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1.
J Plast Reconstr Aesthet Surg ; 73(5): 959-964, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32059943

RESUMO

While surgical management of cubital tunnel syndrome (CuTS) results in the improvement of pain, paresthesia and restoration of motor function, there is a subset of patients who do not improve after primary surgery and require revision. The purpose of this study was to evaluate the incidence and risk factors for revision after primary CuTS. A retrospective review of patients who underwent revision CuTS after unsuccessful primary surgery from February 1989 to May 2009 was performed. Data regarding patients' demographics, age at primary and revision surgeries, handedness, presenting symptoms and the duration, physical examination, McGowan grading, electrodiagnostic findings and final outcomes were collected. A total of 1239 patients undergoing 1279 cubital tunnel surgeries were identified; of which 17 patients who underwent 18 revision CuTS met our inclusion criteria. Forty-one randomly selected consecutive patients who underwent primary CuTS (control cohort) were compared to identify the risk factors associated with revision CuTS. Younger age at presentation, greater static 2-point discrimination (S2PD) and a history of diabetes were associated with a greater number of revision surgeries. Patients requiring revision for primary CuTS were 8.4 years on average younger, had greater S2PD and were more likely to have diabetes. Pain as a presenting symptom compared to weakness and numbness was also a more common complaint in this cohort of patients. Future larger multicenter prospective studies are recommended.

2.
J Burn Care Res ; 40(6): 907-912, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31284296

RESUMO

Frostbite causes tissue damage through five major mechanisms, out of which two are amenable to treatment. The first-line treatment is rapid rewarming therapy using water at 40°C to 42°C, which addresses the formation of ice crystals in the intra and extra cellular compartments. The second mechanism is progressive tissue ischemia after rewarming and is only accessible to a second-line therapy represented by thrombolysis. This study aimed to determine the efficacy of thrombolysis. This is a single-center retrospective cohort study, where it was aimed to evaluate two groups of patients. A total of 18 patients were included in this study. Mean times between injury to thrombolytic therapy and admission to thrombolytic therapy was 26.04 hours (SD 13.6) and 9.65 hours (SD 9.89), respectively. All patients suffered injuries ranging from second-degree deep to third degree. The rate of patients having complete, partial, and no angiographic responses were 55.6%, 11.1%, and 33.3%, respectively. The main outcome of interest showed that 11 (61.1%) patients in total had amputations at different levels. Results showed that in the intervention group, five (55.6%) of the patients had amputations compared with six (66.7%) from the control group (P = .6) at comparable levels of amputation. The literature supports that the use of intra-arterial tissue plasminogen activator might be beneficial for severe cases of frostbites; however, it lacks of studies of major significance and results are often controversial. Our study has not shown statistically significant results on amputation levels and cannot support the hypothesis of efficacy of thrombolytic therapy.

3.
Int Wound J ; 16(4): 960-967, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30950218

RESUMO

Negative pressure wound therapy (NPWT) represents one of the many solutions for complex wounds of the upper extremity. The goal of this study was to investigate the most common indications for definitive treatment of wound defects in the upper extremity with NPWT and to report revision surgery outcomes after its use. A systematic review of the literature was performed. The following keywords and their combinations were used: "upper extremity," "arm," "forearm," "wrist," "hand," "finger" AND "negative-pressure wound therapy," "VAC therapy," "vacuum assisted closure." A total of 45 articles were included, regrouping 404 cases of NPWT in the upper extremity. The forearm was involved in 53% of cases, followed by hand (36%), fingers (10%), and arm (1%). Seventeen different indications were cited, the most common of which were radial forearm flap reconstruction (23%), burn wounds (18%), and compartment syndromes (17%). Of the cases, 90% did not require any subsequent surgical procedure, as opposed to 6% considered partial failures requiring minor revisions and 4% total failures requiring major revisions. Closure of radial forearm flap donor site required the most revision procedures when treated with NPWT. NPWT can be used for several indications pertaining to the reconstruction of the upper extremity. Positive outcomes as a definitive treatment are demonstrated in this systematic review, which reaffirms NPWT as a potent tool for reconstructive endeavours.


