Abstract:
PURPOSE:Autologous breast reconstruction with abdominally based free flaps has traditionally been associated with a longer hospital stay and higher initial cost relative to other reconstructive methods. One important component of this course is postoperative pain control. Thoracic epidural anesthesia is considered among the most effective methods for pain control in the immediate postoperative period following these procedures. Recently, our institution began using 4 quadrant transversus abdominis plane (TAP) blocks with liposomal bupivacaine. Encouraging trends were observed with utilization of TAP blocks; however, we sought to quantify this effect compared with that of thoracic epidural anesthesia. This study would contribute to a growing body of evidence supporting an enhanced recovery pathway for microvascular breast reconstruction. METHOD:Thirty patients who underwent deep inferior epigastric artery perforator flap-based breast reconstruction from January 2016 to April 2017 were evaluated. Fifteen patients received thoracic epidural anesthesia, and 15 received 4 quadrant TAP blocks with liposomal bupivacaine. Opioid consumption was evaluated and compared for the first 3 days postoperatively. All opioids were converted to oral morphine equivalents (OMEs) for standardization. Day of discharge, day of Foley removal, and several traditionally opioid-related adverse effects were also recorded and compared. RESULT:On postoperative days 0, 1, 2, and 3, opioid consumption among those given epidural anesthesia compared with those who received TAP blocks with liposomal bupivacaine was 34.9 versus 32.6 OMEs (P = 0.81), 98.9 versus 92.4 OMEs (P = 0.78), 59.7 versus 56.0 OMEs (P = 0.79), and 59.6 versus 24.5 OMEs (P = 0.005*), respectively. Total opioid consumption for the epidural group was 253.1 versus 205.4 OMEs for the TAP block group (P = 0.2743). Time until removal of Foley was 2.7 days for patients with an epidural and 2.1 days for those receiving TAP blocks (P = 0.0056*). Length of stay for those receiving epidural was 4.33 days compared with 3.53 days for those receiving TAP blocks (P = 0.0002*). CONCLUSION:When using TAP blocks with liposomal bupivacaine, a statistically significant effect on postoperative day 3 and decreased opioid utilization overall were observed. Patients also had their Foley removed sooner and were discharged from the hospital earlier.
journal_name
Ann Plast Surgjournal_title
Annals of plastic surgeryauthors
Clary Z,Nazir N,Butterworth Jdoi
10.1097/SAP.0000000000002423subject
Has Abstractpub_date
2020-12-01 00:00:00pages
e24-e26issue
6eissn
0148-7043issn
1536-3708pii
00000637-202012000-00009journal_volume
85pub_type
杂志文章abstract::Norian CRS, Bone Cement (Synthes CMF), and Mimix (Lorenz) have been used to reconstruct large cranio-orbital defects in 85 patients. Resorbable mesh (Macropore), used in combination in selected patients, obviates dura pulsations that have been postulated to cause fragmentation of alloplastic material. Norian is compos...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000168157.10664.9c
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Long-term postoperative splinting plays a role in the prevention of contracture of the grafted skin after a second-stage ear reconstruction. The scar retraction could lead to an unfavorable aesthetic outcome. Splinting could play a role to overcome or prevent the loss of projection and the obliteration of th...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001212
更新日期:2018-04-01 00:00:00
abstract::Individuals with gender dysphoria often seek medical interventions, such as hormone treatment and surgery, to live as their identified gender. Cross-sex hormone therapy typically consists of various estrogen formulations which confer varying risks of venous thromboembolism (VTE). Currently, there is no standard practi...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002300
更新日期:2021-01-01 00:00:00
abstract:UNLABELLED:Outcome evaluation of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist). PURPOSE:Scaphoid nonunion or scapholunate ligament instability results in carpal collapse and subsequent arthrosis. These conditions, termed SLAC-...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000194245.94684.54
更新日期:2006-02-01 00:00:00
abstract::A study of the psychological aspects of mastectomy and reconstruction was carried out. A review of the literature revealed varied emotional responses to the mastectomy experience. An initial, limited study was designed to investigate the attitudes of two groups of women, one that chose reconstruction after mastectomy ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198407000-00008
更新日期:1984-07-01 00:00:00
abstract::Five patients, ages 2 to 5 years, were successfully treated for cervical lymphadenitis caused by the avium intercellulari complex of atypical bacteria. Preoperative treatment with standard antituberculosis therapy had been unsuccessful. Extensive surgery requiring a conservative radical neck dissection was sometimes r...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:
更新日期:1981-09-01 00:00:00
