Saturday, May 31, 2008
Friday, May 30, 2008
- includes Jessner's peels, salicylic acid peels, gylcolic acid peels, and light trichloroacetic acid (TCA) peels
- uses include acne treatment, rosacea, and fine lines
- minimal discomfort, no recovery time, may be repeated weekly
- may have mild skin irritation (2 days), temporary flaking, redness or dryness (up to 5 days)
- Use of cosmetics and moisturizers during the time of the peel generally is avoided if at all possible
- includes 30-50% TCA peels, and Jessner's combined with TCA peels
- used for melasma, pigment disorders of the skin such as lentigos, deeper wrinkles, and acne scars
- there is mild to moderate discomfort with these peels
- recovery time may be up to two weeks to heal completely
- there is usually some crusting, swelling, and redness
- includes phenol peels, 75% and higher TCA peels
- used to reduce severe wrinkling, aging and scarring
- severe pain should be expected
- takes two weeks or more to heal
- severe swelling (5-7 days), crusting, and redness (up to 6-8 weeks)
- The patient should stay out of the sun. When unavoidable, the patient should apply a strong sunscreen (SPF 45 or greater) and wear a hat. An ointment, such as petroleum jelly or Aquaphor, should be applied to the involved skin.
- Remind the patient that the skin will exfoliate and may look cosmetically unattractive for a period of time depending on the depth of the peel.
- For superficial peels, a follow-up appointment can be scheduled at the time of the next peel. For deeper peels, patients should be seen 2-3 times the first week following the peel to provide for early intervention if problems (ie infection) develop.
Skin Resurfacing, Chemical Peels; Gregory Caputy MD, PhD; eMedicine Article, March 28, 2008
Chemical Peels; Raymond T Kuwahara MD; eMedicine Article, Jan 19, 2007
Skin Resurfacing: Chemical Peels; Don R Revis Jr MD and Michael B Seagle MD; eMedicine Article, Oct 27, 2005
Thursday, May 29, 2008
Wednesday, May 28, 2008
This is my 5th time to host (Thanks, Nick!) and I have not stopped enjoying the privilege of hosting this wonderful weekly anthology of the best posts of the medical blogosphere. Since FIVE is the lucky number for me today, I am opening this round with five of the best posts submitted to me this week...
Tuesday, May 27, 2008
Dr Norman's site as he explains the basic Anatomy of the Abdominal Wall (great pictures)
Clinically Oriented Anatomy by Keith L Moore and Arthur F Dalley; 5th Edition, Google eBook (pp 196-230)
Abdominal Wall Defects
Immediate reconstruction is preferred.
- It is more cost-effective and less time-consuming in the medically stable patient with a clean wound bed and reliable reconstructive options.
- It may need to be aborted if significant abdominal distention or inflammation is present.
- This is often done in the trauma patient with a loss of domain (for example when the intestines are too swollen to place back into the abdomen and then wound closed). The wounds of such patients are routinely closed with a temporary substance and subsequently reexplored. A skin graft may be applied as a temporary measure until reconstruction can be performed.
- A split-tissue skin graft (STSG) will aid in contracture, decreasing the size of area. STSGs have a higher success rate than a full-thickness skin graft. The down-side is that a STSG will remain fairly fixed.
- If abdominal reconstruction is delayed, surgery should be avoided for 6 months or until the previous abdominal scar has fully matured. This will decrease the number of adhesions and the density of the scar tissue.
The following is adapted from the algorithms found in the 4th reference below (Rohrich, et al).
Partial Skin Defect --
- Primary Closure when 5 cm or less defect
- Skin Graft
- Flap: Random/local or Fasciocutaneous Flaps
- Vacuum-assisted Closure -- Using this procedure, a sterile foam dressing is placed in the wound cavity and an evacuation tube exits the wound parallel to the skin surface. The surface of the wound is covered to create an airtight seal, and subatmospheric pressure is applied to the foam dressing.