Assuntos
Traumatismos do Braço/cirurgia , Tratamento de Ferimentos com Pressão Negativa/métodos , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Cicatrização/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
J Hand Surg Eur Vol ; 44(7): 722-727, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30987512

RESUMO

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal joint osteoarthritis may have both postoperative benefits and complications. This study sought to determine the health state utility outcome measures of trapeziectomy with LRTI. Patients who underwent trapeziectomy with LRTI were invited to complete the brief Michigan Hand Questionnaire and utility questionnaires outcomes using a visual analogue scale , time trade-off and standard gamble. Quality-adjusted life years (QALYs) were derived from these utility measures. For this study 32 patients were recruited, with a mean age of 61. Most patients (27/32) perceived the procedure as successful. Utility measures and QALYs serve the purpose of comparing different surgical procedures in terms of their impact on the quality of life of patients as a function of the benefits and complications of each procedure. In this study, the utility of trapeziectomy with LRTI was less than has been described for open palmar fasciectomy but more than for total wrist arthrodesis. Level of evidence: IV.

5.
Hand (N Y) ; : 1558944719831387, 2019 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-30907136

RESUMO

BACKGROUND: The objective of the study was to evaluate and compare the clinical outcomes of in situ decompression with subcutaneous and submuscular transpositions for surgical management of advanced (McGowan stage III) cubital tunnel syndrome (CuTS). METHODS: A retrospective review of patients in our institution undergoing primary surgery for CuTS from February 1989 to May 2009 was performed. Patients with advanced CuTS with a minimum of 12 months of follow-up without any previous bony or soft tissue procedures around the elbow were included. Seventy-four patients underwent 80 primary ulnar nerve surgeries. Patients' demographics, presenting symptoms, physical examination, electrodiagnostic findings, and perioperative complications were recorded. Primary surgical techniques were compared and the risk factors for revision surgery were assessed. RESULTS: Of the 80 surgical procedures, there were 17 decompressions (21%), 47 subcutaneous transpositions (59%), and 16 submuscular transpositions (20%). Fifty-two percent of patients had resolution of their symptoms after primary surgery. The overall complication rate after primary surgery was 12.5%. Nineteen patients (24%) had revision surgery at a median of 30 months after their primary procedure. Eight patients (42%) had symptomatic improvement after revision surgery. Patients with their dominant extremity affected, static 2-point discrimination (S2PD) greater than 10 mm, and age less than 50 years at presentation had a higher rate of revision surgery. Three patients had a second revision surgery and neurolysis for persistent symptoms. CONCLUSIONS: The overall revision rate in advanced CuTS was 24%. Forty-two percent of patients had reported subjective symptomatic improvement after revision surgery. Younger age at presentation and a greater S2PD were associated with a higher rate of revision surgery.

6.
J Wrist Surg ; 8(1): 37-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30723600

RESUMO

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

8.
Burns ; 44(7): 1767-1774, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30041890

RESUMO

The process of standardising burn care and creating protocols within burn centres has, at its core, evidence-based practice principles combined with the clinical experiences of burn care specialists. Although protocols and pathways have been created for certain topics of burn care, they tend to be tailored to the local individual needs of each burn centre, which is a limiting factor for consideration of larger/nationwide approaches. In order to continue to improve the short and long term outcomes after burn injuries, such as increasing the survival rate, reduction in the incidence of sepsis and organ failure, and improving wound healing and scarring, more generalised care pathways combining the recommendations of a nationwide working group of burn care specialists should be created around the topics of interest to ultimately improve patients' outcomes. We describe the steps put in place in Canada to design and adopt a nationwide protocol from a single burn centre on the topic of wound healing and dermal substitutes as the initial exemplary process. This report summarizes the Canadian experience for this type of initiative, which can be used as framework for developing additional guidelines/protocols in other relevant burn care related topics in Canada or other countries.


