| 1. |
- Arslanian, B., et al.
(författare)
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Forearm Bier Block A New Regional Anesthetic Technique for Upper Extremity Surgery
- 2014
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Ingår i: Annals of Plastic Surgery. - 0148-7043. ; 73:2, s. 156-157
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to introduce the technique and results of a forearm Bier block for upper extremity surgery. Introduction: Various techniques of anesthesia are used for hand surgery. Intravenous regional anesthesia, the Bier block, is an effective anesthetic technique. However, there exist several disadvantages and potential complications. We present our technique and results using the forearm Bier block. Materials and Method: A retrospective review was performed studying our experience using forearm Bier block from May to December of 2010. The technique involves exsanguination of the forearm and inflation of a pneumatic tourniquet placed distal to the elbow joint. Twenty-five milliliter of 0.5% lidocaine is injected intravenously. One hundred five patients underwent hand surgery using this technique. There were 53 females and 52 males with a median age of 56 years. In total, 121 procedures were performed. Patients were interviewed by telephone 24 hours postoperatively. Results: All patients received adequate anesthesia from the block. There were no intraoperative and no postoperative complications. There were no mechanical or tourniquet problems. Average tourniquet time was 10.1 minutes. Total operating time was less than 30 minutes. Discussion: Forearm Bier block presents several advantages over standard upper arm technique. Conventional Bier block involves a double tourniquet and a significant amount of lidocaine, which has potential cardiac and neurologic toxicity. Consequently, minimum tourniquet inflation time is 30 minutes. The dosage of lidocaine needed to provide analgesia using the forearm Bier block is significantly reduced, thereby minimizing the potential for these complications. This lower dose allows for shorter tourniquet time rather than the standard 30 minutes. This shorter tourniquet time in itself presents several advantages. Tourniquet pain and risk of ischemic problems are minimized, and efficiency is increased. This efficiency has practical and financial implications such as decreased total operating and recovery room times, decreased cost of medicines, and decreased operating time for the surgeon. Lastly, this technique might also be used for lower extremity surgeries. Conclusions: Forearm Bier block is a safe and efficient method for upper extremity surgery. It significantly reduces the risk of complications and increases the efficiency of the surgeon and surgery facility.
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| 2. |
- Cotrufo, Stefano, et al.
(författare)
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The Vascular Anatomy of the Rat Superficial Epigastric Flap by Vascular Corrosion Casting and Technical Refinement for the Study of Choke Vessels in Cadaveric Flap Models
- 2010
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Ingår i: Annals of Plastic Surgery. - : Lippincott Williams & Wilkins. - 0148-7043 .- 1536-3708. ; 64:1, s. 93-97
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Tidskriftsartikel (refereegranskat)abstract
- Accurate depiction of cutaneous vascular microanatomy is of relevance to plastic surgical flap research, and to descriptive anatomy. Yet current techniques have not permitted full visualization of the subdermal plexus, or potential angiosomal connections. Nor has endothelial visualization been facilitated. Vascular corrosion casting techniques are promising in that regard, and were applied in an extended lateral thoracoabdominal suprafascial adipocutancous flap in the rat (based on the superficial epigastric bundle). Technical refinements for application to further study of human cadaveric flap models are presented. The intraflap vascular branching pattern of the superficial epigastric artery is described, with filling of the lateral thoracic, intercostals, and iliolumbar angiosomes found when coagulation of vessels at the periphery was delayed until after clearance. The vascular casting protocol presented is an effective and promising tool for the study of macro- and microvascular anatomy.
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| 3. |
- Dabernig, Jörg, et al.
