Consideration on Application of Modified Monitored Anesthetic Care in Plastic Surgery

PURPOSE: Many patients have fear for surgery owing to the injection of lidocaine and the possible pain in the course of the operation. To resolve such a problem the cases to do plastic surgery with monitored anesthetic care are increasing, in which something like sedatives is injected into vein without endotracheal intubation and under voluntary respiration, but the usage is now under the controversy. METHODS: There were 25 patients who had surgery with local anesthesia, and another 25 patients who had surgery with monitored anesthetic care which belongs to ASA class 1 and 2 from January to April, 2009. Their anesthesia records were collected and surveys were given before and after the surgery and the surgery staff recorded OAA/S during the surgery. The postoperative surveys included the awakening during the surgery, pain, anxiety, and the degree of patient's satisfaction through visual analogue scale to identify the difference between the two methods. RESULTS: The OAA/S results according to time lapse show that it is possible to lead a fast effective sedation and recovery with monitored anesthetic care, and monitored anesthetic care enhances both surgeon's convenience level and patient's satisfaction level, and reduces awakening, pain, and anxiety, compared to local anesthesia. CONCLUSION: The current paper shows about the plastic surgery, particularly the outpatient surgery, when monitored anesthetic care method is applied, it could gain a fast sedation and recovery or an effective sedation of patients. The method also has some affirmative effects in regard with surgeon's convenience and the patients' satisfaction degree and the reduction of their awakening, pain, and anxiety. With careful and adequate watch on the measures about vital signs like electrocardiogram, the degree of oxygen saturation, and blood pressure, it could clinically be very useful.

A Case of Chemical Burn due to Indomethacin Cream (Vigel Cream(R)): A Case Report

A 81-year-old female patient was experiencing a second degree burn. The vesicobullous lesion and skin necrosis was accompanied by erythema with a size of 8x11 cm and severe pain. Three days earlier, the patient had bumped her forehead against the wall, her forehead was swelled and hurted. The patient spread ground indomethacin cream (Vigel cream(R)) on her forehead constantly. She was treated with potadine soaked gauze every day. As soon as the erythema had worn out, she was treated by foam dressing using Episurge(R) (Erweis). Epithelialization of the injured area began from the 7th day since the burn. Complete epithelialization took 14th days, and the outpatient's progress is currently being observed.

Abdominoplasty Combined with Wide Excision in Marjolin's Ulcer: Report of 2 Cases

Advances in medical science have produced significant progress in the area of wound healing. Yet, despite proper administration of initial medical treatment, burns or radiation induced wounds often develop into chronic wounds or develop other complications such as scar contractures. In these type of patients, chronic wounds and the potential accompanied ulcers are difficult to heal as malignant changes may occur to the wounds especially in the absence of or in the delay in timely medical treatment. In our beauty oriented society today people have shown great interest in improving their image and many obese patients want to undergo suction-assisted lipectomies or abdominoplasties. Abdominoplasty is an effective procedure to remove locally accumulated fat and to reshape abdominal contours by tightening the muscles of the relaxed abdominal wall. Our medical research conducted on two patients, one with contact burn injuries accompanied by upper abdominal ulcers suffered for fifty years and another with radiation impaired wounds accompanied by lower abdominal ulcers due to cancer treatment for seven years, has shown that through the proper use of abdominoplasty. We have eliminated all possibilities that may trigger the re-occurrence of Marjolin's ulcers which may become malignant. Additionally, we have been able to heal chronic wounds and functionally improve our patient's restrictions of movement caused by the scar contractures by completely removing the lesions, erythemas and discharges from the ulcer areas by performing upper and lower abdominoplasties while still obtaining cosmetically satisfactory results.

Primary Parotid Non-Hodgkin's Lymphoma: A Case Report

PURPOSE: Primary malignant lymphomas of the salivary glands are uncommon, representing only 1.7% to 3.1% of all salivary neoplasms and 0.6% to 5% of all tumors and tumor-like lesions of the parotid gland. Lymphomas of the parotid glands are usually manifestations of a systemic disease process but primary lymphomas of the parotid glands are rare. Most of these lesions are classified as extranodal non-Hodgkin's lymphoma. We report the clinicopathological features of primary malignant lymphoma of the parotid gland based on an analysis of our cases. METHODS: The subject was a 48-year-old male patient with a malignant lymphoma originating in the parotid gland, which had been slowly increasing in size over previous 6 months. The diagnosis was established by MRI and a superficial lobectomy. After diagnosis, the patient was referred to an oncologist for staging and medical treatment. RESULTS: The stage was IIIA. The patient was treated with chemotherapy following surgery with rituximab and CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). The tumor was controlled successfully by chemotherapy. The patient was followed up for 1 year with no relapse. CONCLUSION: A case of primary non-Hodgkin's lymphoma of the parotid gland was treated with a superficial parotidectomy and chemotherapy. The disease was well controlled after a 1 year follow-up.

Usefulness of High-Resolution Ultrasonography after Foreign Body Injection on Aesthetic Plastic Surgery

PURPOSE: The purpose of this study is to demonstrate the usefulness of the high resolutional ultrasonographic features in patients with foreign body. METHODS: From September 2007 to August 2009, we retrospectively reviewed high resolutional ultrasonogram using 5~12MHz linear transducer of 13 patients presenting with inflammation after foreign body injection. They were referred for complications after foreign body injection. Injected foreign bodies were 4 silicone, 4 paraffin, 2 artecoll, and 3 unknown. We treated them with foreign body removal(7), foreign body removal and corrective plastic surgery(4), and conservative treatment with antibiotics and steroid injection(2). RESULTS: High resolutional ultrasonography well demonstrated the existence of foreign body and it's overall size, location within the tissue layer, and vascularity. Comparison between preoperative and postoperative ultrasonographic findings was useful not only to evaluate the prognosis but also to plan the treatment. These ultrasonographic findings aided in precise assessment of the contour and location of the foreign body and led to an accurate surgery. We were able to acquire various information in order to set a detailed plan for the operation which in turn, led to a precise, successful surgery. After the treatment, complication did not occur in 12 patients, except 1 patient. But this patient was also treated after reoperation. Postoperative high resolutional ultrasonography shows almost foreign body removed and inflammation disappeared. CONCLUSION: Considering the usefulness of high-resolution ultrasonography in foreign body injection, high-resolution ultrasonography would be necessary for both the patient and the doctor. Preoperative and postoperative high resolutional ultrasonography is highly accurate, safe, inexpensive and easy. It can be a useful modality in foreign body after plastic surgery.