Assuntos
Queimaduras/terapia , Protocolos Clínicos , Pele Artificial , Unidades de Queimados , Canadá , Cicatriz , Consenso , Humanos , Guias de Prática Clínica como Assunto , Padrões de Referência , Cicatrização
9.
J Reconstr Microsurg ; 34(9): 692-700, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29689575

RESUMO

BACKGROUND: After thumb amputations, restoration of function and aesthetic can be accomplished with microvascular free toe flaps. However, many patients in clinical practice do not choose this reconstruction despite positive reported outcomes. This study aims to determine patients' perceptions with respect to free toe flaps to improve areas of informed consent. METHODS: A retrospective survey was administered to patients with thumb amputations. Participants were required to complete a questionnaire about patient demographics, the Brief Michigan Hand Questionnaire (bMHQ), the standard gamble/time trade-off questionnaires for utility scores, and a questionnaire investigating potential reasons for electing not to undergo a free toe transfer. RESULTS: Thirty patients were enrolled in the study wherein 53% underwent a replantation procedure, 27% a revision amputation, and 20% a delayed reconstruction. Mean normalized score on the bMHQ was recorded as 63.54. Utility questionnaires yielded mean measures of 0.8967 and 0.86 on the standard gamble and time trade-off, respectively. From 14 elements, a majority (87%) stated flap failure as a major source of concern, followed by lack of understanding of risks and benefits (80%) and prolonged hospital stay (53%). Cultural/religious beliefs, aesthetic appearance of the foot, and concerns about footwear were not reported as important reasons in 90, 80, and 79% of patients, respectively. CONCLUSION: A better understanding of patients' attitudes and beliefs with respect to free toe flaps will allow surgeons to better address their concerns during informed consent. This study emphasizes the importance to discuss about failure rates, risks, and benefits of the operation and prolonged hospital stay.


Assuntos
Amputação Traumática , Estética/psicologia , Consentimento Livre e Esclarecido/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Recuperação de Função Fisiológica/fisiologia , Reimplante/métodos , Polegar , Dedos do Pé/transplante , Amputação Traumática/psicologia , Amputação Traumática/cirurgia , Avaliação da Deficiência , Retalhos de Tecido Biológico , Humanos , Consentimento Livre e Esclarecido/psicologia , Medidas de Resultados Relatados pelo Paciente , Percepção , Guias de Prática Clínica como Assunto , Reimplante/psicologia , Estudos Retrospectivos , Inquéritos e Questionários , Dedos do Pé/irrigação sanguínea , Resultado do Tratamento
10.
Burns ; 44(5): 1336-1345, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29573885

RESUMO

BACKGROUND: Skin coverage remains a significant hurdle in large-sized burns. Recent advances have allowed to grow Bilaminar Cultured Skin Autografts (BCSGs) from patients' own donor sites. The aim of this study was to report long-term outcomes in patients with large-sized burns having received BCSGs. METHODS: Nine patients received BCSGs from January 2010 to May 2015. Except one patient who died during hospitalization, all patients were contacted. Four agreed to partake in the study. Patients were tested with the Vancouver Scar Scale (VSS), QuickDASH questionnaire and Burn Specific Health Scale (BSHS). Incisional biopsies of BCSGs were compared with patients' autografts. RESULTS: From nine patients, mean age was 40 years and mean TBSA was 70.3%. For the four patients included, score averaged was 2.25 on the VSS, 29.5 on QuickDASH, 36/36 for psychosocial items and 63/84 for functional abilities on the BSHS. Compared with autografts, BCSGs demonstrated better pliability VSS and functionality. Biopsies showed no evidence of malignancy or atypical changes, but areas of hyperpigmentation. CONCLUSION: This is the first report investigating the long-term outcome of a newly developed BCSG. BCSGs demonstrated comparable results with patients' autografts, functional outcomes on self-reported questionnaires and excellent psychological states. Precaution given the extensive unexpected hyperpigmentation must be taken and a randomized controlled study is underway.


