摘要:

The growing emphasis on cost-effectiveness in the United States health care industry has highlighted the need for comprehensive outcomes research in a variety of medical specialties. Currently, there is a relative paucity of reliable data characterizing the long-term results of many medical and surgical treatments. This shortage of outcomes research is particularly acute within plastic surgery where the benefits of treatment are often intangible and notoriously difficult to measure. In evaluating the effectiveness of medical treatment, conventional clinical research has focused primarily on morbidity and mortality as the outcomes of interest. In contrast, current outcome studies assess the results of interventions from the patient's perspective, measuring the impact of medical care on physical functioning, well-being, and quality of life. The resulting data can assist consumers, providers, and payers in making more appropriate health care decisions. As the outcomes movement has matured, it has evolved into two major areas of study: effectiveness research that evaluates the relationships between specific medical interventions and outcomes of care, and quality assessment that seeks to provide the best outcomes at the most reasonable costs. This review details the origins and trends of current outcomes research, examining the implications of this movement for plastic surgery. The growing impact of outcomes data on treatment guideline formulation in both the public and private sectors is also described. Finally, a brief review of outcomes study design, including definition of variables and selection of instruments, is presented.Wilkins EG, Lowery JC, Smith Jr DJ. Outcomes research: a primer for plastic surgeons.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The utility of the endoscope was realized in a retrospective analysis of 92 consecutive patients undergoing augmentation mammaplasty with saline-filled textured implants. The transaxillary submuscular approach was used. All patients received pre-operative antibiotics and instillation of methylprednisolone into the saline fill, with inflation to manufacturer-recommended levels. Complications included seven implant deflations (3.8%), eight implant malpositions (4.3%), and one capsular contracture (0.6%). Of the eight malpositions, six were corrected using the endoscopic technique without removal of the implant and with early manipulation of the implant within the pocket. We conclude that endoscopic control in augmentation mammaplasty is beneficial in secondary operative procedures and we speculate that the endoscope will lessen the rate of implant malposition observed in this study.Howard PS, Oslin BD, Moore JR. Endoscopic transaxillary submuscular augmentation mammaplasty with textured saline breast implants.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Large midline abdominal hernias are reconstructed with bilateral rectus turnover flaps in a series of 15 patients. Each rectus muscle is turned over from a retracted lateral position to the midline, providing a complete abdominal closure with fascia and muscle. The repairs were frequently reinforced with synthetic materials, but synthetic material was not placed over bowel and simply sutured to the edge of a large hernial defect. The rectus turnover method of reconstruction appears to have significant advantages over the use of synthetic material alone. Successful hernia repair was accomplished in all patients. The surgical technique and complications encountered are described in detail.DeFranzo AJ, Kingman GJ, Sterchi JM, Marks MW, Thorne M. Rectus turnover flaps for the reconstruction of large midline abdominal wall defects.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Transcutaneous blepharoplasty has been the standard for improving the overall appearance of the lower eyelid, as it addresses skin, muscle, and pseudohemiated orbital fat. Postoperative problems, including poor scarring, scleral show, and even frank ectropion, have led many surgeons to alternate techniques. Transconjunctival blepharoplasty is known to be a reliable method of removing lower eyelid fat, but has been touted as inadequate for those possessing excessive skin and has even been cited as being responsible for increasing lower eyelid wrinkling. Chemoexfoliation, utilizing trichloroacetic acid and phenol, was performed simultaneously with transconjunctival blepharoplasty in 146 patients, whose data are retrospectively reviewed. Excellent results were obtained in lower eyelid skin appearance and pseudohemiated fat in the majority of patients, without an external lower eyelid scar.Gilbert SE. Transconjunctival blepharoplasty with chemoexfoliation.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Among the challenges created by reconstruction of mandibular defects using free vascularized bone flaps is sizing and contouring of the bone graft in accordance with the dimensions of the defect. We have developed a rapid and reliable method for constructing a postablative template of the defect using a rapid-setting splint material called Aquaplast. The template can then be used at a site remote from the head and neck as a precise model of the defect for optimal size and shape estimation during bone graft sculpting and fixation. The material also has postablative utility for estimation of internal lining requirements and soft-tissue replacements during osteomusculocutaneous or fasciocutaneous flap planning. We feel that the use of Aquaplast has greatly enhanced our three-dimensional appreciation of mandibular bone defects and enhanced the final aesthetic and functional results in our patients undergoing mandibular reconstruction.Kane WJ, Olsen KD. Enhanced bone graft contouring for mandibular reconstruction using intraoperatively fashioned templates.