Special issues in plastic and reconstructive surgery

Intensivists frequently collaborate with plastic and reconstructive surgeons in treating patients with major wounds, following significant reconstructive procedures, and following free-tissue transfers. Pressure ulcers are a significant source of morbidity and mortality in the intensive care unit; prevention, early recognition, and multidisciplinary treatment are critical components for successful management. Necrotizing fasciitis is an aggressive, soft-tissue infection that requires rapid diagnosis, early surgical intervention frequent operative debridements, and soft-tissue reconstruction Catastrophic abdominal injuries and infections can be treated with an open abdominal approach and require the expertise of a plastic surgeon to reconstruct the abdominal wall. The success of free-tissue transfers and complex reconstructive procedures requires a thorough understanding of the factors that improve flap survival.     

Nursing interventions for wound healing in plastic and reconstructive surgery

Maximizing the normal healing processes reduces costs, time, and the adverse social and psychological effects on the patient. The success of any corrective procedure rests on wound healing and restoration of function. The condition of the host, the surgical technique, and the nursing care all contribute to a satisfactory outcome.     

Local tissue flaps in reconstructive facial plastic surgery.

When a lesion is excised from the facial are and the defect cannot feasibly be closed primarily or by secondary healing, skin grafting or adjacent tissue transfer is usually used to close the defect. In the facial area, adjacent tissue transfer gives a better color and texture match and is preferred over skin grafting whenever possible. This paper presents some local flaps which are available for reconstruction of surgical defects in the facial area.     

Infusion therapy in uretero-enterostomy]

The special problems of the uretero-enterostomy, which is often followed by disturbances of the electrolyte metabolism such as hyperchloremia, metabolic acidosis and hypokalemia with all complications, are dealt with. The pre-operative treatment of the patient and the postoperative infusion therapy are discussed in detail, suggestions as to the infusion, electrolyte and calorie quantity to be administered are made. The postoperative complications are demonstrated on the basis of a special case, the theories on the causes of the electrolyte imbalances are also mentioned.     

Characteristics of the metabolic disorders during prolonged craniofacial surgery]

Brain and liver metabolism has been studied by selective probing of vessels collecting blood from the brain and liver, in 95 patients with various surgical craniofacial pathology. Prolonged general anesthesia in craniofacial traumas has a negative effect on brain metabolism. Changes in indispensible amino acid formulas and hypoxia may cause the loss of brain circulation autoregulation and damages in central mechanisms regulating metabolic processes. A complex scheme of metabolism correction during prolonged anesthesia in craniofacial surgery is suggested.     

High-frequency ventilation of the lungs during reconstructive surgery of the trachea and its bifurcation]

High-frequency jet ventilation was performed to 55 patients during reconstructive plastic surgery for tumour- or cicatrix-induced stenoses of the trachea and its bifurcation. Hemodynamic parameters and acid-base balance indexes confirm the efficacy of high-frequency jet ventilation.     

Endoscopic reconstructive plastic surgery - a review of the state of the art

Summary. A review of the advances in the use of endoscope assistance in reconstructive surgery is presented. Principles of soft tissue endoscopy, its application in various areas of reconstruction and the possible future uses are discussed. An elaborate bibliography is provided.     

Use of combined spinal and epidural anesthesia during reconstructive plastic operations in gynecology

The paper pools the experience with combined spinal epidural anesthesia (CSEA) applied to 39 patients during reconstructive plastic operations. CSEA versus multicomponent general anesthesia was analyzed. The study indicated the efficiency of the former procedure. The findings suggest the reliability of autonomic block, antistress defense, and preserved compensatory adaptive hemodynamic responsiveness. Anesthesia was studied for its impact on lipid peroxidation processes. CSEA was shown to be safe during gynecological reparative plastic operations.     

Perioperative temperature gradient monitoring during reconstructive plastic interventions into the lower extremities

Thermal homeostatic parameters (central and peripheral temperature, deltaTc--Tp of intact and damaged tissues) were studied in 81 patients during reconstructive plastic operations under spinal epidural anesthesia, MBA, and potentiated local anesthesia. The authors show it possible to regard the peripheral tissue perfusion indicator Ta--Tp as a criterion for adequate anesthetic support. They also present data on improved tissue perfusion and better outcomes of reconstructive operations on the lower extremities under central segmental blocks.     

Infusion therapy in disorders of the sodium and water balance]

Water depletion, water in excess and sodium depletion are the most important disturbance of sodium-water balance. Water, electrolytes and acid-base balance have always to be considered in their complex correlation because of their various interrdependency. The restoration of balance concerning imput and output is considered as a basic principle of any intravenous therapy.