Assuntos
Queimaduras/cirurgia , Técnicas de Cultura de Órgãos/métodos , Transplante de Pele/métodos , Atividades Cotidianas , Adulto , Idoso , Cicatriz , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Pele , Inquéritos e Questionários , Transplante Autólogo/métodos , Resultado do Tratamento , Adulto Jovem
11.
Plast Reconstr Surg ; 141(4): 919-928, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29257002

RESUMO

BACKGROUND: Despite benefits in reducing capsular contractures, textured implants have been associated with significant pitfalls, such a propensity for biofilm formation. Few studies have investigated whether the use of acellular dermal matrix on textured implants produces similar findings. This study aims to characterize biofilm formation at the capsular-acellular dermal matrix interface with scanning electron microscopy. METHODS: The authors performed a prospective observational pilot study in patients undergoing two-stage expander-to-permanent implant exchange. Patients were inflated with Biocell or Siltex expanders, and specimens from the capsular-pectoralis interface and capsular-acellular dermal matrix interface were obtained and examined under scanning electron microscopy for capsular ingrowth and biofilm formation using the Van Herdeen Biofilm Grading System and the Biofilm Thickness Grading Scale. RESULTS: Nine patients including 14 breasts (28 capsular samples in total) were examined. Thick biofilm formation was observed in all specimens from the capsular-acellular dermal matrix interface with Biocell and 25 percent of capsule-pectoralis interface, whereas no biofilm formation was found in Siltex implants. For Biocell implants, a significant difference in biofilm coverage between the upper and lower poles was observed using the Van Herdeen Biofilm Grading System (p = 0.0028) and the Biofilm Thickness Grading Scale (p = 0.0161). CONCLUSIONS: Biocell implants produce a significant rate of biofilm formation over acellular dermal matrix-covered capsules, which is not present in the muscular region or in Siltex implants. Further randomized controlled trials will further elucidate the clinical impact of using acellular dermal matrices with macrotextured implants. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Derme Acelular/microbiologia , Biofilmes , Implante Mamário/instrumentação , Microscopia Eletrônica de Varredura , Dispositivos para Expansão de Tecidos/microbiologia , Expansão de Tecido/instrumentação , Adulto , Idoso , Implante Mamário/métodos , Implantes de Mama , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Expansão de Tecido/métodos
12.
Hand (N Y) ; 13(2): 194-201, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28718308

RESUMO

BACKGROUND: Distal radius malunions lead to functional deficits. This study compares isolated ulnar shortening osteotomy (USO) to distal radius osteotomy (DRO) for the treatment of ulnar impaction syndrome following distal radius malunion. METHODS: We retrospectively reviewed 11 patients with extra-articular distal radius malunions treated for ulnar impaction with isolated USO. This group was compared to a 1:1 age- and sex-matched cohort treated with isolated DRO for the same indication. Pain visual analog scale (VAS), wrist motion, grip strength, radiographic parameters, and perioperative complications were analyzed. Mean follow-up was 14.8 months. RESULTS: VAS scores improved. Wrist range of motion improved in both cohorts with the exception of radial deviation, pronation, and supination in the USO cohort, which decreased from a mean of 17°-16°, 67°-57°, and 54°-52°, respectively. There was no significant difference between groups in regard to change in pain or range of motion, with the exception of pronation and ulnar deviation. The mean tourniquet time was shorter in the USO group. The final ulnar variance was 1.8 mm negative in the USO group and 1.1 mm positive in the DRO group. There was 1 reoperation following USO for painful nonunion, while there were 2 reoperations following DRO for persistent ulnar impaction. CONCLUSIONS: An improvement in range of motion, grip strength, and VAS with restoration of the radioulnar length relationship was observed in both cohorts. USO is a simpler procedure with a shorter tourniquet time that can be an attractive alternative to DRO for ulnar impaction syndrome after distal radius malunions.


Assuntos
Fraturas Mal-Unidas/fisiopatologia , Osteotomia/métodos , Fraturas do Rádio/fisiopatologia , Rádio (Anatomia)/cirurgia , Ulna/cirurgia , Adulto , Idoso , Osso Esponjoso/transplante , Seguimentos , Fraturas Mal-Unidas/terapia , Força da Mão/fisiologia , Humanos , Ílio/transplante , Pessoa de Meia-Idade , Duração da Cirurgia , Pronação/fisiologia , Fraturas do Rádio/terapia , Amplitude de Movimento Articular , Estudos Retrospectivos , Supinação/fisiologia , Torniquetes , Ulna/fisiopatologia , Escala Visual Analógica , Adulto Jovem
13.
Clin Plast Surg ; 44(2): 313-324, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28340665

RESUMO

As microsurgical expertise has improved, allowing for the safe transfer of smaller and more refined flaps, free tissue transfer has continued to gain popularity for the management of pediatric soft tissue and bony defects. For the past 2 decades pediatric microsurgery has been shown to be technically feasible and reliable. The major advantage of free tissue transfer in children is the ability to reconstruct defects in a single stage, avoiding the historic treatments of skin grafting, tissue expansion, and pedicled flaps. This article reviews the present state-of-the-art in pediatric microsurgery.


