Residual limbs of amputees are significantly cooler than contralateral intact limbs.

OBJECTIVE: To test the hypothesis that distal residual limbs (DRLs) have significant vasomotor abnormalities. DESIGN: Comparative surface temperature studies of DRLs using paired samples (DRL vs. similar site on intact contralateral limb). SUBJECTS/PATIENTS: Thirty-six volunteer subjects with unilateral, upper or lower limb amputations were recruited and evaluated at a pain research center in an urban academic rehabilitation facility. METHODS: Our main outcomes were subjects' residual limb temperature as measured by quantitative infrared telethermography (qIRT), temperature strips, and examiner's palpation, compared with the contralateral limb. RESULTS: The qIRT showed that the DRLs were significantly cooler than the corresponding area of the contralateral intact limbs (P < 0.01). The difference using temperature strips supported this finding (P < 0.05); while on physical examination, 39% of the residual limbs were perceived by the examiner as cooler than the corresponding unaffected limbs. CONCLUSIONS: DRLs as measured by qIRT were significantly cooler than the corresponding area of the contralateral intact limbs. A better understanding of these findings may be important in elucidating the pathophysiology of relevant clinical features such as a potential sympathetic component of postamputation pain.

The upper lip lift using the 'bull's horn' approach.

Our lift lip technique consists of an excision of the white part of the upper lip directly beneath the nose in the shape of a 'bull's-horn', with advancement of the inferior border of the incision to the area directly beneath the nose. Pre-operative markings on the skin ensure the lip lift is approximately symmetric. Advancement of the inferior edge of skin directly beneath the nasal base lifts the lip, producing more visible vermilion and about 3 mm of tooth show at rest. The position of the final incision is such that it is located within the shadow of the nose. Meticulous technique produces an almost invisible scar. The amount and width of skin excised is individualized depending on the desired aesthetic goals. The procedure is straightforward and is usually performed under local anesthetic. Abdominal fat is frequently injected into both the upper and lower lips to increase the volume and improve the rejuvenation. Lip lifts using this technique provide an immediate, dramatic, and permanent result.