A Randomized Controlled Trial of Three Noninvasive Analgesic Techniques for the Prevention of Pain During Facial Injections.

BACKGROUND: Injections are associated with a certain amount of pain, the tolerance of which can vary between individuals. With regard to noninvasive pain control techniques in subcutaneous injections, few studies with adequate levels of evidence and design quality exist to support any specific analgesic method. OBJECTIVES: In this study, we evaluated the efficacy of 3 noninvasive analgesic techniques (cold, anesthetic cream, and vibration) during subcutaneous forehead injections in 100 healthy volunteers. METHODS: This randomized, single-blind, controlled trial comprised 100 healthy volunteers. Every patient received 4 forehead injections of 0.1 mL physiological saline through 29G needles after 1 of 3 noninvasive analgesic techniques (cold, vibration, or anesthetic cream) or control treatment was applied to each injection site. The results were evaluated through a survey that included a visual analog scale for pain measurements. RESULTS: All analgesic methods demonstrated better pain control than the no-treatment arm (P < 0.001), of which vibration performed better than the other analgesic techniques (P < 0.015 vs cold and P < 0.015 vs anesthetic cream). No differences were observed between cold and anesthetic cream. The average amount of pain per injection in males was higher than in females (P < 0.014). CONCLUSIONS: Vibration analgesia effected significantly better pain control than cold and anesthetic cream. Nevertheless, the choice of anesthetic method should be adapted to the preferences and experiences of each patient to optimize pain control in procedures that involve subcutaneous injections.

A Protocol for Performing Reconstructive Microsurgery on Patients With COVID-19.

On March 11, 2020, the World Health Organization declared COVID-19 to be a pandemic, challenging health care systems all over the world. National health care systems have reorganized to cope with the disease. Surgical services departments around the world have been affected and elective surgical procedures have been postponed to conserve medical resources. When a patient with COVID-19 requires an urgent microsurgical free flap due to trauma or a tumor, personnel from the health care facility must have a protocol in place to follow for the patient's care and follow-up. In this article, we present our protocol for patients with COVID-19 requiring reconstructive microsurgery.

Simultaneous Opponensplasty and Free Gracilis Muscle Flap for Thenar Reconstruction after Arteriovenous Malformation Resection.

We report the case of a thenar eminence arteriovenous malformation presenting with continuous growth and pain that was treated with surgical excision after embolization. Extracapsular resection compromised thenar muscles which function was reconstructed with extensor indicis proprius transfer for opposition and abduction, and neurotized free gracilis muscle flap for opposition and adduction, as well as thenar eminence reconstruction.

Avoiding Above-the-Knee Amputation with a Free Tibiofibular-Talocalcaneal Fillet Flap and Free Latissimus Dorsi Flap.

Despite the advances achieved in reconstructive surgery, amputation is still the only option after some severe traumas. Preservation of the knee joint is considered a significant functional advantage. We present the case of a 39-year-old man with a comminuted Gustilo type IIIC open tibia fracture with massive bone loss. To achieve a well-fashioned amputation stump and preserve the knee joint, a free osteocutaneous fillet flap was performed, including the distal tibia and fibula, talus, and calcaneus bones. As a result, a sensate and long amputation stump covered with thick skin from the sole of the foot provided a stable coverage with an excellent functional result and adjustment to prosthesis.

Reconstruction of Middle-Third Helical Traumatic Defects With a Two-Stage Approach: Retroauricular Flap and Costal Graft.

In this article, we describe the case of a patient suffering from middle-third helical rim avulsion after a bicycle accident, which was reconstructed with a two-stage procedure: (1) performing a postauricular pedicled flap and (2) reconstruction using a costal graft. The article also includes a brief summary of recommendations in the scientific literature about the reconstruction of middle-third auricular defects.

Masseter-to-Facial Nerve Transfer for Reanimation of a Patient With Long-Term Facial Paralysis.

Facial paralysis is a condition caused by a wide variety of etiologies, including neurologic, congenital, infectious, neoplastic, systemic, and iatrogenic causes. A patient suffering from long-term facial paralysis, with minimal innervation detected through electroneurography, who was successfully reanimated by performing a masseter-to-facial nerve transfer, was presented in this study. Facial paralysis had been caused after resection of an acquired middle ear cholesteatoma more than 5 years before.

Instantaneous Specific Burn Debridement With an Enzymatic Debriding Agent: A New Resource for the Treatment of Burns.

Nexobrid is a new resource for debridement that has emerged in recent years and is gaining relevance in the treatment of all kinds of thermal injuries. This product is an ointment (formed with a mixture of pineapple-derived enzymes enriched with bromelain) that is directly applied over the burn. With a single application, it performs a burned tissue-specific debridement in less than 4 hr, leaving a vital and completely debrided wound bed. In this article, we describe our experience with this product, and through a representative case, we explain the management of these patients in our Burns unit in consonance with national and international consensus.

Use of the Meek Micrografting Technique for Coverage of Extensive Burns: A Case Report.