Assuntos
Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Fatores Etários , Criança , Humanos , Seleção de Pacientes , Retalhos Cirúrgicos
14.
Hand (N Y) ; 12(2): NP14-NP18, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28344536

RESUMO

Background: Chondroblastomas are benign tumors that typically occur in the epiphysis of long bones. Carpal bone chondroblastomas are very rare and are known to have less aggressive behavior with no evidence of recurrence reported. Methods: We present a case of a recurrent chondroblastoma in the capitate that was treated with repeat curettage, application of phenol, and bone grafting. Results: At 3 years post surgery, the patient is disease free with excellent functional return. Conclusion: Chondroblastomas are rare within the carpus. We present a review of the literature detailing their occurrence and treatment.


Assuntos
Neoplasias Ósseas/cirurgia , Capitato/cirurgia , Condroblastoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adolescente , Neoplasias Ósseas/diagnóstico por imagem , Transplante Ósseo/métodos , Capitato/diagnóstico por imagem , Condroblastoma/diagnóstico por imagem , Curetagem/métodos , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Recidiva Local de Neoplasia/diagnóstico por imagem , Radiografia , Tomografia Computadorizada por Raios X
15.
Plast Surg (Oakv) ; 23(2): 103-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26090352

RESUMO

BACKGROUND: Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states. OBJECTIVE: To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics. METHODS: Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant. RESULTS: Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance. DISCUSSION: For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to 'perfect health' than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema. CONCLUSIONS: Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.

16.
Plast Reconstr Surg Glob Open ; 3(4): e380, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25973358

RESUMO

BACKGROUND: Nipple-areola complex (NAC) reconstruction occurs toward the final stage of breast reconstruction; however, not all women follow through with these procedures. The goal of this study was to determine the impact of the health state burden of living with a reconstructed breast before NAC reconstruction. METHODS: A sample of the population and medical students at McGill University were recruited to establish the utility scores [visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG)] of living with an NAC deformity. Utility scores for monocular and binocular blindness were determined for validation and comparison. Linear regression and Student's t test were used for statistical analysis, and significance was set at P < 0.05. RESULTS: There were 103 prospective volunteers included. Utility scores (VAS, TTO, and SG) for NAC deformity were 0.84 ± 0.18, 0.92 ± 0.11, and 0.92 ± 0.11, respectively. Age, gender, and ethnicity were not statistically significant independent predictors of utility scores. Income thresholds of <$10,000 and >$10,000 revealed a statistically significant difference for VAS (P = 0.049) and SG (P = 0.015). Linear regression analysis showed that medical education was directly proportional to the SG and TTO scores (P < 0.05). CONCLUSIONS: The absence of NAC in a reconstructed breast can be objectively assessed using utility scores (VAS, 0.84 ± 0.18; TTO, 0.92 ± 0.11; SG, 0.92 ± 0.11). In comparison to prior reported conditions, the quality of life in patients choosing to undergo NAC reconstruction is similar to that of persons living with a nasal deformity or an aging neck requiring rejuvenation.

