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1.
Clin Plast Surg ; 49(1): 191-195, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782136

RESUMO

Nonsurgical rhinoplasty is increasing in popularity, and when used appropriately, can be less costly and have less downtime than surgical rhinoplasty. It can offer patients a means of seeing how they would feel about a surgical rhinoplasty later. Injection can be safe but patients should still be counseled regarding the rare, possible risks of tissue loss and potentially irreversible tissue ischemia and irreversible blindness. Treatment with hyaluronidase can be partially effective when signs and symptoms are caught early; however, avoidance is still the best medicine along with seeking an experienced, qualified rhinoplasty plastic surgeon.


Assuntos
Rinoplastia , Humanos , Isquemia , Nariz/cirurgia
2.
Clin Plast Surg ; 49(1): 71-79, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782141
4.
Plast Reconstr Surg ; 148(4): 927-929, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34550952
7.
Craniomaxillofac Trauma Reconstr ; 12(2): 150-155, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31073366

RESUMO

Since 2005, facial transplantation has emerged as a viable reconstructive option for the most severe defects not amenable to conventional reconstructive techniques, with promising aesthetic and functional outcomes to date. Key facial subunits and midface structures such as the eyelids, lips, and nose are now able to be successfully replaced rather than reconstructed, enabling adequate functional outcomes in even the most extensive defects. However, even in cases of severe facial disfigurement, the decision to proceed with transplantation versus autologous reconstruction remains a source of debate, with no current consensus regarding precise indications and inclusion/exclusion criteria. This report details the case of a candidate referred for face transplantation who ultimately underwent autologous facial reconstruction. Through this representative case, our objective is to clarify the criteria that make a patient a suitable face transplant candidate, as well as to demonstrate the outcomes achievable with a conventional autologous reconstruction, using a methodically planned, multistaged approach.

8.
Plast Reconstr Surg Glob Open ; 6(3): e1693, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29707453

RESUMO

Background: High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author's early and definitive staged reconstructive approach to these challenging patients. Methods: A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes. Results: Initial query revealed 41 articles, of which 17 articles met inclusion criteria. A single comparative study revealed that early versus delayed management resulted in a decreased incidence of soft-tissue contracture, required fewer total procedures, and resulted in shorter hospitalizations (level 3 evidence). Seven of the 9 studies (78%) that advocated delayed reconstruction were from the Middle East, whereas 5 of the 6 studies (83%) advocating immediate or early definitive reconstruction were from the United States. No study compared debridement timing directly in a head-to-head fashion, nor described flap selection based on defect characteristics. Conclusions: Existing literature suggests that early and aggressive intervention improves outcomes following avulsive ballistic injuries. Further comparative studies are needed; however, although evidence is limited, the senior author presents a 3-stage reconstructive algorithm advocating early and definitive reconstruction with aesthetic free tissue transfer in an attempt to optimize reconstructive outcomes of these complex injuries.

9.
Plast Reconstr Surg ; 137(2): 386e-393e, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26818329

RESUMO

BACKGROUND: This study investigates the hypothesis that mechanisms of injury, fracture patterns, and burden to the health care system differ between geriatric and nongeriatric populations sustaining blunt-force craniofacial trauma. METHODS: A 5-year retrospective chart review of patient records and computed tomographic imaging was performed. Demographic and outcome data were extracted for equally numbered samples of blunt-mechanism facial fracture patients aged 60 years or older (geriatric), and adult patients aged 18 to 59 years (adult nongeriatric). Comparisons were made between these two populations using t tests and multivariable logistic regression. RESULTS: One thousand eighty-seven geriatric and 1087 nongeriatric patients were included. Geriatric patients were significantly more likely to be Caucasian, female, and have sustained fractures as the result of falling. They also had significantly longer hospital stays, were more likely to die, and were more likely to be discharged to home with services. Mandible fractures and panfacial fractures were significantly more common in the nongeriatric population. Geriatric age was associated with doubled length of hospitalization for patients with midface fractures. Logistic regression revealed that significantly higher incidences of orbital floor, maxillary, and condylar fractures in geriatric patients were dependent on geriatric age status, rather than mechanism of injury alone. CONCLUSIONS: Resource allocation for geriatric patients with craniofacial trauma should differ from that of their nongeriatric adult counterparts, with more resources allocated to supportive care during hospitalization and assistive care after discharge. The authors' data indicate that structural and biological changes in the craniofacial skeleton contribute to differences in fracture location independent of mechanism of injury. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Ossos Faciais/lesões , Recursos em Saúde/provisão & distribuição , Recursos em Saúde/estatística & dados numéricos , Traumatismo Múltiplo/terapia , Fraturas Cranianas/terapia , Ferimentos não Penetrantes/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas Cranianas/complicações , Adulto Jovem
10.
Plast Reconstr Surg ; 136(4): 822-828, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26397254

