To study the effects of smoking on wound healing, the authors retrospectively analyzed the records of 132 patients (121 women and 11 men) who had undergone abdominoplasty in the previous 5 years. All patients had received a full abdominoplasty, with large mobilization up to the ribs and a belly transposition. Patients were excluded from the study if they had arteriosclerosis, diabetes mellitus, or other systemic diseases, and if they had received a simple pannus resection without a belly transposition. The following study parameters were taken for analysis: age at the time of operation, body mass index, preoperative weight loss, amount of resection, and smoking habits indicated by the patients preoperatively. Smokers were interviewed by telephone postoperatively concerning their perioperative smoking habits. Wound healing problems were registered when medical intervention was necessary, such as débridement, treatment for infection, lavage after fat necrosis, or a secondary skin closure after skin slough. Hematoma and seroma were not considered to be wound healing problems and were registered separately. Among the 132 patients, 53.8 percent admitted to smoking and 46.2 percent reported being nonsmokers. No significant difference was seen between smokers and nonsmokers concerning age or body mass index. Smokers reported consuming, on average, 18.4 cigarettes per day. The rate of wound problems and wound dehiscence showed a statistical difference between smokers and nonsmokers (p < 0.01); 47.9 percent of the smokers showed wound healing problems before hospital discharge versus 14.8 percent of the nonsmokers. The patients had been asked to quit smoking 2 weeks before the operation through 2 weeks postoperatively. The retrospective telephone inquiry found that just 14.7 percent stopped smoking preoperatively and only 41.2 percent quit temporarily after the operation. Smokers should be informed about their possible higher risk of wound healing problems. Because it seems impossible to turn smokers into nonsmokers, the authors continue to perform abdominoplasties in smokers. During the operation, they try to mobilize and resect less tissue and to immobilize patients for the critical first 3 postoperative days to prevent them from smoking.
The osmotic tissue expander is a new device made of a hydrogel expanding skin that does not require external fillings. Once implanted, it absorbs body fluids, which leads to a gradual swelling of the device. The swelling phase is completed in 6 to 8 weeks and results in skin gain. Different shapes and sizes are available, and the devices can be used in almost every area of the body. Over a 4-year period, the osmotic tissue expander was used in 58 patients in different areas of the body. A round osmotic tissue expander was mainly used in breast reconstruction, and a rectangular expander was used for defect coverage after excision (i.e., of scars and tumors). The mean age of the patients was 49.34 years (range, 4 to 76 years). During the expansion phase, the patients noted only a little discomfort and pain for the first few days. Without a silicone membrane in the first-generation expander, the rate of successful explantation and good final result was 81.5 percent. In a few cases, rapid swelling of the device led to the introduction of a silicone membrane that encloses the expander and leads to a slower, more gradual, and consistent swelling. After introduction of the silicone envelope, the success rate improved to 91 percent. The expander is now used with a silicone membrane in every case. The osmotic tissue expander has many advantages compared with the conventional expander: there is no need for painful external fillings and the risk of external infections is avoided. The expander is 10 percent of its final volume and only requires a short incision and a small pocket. An operation can easily be performed under local anesthesia, with minimal tissue mobilization in older children and compliant patients.
We describe a 56-year-old Caucasian man with history of multiple regressed basal cell carcinomas. During the last 20 years approximately 200 histologically proven basal cell carcinomas preferentially localized on the face were surgically treated. Several large skin grafts were necessary to cover the extensive tissue defects on the face and scalp. Although all excised tissues were histologically proven to be basal cell carcinomas with tumor-free margins, new tumors developed in proximity to the skin graft margins. The dissemination of the new tumors made it difficult to perform additional invasive operation procedures without influencing the cosmetic result. Thus, we used photodynamic diagnosis to improve detection and demarcation of the neoplastic tissues. This procedure facilitated surgical planning and enabled primary in toto excisions. Surgical trauma and a number of interventions were thus minimized with the consequence of improved cosmetic and functional results.
The patients did not experience high plasma levels of prilocaine or methemoglobinemia undergoing liposuction involving less than 2,000 ml using a 0.05% hypotonic prilocaine solution. The authors therefore conclude that this procedure can be performed safely with a monitoring period of 12 h.
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