(författare)
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The anatomic and radiologic basis of the circumflex scapular artery perforator flap
- 2010
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Ingår i: Annals of Plastic Surgery. - 0148-7043 .- 1536-3708. ; 64:6, s. 784-788
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Tidskriftsartikel (refereegranskat)abstract
- Microsurgical development has recently focused upon the perforator paradigm and primary thinning. Existing perforator flaps may require intramuscular dissection or lack reliable surface markings, whereas traditional scapular/parascapular flaps have low donor morbidity and reliable anatomy, but can be excessively bulky. Clinical application of a new flap based on a perforator from the circumflex scapular axis (CSA) has recently been published, but the vessel's anatomy has not been adequately characterized. The CSA was dissected in 115 sites in 69 cadavers. The number, external vessel diameter, and site of origin of perforators were measured relative to the CSA bifurcation. Color Doppler ultrasound was used to delineate the CSA and its perforators bilaterally in 40 volunteers. The number, origin relative to CSA bifurcation, diameter, length, and flow velocity of cutaneous perforators were determined. A CSA perforator was always present, running into the subdermal plexus, arising within 2.4 cm of the bifurcation. Cadaver studies: mean perforator diameter, 1.3 mm (SD, 0.66); 13% arose at bifurcation, 36% arose proximal (mean, 1.1 mm; SD, 0.63), and 52% distal to bifurcation (mean, 1.5 mm; SD, 0.88). Ultrasound: mean perforator diameter, 1.18 mm (SD, 0.41); mean flow velocity, 16.3 cm/s (SD, 3.65); perforator arose in 36% proximal, in 40% distal to bifurcation, and in 24% from the bifurcation. We definitively describe the anatomy of the perforator from the circumflex scapular artery upon which a new flap has been based. Its origin and dimensions are anatomically and radiologically reliable. The flap has certain potential benefits over existing perforator flaps.
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| 4. |
- Fryzek, J.P., et al.
(författare)
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Characteristics of women with cosmetic breast augmentation surgery compared with breast reduction surgery patients and women in the general population of Sweden
- 2000
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Ingår i: Annals of Plastic Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0148-7043 .- 1536-3708. ; 45:4, s. 349-356
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Tidskriftsartikel (refereegranskat)abstract
- To determine whether women with cosmetic breast implants have distinct demographic, lifestyle, and reproductive characteristics that put them at increased risk for subsequent morbidity, the authors compared 1,369 such women to 2,211 women who had undergone breast reduction surgery, and to a random sample of 49,262 women from the general population of Sweden. Information was collected through self-administered questionnaires, and comparisons were made using the prevalence odds ratio. Women with cosmetic breast implants were significantly (p <0.05) more likely to be current smokers, have a lower body mass index, have had a prematurely terminated pregnancy (induced abortion or miscarriage), and have had fewer live births than either women who underwent breast reduction or women from the general population. Type of implant (silicone gel or saline) did not modify the associations. Regardless of the comparison group used, studies of the health effects of breast implants need to consider that women who undergo cosmetic breast implantation have certain distinct characteristics.
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| 9. |
- Lorenzo, Andres Rodriguez, et al.
(författare)
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Acute transfer of superficial radial nerve to the medial nerve : Case Report
- 2012
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Ingår i: Annals of Plastic Surgery. - 0148-7043 .- 1536-3708. ; 69:5, s. 547-549
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Tidskriftsartikel (refereegranskat)abstract
- Distal nerve transfers have proven to be an important addition to the armamentarium for reconstruction of peripheral nerve injuries. As new nerve transfer procedures are developed, the indications for their use continue to broaden. We report a case of a 77 year-old male who had a 9 centimeters long gap of the median nerve after suffering from an avulsion injury to his right forearm. This was successfully treated by transferring superficial radial nerve to the median nerve at the carpal tunnel level, thus restoring thumb, index and first web sensation. Our report emphasizes that nerve transfers in the emergency setting may be the treatment of first choice in cases were conventional nerve grafting is known to result in poorer outcomes such as in long nerve gaps or in the elderly patient population.
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| 11. |
- Power, Dominic, et al.
