Timothy J. Bill

Reduction in Morbidity After Iliac Crest Bone Harvesting: The Concept of Preemptive Analgesia

The technique of autologous iliac crest bone grafting is an important aspect in the treatment of patients with cleft lip, cleft palate, and other craniofacial disorders. In patients with cleft lip and palate, the alveolar bone graft creates a continuous maxillary arch, closes the oronasal fistula, provides bony support for facial soft tissue and teeth, and facilitates orthodontic movement of teeth. The anatomic and physiologic benefits of this and similar autologous bone graft procedures are apparent. However, pain at the donor site represents a significant source of postoperative morbidity. This study was conducted to evaluate postoperative pain and the ability to perform activities of daily living after bupivacaine infiltration to iliac crest donor sites. Thirty-four alveolar bone graft patients (18 females, 16 males) treated at two teaching hospitals were included in the study. Eleven of the patients received intraoperative bupivacaine at the iliac donor site and 23 did not. A questionnaire was returned by all participants, and telephone follow-up was obtained. Responses to postoperative pain, time period to ambulation, and ability to perform activities of daily living were evaluated. Patients who received postoperative bupivacaine experienced delayed onset of postoperative pain, earlier ambulation, and were able to return to normal daily activity in a shorter period of time than those patients who received no local anesthesia. The concept of preemptive analgesia and its application to craniofacial surgery is discussed.

Electric heating pad burns

Patients with sensory deficits are especially prone to heating pad burns. Two cases are reported of patients with anesthetic skin who received partial and full-thickness burns of their feet from an electric heating pad. These burn injuries could have been prevented if the patients understood the potential hazard of heating pads.

Applications of hyperbaric oxygen in otolaryngology head and neck surgery : Facial cutaneous flaps

Hyperbaric oxygen therapy is of significant benefit in the setting of an ischemic flap of the head and neck. Mechanistically, hyperbaric oxygen decreases local tissue edema and improves oxygen delivery to compromised tissues. Both capillary and fibroblast in-growth occur at a greater rate with hyperbaric oxygen therapy, and there is an increase in the tensile strength of the wound. Additional indications in the head and neck include traumatic composite amputations, necrotizing soft-tissue infections, and osteoradionecrosis of the facial skeleton.

Lidocaine metabolism pathophysiology, drug interactions, and surgical implications.

A thorough understanding of the pathophysiology of lidocaine metabolism is an important prerequisite to minimizing the risk of morbidity and mortality associated with lipoplasty. Although the tumescent technique has greatly improved the safety of large-volume lipoplasty through decreased blood loss and reduced anesthetic needs, it has introduced the possibility for lidocaine toxicity. Because lidocaine is metabolized by the cytochrome P450 system, the potential for drug interactions is heightened. These drug interactions are implicated as a cause of lidocaine toxicity. A comprehensive review of the patients preoperative, intraoperative, and postoperative medication profile is critical to perioperative patient safety.

CHONDRITIS OF THE EAR: A LATE SEQUELA OF DEEP PARTIAL THICKNESS BURNS OF THE FACE

Chondritis of the ear is a late sequela of deep partial thickness burns of the face. It is the purpose of this article to describe two patients who came to the emergency department 21 days and 35 days after sustaining deep partial thickness burns of the face from explosions. The patients were hospitalized for incision and drainage of the infected wound that included excision of the infected cartilage complemented by systemic antibiotic therapy.

Grease burns of the hand: Preventable injuries☆

Grease burns to the hand represent a serious and preventable hazard. These injuries account for over 10% of all major burns seen in the emergency department. These burns occur when the cook attempts to move a pan with burning cooking oil and inadvertently spills the oil on the hand holding the pan. These burns are usually full thickness because of either the high temperatures of the flaming oils or the subsequent ignition of clothing. This article describes a patient who received severe partial and full thickness burns to the dominant hand following a grease burn in the domestic setting. Prevention through improved consumer education and warning labels for cooking oils should reduce the incidence of these serious injuries.

Biomechanical performance of a disposable graft stapler with absorbable skin tacs

A stapler has been specially designed for fixing skin grafts to the underlying wound. The stapler has a loading unit which can be reloaded with cartridges of absorbable tacs. Each tac is made of a polymer which is biocompatible with tissue. The stapler ejects the tac into the graft, reliably securing it to the underlying tissue. The force and work required to eject the tacs were significantly less than that needed to form the metal staples. The most obvious advantage of the tac is that the majority of the tacs spontaneously extrude after the first dressing change. The performance of the disposable graft stapler with absorbable skin tacs has been compared to that of the disposable skin stapler with metal staples.

A new device for securing meshed split-thickness skin grafts

This report describes the design, operation, and biomechanical performance of the Auto Suture Multifire Graftac-S disposable surgical staplers and absorbable tacks. The performance of this reloadable stapler has been compared to that of the Auto Suture Multifire Premium disposable skin stapler. The Premium stapler forms stainless steel staples to close the wound. The Graftac-S ejects absorbable tacks into the graft from a cartridge, which can be reloaded during a single operation. In two clinical trials of 10 patients each, the Graftac-S delivered absorbable tacks which were biocompatible and successfully secured the graft to the wound. The most obvious advantage of this device is that it obviates the need to remove the staples from the wound later. By the tenth postoperative day, about 90% of the tacks had extruded spontaneously, thereby reducing the amount of postoperative care required; discomfort to the patient during removal of the stainless steel staples is eliminated.