RESUMO

BACKGROUND: Orbital floor fractures are uncommon in the pediatric population. The aim of this study was to review the presentation, management, and outcomes for children with these injuries. METHODS: A retrospective review was performed on 72 consecutive children with orbital floor fractures over a 21-year period. RESULTS: Seventy-two patients with 76 fractures were identified. Mean follow-up time was 14.2 ± 4 months. The majority (50 percent) of patients suffered minimally displaced fractures, whereas 17 percent (13 of 76) suffered blowout fractures and 5 percent (four of 76) suffered trapdoor fractures. Nineteen percent of children (14 of 72) presented with decreased visual acuity and 8 percent (six of 72) had enophthalmos on presentation. Thirty-three percent (24 of 72) underwent surgery. The most common indications for surgery were size of the fracture, followed by muscle entrapment. Fracture width and the defect width-to-orbital width ratios were significantly greater in the operative cohort versus their conservatively managed counterparts (20.7 mm versus 7.7 mm, p < 0.05, and 0.54 versus 0.32, p < 0.05, respectively). Surgery was not associated with improved visual outcomes (p < 0.05). However, patients who underwent reconstruction had a significantly lower adjusted risk of enophthalmos on follow-up (relative risk, 0.02; 95 percent CI, 0.00 to 0.49; p < 0.05). CONCLUSIONS: Operative intervention prevents enophthalmos in pediatric patients with pediatric orbital floor fractures, and patients who present with decreased visual acuity should be cautioned that surgical intervention does not improve visual outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Fraturas Orbitárias/terapia , Adolescente , Transplante Ósseo , Criança , Pré-Escolar , Enoftalmia/etiologia , Enoftalmia/prevenção & controle , Feminino , Seguimentos , Fixação de Fratura/métodos , Humanos , Lactente , Modelos Logísticos , Masculino , Fraturas Orbitárias/complicações , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/cirurgia , Estudos Retrospectivos , Transplante Autólogo , Resultado do Tratamento
11.
Acad Radiol ; 22(11): 1439-42, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26341540

RESUMO

RATIONALE AND OBJECTIVES: Cellulitis is a common cause for emergency department (ED) presentation and subsequent hospital admission. Underlying fracture, osteomyelitis, or foreign body is often considered in the clinical evaluation of these patients. Accordingly, plain radiographs (XRs) of the affected extremity are often ordered during the initial work-up. The utility of these imaging studies in the treatment of uncomplicated lower-extremity cellulitis, however, remains unclear. In an effort to treat this common problem more efficiently, we evaluated our imaging practices and results in a cohort of consecutive patients admitted to a large public city hospital for treatment of uncomplicated lower-extremity cellulitis. MATERIALS AND METHODS: Retrospective cohort study of 288 consecutive ED admissions for treatment of uncomplicated cellulitis, of which 214 met the inclusion criteria for this study. Patient demographics, history, vitals, laboratory values, and test results were evaluated with univariate and multivariate statistical analyses. RESULTS: XRs of the affected lower extremity were obtained in 158 patients (73.8%). Positive XR findings were present in 19 patients (12.0%) and positively correlated with a history of acute trauma to the extremity (P < .001) or the presence of a chronic wound (P < .01). Multivariable logistic regression analysis revealed a history of trauma (P < .001) or the presence of a chronic wound (P < .05) to be independent predictors of positive XR findings with relative risks of 6.24 and 2.98, respectively. CONCLUSIONS: The establishment of evidence-based guidelines for the treatment of lower-extremity cellulitis has potential to significantly improve clinical efficiency and reduce cost by eliminating unnecessary testing. Based on our results, patients without a recent history of trauma to the affected extremity or the presence of a chronic wound do not appear to warrant XRs. When applied to our cohort, only 48 of 158 patients had a history of trauma or chronic wound. This means that 110 patients unnecessarily had plain films taken as part of their initial work-up. In a largely uninsured inner city patient population such as this cohort, that extra cost falls on the public hospital system.