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Biomechanical tests of torsional loading and cantilevered bending were used to study the effects of varying screw size and design of five different titanium miniscrews and microscrews in a metacarpal spiral oblique fracture model. Sixty-six fresh frozen human cadaveric metacarpal bones were subjected to torsional loading until failure, producing a spiral oblique fracture. The randomized fractured metacarpal bones were then repaired utilizing two 1.2-mm, 1.7-mm, or 2.3-mm self-tapping Leibinger lag screws; and 1.5-mm or 2.0-mm pretapped Synthes lag screws. Following repair, the specimens were then subjected to cantilevered bending or torsional loading. Failure torque and bending loads were then used to calculate failure stresses at the midshaft for torsional loading or at the proximal screw for cantilevered bending. Analysis of variance statistical analysis revealed that within the cortical thickness of bone studied, no significant difference in shear stress or axial stress was observed with increasing screw diameter and screw design.Prevel CD, Morgan R, Molnar J, Eppley BL, Moore K. Biomechanical testing of titanium self-tapping versus pretapped lag screw fixation of spiral metacarpal fractures.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Conventional methods of microvascular anastomosis using sutures cause vessel narrowing, foreign body reactions, and intra-vascular thrombosis. Although fibrin glue seems to be the ideal material to perform a microvascular anastomosis, its success has been limited. Excess fibrin used in some of the earlier methods has caused vessel narrowing and intravascular thrombosis. We evaluated the quality of end-to-side anastomosis using fibrin glue applied with a new technique and minimal sutures, and compared the results to those obtained with a standard suture technique. End-to-side anastomosis of femoral vessels was performed in 32 male Sprague-Dawley rats. Fibrin glue was topically applied at the anastomotic site, after inserting only two corner sutures. The fibrinogen component obtained from single donor human cryoprecipitate, was combined with bovine thrombin (500 IU per milliliter). In the control group (N = 16), the anastomosis was performed using eight to ten interrupted 10/0 nylon sutures. Fibrin glue-assisted anastomosis took less time, caused less bleeding at the anastomotic sites, and achieved a patency rate comparable to that provided by the suture technique. We have shown that a new, atraumatic technique of microvascular anastomosis with cryoprecipitate-thrombin glue and only two sutures, can produce excellent patency rates. This technique is easy to perform, inexpensive, and does not involve new equipment.Padubidri AN, Browne E, Kononov A. Fibrin glue-assisted end-to-side anastomosis of rat femoral vessels: comparison with conventional suture method.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A new flap raised on the inner medial upper arm to the anterior forearm surface to cover soft-tissue defects has been described. The blood supply to this flap comes from the superficial brachial artery. The presence of this vessel permits safely transferring arm skin as on island or free flap. This vessel was present in 25% of our series of 64 angiographic investigations and 10 cadaver dissections. Some earlier reports confirm that this vessel averaged 22.8% finding. The superficial brachial flap has been used as a pedicled or free flap to cover various defects in 8 patients and the results have been excellent. There were no complications or loss of overlying skin. Furthermore, no functional impairment or sensory disturbance occurred. Raising this flap is a relatively simple procedure, as the superficial brachial artery runs superficially in the subcutaneous layer.Iwahira Y, Maruyama Y, Hayashi A. The superficial brachial flap.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The authors report on 23 patients treated for tuberculosis of the hand and wrist during the past 20 years. Duration of symptoms prior to diagnosis ranged from several months to years. Swelling and pain on motion were common symptoms, as was increased sedimentation rate. Granulomatous inflammation was seen on paraffin section in most of the patients, however tissue cultures were positive forMycobacterium tuberculosisin only 6 patients in this study. Treatment of these patients was divided into medical and surgical treatments. The incisional biopsy and antituberculous drug were carried out and administered in the medical-treated group for 2 years. The surgical synovectomy as well as debridement and administration of antituberculous drugs were carried out on the surgical group. The results showed no recurrence in this study. Most of the patients showed improved symptoms and an increased range of motion. In conclusion, this treatment resulted in good recovery of function with low morbidity.Visuthikosol V, Kruavit A, Nitiyanant P, Siriwongpairat P. Tuberculous infection of the hand and wrist.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A case of right-sided ilioinguinal and iliohypogastric neuralgia following laparoscopic repair in a 52-year-old man is presented. Significant pain persisted despite conservative measures and was successfully treated with resection of the ilioinguinal and iliohypogastric nerves in the retroperitoneal space. The anatomy, mechanisms of injury, and management of postherniorrhaphy neuropathy are reviewed.Choi PD, Nath R, Mackinnon SE. Iatrogenic injury to the ilioinguinal and iliohypogastric nerves in the groin: a case report, diagnosis, and management.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID