ABSTRACT
Fire is a rare but potentially disastrous operating room misadventure. In this article, the authors describe the elements of operating room fires and present an illustrative case. The risk of fire can be minimized when the operating room team understands the interactions among the three sides of the classic fire triangle: oxidizers, fuels, and ignition sources. Lists of fire prevention techniques and steps to take in the event of an operating room fire are provided.
Subject(s)
Fires , Operating Rooms , Adult , Catheterization , Chalazion/surgery , Electrocoagulation , Female , Fires/prevention & control , Fires/statistics & numerical data , Humans , Laser Therapy , Safety Management , United StatesSubject(s)
Bites and Stings/epidemiology , Dogs , Adult , Animals , California/epidemiology , Child , Dogs/classification , Facial Injuries/epidemiology , Facial Injuries/etiology , Hand Injuries/epidemiology , Hand Injuries/etiology , Humans , Incidence , Mandatory Reporting , Seasons , Wrist Injuries/epidemiology , Wrist Injuries/etiologyABSTRACT
A simplified approach to subperiosteal midface lifting with suspension is described, which has been performed on 75 patients since 1986. In comparison with standard facelifting, this technique results in long-lasting vertical resuspension of ptotic midfacial tissues. To date there has been a high rate of patient satisfaction with no cases of nerve injury or hematoma. There is a rare incidence of minor complications.
Subject(s)
Blepharoplasty/methods , Periosteum/surgery , Rhytidoplasty/methods , Adult , Blepharoplasty/standards , Facial Bones/anatomy & histology , Facial Muscles/anatomy & histology , Facial Muscles/surgery , Facial Nerve/anatomy & histology , Fascia/anatomy & histology , Fasciotomy , Female , Humans , Male , Middle Aged , Patient Satisfaction , Rhytidoplasty/standards , Time Factors , Treatment OutcomeABSTRACT
The inversion deformity of club foot is characterized by shortened ligaments and tendons on the medial side of the foot. The condition, when refractory to castings, is treated easily by operative intervention with neutralization of the foot and ankle. Closure of the resulting incision creates tension on the skin that is well tolerated in most children. Correction of severe deformities leaves incisions that will not close primarily, leaving tendons and neurovascular structures exposed on the posteromedial aspect of the foot. Free tissue transfer or spontaneous secondary closure are 2 options that have drawbacks. Application of human skin allograft affords protection to underlying tissue while allowing granulation tissue formation and wound contraction. Subsequent skin autograft and secondary skin contraction and epithelialization provide satisfactory wound closure with normal foot contour and preservation of ankle correction. Complete healing is achieved by the time cast immobilization is discontinued 6 weeks after surgery.
Subject(s)
Clubfoot/surgery , Orthopedic Procedures/adverse effects , Skin Transplantation/methods , Surgical Wound Infection/surgery , Child, Preschool , Female , Graft Rejection , Graft Survival , Humans , Infant , Male , Orthopedic Procedures/methods , Prognosis , Recovery of Function , Risk Assessment , Sampling Studies , Transplantation, Homologous , Treatment Outcome , Wound Healing/physiologySubject(s)
Breast Implants , Breast Neoplasms/surgery , Carcinoma, Intraductal, Noninfiltrating/surgery , Mammaplasty/methods , Mastectomy, Subcutaneous/methods , Suture Techniques , Adult , Biopsy , Breast Neoplasms/pathology , Carcinoma, Intraductal, Noninfiltrating/pathology , Female , Humans , Neoplasm Staging , Tissue Expansion DevicesABSTRACT
The anatomy of the cervical and marginal mandibular branches of the facial nerve is reviewed. In the senior author's practice, "pseudoparalysis of the marginal mandibular nerve" due to cervical branch injury occurred in 34 of 2002 superficial musculoaponeurotic system-platysma face lifts (1.7 percent) and was associated with a full recovery in 100 percent of cases within a time period ranging from 3 weeks to 6 months. Cervical branch injury can be distinguished from marginal mandibular nerve injury by the fact that the patient will be able to evert the lower lip because of a functioning mentalis muscle.
Subject(s)
Facial Nerve Injuries/epidemiology , Facial Paralysis/epidemiology , Postoperative Complications/epidemiology , Rhytidoplasty/adverse effects , Trigeminal Nerve Injuries , Adult , Cross-Sectional Studies , Facial Nerve Injuries/etiology , Facial Paralysis/etiology , Female , Follow-Up Studies , Humans , Lip/innervation , Middle Aged , Postoperative Complications/etiology , Remission, Spontaneous , Rhytidoplasty/statistics & numerical data , Smiling/physiologyABSTRACT
Leg amputations are associated with marked morbidity and mortality in the atherosclerotic population. The survival in patients undergoing lower extremity amputations is 50% at 3 years and 30% at 5 years. Despite excellent reported results with pedal bypass, some patients are "nonbypassable" with traditional techniques because of very small, short target vessels in the pedal arch. The authors report six cases of microscope-assisted inframalleolar bypass using autogenous artery in 5 patients presenting with threatened limb loss, with 83% graft patency at 52 months average follow-up. They hypothesize that the success in these patients is the result of less surgical trauma and less compliance mismatch at the distal anastomosis, and perhaps the result of vasoactive substances secreted by the arterial grafts. Microscope-assisted pedal bypass with autogenous artery should be considered for "nonbypassable" patients with tissue necrosis or rest pain who do not appear to have sufficient inflow to heal a forefoot amputation.
