This study investigated the use of endonasal infiltrative anesthesia for the management of pain associated with nasal bone fracture reduction. Fifty-two patients with nasal bone fractures were distributed in 2 groups. In...This study investigated the use of endonasal infiltrative anesthesia for the management of pain associated with nasal bone fracture reduction. Fifty-two patients with nasal bone fractures were distributed in 2 groups. In the first group, topical endonasal anesthesia and external transcutaneous infiltrative anesthesia were employed. In the second group, endonasal infiltrative anesthesia was also added. Visual analog scale pain scores related to the different steps of the procedure were registered. The addition of endonasal infiltrative anesthesia was associated with a significant decrease (p < .05) in pain during reduction maneuvers (6.71 vs. 4.83) and nasal packing (5.18 vs. 3.46). Addition of endonasal infiltrative anesthesia is an effective method of pain reduction during nasal bone fracture treatment.
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-deri...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.
The upper limb is involved in burns in a high percentage of cases and its reconstruction is extremely important, given the functional impact of this anatomical region. Among the reconstruction choices for severe and larg...The upper limb is involved in burns in a high percentage of cases and its reconstruction is extremely important, given the functional impact of this anatomical region. Among the reconstruction choices for severe and large structural defects, the pedicled anterolateral thigh flap is an available option. This case study discusses the utilization of the pedicled anterolateral thigh flap for reconstruction of a complex full-thickness hand burn, when adequate arterial perforators were not available. Complex hand burns can often present challenges for reconstructive coverage, because of the complex anatomy of the upper extremity and the need to preserve as much function as possible. The use the anterolateral thigh free flap is one option that can be utilized for coverage of these large hand defects, in the face of poor local tissue advancement options. The finding of inadequate or lack of perforator vessels necessitates intraoperative changes in the surgical approach. In these cases, different alternatives exist depending on the dimensions and characteristics of the required coverage, the dissection of a pedicled flap being one of them. The pedicled anterolateral thigh flap represents an alternative for the coverage of large hand defects in the absence of valid perforators during free-flap dissection.
Forearm compartment syndrome is a relatively underreported event compared with compartment syndrome of the lower extremity or trunk. The aim of this review of the literature was to provide insight into the potential cons...Forearm compartment syndrome is a relatively underreported event compared with compartment syndrome of the lower extremity or trunk. The aim of this review of the literature was to provide insight into the potential consequences of certain treatment modalities in the control of acute compartment syndrome of the forearm based on data presented over the past 44 years. A comprehensive search was conducted across several databases including EMBASE, Ovid MEDLINE, Cochrane Database of Systematic Reviews, and Scopus, capturing studies published from 1973 to 2017 to identify potential articles for inclusion in the review. Outcomes data were evaluated for each of the studies included in this analysis on the basis of treatment utilized (fasciotomy vs. no fasciotomy) and respective outcome (favorable vs. unfavorable). Relative risk (RR) analysis was performed to determine risk factors for unfavorable outcomes from the pooled data. The analysis revealed a statistically significant higher likelihood of unfavorable outcomes resulting from performing fasciotomy in the event of forearm compartment syndrome compared with conservative management (RR = 4.82, p < .01). Fasciotomy treatment was associated with a higher likelihood of patients presenting with forearm compartment syndrome to experience unfavorable outcomes. The results of this study can help guide awareness of potential sequelae of treatment choices in forearm compartment syndrome, and clinical decision-making for wise patient selection for surgical intervention, when necessary.
The medical device industry is an incredibly profitable and rapidly growing sector of health care. In plastic surgery, the nonsurgical medical aesthetic device industry presents ongoing ethical challenges, specifically r...The medical device industry is an incredibly profitable and rapidly growing sector of health care. In plastic surgery, the nonsurgical medical aesthetic device industry presents ongoing ethical challenges, specifically related to the principles of nonmaleficence and respect for autonomy. The purpose of this article is to increase awareness of the ethical challenges the nonsurgical medical aesthetic device industry presents, including use of deceptive or misleading language in advertising, limited evidence of efficacy, and lack of public and professional understanding of the U.S. Food and Drug Administration regulation of medical devices. Practical application of ethics is presented through the lens of the Code of Ethics for Nurses With Interpretive Statements () and the Code of Ethics of the American Society for Aesthetic Plastic Surgery ().
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 post...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.