Assuntos
Celulite (Flegmão)/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Idoso , Celulite (Flegmão)/etiologia , Doença Crônica , Custos e Análise de Custo , Serviço Hospitalar de Emergência , Feminino , Corpos Estranhos/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteomielite/diagnóstico por imagem , Radiografia/economia , Estudos Retrospectivos
12.
Plast Reconstr Surg ; 136(4): 811-821, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26090769

RESUMO

BACKGROUND: Mandibular condyle fractures are common following facial trauma and carry an increased risk for concomitant blunt carotid artery injuries. Further elucidation of this relationship may improve vascular injury screening and management. METHODS: A retrospective cohort study was performed for all patients sustaining condylar fractures presenting to a large trauma center over twelve years. Fracture locations were classified according to the Strasbourg Osteosynthesis Research Group (1, condylar head; 2, condylar neck; and 3, extracapsular condylar base). Carotid artery injury severity was based on the Biffl scale. Severe vascular injury was defined as a Biffl score greater than I. RESULTS: 605 patients were identified with mandibular condyle fractures consisting of 21.0 percent (n = 127) condylar head; 26.8 percent (n = 162) condylar neck; and 52.2 percent (n = 316) extracapsular condylar base. The incidence of vascular injuries in this population was 5.5 percent (n = 33), of which 75.8 percent (n = 25) were severe. Severe vascular injuries occurred in 1.6 percent (n = 2) of condylar head, 2.5 percent (n = 4) of condylar neck, and 6.0 percent (n = 19) of extracapsular condylar base fractures (p < 0.05). Extracapsular condylar base fractures were independently associated with a 2.94-fold increased risk of a severe blunt carotid artery injury compared with other condyle fractures on multivariable analysis (p < 0.05). CONCLUSIONS: Extracapsular subcondylar fractures should heighten suspicion for concomitant blunt carotid artery injury. The data support a force transmission mechanism of injury in addition to direct injury from bony fragments. CLINICAL QUESTIONS/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna , Côndilo Mandibular/lesões , Fraturas Mandibulares/complicações , Ferimentos não Penetrantes/etiologia , Adulto , Lesões das Artérias Carótidas/diagnóstico , Lesões das Artérias Carótidas/epidemiologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Fraturas Mandibulares/diagnóstico , Análise Multivariada , Estudos Retrospectivos , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/epidemiologia
13.
Plast Reconstr Surg ; 135(3): 883-892, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25719704