(författare)
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Surgical Treatment of Symptomatic End-Neuroma With a New Bioresorbable Copolyester Nerve Capping Device A Multicenter Prospective Cohort Study
- 2023
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Ingår i: Annals of Plastic Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 0148-7043 .- 1536-3708. ; 91:1, s. 109-116
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundNeuroma-induced neuropathic pain is associated with loss of function and reduced quality of life. No consistently effective standard-of-care treatment has been defined. Neurocap, a bioresorbable nerve capping device, has been designed to isolate the nerve stump from surrounding tissues to reduce development of symptomatic end-neuromas.MethodsPatients with peripheral symptomatic end-neuromas were included in a prospective, multicenter, single-arm design. Data were collected presurgery up till 24 months postsurgery. Eligible patients with neuromas were identified based on blocks using anesthetic. Intervention included surgical excision and capping of the transected proximal nerve end with the Neurocap. Main outcome measures were pain, function, recurrence of symptomatic neuroma, use of analgesics, and adverse events.ResultsIn total, 73 patients with 50 upper-extremity and 23 lower-extremity end-neuromas were enrolled. End-neuromas were predominately located in the digits and lower leg. Statistical power of the study outcomes was preserved by 46 of 73 patients completing 24-month follow-up. The mean VAS-Pain score at baseline was 70.2 & PLUSMN; 17.8 (scale 0-100) and decreased significantly to 31 & PLUSMN; 32.5 (P < 0.001). Function significantly improved over time. The recurrence rate of confirmed symptomatic neuroma was low (2 of 98 capped nerves). Adverse event rate was low and included pain and infection; there were no unexpected device-related adverse events. Most patients reported lower use of nonsteroidal anti-inflammatory drugs, opioids, and antineuropathic medications at last follow-up compared with baseline.ConclusionsEnd-neuroma treatment with excision and capping resulted in long-term significant reduction in reported pain, disability, and analgesic medication use. Adverse event rate was low.
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| 12. |
- Rodriguez-Lorenzo, Andres, et al.
(författare)
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Influence of Flap Prefabrication on Seeding of Subcutaneously Injected Mesenchymal Stem Cells in Microvascular Beds in Rats
- 2014
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Ingår i: Annals of Plastic Surgery. - 0148-7043 .- 1536-3708. ; 73:2, s. 234-238
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Tidskriftsartikel (refereegranskat)abstract
- Background: In this article, the authors investigated whether the prefabrication of an autologous pedicled flap by isolation from the surrounding with artificial skin substitutes would increase mesenchymal stem cell (MSC) seeding. Methods: Mesenchymal stem cells were isolated from human umbilical cords and were cultured and characterized by fluorescence-activated cell sorting. Oxacarbocyanine and its green fluorescence emission were used to label the MSCs population. Sixteen adult Wistar rats were randomized in 4 groups (n = 4 animals per group). In group 1, a prefabricated groin flap (GF) with skin substitutes was harvested without cell injection; in group 2, 1 million MSCs were injected subcutaneously in the area corresponding to the GF without flap harvesting; in Group 3, a prefabricated GF with skin substitutes was harvested and 1 million MSCs were injected subcutaneously; and in Group 4, a prefabricated GF with skin substitutes was harvested and 2 million MSCs were injected subcutaneously. All procedures were performed bilaterally in each animal. Animals were sacrificed 2 weeks after the surgery. Flap viability was then assessed by clinical inspection and histology, and seeding of MSCs was observed. Results: All flaps survived 2 weeks after the surgery. Oxacarbocyanine-labeled cells were found in all prefabricated flaps injected (Groups 3 and 4) in higher number in comparison with the group where subcutaneous injection without flap harvesting was performed (Group 2). This difference was statistically significant (P < 0.05). Conclusions: Prefabricated skin flaps with skin substitutes may provide a useful vehicle for the implantation of MSCs to serve as an autologous microvascular bioscaffold.
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| 16. |
- Warren, Anne G., et al.