As skin cancer prevalence continues to rise, the importance of sun protection, including sunscreen use, has become accepted in the public. Sunscreens are divided into two main categories based on the type of their active...As skin cancer prevalence continues to rise, the importance of sun protection, including sunscreen use, has become accepted in the public. Sunscreens are divided into two main categories based on the type of their active ingredient, organic and inorganic ultraviolet (UV) filters. It has been shown that inorganic filters are more effective at blocking forms of UV light, both UVA and UVB, as compared with organic filters because organic sunscreens absorb and convert radiation whereas inorganic sunscreens reflect radiation. The use of the two most common organic filters, oxybenzone and octinoxate, has recently been restricted in Hawaii due to their harmful effect on the coral reefs. Here, we discuss recent studies about these specific filters related to the adverse health risks they pose for humans and other organisms, as well as environmental repercussions.
Aesthetic medicine nursing is a highly skilled specialty, which continues to evolve. A survey of 197 experienced aesthetic medicine nurses practicing in eight countries revealed shortcomings in the current approach to th...Aesthetic medicine nursing is a highly skilled specialty, which continues to evolve. A survey of 197 experienced aesthetic medicine nurses practicing in eight countries revealed shortcomings in the current approach to their education, training, and registration. Education and training are currently self-identified and self-funded and are often provided by the companies that manufacture or distribute the products used in aesthetic medicine treatments. Accreditation and registration schemes are not mandatory, and an international professional governing body is lacking to facilitate international cooperation and sharing of best practice. There is a need for an academic, coherent, and comprehensive approach to the training and education of aesthetic medicine nurses that will equip them with the knowledge and experience to not only administer treatments and attain natural looking results but also prevent, recognize, and manage any potential complications associated with such treatments.
Lipedema is a fat disorder that is often misdiagnosed. It was first identified at the Mayo Clinic in 1940, but medical schools do not include it in their curriculum and is therefore poorly understood. It presents as disp...Lipedema is a fat disorder that is often misdiagnosed. It was first identified at the Mayo Clinic in 1940, but medical schools do not include it in their curriculum and is therefore poorly understood. It presents as disproportionate and symmetrical accumulations of fat (bilateral), which is often accompanied by orthostatic edema. Early diagnosis and treatment are crucial, as the disease is progressive and can lead to immobility as well as a significant decrease in the quality of life. Lipedema differs from obesity because it does not respond to diet and exercise. This article gives you a glimpse into what lipedema is about and will help you identify some differences between lipedema and lymphedema. It will also help you identify which surgical procedures have been successful in treating the disease.
Objective of this study was to evaluate the efficacy of the autolytic debridement promoted by hydrogel with sodium alginate enriched with fatty acids and vitamins A and E in the healing of foot wounds in diabetic patient...Objective of this study was to evaluate the efficacy of the autolytic debridement promoted by hydrogel with sodium alginate enriched with fatty acids and vitamins A and E in the healing of foot wounds in diabetic patients. A clinical study was conducted at an outpatient clinic of medical specialties. The sample comprised 8 patients supervised for a 3-month period, from April to July 2017, by means of a clinical history, photographic record, planimetry, and classification of the wound severity by the Pressure Ulcer Scale for Healing (PUSH) system. Of the 8 patients supervised, 1 dropped out and 7 were followed up for 12 weeks. Only 2 had complete wound healing, but all presented a reduction of the lesion area of approximately 22.2% and PUSH score of 9.8 to 6.6. This study found that hydrogel showed good results for the treatment of diabetic feet, reducing the area and overall PUSH score of the wounds.
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 aggre...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.
Stevens-Johnson syndrome (SJS) is a disease that causes skin exfoliative lesions, characterized by fever, necrosis, and epidermal detachment. Biological skin substitutes may be considered interesting options for the trea...Stevens-Johnson syndrome (SJS) is a disease that causes skin exfoliative lesions, characterized by fever, necrosis, and epidermal detachment. Biological skin substitutes may be considered interesting options for the treatment of this disease. This study aims at identifying in the literature the evidence on the current role of these biomaterials in the treatment of SJS and its related diseases. A systematic review with a search period between 2003 and 2017 was carried out, consulting the Lilacs, BVS, and PubMed databases. The quality of the included studies was evaluated by the Oxford Center for Evidence-Based Medicine Classification, for evaluating levels of evidence from the scientific publications. Ninety-five publications were found, and after applying inclusion and exclusion criteria, they resulted in 9 articles. In total, 20 patients with 73.87% average of body surface affected received SJS skin treatment with some biological substitutes, among them are cutaneous allograft, amnion, and xenograft. Mortality rate was 10%, and in these situations, literature indicates mortality rates ranging from 25% to 70%. Effectiveness of the use of biological dressings may be a possible explanation for this finding. Findings indicate the use of these biomaterials may favor reepithelialization, reduce water loss, decrease the chance of infection, and, consequently, improve the survival of patients with SJS and toxic epidermal necrolysis. Biological skin substitutes have characteristics that make them very promising in the topical treatment of these wounds, but their use remains very restricted in the treatment of SJS.