- Tissue Expander
- Primary Closure
- Component Separation
- Local Flaps -- for example: ext oblique, int oblique
- Distant Flaps -- ie Tensor Fascia Lata Flap, gracilis flap
- Tissue Expansion
- Free Tissue Transfer (FTT)
Adequate Skin (less than 15 cm defect) with musculofascial defect --see above recommendations under Partial Defect
Inadequate Skin (more than 15 cm defect) -- Immediate Reconstruction
Local Flaps/Skin Grafts
- Sup Rectus Abd or Ext Oblique [upper third defects]
- Rectus Abd or ext Oblique [middle third defects]
- Inf rectus abd or int oblique [lower third defects]
- ext latissimus dorsi or ext TFL [upper third defects]
- TFL or RF [both middle and lower third defects]
- vastus lateralis or gracilis [lower third defects]
Free Tissue Transfer
Delayed reconstruction with absorbable mesh and a split-tissue skin graft can be a temporizing solution.
because wound infection in patients in whom a prosthetic repair was performed had major consequences, resulting in removal of the prosthesis in 7, whereas wound infection in patients after CST had only minor consequences.Disturbed wound healing frequently complicates repair of large abdominal wall hernias. Wound complications such as hematoma, seroma, skin necrosis, and infection are reported in 12%–67% of patients after CST and in 12%–27% after prosthetic repair. Wound complications are associated with the extensive dissection needed in both procedures, which are often performed after intra-abdominal catastrophes. The risk is further increased by the long duration of the operative procedure and the need to mobilize the skin in dividing the epigastric perforating arteries. This endangers the blood supply of the skin, because then it solely depends on the intercostal arteries, which may have been damaged during former operations by introduction of drains, or by stoma construction and other procedures needed in patients with intra-abdominal sepsis.
COMPONENTS SEPARATION TECHNIQUE
Operative technique of the “components separation technique.”
1 = rectus abdominis muscle; 2 = external oblique muscle;
3 = internal oblique muscle;
4 = transversus abdominis muscle;
5 = posterior rectal sheath.
A. Dissection of skin and subcutaneous fat.
B. Transaction of aponeurosis of external oblique muscle and separation of internal oblique muscle.
C. Mobilization of posterior rectal sheath and closure in the midline.
1. Abdominal Wall Reconstruction; eMedicine Article, Feb 26, 2003; Bradon Wilhelmi MD, Arian Mowlavi MD, Michael Neumeister MD, Elvin Zook MD
2. Basic Anatomy of the Abdominal Wall -- good explanation with great pictures (Wesley Norman, PhD, DSc)
3. Clinically Oriented Anatomy by Keith L Moore and Arthur F Dalley; 5th Edition, Google eBook (pp 196-230)
4. An Algorithm for Abdominal Wall Reconstruction; Plastic & Reconstructive Surgery. 105(1):202-216, January 2000; Rohrich, Rod J. M.D.; Lowe, James B. M.D.; Hackney, Fred L. M.D., D.D.S.; Bowman, Julie L. M.D.; Hobar, P. C. M.D.
5. Restoration of Abdominal Wall Integrity as a Salvage Procedure in Difficult Recurrent Abdominal Wall Hernias Using a Method of Wide Myofascial Release; Plastic & Reconstructive Surgery. 107(3):707-716, March 2001; Levine, Jamie P. M.D., and; Karp, Nolan S. M.D.
6. Abdominal Wall Reconstruction following Severe Loss of Domain: The R Adams Cowley Shock Trauma Center Algorithm; Plastic & Reconstructive Surgery. 120(3):669-680, September 1, 2007; Rodriguez, Eduardo D. D.D.S., M.D.; Bluebond-Langner, Rachel M.D.; Silverman, Ronald P. M.D.; Bochicchio, Grant M.D.; Yao, Alice B.A.; Manson, Paul N. M.D.; Scalea, Thomas M.D.
7. Vacuum-Assisted Closure for Defects of the Abdominal Wall; Plastic & Reconstructive Surgery. 121(3):832-839, March 2008; DeFranzo, Anthony J. M.D.; Pitzer, Keith M.D.; Molnar, Joseph A. M.D., Ph.D.; Marks, Malcolm W. M.D.; Chang, Michael C. M.D.; Miller, Preston R. M.D.; Letton, Robert W. M.D.; Argenta, Louis C. M.D.
8. "Components separation” method for closure of abdominal wall
defects: An anatomic and clinical study; Plast.Reconstr. Surg. 86: 519, 1990; Ramirez, O. M., Ruas, E., and Dellon, A. L.
