ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Hypertrophic scarring occurs frequently in the trunk and extremities, and sporadically in other areas even under favorable circumstances. Unfortunately, the existing methods of scar manipulation have not been effective in preventing these unfavorable scars. Established hypertrophic scars have been treated by Anderson and Parrish, Alster, and others using the 585-nm pulse dye laser. The current study is the first report of prevention of hypertrophic scarring using the 585-nm pulse dye laser in a large group of elective and traumatic incisions. Treatment within the first few weeks resulted in faster resolution of scar stiffness and erythema, and less frequent development of hypertrophic scarring. An unexpected finding was the substantial improvement in the quality of scarring in all areas of the body, attributed to the excellent color match of the treated scars. These observations suggest that early pulse dye laser treatments can change fundamentally the physiology of wound healing if applied in the early phases. This report provides the first clinical correlation between prophylactic laser reduction of scar microcirculation and prevention of excessive scar formation.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

35 mm photography is currently the standard method of documenting a patient's appearance and recording the post-operative changes. With rapidly advancing technology, the digital system is now capable of providing vivid pictures that have multiple advantages over conventional 35 mm photography. Namely, digital pictures are comparatively inexpensive to take, can be stored as digital information, easily retrieved, and immediate viewing and imaging are possible. For many applications in plastic surgery patient documentation, digital photography is now more affordable and flexible than the 35 mm film system. The following is a cost and quality comparison between the two systems.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Skin resurfacing with carbon dioxide (CO2) lasers is a commonly used method for skin rejuvenation. With these lasers, there is substantial skin improvement with lessening of rhytids and skin discoloration, and noticeable skin tightening. However, there is also significant morbidity associated with their use. To decrease the healing and erythema times, other types of lasers have been developed. The author discusses the practice of combining the CO2and Erbium: YAG lasers for limiting thermal injury. For deeper rhytids in the periorbital, perioral, and forehead regions, multiple passes with the CO2laser are often the preferred treatment. For moderate rhytids, the CO2laser can be used for the first pass followed by one to multiple passes with the Erbium: YAG laser. Erbium: YAG lasers when used alone are beneficial for removing fine wrinkles and discolorations. Combining these lasers results in both rhytid improvement and decreased morbidity.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Traditionally, most of transverse rectus abdominis musculocutaneous (TRAM) flap shaping takes place after transfer of the flap to the chest. As skin-sparing mastectomies become more commonplace, flap tailoring becomes a more difficult and lengthy process due to lack of exposure through these small incisions. Immediate breast reconstruction was performed on 40 patients using the mastectomy specimen as a model for TRAM flap fabrication. Detailed measurements of the specimen were taken and a template was created as a guide for shaping the flap. All flaps were shaped on the abdomen, and additional tailoring was not necessary after transfer to the chest. Significant differences in weight were recorded between the shaped flap and the specimen. Size, shape, and orientation were found to be more reliable parameters in matching the flap to the specimen than approximating their weights. This approach allows for greater accuracy in shaping the flap, reduces operative time, and avoids flap manipulation after transfer.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The records of 90 patients who underwent an abdominoplasty at the University of Virginia Health Sciences Center were analyzed to determine the effect of obesity on the incidence of complications after this surgery. The study patients were divided into three groups-obese, borderline, and nonobese-based on the degree to which their preoperative weights varied from their ideal body weight. A history of previous bariatric surgery was also analyzed to determine what impact that might have on subsequent abdominoplasty. Results showed that 80% of obese patients had complications compared with the borderline and nonobese patients, who had complication rates of 33% and 32.5% respectively (p= 0.001). Previous gastric bypass surgery had no significant effect on the incidence of postabdominoplasty complications. Based on these findings the authors conclude that obesity at the time of abdominoplasty has a profound influence on the wound complication rate following surgery, regardless of any previous weight reduction surgery.