RESUMO

BACKGROUND: Multiple perfusion assessment technologies exist to identify compromised microvascular free flaps. The effectiveness, operability, and cost of each technology vary. The authors investigated surgeon preference and clinical behavior with several perfusion assessment technologies. METHODS: A questionnaire was sent to members of the American Society for Reconstructive Microsurgery concerning perceptions and frequency of use of several technologies in varied clinical situations. Demographic information was also collected. Adjusted odds ratios were calculated using multinomial logistic regression accounting for clustering of similar practices within institutions/regions. RESULTS: The questionnaire was completed by 157 of 389 participants (40.4 percent response rate). Handheld Doppler was the most commonly preferred free flap-monitoring technology (56.1 percent), followed by implantable Doppler (22.9 percent) and cutaneous tissue oximetry (16.6 percent). Surgeons were significantly more likely to opt for immediate take-back to the operating room when presented with a concerning tissue oximetry readout compared with a concerning handheld Doppler signal (OR, 2.82; p < 0.01), whereas other technologies did not significantly alter postoperative management more than simple handheld Doppler. Clinical decision making did not significantly differ by demographics, training, or practice setup. CONCLUSIONS: Although most surgeons still prefer to use standard handheld Doppler for free flap assessment, respondents were significantly more likely to opt for immediate return to the operating room for a concerning tissue oximetry reading than an abnormal Doppler signal. This suggests that tissue oximetry may have the greatest impact on clinical decision making in the postoperative period.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Retalhos de Tecido Biológico , Microcirurgia/métodos , Monitorização Intraoperatória/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sociedades Médicas , Inquéritos e Questionários
14.
Plast Reconstr Surg ; 135(4): 1077-1084, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25502856

RESUMO

BACKGROUND: The purpose of this study was to gain insight into the impact of age at repair on relapse rates in syndromic patients undergoing cranial vault remodeling. METHODS: Retrospective chart review was performed for patients surgically treated for syndromic craniosynostosis from 1990 to 2013. Surgical procedures were assigned a Whitaker category based on need for reoperation as follows: no additional surgery required (category I); minor contouring revisions required (II); major revisions required (III); or failure of original surgery (IV). Age at surgery was grouped as follows: younger than 6 months; aged 6 to 9 months; and older than 9 months. Multivariable logistic regression analysis was performed to determine the relationship between age at surgery and need for reoperation by Whitaker category. RESULTS: Fifty-two patients undergoing a total of 65 planned cranial vault remodeling procedures were included. Multivariate logistic regression analysis revealed that patients younger than 6 months at the time of primary surgery carried a 4.10 greater odds (95 percent CI, 1.31 to 12.87; p = 0.016) of requiring a subsequent major reoperation, and being older than 9 months of age carried a 13.2 greater odds (95 percent CI, 1.39 to 124.30; p = 0.024) of requiring a subsequent minor revision. CONCLUSIONS: Timing of surgery is an important factor to consider when planning vault remodeling in syndromic craniosynostosis. Based on our institution's experience, when there is no concern for elevated intracranial pressure the ideal operative window for these procedures in the syndromic population appears to be 6 to 9 months of age.


Assuntos
Craniossinostoses/cirurgia , Crânio/cirurgia , Fatores Etários , Feminino , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação , Estudos Retrospectivos
15.
Plast Reconstr Surg ; 133(4): 864-873, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24675189

RESUMO

BACKGROUND: Continuing advances in cranioplasty have enabled repair of increasingly complicated cranial defects. However, the optimal materials and approaches for particular clinical scenarios remain unclear. This study examines outcomes following cranioplasty for a variety of indications in patients treated with alloplastic material, autogenous tissue, or a combination of both. METHODS THE AUTHORS CONDUCTED: a retrospective analysis on 180 patients who had 195 cranioplasties performed between 1993 and 2010. RESULTS: Materials used for cranioplasty included alloplastic for 42.6 percent (83 of 195), autologous for 19.0 percent (37 of 195), and both combined for 38.5 percent (75 of 195). Mean defect size was 70.5 cm. A subset of patients had undergone previous irradiation (12.2 percent; 22 of 180) or had preoperative infections (30.6 percent; 55 of 180). The most common complication was postoperative infection (15.9 percent; 31 of 195). Factors that significantly predisposed to complications included preoperative radiation, previous infection, and frontal location. Preoperative radiation was the strongest predictor of having any postoperative complications, with an adjusted odds ratio of 6.91 (p < 0.005). Irradiated patients (OR, 7.96; p < 0.05) and patients undergoing frontal cranioplasties (OR, 2.83; p < 0.05) were more likely to require repeated operation. Preoperative infection predisposed patients to exposure of hardware in alloplastic reconstructions (OR, 3.13; p < 0.05). CONCLUSIONS: Despite the evolution of cranioplasty techniques and materials, complications are not uncommon. The choice of reconstructive material may modify the risk of developing postoperative complications but appears less important than the clinical history in affecting outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Retalhos de Tecido Biológico , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Implantação de Prótese/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Fatores de Risco , Crânio/anormalidades , Crânio/lesões , Neoplasias Cranianas/cirurgia , Adulto Jovem
17.
J Craniofac Surg ; 24(6): 1922-6, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24220374