9. Sliding myofascial flap of the rectus abdominis muscles for closure of recurrent ventral hernias; Plast. Reconstr. Surg. 98: 464, 1996; DiBello, J. N., Jr., and Moore, J. H.
10. Risks associated with “components separation” for closure of complex abdominal wall defects. Plast Reconstr Surg 2003;111:1276–1283; Lowe JB III, Lowe JB, Baty JD, et al.
11. Repair of Giant Midline Abdominal Wall Hernias: “Components Separation Technique” versus Prosthetic Repair; World J Surg. 2007 April; 31(4): 756–763; T. S.de Vries Reilingh, H. Goor, J. A. Charbon, C. Rosman, E. J. Hesselink, G. J. Wilt, and R. P. Bleichrodt
12. Method of Surgical Treatment of an Extensive Post-Burn Deformity of the Abdominal Wall and the Lumbosacral Region; Annal of Burns and Fire Disasters, Vol XVII, #1, March 2004; Moroz V., Adamskaya N., Sarygin P., Yudenich A.A.
Monday, May 26, 2008
May we all stop at 3 pm today for a moment of silence as "one nation, one remembrance". My thanks to all those who serve.
You may also wish to visit these blogs to see their Memorial Day posts:
Dr Wes -- Happy Memorial Day
Movin' Meat -- very moving youtube video
Medinnovationblog -- two posts: In Remembrance of Military Doctors and God Bless the USA
And if you'd like to hear "God Bless the USA Bless the USA"
Sunday, May 25, 2008
Saturday, May 24, 2008
Friday, May 23, 2008
REFERENCEZanfel™ is a soap mixture of ethoxylate and sodium lauroyl sarcosinate surfactants. When "activated" (worked into a paste that can be spread effectively on the skin), the soap is able to bind urushiol and thus allow it to be removed from the skin by rinsing.
Zanfel™ is unique with respect to poison ivy/oak/sumac remedies in that it is supposed to remove resin from the skin after the rash has appeared. In one study, this effect was present even at 144 hours post exposure. However, it seems logical that at some point post exposure, urushiol is no longer present in the skin and that the allergic contact dermatitis (manifested as redness, itching, swelling, and blisters), would not be lessened by Zanfel™, unless it has some direct anti-inflammatory properties
Leaves of Three, Let Them Be: If Only It Were That Easy; Medscape Article, May 28, 2004; Patricia L Jackson Allen, MS, RN, PNP, FAAN
Thursday, May 22, 2008
Often I am asked about pain. I'll give you a couple of examples.
"Will the it hurt?"
This from a patient who wanted her earlobe repaired. She had missed out on a pair of diamond ear rings for Christmas, so now she had worked up the courage to have the repair done.
"I have to use a needle to put the numbing medicine in your earlobe. There will be a little pain with that, but you won't feel any pain with the actual repair. You may feel me gently move your ear as your cheek and the surrounding area won't be numb. You may also hear me cut the suture with the scissors as I will be working so near your ear."
"So you have to use scissors?!"
"Yes, I will use scissors for the suture. I will have to use a knife to cut the skin."
"But I won't feel you cut?"
"Correct. Your earlobe will be numb."
So I keep chatting with her as I get the local ready and do the injection. I finish and turn to busy myself with getting everything else set up for the procedure.
"You're done? That didn't hurt."
I smile and say, "Good. That's all the pain involved. You won't need anything other then ibuprofen when the numbing medication wears off."
A young woman who wants a cosmetic breast procedure.
"How much pain will there be after surgery?"
I recheck her surgery history. None listed. No children yet.
"Have you ever had any cuts that needed stitches? Any broken bones? Pulled muscles?" I'm looking for something to compare the pain/soreness to.
"Well, the pain of the incision is often a burning, stinging kind of pain for the first several hours. Think paper cut. Then there will be a pain similar to a deep bruise. The first couple of days are the worst. Remember it will feel less painful, less sore each day."
She seems satisfied, but I am left wondering how I could better prepare her. When someone has had surgery before, I can use it as a reference point. The purposed surgery will have less, similar, or more pain involve. When the patient is female, has had children, and the surgery is breast implants -- patients have taught me that it feels very much like "when the milk first comes in--full and tight" initially. That often helps when discussing this question.
