Surgical management of hand contractures and pseudosyndactyly in dystrophic epidermolysis bullosa.

The term epidermolysis bullosa refers to a group of disorders characterized by skin blistering following minor trauma. The hands, because of constant use during normal daily activity, are especially exposed to blistering, with secondary scarring leading to pseudosyndactyly, adduction contracture of the thumb, and flexion or extension contracture of the fingers. The standard surgical approach for the correction of these deformities is based on the incisional release of pseudosyndactyly and contractures, and split skin grafting of the secondary wounds. A simplified approach without skin grafting is presented in this paper. Four children (8 hands) underwent 25 operations over two decades. The results, in terms of postoperative healing and recurrence, were comparable with those of the standard approach involving skin grafting.

Blood loss and hematological recovery following reduction mammaplasty and dermolipectomy: a prospective study.

A study was made to assess the impact of surgery on the hematological status and postoperative hematological recovery of 75 consecutive patients undergoing either reduction mammaplasty or dermolipectomy. Blood losses were estimated the morning after surgery, measuring decreases in hemoglobin level and hematocrit, while postoperative recovery was evaluated in terms of hemoglobin level and hematocrit at 10 weeks. The postoperative hemoglobin decrease was 2.69 g%, and the hematocrit dropped 7.25%. By 10 weeks, however, the patients had recovered their preoperative values. We found no significant differences in the evolution of hemoglobin level and hematocrit during the study between reduction mammaplasty and dermolipectomy patients. A significant positive correlation between surgical piece weight and postoperative reduction in hemoglobin concentration and hematocrit was observed. Conversely, at 10 weeks, a significant but negative correlation between surgical specimen weight and hemoglobin concentration and hematocrit was recorded. The anticipated weight of the surgical piece could thus be used as a predictor of intraoperative blood loss and of the speed of postoperative recovery. Since patients with surgical resection of > 3 kg remained anemic at 10 weeks, oral iron supplements could benefit this subset of patients.

Squamous cell carcinoma of the tongue in a patient with Rothmund-Thomson syndrome.

Rothmund-Thomson syndrome is a rare autosomal recessive genodermatosis characterised by poikilodermatous skin changes that appear in childhood. Patients exhibit variable additional features including juvenile cataracts, skeletal abnormalities and a higher than expected incidence of malignancies. We report a case of squamous cell carcinoma of the tongue in a 37-year-old Rothmund-Thomson syndrome patient and review the natural history of this rare disease, given that the patient was diagnosed with Rothmund-Thomson syndrome at the age of 8 years and was first reported in 1975.

A controlled, randomized, double-blind study of ketorolac for postoperative analgesia after plastic surgery.

The present study was designed to evaluate the efficacy and safety of ketorolac compared with metamizol (Nolotil) in the control of pain after plastic surgery. Almost no literature exists on postoperative pain control in this specialty. A multiple-dose, randomized, double-blind study of parallel design was carried out. One hundred patients received either ketorolac 30 mg intramuscularly (IM) every 8 hours or metamizol 2 g IM every 8 hours for postoperative analgesia during the first 48 postoperative hours. Pain severity was assessed using a visual analog scale. Adverse events were recorded. There were no significant differences between the groups in terms of pain scores or frequency of adverse events throughout the study. Two postoperative hemorrhages were recorded in the ketorolac group. Ketorolac and metamizol were found to be equally safe and effective in reducing postoperative pain after plastic surgery. It should be noted that 52% of patients in the ketorolac group and 48% in the metamizol group considered their postoperative analgesia to be very good. Nevertheless, for surgical procedures or for patients in whom postoperative hematoma formation is a particular concern, ketorolac probably should not be used.

Does double gloving protect surgical staff from skin contamination during plastic surgery?

In a randomized study, the effectiveness of double gloving in maintaining an intact barrier between the patient and the hands of the surgical staff during plastic surgery operations was tested. For 2 months, the surgical staff of a plastic surgery unit randomly wore single or double gloves during all elective surgical procedures. At the end of the operations, the gloves were tested by the water filling test. A total of 1092 gloves were examined. Twelve accidental injuries were noticed during the operations, and 67 unnoticed perforations occurred. The data suggest that the risk of perforation and exposure increases with the length and complexity of the procedures. It was concluded that double gloving is effective in plastic surgery, inasmuch as the barrier protection was maintained by the inner glove in two of three cases in which the outer glove was perforated inadvertently. Plastic surgeons must balance the improved security of double gloving with the possible discomfort or reduced sensitivity.

Nevus comedonicus: report of a case with genital involvement.

We report the case of a 6-year-old girl with a nevus comedonicus involving the left perineal region and ipsilateral labium majus. This lesion constitutes a rare hamartomatous malformation of the pilosebaceous apparatus, most frequently located on the face or trunk. Genital involvement has only very rarely been reported.

Mondor's disease and aesthetic breast surgery: report of case secondary to mastopexy with augmentation.

Although the etiology of Mondor's disease remains obscure, trauma of some form is the most commonly cited cause. Surgical trauma has frequently been quoted, but references in the literature specifically implicating aesthetic breast surgery are scarce. In this article, we report a case of Mondor's disease secondary to mastopexy with concomitant augmentation mammaplasty.

[Reconstruction of the nose using expanded forehead flap]. / Reconstrucción nasal utilizando un colgajo frontal expandido.

The history of using forehead flaps for nasal reconstruction is reviewed. A case of nasal reconstruction in a man who underwent amputation for squamous cell carcinoma is reported. The surface of the forehead flap was augmented by expanded tissues at the donor site. We describe the surgical procedure and its excellent results.