(författare)
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Lymphedema - A comprehensive review
- 2007
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Ingår i: Annals of Plastic Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1536-3708 .- 0148-7043. ; 59:4, s. 464-472
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Forskningsöversikt (refereegranskat)abstract
- Background: Lymphedema is a chronic, debilitating condition that has traditionally been seen as refractory or incurable. Recent years have brought new advances in the study of lymphedema pathophysiology. as well as diagnostic and therapeutic tools that are changing this perspective. Objective: To provide a systematic approach to evaluating and managing patients with lymphedema. Methods: We performed MEDLINE searches of the English-language literature (1966 to March 2006) using the terms lymphedema, breast cancer-associated lymphedema, lymphatic complications, lymphatic imaging, decongestive therapy, and surgical treatment of lymphedema. Relevant bibliographies and International Society of Lymphology guidelines were also reviewed. Results: In the United States, the populations primarily affected by lymphedema are patients undergoing treatment of malignancy, particularly women treated for breast cancer. A thorough evaluation of patients presenting with extremity swelling should include identification of prior surgical or radiation therapy for malignancy, as well as documentation of other risk factors for lymphedema, such as prior trauma to or infection of the affected limb. Physical examination should focus on differentiating signs of lymphedema from other causes of systemic or localized swelling. Lymphatic dysfunction can be visualized through lymphoscintigraphy; the diagnosis of lymphedema can also be confirmed through other imaging modalities, including CT or MRI. The mainstay of therapy in diagnosed cases of lymphedema involves compression garment use, as well as intensive bandaging and lymphatic massage. For patients who are unresponsive to conservative therapy; several surgical options with varied proven efficacies have been used in appropriate candidates, including excisional approaches, microsurgical lymphatic anastomoses, and circumferential suction-assisted lipectomy, an approach that has shown promise for long-term relief of symptoms. Conclusions: The diagnosis of lymphedema requires careful attention to patient risk factors and specific findings on physical examination. Noninvasive diagnostic tools and lymphatic imaging can be helpful to confirm the diagnosis of lymphedema or to address a challenging clinical presentation. Initial treatment with decongestive lymphatic therapy can provide significant improvement in patient symptoms and volume reduction of edematous extremities. Selected patients who are unresponsive to conservative therapy can achieve similar outcomes with surgical intervention, most promisingly suction-assisted lipectomy.
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| 17. |
- Zabojova, Jorga, et al.
(författare)
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Relational Anatomy of the Mimetic Muscles and Its Implications on Free Functional Muscle Inset in Facial Reanimation
- 2018
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Ingår i: Annals of Plastic Surgery. - : Lippincott Williams & Wilkins. - 0148-7043 .- 1536-3708. ; 81:2, s. 203-207
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Tidskriftsartikel (refereegranskat)abstract
- Background: The human smile is a complex coordinated activity of mimetic muscles predominantly recognizable by a superolateral pull at the commissure and elevation of the upper lip. The aim of this study was to revisit the muscles of facial expression responsible for these motions, evaluate their relational anatomy and orientation, and relate this to optimal positioning of free muscle transfer in smile reanimation.Methods: Nineteen hemifaces from fresh cadaveric specimens were dissected. A subsuperficial muscular aponeurotic system skin flap was elevated to expose the zygomaticus major, zygomaticus minor, levator labii superioris, and levator labii superioris alaeque nasi. Muscle location, length, width, angle of pull, and any anatomic variation were noted.Results: All specimens had zygomaticus major, levator labii superioris, and levator labii superioris alaeque nasi muscles present bilaterally. Conversely, the zygomaticus minor was present in only 10 of 19 hemifaces. There was no significant difference in muscle length, width, or line of pull between specimen sides. Of all the assessed muscles, the zygomaticus minor had the most transverse line of pull, at 31.6 degrees; the zygomaticus major was more oblique with a line of pull of 55.5 degrees; and the levator labii superioris and levator labii superioris alaeque nasi were oriented almost vertically with angles of 74.7 degrees and 79.0 degrees, respectively.Conclusions: The mimetic muscle vector is quite vertical in comparison to the angle obtained by traditional dynamic smile reconstruction surgeries. A more vertical vector, especially at the upper lip, should be considered in smile reconstruction.
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