ABSTRACT
Alar flare is a common feature that contributes to the width of the lower third of the nose. In the right patient, alar flare reduction can improve nasal harmony and facial aesthetic balance; however, it is also difficult to correct if conducted inappropriately or overzealously. The unique anatomy and diverse morphologies of the alar lobule, and the dynamic relationship between flare and changes in tip projection, must be considered. The authors provide guidelines for flare reduction: when it is appropriate and how to tailor the excision pattern to safely and effectively refine nasal width. Alar flare is classified into three types according to alar rim shape on basal view analysis. By designing the excision pattern based on specific flare type, the lower third of the nose is narrowed without creating an operated appearance. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
Subject(s)
Nose/anatomy & histology , Rhinoplasty/methods , Adult , Female , Humans , Nose/surgeryABSTRACT
Corneal abrasion is the most common ocular complication in surgery. Treatment requires pain control, antimicrobial prophylaxis, and close monitoring. Pain improves significantly after 24 hours and should be resolved by 48 hours. Persistent, worsening, or new symptoms warrant immediate specialist consultation. The authors review the pathophysiology of perioperative corneal abrasion, and propose updated evidence-based guidelines for improved patient care.
Subject(s)
Anesthesia, General/adverse effects , Corneal Injuries/prevention & control , Corneal Injuries/therapy , Intraoperative Complications/prevention & control , Intraoperative Complications/therapy , Ophthalmologic Surgical Procedures , Postoperative Complications/prevention & control , Postoperative Complications/therapy , Practice Guidelines as Topic , Administration, Topical , Analgesics/therapeutic use , Antibiotic Prophylaxis , Corneal Injuries/diagnosis , Corneal Injuries/etiology , Corneal Injuries/physiopathology , Dry Eye Syndromes/complications , Epithelium, Corneal/pathology , Head Movements , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/physiopathology , Lubricant Eye Drops/therapeutic use , Mydriatics/therapeutic use , Patient Positioning , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Premedication , Randomized Controlled Trials as Topic , Wound HealingABSTRACT
UNLABELLED: Surgery remains the gold standard in the treatment of Dupuytren contracture but is technically demanding, carries significant risk of complications, and requires prolonged recovery time. Collagenase injection is an efficacious alternative to surgery; however, contracture release often requires multiple treatments spaced a month apart. We report our experience with a new collagenase treatment protocol aimed to minimize the total treatment time per joint contracture. METHODS: We performed a single institution retrospective review of patients with Dupuytren contracture treated with collagenase using our protocol from 2011 to 2013. Patients returned 24 hours after collagenase injection for cord manipulation by a certified hand therapist while under digital block. Treatment success was defined as reduction in contracture to 5 degrees or less. Successfully treated joints were evaluated for recurrence (>10 degrees contracture) at 30-day and 6-month follow-up appointments. Serious adverse events, including skin tears, were recorded. RESULTS: Success was achieved in 36 of 47 treated joints (76.6%) after a single injection. There were 2 recurrences in 32 joints at 30-day follow-up (6.2%) and no recurrences in 17 joints available at 6-month follow-up. Skin tears were the only serious adverse event occurring in 18 of 47 cord ruptures (38.3%). All healed secondarily without complication. CONCLUSIONS: Our protocol preserves treatment efficacy while maximizing efficiency. Achieving successful cord rupture with a single injection allows earlier return of function, reduced cost of treatment, and increased convenience for the patient. Patients, particularly those with greater contractures, should be counseled regarding the risk of skin tear during cord manipulation.