Anyone have any suggestions when it's the patient's first surgery and there seems to be no history of painful injury (past surgery, past injury, etc) to use as a reference point? I am always looking for better ways to communicate with my patients.
Wednesday, May 21, 2008
Tuesday, May 20, 2008
Next week's host will be Emeritus (Parallel Universes).IN THE BEGINNING, Nick Genes created Grand Rounds. And the Rounds were unformed and void; and Nick Genes said, "Let there be Hosts!" And there were Hosts; and Nick Genes saw that it was good, so he did pre-Grand Rounds interviews with the Hosts on Medscape. And it came to pass that on May 20, 2008 Grand Rounds did come to be hosted by #1 Dinosaur, who was pleased as punch to be hosting for the second time.
Monday, May 19, 2008
1. The number of HIV-positive patients who still seek cosmetic surgery treatment for lipodystrophy is likely to increase.
2. HIV-positive patients are not at increased risk for complications unless their medical health indices are poor, their CD4 count is less than 200 cells/mm3, their CD4 ratio is changing, or their viral load is greater than 10,000 copies/ml.
3. The relative risk for transmission is unknown but is probably 0.03 percent for surgical sharps, considerably less than for hepatitis.
4. Ethically, it is difficult to refuse an HIV-positive patient services if you provide those services to non-HIV-positive patients.
5. Medicolegal implications: Refusing an HIV-positive patient appropriate care based on HIV-positivity alone is malpractice for omission of care and is a violation of the Americans with Disabilities Act.
- Highly active antiretroviral therapy medications should be continued throughout the perioperative period to avoid the development of resistant viral strains.
- Preoperative workup should assess cardiovascular status, insulin resistance/hyperlipidemia, viral hepatitis, tuberculosis, nutrition, and disease status (by means of absolute CD4 count and viral load within 3 months of surgery date).
- Prophylactic antibiotic therapy has not been evaluated adequately in immunocompromised patients. So HIV-positive patients should be regarded in the context of normally associated risks factors (ie smoker, diabetes, etc) for surgical infection.
- If the patient cannot tolerate oral medications following the procedure, highly active antiretroviral therapy should be held and parenteral alternatives for antimicrobial prophylaxis should be used.
- Follow normal patient care for given procedure.
The risk of HIV transmission is dependent on the type of exposure.
Percutaneous transmission through hollow-bore needlesticks with the transfer of one drop of blood (1/30 cc) has been estimated to be 0.3 percent per occurrence.The risk of transmission from suture needlesticks and other sharps is thought to be on the order of a magnitude lower than that, or 0.03 percent.Mucous membrane exposure transmission risk is approximately 0.09 percent.
The risk of transmission from nonintact skin exposure is estimated to be less.
The risk of transmission from fluids or tissue other than blood is considered to be significantly lower than the risk of transmission from blood.It should be noted that the average risk of hepatitis C seroconversion from occupational exposure is 1.8 percent, 10 times greater than HIV. The risk of seroconversion after exposure to hepatitis B is 37 to 62 percent
* Postexposure prophylaxis should be initiated within hours of exposure.REFERENCES
* Start a basic two-drug regimen immediately (zidovudine or stavudine or tenofovir plus lamivudine or emtricitabine).
* If the source blood is drug resistant or the injury involves an increased risk for transmission, a third drug (lopinavir/ritonavir) should be added.* If the source is determined to be HIV-negative, postexposure prophylaxis should be discontinued.* The Centers for Disease Control and Prevention recommends 4 weeks of postexposure prophylaxis therapy.* Unfortunately, nearly 50 percent of health care personnel report adverse events while taking postexposure prophylaxis and approximately one-third stop taking the drugs. The three-drug regimen should therefore be avoided when possible to decrease toxicity and increase compliance.
Sunday, May 18, 2008
Saturday, May 17, 2008
Friday, May 16, 2008
Thursday, May 15, 2008
- All dermal fillers have the potential for complications.
- Appropriate filler and injection-site selection, correct injection technique, and appropriate patient selection will minimize most complications.
- Temporary side effects associated with all fillers include swelling, redness, itching, bruising, and mild pain.
- Patients should limit their expressions and normal facial movements for 3 days after injection.