Traditional mechanical meshing methods have generally been the first-choice treatment of patients with extensive burns (>20% total body surface area). The limited availability of donor areas has sparked the development of resources such as the Meek micrografting technique. We present the case of a 43-year-old male patient with an 85% total body surface area third-degree flame burn. After the initial stabilization, there was a need for rapid and effective coverage of as much burned surface as possible. Thus, Meek micrografting was chosen. Its results in this patient are presented and discussed. The Meek technique is a useful method of skin expansion. It is indicated in patients with extensive burns, where donor areas are limited. The high rates of graft take and quality of the coverage attained make this technique appealing, albeit at a greater economic cost than with traditional mechanical meshing methods.

Inguinal Reconstruction Using Pedicled Rectus Abdominis Flap: A Useful Option for the Application of Radiotherapy.

Given their high rate of complications, radical surgical procedures of anorectal and gynecological tumors require a reliable and individualized reconstruction. The latter is influenced by the frequent indication of adjuvant chemo/radiotherapy that they present. We describe the case of a patient with medical history of vulvar carcinoma that required radical surgery and bilateral inguinal lymphadenectomy. Because of the stage of the tumor, the application of postoperative radiotherapy was clinically indicated; however, after surgery, the patient developed bilateral inguinal ulcers that made postoperative radiotherapy application impossible. Using a radical surgical approach in combination with postoperative radiotherapy increases survival in patients with these types of tumors. Therefore, delaying its use because of wound complications or inadequate reconstruction cannot be justified. The pedicled abdominal rectus flap is an excellent option for this purpose in patients with moderate- to large-sized defects.

Absorption Capacity of Wound Dressings: A Comparative Experimental Study.

In this study, absorption capacity of the most commonly used types of wound dressings was measured with an objective, quantifiable, and easily reproducible method. The use of objective measurements allowed us to perform an objective comparison of the capacity of the different types of dressings. An experimental study was performed, in which the absorptive capacity of polyurethane foams, alginate, hidrofiber, and hydrocolloid dressings was measured by using a methodology designed by the researchers. Polyurethane foams showed a higher absorption capacity than hidrofibers, alginates, and hydrocolloids when using a similar surface of dressing. A modification of dressing size after saturation was also observed, increasing its size in the case of foams and decreasing or maintaining it in the case of hidrofibers, alginates, and hydrocolloids. The results of this study show a better wound exudate management for polyurethane foams. However, when deciding which dressing to use for a specific wound, absorption capacity is not the only quality that should be taken into account, as other properties should also be considered.

Therapeutic and Reconstructive Approach of Lower Lip Amputation After Human Bite: Case Report.

In this article, we describe the case of a patient suffering from labial avulsion after a human bite, initially treated with direct closure and reconstructed surgically later on. Also, a brief summary of existent recommendations in scientific literature about the management of bite wounds is provided.

Reconstruction of a Posterior Tracheal Wall Defect With a Myocutaneous Pectoralis Major Flap After Salvage Cervical Exenteration for a Squamous Carcinoma of the Upper Third of the Esophagus.

In this article, we describe the case of a 59-year-old patient suffering from a squamous cell carcinoma affecting the upper third of the esophagus, treated with a cervical exenteration with extended resection of the posterior wall of the trachea, which was reconstructed with a gastric tube transposition and a myocutaneous pectoralis major flap for coverage of the gastropharyngeal anastomosis and stabilization of the posterior tracheal wall. Also, a review of literature regarding posterior tracheal wall reconstruction is performed.

Study About the Efficacy of an Aerosol Plastic Dressing in Wound Prevention After Compressive Adhesive Dressing Application in Plastic Surgery Procedures.

The use of compressive adhesive bandages is widely extended in the field of plastic, aesthetic, and reconstructive surgery, and the apparition of skin damage after its removal is a relatively frequent complication. The aim of this study was to evaluate the capacity of an aerosol plastic dressing for protecting the skin from the apparition of damage caused by adhesive dressings. A prospective, randomized, simple-blind study was performed, evaluating skin damage incidence after removal of adhesive compressive bandages in 80 subjects. The patients carried for 48 hr an adhesive compressive dressing on their abdomen placed over a layer of an aerosol plastic dressing and another bandage placed directly over the skin. A statistically significant decrease in skin damage incidence was observed in areas in which the aerosol plastic dressing was applied as a layer between the adhesive dressing and the skin. Furthermore, a reduction in symptoms associated with the use of these adhesive dressings was found. The results of this study support the use of aerosol plastic dressings as a barrier for skin protection in patients in whom an adhesive compressive dressing is applied to reduce the incidence of skin damage.

Forequarter Amputation, Thoracic Resection, and Reconstruction on Giant Ulcer Due to Locally Advanced Oncological Disease.

We present the case of a 67-year-old man suffering from a squamous cell carcinoma with extensive thoracic locoregional affection measuring 28 cm. After being considered inoperable at another center, he underwent an aggressive tumor resection and coverage with a free latissimus dorsi flap as a palliative reconstructive procedure that allowed for a considerable improvement of his quality of life.