Annals of plastic surgery
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Annals of plastic surgery · Jun 2013
A nationwide review of the treatment patterns of traumatic thumb amputations.
Traumatic thumb amputations are a common problem with significant associated cost to patients, hospitals, and society. The purpose of this study was to review practice patterns for traumatic thumb amputations using the National Trauma Data Bank. By using a large nationwide database, we hoped to better understand the epidemiology and predictors of attempts and successful replantation. ⋯ Treatment at a high-volume center increased the rate of attempted replantation by a factor of 3.4 (P < 0.001), as compared to low-volume hospitals. Practice patterns show that teaching and high-volume hospitals attempt to replant a higher percentage of amputated thumbs. Success rates are similar across practice settings.
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Annals of plastic surgery · May 2013
Case ReportsIncidence and management of adverse events after the use of laser therapies for the treatment of hypertrophic burn scars.
Hypertrophic burn scars may generate significant morbidity, due to intense pruritus, persistent dysesthesias, and contracture. Although treatment with pulsed dye laser and fractional CO2 laser may improve symptoms, incidence of secondary wound complications is not well known. We examined the adverse event profile of laser therapies for the treatment of hypertrophic burn scars. ⋯ Despite the frequent occurrence of pain and mild blistering after laser treatment of hypertrophic burn scars, major adverse effects were exceedingly rare, with improvement noted in all patients. Patients with higher Fitzpatrick skin types must be handled with care, to avoid complications of blistering and hypopigmentation.
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Annals of plastic surgery · May 2013
Laser-assisted indocyanine green angiography: a critical appraisal.
Laser-assisted indocyanine green angiography (ICG-A) has been promoted to assess perfusion of random skin, pedicled, and free flaps. Few studies address its potential limitations. ⋯ Indocyanine green angiography often confirmed our clinical/radiologic findings in abdominal perforator and fasciocutaneous flaps. It tended to underestimate perfusion in pedicle and skin flaps. When clinical examination was obvious, ICG-A rendered clear-cut findings. When clinical examination was equivocal, ICG-A tended to provide ambiguous findings, demonstrating that a distinct cutoff point does not exists for every patient or flap. Indocyanine green angiography is a promising but expensive technology that would benefit from standardization. Further research is needed before ICG-A can become a reliable tool for surgeons.
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Annals of plastic surgery · May 2013
Case Reports Clinical TrialProspective, before-after cohort study to assess the efficacy of laser therapy on hypertrophic burn scars.
Hypertrophic burn scars produce significant morbidity, including itching, pain, stiffness, and contracture. Best practices for management continue to evolve. Lasers have recently been added to treatment algorithms, but indications and efficacy have not been fully defined. We studied the impact of laser therapies on hypertrophic burn scars. ⋯ Laser therapies significantly improve both the signs and symptoms of hypertrophic burn scars, as measured by objective and subjective instruments.
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Annals of plastic surgery · May 2013
ReviewThe evils of nicotine: an evidence-based guide to smoking and plastic surgery.
As nearly 1 of 5 adult Americans are smokers, plastic surgeons should be familiar with the effect of smoking on perioperative risk, the importance of smoking cessation, and the tools to help patients quit. Cigarette smoke contains over 250 known toxins, including nicotine, carbon monoxide, hydrogen cyanide, and nitric oxide, which all are known to impair wound healing, through multiple mechanisms. ⋯ The ameliorating effects of cessation are supported by level 1 evidence, which suggests that the optimal duration of preoperative cessation is 4 weeks or longer. Nicotine replacement therapy and smoking cessation medications are effective aids for quitting and should be familiar to plastic surgeons.