- The face should also be protected from extreme cold postinjection (ie snowmobiling without facial protection).
- By 3 months, permanent implants will have assumed their final shape. Touch-ups can provide additional symmetry and correction at this point.
Early complications include
- Persistent erythema (long-lasting redness) is the most frequent early complaint. It is usually due to unintended intradermal injection. If the erythematous area is flat, then intense pulsed light (IPL) can be used to effectively reduce the lesion.
- Ridges along the injection site and superficial beading are due to superficial intradermal injection and generally appear within 2 weeks. Injected strands (in particular those in the nasolabial folds) can separate unless an attempt is made to minimize motion at the injection site for 3 days. Limiting motion will allow the implanted material to become encapsulated and prevent it from dislocating.
- Blanching after a particulate injectable indicates that a ridge may form later unless pressure is applied to the area to distribute the implant evenly.
- Nodules will often appear within the first 4 weeks. They are often due to superficial or improper technique or inappropriate injection location. They tend to be small, isolated, well encapsulated, and respond poorly to intralesional steroids. They may require excision.
- Hypertrophic scarring may occur in patients who are prone, but only if the substance is injected too superficially (intradermally).
- Late inflammatory reactions include localized redness, swelling, and paresthesias. These can occur years after injection in all but the temporary fillers. Treatment with IPL or intralesional steriods is frequently effective.
- Granulomas tend to appear 6-24 months after injection. They are true foreign-body reactions. They can occur despite proper injection technique. They are characterized by their late-onset rapid growth, inflammatory appearance, relatively large size, discoloration, and projections into surrounding tissues. They seem to appear simultaneously at all injection sites. They usually respond well to intralesional steroids.
- Steroid atrophy, depending on the dose, may occur in 5-30% of patients treated for chronic redness, nodules, or granulomas.
- Triamcinolone 20-40 mg
- Betamethasone 5-7 mg
- Methylprednisonlone 20-40 mg
- Betamethasone (0.5 mL) in combination with 5-fluorouracil (1.6 mL) and lidocaine (1 mL)
- Triamcinolone (10 mg/mL) with 5-fluorouracil
- Some patients are better candidates for aesthetic volumizing with Sculptra than others, because they are better at making collagen.
- Ideal locations for Sculptra injection are the nasolabial folds or creases, marionette lines, cheek hollows, zygomatic arches, temporal depressions, and depressed, scarred areas.
- Some physicians also use Sculptra for lateral eyebrows and dorsal hand areas.
- Large areas, such as cheek hollows benefit from serial injections of very small volumes (0.1-0.2 mL or less) applied in a cross-hatched pattern. Advanced needle techniques such as fanning and retrograde tunneling using very small volumes work well in these areas. Specialized training and experience are necessary to utilize these techniques.
- Sculptra should not be used in the body of the lip. This site offers a high probability of having nodules or papules form. Injections into the glabella and forehead are not recommended because of the risk of necrosis with any particulate product in these areas.
- Nodule or papule development can be prevented by proper injection technique and appropriate identification of areas to be injected. Ice application postinjection may minimize bruising. A massage several times a day postinjection to the area can minimize papule formation.
Treatment Options for Dermal Filler Complications; Aesthetic Surg J 2006; 26:356-365; Gottfried Lemperle MD, PhD and David M Duffy MD
Use of Sculptra in Esthetic Rejuvenation; Semin Cutan Med Surg 206; 25:127-131; Kenneth R Beer, MD and Marta I Rendon, MD
Wednesday, May 14, 2008
"Despite variations in water temperature and beachgoer population size, the seasonal variations of bacterial species were minimal. Throughout all four studies, the most effective antibiotics against most Gram-positive microorganisms were penicillin, ampicillin, vancomycin, and levofloxacin, whereas the most effective antibiotics against all Gram-negative microorganisms were levofloxacin, lomefloxacin, and cefepime. Because all four studies contained similar trends in both Gram-positive and Gram-negative microorganisms, these authors believe that it is necessary to prescribe initial antibiotics that provide dual coverage of Gram-positive and Gram-negative organisms to patients with seawater-contaminated wounds, regardless of the season. Although the majority of organisms analyzed showed some sensitivity to levofloxacin, this drug has somewhat limited Gram-positive coverage that the addition of penicillin will address more appropriately. Thus, prescribing a combination of penicillin or ampicillin with levofloxacin to patients with seawater-contaminated penetrating wounds at any time throughout the fall, winter, spring, or summer should provide the necessary coverage to promote proper wound healing and functional recovery of the injured site. As is usually practiced, antibiotic therapy should be administered for a period of 5 to 7 days, with further changes being made based on the treating physician's clinical judgment. Using this regimen will also cover the dangerous Vibrio species and aid in preventing the morbidity and mortality associated with such infections."