abstract::The purpose of this study was to evaluate third-year medical students' knowledge of and exposure to cleft palate before and after a rotation in plastic surgery. A 26-item questionnaire was administered to 37 students before and after their 12-week rotation that included the evaluation and management of patients with c...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199604000-00009
更新日期:1996-04-01 00:00:00
abstract::Oncologic resection of musculoskeletal sarcoma sometimes requires reconstruction with vascularized soft tissue transplantation. To date, few reports have described treatment outcomes of such cases. In the present study, 55 cases were enrolled to examine oncologic/functional outcomes, complications, and the risks for p...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31817fe4b3
更新日期:2009-03-01 00:00:00
abstract::During 1998, 13 patients were treated in the Tel-Aviv Sourasky Medical Center for complex facial soft-tissue injuries caused by passing through large, clear glass doors. All epidemiological details were gathered and analyzed. Of 1,100 soft-tissue facial injury admissions in 1 year, 13 patients had a substantial soft-t...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200106000-00007
更新日期:2001-06-01 00:00:00
abstract:PURPOSE:This study aims to understand the degree to which ptosis is recognizable to a layperson. METHODS:Fifteen color drawings of a gender-neutral human face were created. Six faces exhibited right-sided ptosis (decreased margin reflex distance 1 and lengthened tarsal platform show) of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 2.5...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001524
更新日期:2018-09-01 00:00:00
abstract::Construction of male genitalia in biological female transsexual patients is problematic. We report 3 transsexuals with scrotal construction by tissue expansion of the labia majora. In each patient, tissue expanders were inserted into the labia majora several months before free flap phalloplasty. In 2 patients, the tis...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199310000-00016
更新日期:1993-10-01 00:00:00
abstract::The present study describes the techniques available for single-stage sarcoma resection, soft-tissue reconstruction, and radiotherapy for limb preservation in patients who are unable to undergo primary wound closure after a complete soft-tissue resection of their primary sarcoma. From 1989 to 1994, 19 patients (age ra...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199711000-00003
更新日期:1997-11-01 00:00:00
abstract::Whereas any contemplation suggesting routinization in a plastic surgery endeavor may engender abhorrence or bespeak heresy, some generalizations are essential at least as a foundation from which a logical divergence may proceed. Such an approach for the selection of preferable local flaps in wound coverage within the ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/00000637-199012000-00009
更新日期:1990-12-01 00:00:00
abstract::The elevation plane for the anterolateral thigh perforator flap is either subfascial or suprafascial approach. But extensive debulking is frequently performed with possibilities of endangering viability. We hypothesized that by elevating the flap in the layer between the deep and the superficial fat, the superficial f...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3182367c2f
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Whether postoperative care in the intensive care unit (ICU) is a necessity for patients undergoing head and neck free flap reconstruction remains debatable. In August 2012, our institute initiated a policy to care for these patients in the ICU, opposed to the previous policy of care in the ward. Thus, we use...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001301
更新日期:2018-02-01 00:00:00
abstract::We developed a new operative procedure involving the combination of 5 flaps to treat little toe polysyndactyly. We applied this procedure to 4 toes of 3 patients who had severe polysyndactyly involving skin fusion of the area from the distal interphalangeal joint to the periphery. In all 3 patients, this procedure all...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181cbfcf2
更新日期:2011-08-01 00:00:00
abstract::Many controllable factors can influence free flap success rates, including the choice of recipient vessels, which can be as crucial as selecting the optimum donor site. The extremities are unique in that their dual venous systems offer an even greater diversity of options and perhaps risks. Whether the superficial as ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200044060-00009
更新日期:2000-06-01 00:00:00
abstract::Chronic wounds have been defined as those that do not follow the orderly manner of healing, and thus do not achieve closure. Such wounds are notoriously difficult to treat and the number of treatments around attest to the fact that management of chronic wounds is not possible with one agent and definitely never achiev...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0b013e318053eb5e
更新日期:2008-02-01 00:00:00
abstract:INTRODUCTION:Mallet finger injuries are common and involve disruption of the terminal extensor mechanism overlying the distal interphalangeal joint. Many operative techniques have been advocated. The pull-in suture technique is a useful surgical procedure for the treatment of mallet finger. Although this procedure allo...
journal_title:Annals of plastic surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SAP.0b013e31822f9ac1
更新日期:2013-01-01 00:00:00
abstract::During the past 10 years, there have been extensive developments in both "island" muscle and musculocutaneous flaps and in "free" microvascular transfers. Competition still exists between these two schools of surgical methodology, even though both methods are known to be complementary and have comparable success rates...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/00000637-198710000-00012
更新日期:1987-10-01 00:00:00
abstract::The first reports on gender-confirming surgery had been published in Germany in the 1920s, but it took some 30 years before sex reassignment surgery for transsexuals became generally known. Initially, such surgery was performed mostly in Europe and Casablanca. In 1956, the gynecologist Dr Georges Burou (1910-1987) ind...
journal_title:Annals of plastic surgery
pub_type: 传,历史文章,杂志文章
doi:10.1097/01.sap.0000258974.41516.bc
更新日期:2007-12-01 00:00:00
abstract:INTRODUCTION:The aim of this study is to present an anatomic study and a dissection technique to prepare maxilla graft for transplantation. METHODS:Six fixed adult human cadavers were used for dissection of the maxilla grafts. Retrospective reviews of archives of 10 MRI and 5 angiographies of the maxillary region were...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e318095a7a1
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND:The challenging breast reshaping after massive weight loss (MWL) has been increasingly performed as the number of bariatric surgery procedures increase worldwide. The breasts often appear wide, lateralized, and deflated, with significant ptosis. OBJECTIVES:The aim of this article is to share our initial exp...
journal_title:Annals of plastic surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SAP.0000000000000816
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Concerns of nonlasting results and potential nasal growth damage precluded cleft nasal correction at the time of initial cleft lip repair. Our goal was to evaluate the outcome of primary cleft nasal correction in our patients with unilateral cleft lip. METHODS:A retrospective review of patients with complet...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002039
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Postoperative infection after breast reduction surgery is a common complication, with the most commonly involved pathogen being Staphylococcus aureus. Previous studies of antibiotic prophylaxis in breast reduction surgery have been inconclusive. The aim of the present study was to clarify the role of prophyl...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SAP.0000000000000352
更新日期:2015-01-01 00:00:00
abstract::Le Fort defined the classic weak points of facial fractures. Fractures of the midface and mandible are believed to require management with standard rigid fixation. Recent work has allowed mini- and microplating of multiple fracture fragments into more manageable larger segments for reduction and subsequent plating wit...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/00000637-199505000-00001
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Extensive orbital floor and medial wall fractures compared with isolated orbital wall fractures are more likely to require surgical correction because of a higher possibility of complications like diplopia, enophthalmos, or numbness. The unique and complex contours of the orbital anatomy limit th...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001700
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Patients with craniofacial anomalies can have hard and soft tissue deficiencies. In some cases, distraction osteogenesis can restore the bony deficiencies, but the soft tissue contour defect remains problematic. For these patients, the union of distraction osteogenesis and microvascular free flaps (MVFF) can...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000263453.42788.67
更新日期:2007-07-01 00:00:00
abstract::One of the most common complications of double eyelid operations is asymmetry. To reduce asymmetry, we fixed the dermis to the tarsal plate at the same level as the skin incision, and objectively evaluated the symmetry of the height using photogrammetry.Of 30 patients who had double eyelid operations by the intratarsa...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181b022e3
更新日期:2010-03-01 00:00:00
abstract::Marjolin's ulcer is an uncommon condition in which malignant transformation occurs in a chronic inflammatory focus. It was originally described in association with a thermal injury, however, its occurrence with protean chronic inflammatory foci has been described. We report the occurrence of and aggressive squamous ca...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199512000-00016
更新日期:1995-12-01 00:00:00