Pre-operative blood tests in children undergoing plastic surgery.
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In a retrospective review of 1177 children presenting for plastic surgical procedures, investigations were performed in 487 and abnormal results were found in 138 as defined by variation from the local laboratory reference range. Most of the abnormalities were of no clinical significance. Twenty one children had abnormal haemoglobin results (the lowest was 9 g/dl) and 101 children had clinically insignificant platelet or white cell abnormalities. One child, with a family history of sickle cell trait, was confirmed as sickle-cell trait. No case was postponed as a result of these investigations. The non-selective ordering of pre-operative blood tests leads to unnecessary patient discomfort, the potential for additional superfluous investigations and higher costs. (+info)
Reducing non-attendance at outpatient clinics.
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Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists. A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%--i.e. 30% lower than before. Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties. (+info)
Possibilities of preventing osteoradionecrosis during complex therapy of tumors of the oral cavity.
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In recent years, there has been a dramatic increase in the number of tumors of the head and neck. Their successful treatment is one of the greatest challenges for physicians dealing with oncotherapy. An organic part of the complex therapy is preoperative or postoperative irradiation. Application of this is accompanied by a lower risk of recurrences, and by a higher proportion of cured patients. Unfortunately, irradiation also has a disadvantage: the development of osteoradionecrosis, a special form of osteomyelitis, in some patients (mainly in those cases where irradiation occurs after bone resection or after partial removal of the periosteum). Once the clinical picture of this irradiation complication has developed, its treatment is very difficult. A significant result or complete freedom from complaints can be attained only rarely. Attention must therefore be focussed primarily on prevention, and the oral surgeon, the oncoradiologist and the patient too can all do much to help prevent the occurrence of osteoradionecrosis. Through coupling of an up-to-date, functional surgical attitude with knowledge relating to modern radiology and radiation physics, the way may be opened to forestall this complication that is so difficult to cure. (+info)
Parental consent to cosmetic facial surgery in Down's syndrome.
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It is suggested that the practice of attempting to normalise children with Down's syndrome by subjecting them to major facial plastic surgery has no therapeutic benefit, and should be seen as multilating surgery comparable to female circumcision. (+info)
New surgical concepts resulting from cranio-orbito-facial surgery.
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The authors have defined the subspecialty of craniofacial surgery and described the organization of the multi-disciplinary team required to care for such patients. Common features of the craniofacial patient have been summarized and three major categories of patients have been proposed. These are: I. Syndromes associated with hypertelorism; II. Syndromes associated with premature synostoses or growth arrests; III. Syndromes associated with primarily mid- and lower face anomalies. Growing out of an experience with 242 operations on 106 patients, the authors have listed 9 relatively new surgical "principles." Each has led to a current surgical approach that is now being employed by the craniofacial team at The University of Virginia. A number of examples are given to show ways in which the lessons learned from the craniofacial patients are now being applied, with improved results, to patients with neoplasms, traumatic injuries, or other conditions. (+info)
The neurovascular island flap for defective sensibility of the thumb.
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In six patients with defective sensibility of the thumb the transfer of a neurovascular island flap was performed according to Littler's technique. This review one to eleven years later was mainly to determine if reorientation of the cortical representation of stimuli had developed and if tactile gnosis had persisted. The pick-up test was carried through by the three patients with a lesion of the dominant hand. All six patients referred pin-prick in the flap to the donor finger; all had absent two-point discrimination corresponding to the flap, although it had been present within normal limits a few months after operation; and all had better touch, pain and temperature sensibility in the flap than in the surrounding recipient area. All six reported functional improvement. For the best results an intelligent patient is required who has a lesion of the dominant hand and is prepared to use or exercise it regularly. (+info)
The pursuit of beauty: the enforcement of aesthetics or a freely adopted lifestyle?
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Facelifts, tummy tucks and breast enlargements are no longer the privilege of the rich and the famous. Any woman can have all these and many more cosmetic surgical treatments, and an increasing number of women do. Are they having cosmetic surgery because they are duped by a male-dominated beauty system, or do they genuinely choose these operations themselves? Feminists (and others) give diametrically opposed answers to this question. At the heart of the controversy, or so I claim in this article, lies a conceptual problem about free choice; therefore, the only thing that can settle it is a conceptual analysis of "freedom". After having briefly outlined the views of both sides of the debate, I offer such an analysis. (+info)
Improving the outcome of facial resurfacing--prevention of herpes simplex virus type 1 reactivation.
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Facial resurfacing is becoming an increasingly popular method of cosmetic surgery for improving the appearance of the skin on the face and neck. However, since the majority of the population is infected with herpes simplex virus type 1 (HSV-1) by adulthood, complications such as widespread facial lesions and post-operative scarring arising from reactivation of the virus can threaten the success of the procedure. Although there are no prospective controlled trials, oral antiviral therapy has been shown to be effective in preventing post-operative reactivation of HSV-1 when administered from a minimum of 2 h before surgery and continued up to 10 days thereafter. Since such therapies have very acceptable clinical safety profiles, it has become common practice for all individuals undergoing facial resurfacing to be treated with oral antivirals effective against HSV-1, regardless of their HSV-1 history or baseline serology. (+info)