Annals of plastic surgery
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Facial paralysis is a debilitating condition. Dynamic and static facial reanimation remains a challenge for plastic surgeons and requires important resources. Our objective was to quantify the health state utility assessment (ie, utility score outcomes) of living with unilateral facial paralysis. ⋯ In samples of the general population and medical students, all utility score outcome measures for facial paralysis were lower than those for monocular blindness. Our sample population, if faced with unilateral facial paralysis, would theoretically undergo facial reanimation procedures with a willingness to sacrifice 8 years of life and be willing to undergo a procedure with a 21% chance of mortality to attain perfect health, respectively.
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Annals of plastic surgery · Oct 2012
Anesthesia duration as a marker for surgical complications in office-based plastic surgery.
Office-based plastic surgery has continued to rise in the past 2 decades with the increased demand for cosmetic surgery. Although several large studies have shown the safety of office-based surgery, current regulations place some restrictions on ambulatory office-based surgical facilities. To provide further evidence-based literature on the safety of office-based plastic surgery, we examine surgical complication rates as a function of anesthesia duration. ⋯ Duration of general anesthesia in office-based plastic surgery does not seem to be an indicator of major morbidity and mortality. Although minor complications such as postoperative nausea and vomiting and urinary retention were higher in patients with anesthesia greater than 4 hours, there was no significant increase in major complications. Change in surgical venue would not likely alter the outcome of the increase in minor complications. Therefore, anesthesia duration should not be used as a guideline for safety of office-based plastic surgery.
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Trauma patients are at high risk for delayed diagnosis of injuries, including those to the hand, with reports in the literature as high as 50%. As a result, patients may have prolonged disability and longer hospital stays with associated increased costs. Our objective was to elucidate risk factors for the delayed diagnosis of hand injuries. ⋯ Patients with delayed diagnoses had a lower GCS and a higher ISS and length of hospitalization. With a decreased GCS and elevated ISS, patients are at risk for delayed diagnoses of hand injuries. A focused tertiary survey is mandatory, particularly in patients with an altered mental status or with multiple injuries.
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Annals of plastic surgery · Oct 2012
The impact of living with a functional and aesthetic nasal deformity after primary rhinoplasty: a utility outcomes score assessment.
Revision rhinoplasty for functional deformities can be both an aesthetic and reconstructive surgical challenge. We set out to quantify the health state utility assessment of living with the physical appearance of nasal asymmetry along with having nasal obstruction. The use of utility scores has helped to establish the health burden of living with various medical conditions. We sought to quantify living with a health state of nasal asymmetry with nasal obstruction after primary rhinoplasty using utility outcome scores. ⋯ In a sample of the population and medical students, VAS, TTO, and SG utility scores for revision rhinoplasty were determined and can be compared objectively with other health states and diseases with known utility scores. In a preoperative setting, women were objectively willing to potentially "trade" more years of life to treat a functional nasal deformity. If faced with a deformed nose after primary rhinoplasty, our sample population would consent to undergo a revision rhinoplasty procedure with a theoretical 9% chance of mortality and were willing to trade 3.6 years of their remaining life.
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Annals of plastic surgery · Oct 2012
Indications and outcomes following complex abdominal reconstruction with component separation combined with porcine acellular dermal matrix reinforcement.
Component separation (CS) is an effective technique for complex abdominal wall reconstruction (AWR). Reinforcement of the repair with mesh can add durability. The purpose of this study was to evaluate the indications and outcomes following CS combined with a porcine acellular dermal matrix (PADM) for reinforcement. ⋯ Strattice is an effective adjunct to AWR when used as reinforcement during CS for a wide variety of indications. Complication rates remain low in complex patients. In addition, Strattice appears to add durability to midline reconstructions with no recurrences during the follow-up period.