RESUMO

PURPOSE: The aim of this article was to assess how regional facial fracture patterns predict mortality and occult intracranial injury after blunt trauma. METHODS: Retrospective chart review was performed for blunt-mechanism craniofacial fracture patients who presented to an urban trauma center from 1998 to 2010. Fractures were confirmed by author review of computed tomographic imaging and then grouped into 1 of 5 patterns of regional involvement representing all possible permutations of facial-third injury. Mortality and the presence of occult intracranial injury, defined as those occurring in patients at low risk at presentation for head injury by Canadian CT Head Rule criteria, were evaluated. Relative risk estimates were obtained using multivariable regression. RESULTS: Of 4540 patients identified, 338 (7.4%) died, and 171 (8.1%) had intracranial injury despite normal Glasgow Coma Scale at presentation. Cumulative mortality reached 18.8% for isolated upper face fractures, compared with 6.9% and 4.0% for middle and lower face fractures (P < 0.001), respectively. Upper face fractures were independently associated with 4.06-, 3.46-, and 3.59-fold increased risk of death for the following fracture patterns: isolated upper, combined upper, panfacial, respectively (P < 0.001). Patients who were at low risk for head injury remained 4 to 6 times more likely to suffer an occult intracranial injury if they had involvement of the upper face. CONCLUSIONS: The association between facial fractures, intracranial injury, and death varies by regional involvement, with increasing insult in those with upper face fractures. Cognizance of the increased risk for intracranial injury in patients with upper face fractures may supplement existing triage tools and should increase suspicion for underlying or impending neuropathology, regardless of clinical picture at presentation.


Assuntos
Traumatismos Craniocerebrais/epidemiologia , Ossos Faciais/lesões , Fraturas Cranianas/mortalidade , Ferimentos não Penetrantes/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Baltimore/epidemiologia , Causas de Morte , Estudos de Coortes , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Hemorragia Intracraniana Traumática/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Fraturas Cranianas/classificação , Tomografia Computadorizada por Raios X/métodos , Saúde da População Urbana/estatística & dados numéricos , Ferimentos não Penetrantes/classificação , Adulto Jovem
18.
Microsurgery ; 33(7): 575-7, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24014380

RESUMO

A neuroma is a collection of disorganized nerve sprouts emanating from an interruption of axonal continuity, forming within a collagen scar as the nerve attempts to regenerate. Lingual neuroma formation secondary to iatrogenic trauma to the tongue is likely not uncommon; however, we could not find a report in the literature of treatment of a distal tongue end-neuroma treated by resection and implantation into muscle. Here we describe a patient who experienced debilitating chronic tongue pain after excision of a benign mass. After failing conservative management, the patient was taken to the operating room where an end-neuroma of the lingual nerve was identified and successfully treated by excision and burying of the free proximal stump in the mylohyoid muscle. At 17 months postoperatively, she remains pain free without dysesthesias.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Nervo Lingual/patologia , Neuroma/cirurgia , Dor Pós-Operatória/cirurgia , Retalhos Cirúrgicos/transplante , Doenças da Língua/cirurgia , Adulto , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Dor Crônica/cirurgia , Neoplasias dos Nervos Cranianos/etiologia , Neoplasias dos Nervos Cranianos/patologia , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Nervo Lingual/cirurgia , Neuroma/etiologia , Neuroma/patologia , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Reoperação/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Doenças da Língua/patologia , Resultado do Tratamento
19.
Microsurgery ; 33(6): 421-31, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23836495

