medial scar depression and diastasis of the pubic hair of the mons veneris in three postpuberal female patients operated on for bladder exstrophy are reported. The reconstructive surgery is carried out using skin expanders. The expanded skin is utilized to create two dermoadipose flaps to fill the medial depression, to outline again the public hair areas, and to allow sutures without tension.
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Plast. Reconstr. Surg. · Mar 1993
Case ReportsIntraoperative rapid expansion in cleft palate repair.
Intraoperative rapid expansion in cleft palate repair increases surface area by distension of the palate and recruitment of the surrounding palate tissue. A 5-cc Foley catheter with the distal tip trimmed is employed as the tissue expander. Intraoperative rapid palate expansion is proposed for closure with less tension of large gaps between cleft borders. This procedure has not demonstrated any deleterious clinical effects in cleft palate repair.
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Plast. Reconstr. Surg. · Mar 1993
Combined tissue expansion: clinical attempt to decrease pain and shorten placement time.
Tissue expansion can be characterized as a unique reconstructive procedure that takes advantage of the intrinsic ability of tissues to stretch and, in some instances, to grow in response to expansive forces. The efficacy of combined intraoperative expansion to obtain sufficient expanded tissue more rapidly was tested in reconstructions of the extremities, and the comparison between conventional and combined expansion was performed observing five parameters: initial injected volume, pain score, duration of pain, total period of expansion, and histologic findings. We treated 22 patients with conventional expansion and 29 with combined expansions. ⋯ Histologically, only minor differences were seen between groups. In this study, intraoperative expansion combined with subsequent rapid overinflated expansion proved to be superior to conventional expansion not only in reducing expansion time but also in decreasing pain. We consider the following effects to contribute to this result: (1) increased skin elasticity due to repeated intraoperative load cycling, which leads to easier expansion of the skin and less irritation of the sensory nerves, (2) improved survival and vascularization of skin flaps due to the "delayed-flap" phenomenon, and (3) prevention of shrinkage of the expanded skin and widening of scars due to overinflated expansion.(ABSTRACT TRUNCATED AT 250 WORDS)