ABSTRACT
This case presents the dilemma of a scalp infection emerging at the conclusion of soft-tissue expansion. Basic principles of wound infection would dictate that the foreign body (the inflatable prosthesis) be removed and that the infection be treated before inset of the flap. The prevention of possible loss of flap length due to skin contraction during treatment of the infection was avoided by stretching the flap over the intact scalp temporarily, thus maintaining its expanded status.
Subject(s)
Alopecia/surgery , Burns/complications , Scalp/transplantation , Staphylococcal Infections/complications , Surgery, Plastic/methods , Alopecia/etiology , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Child , Debridement , Humans , Male , Staphylococcal Infections/therapy , Therapeutic IrrigationABSTRACT
This two-part study investigated the topical treatment of vasospasm in the tail arteries of rats. In part A, an epinephrine-induced model of vasospasm was used to study a variety of vasodilating agents with actions on at least five different sites in the contractile mechanism of the vascular smooth-muscle cell. The most effective commercially available agents evaluated in this part of the study appeared to be 20% lidocaine and Thorazine (25 mg/ml). In part B, a model was established in which epinephrine-induced vasoconstriction was found to significantly impair anastomotic patency. Thorazine was shown to improve the patency rate of vessels in this setting, and it was found to be superior to 20% lidocaine in improving anastomotic patency.
Subject(s)
Spasm/drug therapy , Vasodilator Agents/administration & dosage , Administration, Topical , Animals , Chlorpromazine/administration & dosage , Disease Models, Animal , Drug Evaluation , Epinephrine , Lidocaine/administration & dosage , Male , Muscle Contraction/drug effects , Muscle, Smooth, Vascular/drug effects , Rats , Rats, Inbred Strains , Spasm/chemically induced , Tail/blood supply , Time Factors , Vascular Diseases/chemically induced , Vascular Diseases/drug therapy , Vasoconstriction/drug effectsABSTRACT
Characterization and resolution of microvascular spasm were investigated in 170 studies with the use of tail or femoral arteries of the rat. Topical epinephrine reliably produced vasospasm and topical vasodilators which included 2% and 20% lidocaine (Xylocaine) and 0.75% bupivacaine (Marcaine) were applied to resolve the vasoconstriction. Extensive vessel dissection was necessary to obtain significant resolution of vasospasm, and adventitial stripping was associated with even more impressive results. Local anesthetics appear to have a concentration dependent ability to resolve vasospasm, and 20% Xylocaine is the most effective agent yet studied.
Subject(s)
Anesthetics, Local/therapeutic use , Arteries/surgery , Vasodilator Agents/therapeutic use , Animals , Arteries/drug effects , Bupivacaine/therapeutic use , Constriction, Pathologic/drug therapy , Constriction, Pathologic/etiology , Drug Evaluation, Preclinical , Epinephrine/toxicity , Lidocaine/therapeutic use , Male , Microsurgery , Postoperative Complications , Rats , Rats, Inbred StrainsABSTRACT
A rat restraining cage is described for use in epigastric flap studies requiring IV infusions of 24 hours or more. The device is simple, effective, and reliable; it appears to be less stressful for the rat than other methods of restraint.