Tuesday, May 13, 2008
Next week's host will be Dino (Musings of a Dinasaur).Welcome to the latest edition of Grand Rounds at the Health Business Blog. This is my fourth time hosting (fifth if you include the April Fool’s edition).
Monday, May 12, 2008
Von Willebrand disease (VWD) is an inherited bleeding disorder that is caused by deficiency or dysfunction of von Willebrand factor (VWF), a plasma protein that mediates the initial adhesion of platelets at sites of vascular injury and also binds and stabilizes blood clotting factor VIII (FVIII) in the circulation. Therefore, defects in VWF can cause bleeding by impairing platelet adhesion or by reducing the concentration of FVIII.VWD is a relatively common cause of bleeding, but the prevalence varies considerably among studies and depends strongly on the case definition that is used. VWD prevalence has been estimated in several countries on the basis of the number of symptomatic patients seen at hemostasis centers, and the values
range from roughly 23 to 110 per million population (0.0023 to 0.01 percent)
Suggested Questions to Ask Patients in Screening
2. Have you ever had prolonged bleeding from trivial wounds, lasting more than 15 minutes or recurring spontaneously during the 7 days after the wound?
3. Have you ever had heavy, prolonged, or recurrent bleeding after surgical procedures, such as tonsillectomy?
4. Have you ever had bruising, with minimal or no apparent trauma, especially if you could feel a lump under the bruise?
5. Have you ever had a spontaneous nosebleed that required more than 10 minutes to stop or needed medical attention?
6. Have you ever had heavy, prolonged, or recurrent bleeding after dental extractions that required medical attention?
7. Have you ever had blood in your stool, unexplained by a specific anatomic lesion (such as an ulcer in the stomach, or a polyp in the colon), that required medical attention?
8. Have you ever had anemia requiring treatment or received blood transfusion?
9. For women, have you ever had heavy menses, characterized by the presence of clots greater than an inch in diameter and/or changing a pad or tampon more than hourly, or resulting in anemia or low iron level?
If the patient answers yes to one or more of the above:
- VWF:Ag -- an immunoassay that measures the
concentration of VWF protein in plasma.
- VWF:RCo -- a functional assay of VWF that measures
its ability to interact with normal platelets.
- FVIII coagulant assay -- a measure of the cofactor
function of the clotting factor, FVIII, in plasma.
Also, available for CME credit through Medscape: Management of Surgical Patients with VWD: New Research-based Options [CME available through May 5, 2009];released May 5, 2008; Joan Cox Gill, MD; Prasad Mathew, MD
Sunday, May 11, 2008
Friday, May 9, 2008
Help Stamp Out Hunger
National Association of Letter Carriers Community Service
Thursday, May 8, 2008
If you seek for wealth you have mistaken your avocation. There must be something more, and something higher. That something is a love of your profession; a passion for science for its own sake; a broad humanity, which covers all the sick with a mantle of charity. Never lose sight of that motive, for if it once takes flight, your profession is reduced to a trade, and there is absolutely nothing left. As long as you can keep alive the sacred flame of this early passion which first called you to embrace the medical
profession, so long shall you be warmed, sustained, upheld amid disappointment, unjust treatment or reverses."
Wednesday, May 7, 2008
dermatome /der·ma·tome/ (der´mah-tom)
1. an instrument for cutting thin skin slices for grafting.
2. the area of skin supplied with afferent nerve fibers by a single posterior spinal root.
3. the lateral part of an embryonic somite.
It's the first definition that I will be discussing.
- These provides rapid harvest of large grafts of uniform thickness. These may be air powered, electric, or manually operated.
- All of these harvest by the same mechanism: a rapidly oscillating side-to-side blade is advanced over the skin with thickness and width settings adjusted by the surgeon.