Children with cleft lip and/or palate (CL ± P) undergo several surgical procedures from birth to adulthood to achieve functional, aesthetic, and psychosocial normalcy. Although children with CL ± P have normal physical d...Children with cleft lip and/or palate (CL ± P) undergo several surgical procedures from birth to adulthood to achieve functional, aesthetic, and psychosocial normalcy. Although children with CL ± P have normal physical development apart from their CL ± P, they face increased risk for emotional, social, behavioral, and academic concerns. In this article, we discuss how the psychology team helps support children with CL ± P and their families. We also explore how the child's overall functioning is evaluated through interview and assessment tools. Throughout, we validate the need for specialized considerations related to having a CL ± P such as increased risk for peer victimization as well as readiness for medical and surgical procedures. By examining the psychology team's role across a child's lifespan, we hope to show that our goal is to advocate for the child and to encompass the child's voice throughout the treatment process.
With the increasing interest in nonsurgical cosmetic procedures, this research study sought to evaluate the onset of Botulinum toxin Type A (BoNTA) between naive and non-naive consumers and its effect on satisfaction. Th...With the increasing interest in nonsurgical cosmetic procedures, this research study sought to evaluate the onset of Botulinum toxin Type A (BoNTA) between naive and non-naive consumers and its effect on satisfaction. This single-blinded research study consisted of 15 adults with scheduled appointments for neurotoxin treatment of undesired glabellar lines. Participants completed pretreatment FACE-Q scales. Both the participant and the researcher rated pretreated glabellar lines with the Merz 5-point scale. Daily photographs of the treated area were taken by the participant and submitted to the researcher over a secure electronic system. Photographs were started on the treatment day and continued until both participant- and researcher-reported onset. The day of onset was determined with at least 1-point improvement when observed by both the participant and the researcher on the Merz 5-point scale. Once onset was determined, participants completed posttreatment FACE-Q scales. The average onset of treatment was 2.3 days. The average day of onset was 1.8 days in the naive group and 2.65 days in the non-naive group. Posttreatment, patients reported an average of 47.65% reduction in the appearance of glabellar lines; a 35.65% reduction was reported in the non-naive group, and a 59.67% reduction was reported in the naive group. The average participants perceived themselves 2.07 years younger prior to treatment and 6.47 years younger than their actual age posttreatment. On average, participants perceived themselves 4.4 years younger than at baseline. Both groups reported a high level of satisfaction with decision at an average of 85.73% and an average of 86.20% on satisfaction with outcome. The posttreatment FACE-Q expectation scores on average exceeded the pretreatment expectation scores by 8.25%; in the naive group, the scores were exceeded by 25.54%. The onset of BoNTA treatment in naive and non-naive participants demonstrated differences. The naive group experienced onset, on average, 1 day sooner than the non-naive group. The amount of time for a participant to see a noticeable difference influences patient satisfaction. Improvements in appearance and a reduction in the appraisal of age in relation to actual age enhanced satisfaction with treatment. Findings indicate that satisfaction is not solely based on onset, improvements in appearance, and reports of looking younger. The patient perception is also a key factor affecting satisfaction, which can be improved by setting clear expectations, improving patient communication, and encouraging follow-up assessments. The need for additional research on naive and non-naive patients demonstrating the influence of onset on satisfaction scores is crucial to confirm the evidence of this study.
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 a...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.
Sickle cell disease is an autosomal recessive genetic disorder that affects the shape and function of red blood cells, causing a myriad of systemic complications. Rigid and deformed red blood cells can become trapped in...Sickle cell disease is an autosomal recessive genetic disorder that affects the shape and function of red blood cells, causing a myriad of systemic complications. Rigid and deformed red blood cells can become trapped in the microvascular circulation, causing tissue ischemia and severe pain. Skin ulcerations of the lower extremities present a unique challenge for patients suffering from this condition. This case study discusses the pathophysiology of these ulcers, treatment options, and a patient case.