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Treatment of large and/or invasive head and neck cancers results in defects that are complex, such that immediate free tissue transfer provides the best functional outcomes. Consequently, delayed use of free flaps in such patients is seldom seen in today's practice. The purpose of this study was to analyze a recent experience of such delayed microsurgical procedures to evaluate their efficacy and outcomes. Between November 1995 and May 1997, 13 patients underwent free flap reconstruction of residual or secondary defects following initial head and neck cancer ablation. Preoperative status was categorized as open wounds in 8 patients, oral incontinence in 9 patients, poor speech in 5 patients, and difficulty swallowing in 7 patients. Microvascular reconstruction was performed for the mandible and floor of the mouth/chin in 7 patients, cervical esophagus in 2 patients, sinus cavity in 2 patients, and one patient each underwent microvascular reconstruction of the orbit and cranial base. The free flaps utilized were fibular osteocutaneous (N = 6), radial forearm fasciocutaneous (N = 2), rectus abdominis (N = 2), jejunum (N = 1), radial forearm osteocutaneous (N = 1), and serratus (N = 1). There were no flap failures and the overall complication rate was 62%. Functional outcomes were best for the static conditions of open wound and oral incontinence, each demonstrating a 75% and 78% substantial improvement respectively. Conversely, functional improvement in dynamic functions such as poor speech and difficulty swallowing fared less well. Only 60% of patients with poor speech and 14% with difficulty swallowing showed significant improvement despite aggressive speech and swallowing therapy. These data show that the functional outcomes of free flap reconstruction of delayed had and nck cancr complications ar infio to those xpectd ith immediate rconstruction using fre tissue transfer. Neverthlss, reconstruction can be very useful with a hgh likelihod of flap survival and patient improvement.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Current treatment of flexor digitorum profundus (FDP) avulsion with complex external wire or button fixation is associated with significant morbidity. A new method of internal fixation avoids the complications that are associated with previous techniques. Through a volar Bruner incision, the profundus tendon is retrieved. A transverse dorsal incision is made and two holes are drilled. A double-arm suture is passed through the tendon and bone, and is tied dorsally. Both incisions are closed, leaving the repair entirely internal. This simple technique produces a solid reinsertion of the FDP tendon and avoids damage to the nail bed and matrix. Internal fixation eliminates nail plate deformities, reduces cost, speeds recovery, and produces a stable reconstruction.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

It is essential to develop a method that is technically easier and faster to perform microvascular anastomosis. Therefore the authors have utilized a nonpenetrating microvascular stapling device (VCS; Auto Suture, Tokyo, Japan). Eight vascularized free tissue transfers were performed using this stapling device. All of the transferred tissues were grafted successfully. The time required to perform the stapled microvascular anastomosis ranged from 8 to 18 minutes (mean, 12 minutes). Two arterial anastomoses required suture repairs because they could not be repaired with the use of this stapling device due to thickened vessel walls and intimal dissections. The microvascular stapling device proved useful for vascularized free tissue transfers, but the vessels suitable for this technique should be chosen carefully. Not only the surgeon but also the assistant must be experienced in microscopic surgery.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Although outcome measurement in medical care has traditionally included various aspects of clinical and functional status, patient satisfaction is another important metric in the assessment of health care quality. Determining which factors contribute most to patient satisfaction can assist health care providers in improving care. In an era of diminishing resources, satisfaction ratings can further aid third-party payers in determining who provides those services. The authors used the ordinal logistic regression method to develop a predictive model for patient satisfaction in an outpatient plastic surgery clinic. Consecutive patients who attended a university outpatient plastic surgery clinic were asked to complete the Visit Specific Patient Satisfaction Questionnaire (VSQ) after their clinic visit. Type of clinic (e.g., hand clinic, aesthetic clinic, breast clinic) and demographic variables like age, gender, race, and education were added to the questionnaire to control for possible confounding effects. The authors constructed an ordinal logistic regression model using the overall visit response as the dependent variable and the eight other response categories as independent variables. A total of 345 patients completed the VSQ, which takes each patient less than 2 minutes to complete. The patient response rate was more than 95%. Statistically significant predictors included (1) personal manner of physician (odds ratio [OR], 18.0;p= 0.0002), (2) time spent with physician (OR, 4.7;p=0.0099), (3) length of tme to get an appointment (OR, 4.6;p=0.0055), and (4) explanation of what was done (OR, 3,9;p=0.0263). There was no statistically significant association betwen overall satisfaction scores and the folowing factors: (1) lnght of wait in the clinic (OR, 2.7;p=0.0747), (2) gtting through to the clnc by phone (OR, 0.71;p=0.5439), (3) convenience of the clinic's location (OR, 2.3;p=0.1368), and (4) technical skills of the physcian (OR, 1.0;p=0.9974). The predictive model as adjusted for possible confounding due to the type of clinic and demographic variables. In this study the most important prdictors of patient satisfaction were those related to efficient clinic opeation (scheduling of appointments and clinic waiting time) and the quality of the patient-physcian interaction. Clinic facilities (like clinic location and ease of phone contact) were nt significant predictors. Because patients often have difficulty assessing the technical skills of physcians, this variable was not a significant predictor. To improve patient satisfaction in plastic surgery outpatient clinics, efforts and resorces should be dircted toward xpedient and empathic delivery of care.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID