Summary Outpatient hand surgery is often performed in the operating room, which can result in prolonged waiting times for patients when operating room resources are limited. Few studies have explored the application of ultrasound-guided nerve blocks in the setting of outpatient hand surgery. Fifty patients were enrolled in this prospective study. Ultrasound-guided peripheral nerve blocks were performed at the level of the elbow and proximal forearm for outpatient hand surgeries. A timer was used to record the time to administer the block and time to affect. A post-procedure survey was administered, which included a numerical analogue scale (0–10) and Likert rating scale questions to characterize the patients’ pain experience for receiving the block and pain during the procedure: pain experienced by patients receiving the ultrasound-guided nerve block(s) (0–10), mean: 1.84; pain experienced by patients during a procedure (0–10), mean: 0.56; surgeon satisfaction during the procedure (0–10), mean 9.78. Average time to perform the ultrasound-guided nerve block(s) was 4 minutes 58 seconds; average time from completion of the block to effect reported by patients, 5 minutes 42 seconds; the average time for performing the procedure, 21 minutes 30 seconds. Our study shows that the use of ultrasound to block peripheral nerves of the forearm is effective; <10% of patients required additional local anesthetic. The technique is safe; no complications were reported. The technique is efficient in an outpatient hand surgery setting.
The use of polyacrylamide hydrogel (PAAG) as an injectable filler for breast augmentation has fallen out of popularity since its first use in the 1980s, but has produced an increasing patient population presenting with complications related to PAAG injections. PAAG use was popularized most notably in China, Russia and Iran. However, given immigration trends and medical tourism, PAAG-related complications have become increasingly more common in North America. These complications can be difficult to treat, often necessitating complex surgery that includes gel removal, debridement procedures and, often, breast reconstruction. Approaches to surgical treatment and subsequent breast reconstruction are not universally defined primarily because of the limited knowledge about this group of patients. The present article presents the option of autologous free flap reconstruction for a patient with extensive muscular involvement, and aims to summarize complications and risks associated with PAAG through a case presentation and literature review.
The use of polyacrylamide hydrogel (PAAG) as an injectable filler for breast augmentation has fallen out of popularity since its first use in the 1980s but has produced an increasing patient population presenting with complications related to PAAG injections. Polyacrylamide hydrogel use was popularized most notably in China, Russia, and Iran. However, given immigration trends and medical tourism, PAAG-related complications have become increasingly more common in North America. These complications can be difficult to treat, often necessitating complex surgery that includes gel removal, debridement procedures, and often breast reconstruction. Approaches to surgical treatment and subsequent breast reconstruction are not universally defined primarily because of the limited knowledge about this group of patients. This article presents the option of autologous free flap reconstruction for a patient with extensive muscular involvement and aims to summarize complications and risks associated with PAAG through case report and a review of the literature. Résumé L'hydrogel de polyacrylamide (PAAG) utilisé comme produit de remplissage injectable pour l'augmentation mammaire a perdu toute sa popularité depuis sa première utilisation dans les années 1980, mais est responsable d'une population croissante de patientes ayant des complications liées aux injections de PAAG. L'utilisation de PAAG a surtoutété popularisée en Chine, en Russie et en Iran, maisétant donné les tendances d'immigration et le tourisme médical, les complications qui s'y rapportent sont de plus en plus courantes en Amérique du Nord. Ces complications peuventêtre difficiles à traiter, exigent souvent des opérations complexes qui comprennent l'extraction du gel, des interventions de débridement et, dans bien des cas, une reconstruction mammaire. Les approches au traitement chirurgical et la reconstruction mammaire subséquente ne sont pas universelles en première ligne, en raison des connaissances limitées au sujet de ce groupe de patientes. Le présent article présente la possibilité de reconstruction autologue par lambeau libre chez une patiente ayant une importante atteinte musculaire. De plus, les complications et les risques associés au PAAG y sont résumés dans le rapport de cas et une analyse bibliographique.
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