- When using the air or electric powered dermatomes, the operating surgeon must be familiar with the installation of the blade and how to adjust the setting for graft thickness and must check these before operating the device. There is a correct and an incorrect orientation of the blade, and the two may easily be confused.
- Insertion of a No. 15 blade scalpel simulates a thickness of 0.015 inches and can be used to check that thickness settings are uniform and correct. After the blade orientation, width guard and depth setting are confirmed, and harvesting may begin.
- Drum dermatomes are less frequently used today but are available for specialized grafting needs.
- On these instruments, the oscillating blade is manually powered as the drum is rolled over the skin surface. These dermatomes can be used to harvest broad sheets of skin of exacting thickness.
- They are useful when the donor site is irregular, with a convexity, concavity, or bony prominence (neck, flank, buttock), because the skin to be harvested is first made adherent to the drum with a special glue or adhesive tape.
- These dermatomes also allow precise irregular patterns to be harvested by varying the pattern of adhesive applied to the skin and drum.
- Disadvantages include the risk of injury to operating personnel by the swinging blade, the need to use flammable agents such as acetone or ether to cleanse the donor site and remove surface oils to ensure secure adhesion of the skin to the dermatome drum, and greater technical expertise required to safely and effectively operate these devices.
- Reese and Padgett-Hood are examples of this type. Check out the 5th reference article.
- Called knives and not dermatomes, these still fit the definition. Examples include the Humby knife, Weck blade, and Blair knife.
- The disadvantages include grafts with irregular edges and varying thicknesses. As with the drum dermatomes, greater technical expertise is necessary, and graft quality tends to be operator dependent.
- Check out this link on "preparing a Humby knife"
Tuesday, May 6, 2008
Here are some folks who received honors or should have this week--
Shadowfax states "When finally they were done, I made it a point to express my admiration and gratitude in the most direct way I could -- I went down to the hospital Starbuck's and bought them their favorite drinks (white chocolate mochas). Nurses rock!" I agree.
Christine, But Your Don't Look Sick, was recently honored at the NY Lupus Alliance Gala Brunch. Her acceptance speech focused on the " Yes, this has been my battle, my war with lupus… but luckily I have had an army to fight with me. We all have had lupus."
MedGadget highlights the National Marrow Donor Program's registration campaign to boost the ranks of committed bone marrow donors by allowing potential donors to register for free during the month of May.
Come visit us here in Arkansas. We'd love to see you.
Sunday, May 4, 2008
I was tagged by Midwife with a Knife who was tagged by TBTAM for the six word memoir meme.
The instructions? Write a 6 word memoir and tag 6 others. Leave a comment on the tagged blogs with an invitation to play.
MWWAK's --- Catch a baby, watch the floor.
TBTAM's --- I want to do it all.
Dr Wes' --- Show them kindness, integrity, and love.
So here's mine:
My life is full of stitches.
To me that covers my work (plastic surgery), my hobbies (quilting, sewing, knitting), my jogging (the occasional side-stitch), and my enjoyment of good jokes (keep me in stitches).
It somehow doesn't cover my family, friends, dogs. Unless you allow me to call them the threads that hold everything together.
Here are some links to others who have played:
Seaspray, Whitecoat, Monkey Girl, Scalpel
I'll tag: Sterile Eye, Knudsen, Bongi, Scanman, Bruce, and Val. And Dr David because he feels left out and we don't want that (added 5-7-08).
Unlike last time, I thought I’d go for a themed edition this time around. And the theme will be: Tools of the trade. Nuff said. The rest is up to you.
Please submit your posts by May 9th here.
Saturday, May 3, 2008
Here is a view of the backing which is made up of five different flannel pieces.
Friday, May 2, 2008
Well, The answer is quite simple...
Long ago, steamboats traveled the Arkansas River when the water was at the right depth. When it wasn't, the captains and their crew tied up to wait where the Toad Suck Lock and Dam now spans the river. While they waited, they refreshed themselves at the local tavern there, to the dismay of the folks living nearby, who said: "They suck on the bottle 'til they swell up like toads." Hence, the name Toad Suck. The tavern is long gone, but the legend and fun live on at Toad Suck Daze.