RESUMO

BACKGROUND: Some sensation to the breast returns after breast reconstruction, but recovery is variable and unpredictable. We primarily sought to assess the impact of different types of breast reconstruction [deep inferior epigastric artery perforator (DIEP) flaps versus implants] and radiation therapy on the return of sensation. METHODS: Thirty-seven patients who had unilateral or bilateral breast reconstruction via a DIEP flap or implant-based reconstruction, with or without radiation therapy (minimum follow-up, 18 months; range, 18-61 months) were studied. Of the 74 breasts, 27 had DIEP flaps, 29 had implants, and 18 were nonreconstructed. Eleven breasts with implants and 10 with DIEP flaps had had prereconstruction radiation therapy. The primary outcome was mean patient-perceived static and moving cutaneous pressure threshold in nine areas. We used univariate and multivariate analyses to assess what independent factors affected the return of sensation (significance, P < 0.05). RESULTS: Implants provided better static (P = 0.071) and moving sensation (P = 0.041) than did DIEP flaps. However, among irradiated breasts, skin over DIEP flaps had significantly better sensation than did that over implants (static, P = 0.019; moving, P = 0.028). Implant reconstructions with irradiated skin had significantly worse static (P = 0.002) and moving sensation (P = 0.014) than did nonirradiated implant reconstructions. CONCLUSIONS: Without irradiation, skin overlying implants is associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia , Retalhos Cirúrgicos/inervação , Adulto , Idoso , Implante Mamário , Neoplasias da Mama/radioterapia , Feminino , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Transferência de Nervo , Mamilos/inervação , Mamilos/cirurgia , Projetos Piloto , Período Pós-Operatório , Sensação
20.
J Oral Maxillofac Surg ; 71(9): 1556-62, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23866783

RESUMO

PURPOSE: To investigate whether complex midface fractures have a greater association with death and intracranial injury than simple midface fractures. MATERIALS AND METHODS: A retrospective chart review was performed for patients with blunt-mechanism midface fractures who had presented to an urban trauma center from 1998 to 2010. The survival and intracranial injury status was evaluated for patients with simple and complex midface fractures, including Le Fort, naso-orbitoethmoid, and/or zygomaticomaxillary fractures. Intracranial injury included hemorrhage and brainstem injury. Patients with upper face fractures were excluded to minimize confounding. Adjusted relative risk estimates were obtained using multivariate regression analysis. RESULTS: Of 3,291 patients with midface fractures, 213 (6.3%) died and 693 (21.3%) had an intracranial injury. The cumulative mortality reached 11.6% in patients with complex midface fractures and 5.1% in those with simple midface fractures (P < .001). Patients with complex midface fractures were 57% more likely to die (relative risk = 1.57; P < .005). Specifically, Le Fort II fractures independently conferred a 94% increased risk of death (relative risk = 1.94; P < .01), but Le Fort I and III fractures were not significantly associated with death. Among patients presenting without neurologic impairment, those with Le Fort II and III fractures remained 2.88-fold (P < .01) and 2.54-fold (P < .001) more likely to have an underlying intracranial injury, respectively. CONCLUSIONS: Le Fort II fractures are associated with increased mortality. Furthermore, Le Fort II and III fractures are associated with serious intracranial injury, even in the absence of alterations in consciousness. These patients should be monitored with heightened vigilance and followed up closely during hospitalization, regardless of the presenting clinical findings.


Assuntos
Ossos Faciais/lesões , Fraturas Maxilares/mortalidade , Fraturas Cranianas/mortalidade , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Baltimore/epidemiologia , Lesões Encefálicas/mortalidade , Tronco Encefálico/lesões , Hemorragia Cerebral/mortalidade , Estudos de Coortes , Osso Etmoide/lesões , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Masculino , Fraturas Maxilares/classificação , Pessoa de Meia-Idade , Osso Nasal/lesões , Fraturas Orbitárias/mortalidade , Estudos Retrospectivos , Fraturas Cranianas/classificação , Taxa de Sobrevida , Violência/estatística & dados numéricos , Ferimentos não Penetrantes/mortalidade , Adulto Jovem , Fraturas Zigomáticas/mortalidade
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