17.
J Craniofac Surg ; 26(1): 113-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25534061

RESUMO

BACKGROUND: Cranioplasty can be performed either with gold-standard, autologous bone grafts and osteotomies or alloplastic materials in skeletally mature patients. Recently, custom computer-generated implants (CCGIs) have gained popularity with surgeons because of potential advantages, which include preoperatively planned contour, obviated donor-site morbidity, and operative time savings. A remaining concern is the cost of CCGI production. The purpose of the present study was to objectively compare the operative time and relative cost of cranioplasties performed with autologous versus CCGI techniques at our center. METHODS: A review of all autologous and CCGI cranioplasties performed at our institution over the last 7 years was performed. The following operative variables and associated costs were tabulated: length of operating room, length of ward/intensive care unit (ICU) stay, hardware/implants utilized, and need for transfusion. RESULTS: Total average cost did not differ statistically between the autologous group (n = 15; $25,797.43) and the CCGI cohort (n = 12; $28,560.58). Operative time (P = 0.004), need for ICU admission (P < 0.001), and number of complications (P = 0.008) were all statistically significantly less in the CCGI group. The length of hospital stay and number of cases needing transfusion were fewer in the CCGI group but did not reach statistical significance. CONCLUSION: The results of the present study demonstrated no significant increase in overall treatment cost associated with the use of the CCGI cranioplasty technique. In addition, the latter was associated with a statistically significant decrease in operative time and need for ICU admission when compared with those patients who underwent autologous bone cranioplasty. LEVEL OF EVIDENCE: IV, therapeutic.


Assuntos
Autoenxertos/economia , Substitutos Ósseos/economia , Transplante Ósseo/economia , Desenho Assistido por Computador , Craniotomia/educação , Procedimentos Cirúrgicos Reconstrutivos/economia , Adolescente , Adulto , Materiais Biocompatíveis/economia , Transfusão de Sangue/economia , Criança , Pré-Escolar , Estudos de Coortes , Custos e Análise de Custo , Cuidados Críticos/economia , Feminino , Seguimentos , Custos de Cuidados de Saúde , Unidades Hospitalares/economia , Humanos , Cetonas/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Polietilenoglicóis/economia , Próteses e Implantes/economia , Cirurgia Assistida por Computador/economia , Adulto Jovem
18.
Eur J Pediatr Surg ; 25(2): 151-4, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24163199

RESUMO

Dupuytren contracture of the palm is a relatively common benign fibroproliferative disease of the palmar fascia typically affecting the adult population. There have however been several reported cases of Dupuytren contracture in children. We sought to review the literature for Dupuytren contracture and highlight the main clinical features and management of the disease in children.


Assuntos
Contratura de Dupuytren , Criança , Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/etiologia , Contratura de Dupuytren/cirurgia , Mãos/patologia , Humanos
19.
Plast Surg Int ; 2014: 281923, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25225615

RESUMO

Background. Three educational models for plastic surgery training exist in the United States, the integrated, combined, and independent model. The present study is a comparative analysis of aesthetic surgery training, to assess whether one model is particularly suitable to provide for high-quality training in aesthetic surgery. Methods. An 18-item online survey was developed to assess residents' perceptions regarding the quality of training in aesthetic surgery in the US. The survey had three distinct sections: demographic information, current state of aesthetic surgery training, and residents' perception regarding the quality of aesthetic surgery training. Results. A total of 86 senior plastic surgery residents completed the survey. Twenty-three, 24, and 39 residents were in integrated, combined, and independent residency programs, respectively. No statistically significant differences were seen with respect to number of aesthetic surgery procedures performed, additional training received in minimal-invasive cosmetic procedures, median level of confidence with index cosmetic surgery procedures, or perceived quality of aesthetic surgery training. Facial aesthetic procedures were felt to be the most challenging procedures. Exposure to minimally invasive aesthetic procedures was limited. Conclusion. While the educational experience in aesthetic surgery appears to be similar, weaknesses still exist with respect to training in minimally invasive/nonsurgical aesthetic procedures.

20.
Indian J Plast Surg ; 47(2): 263-6, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-25190927

RESUMO

Abdominoplasty is among the most commonly performed aesthetic procedures in plastic surgery. Despite high complication rate, abdominal contouring procedures are expected to rise in popularity with the advent of bariatric surgery. Patients with a history of gastric bypass surgery have an elevated incidence of small bowel obstruction from internal herniation, which is associated with non-specific upper abdominal pain, nausea, and a decrease in appetite. Internal hernias, when subjected to elevated intra-abdominal pressures, have a high-risk of developing ischemic bowel. We present a case report of patient with previous laparoscopic Roux-en-y gastric bypass who developed acute ischemic bowel leading to abdominal compartment syndrome following abdominoplasty. To the best of our knowledge, this is the first reported case in the literature. We herein emphasise on the subtle symptoms and signs that warrant further investigations in prospective patients for an abdominal contouring procedure with a prior history of gastric bypass surgery.

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