RESUMO
A unique case of congenital nasal septal deformity is reported with a chronological summary of literature pertaining to congenital nasal defects.
Assuntos
Cartilagens Nasais/anormalidades , Cartilagens Nasais/cirurgia , Septo Nasal/anormalidades , Septo Nasal/cirurgia , Rinoplastia/métodos , Adolescente , Feminino , HumanosRESUMO
A pilot study of the use of digital images as an adjunct to telephone referral was undertaken. Hand trauma represented the majority of the twenty patients included in the study, and the system was found to be an effective aid to delivering appropriate management. We have found image analysis to be a useful addition to the telephone referral process already in use in our unit, but it is unlikely to replace the need for real time clinical assessment of the patient.
Assuntos
Linhas Diretas , Relações Médico-Paciente , Consulta Remota/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos , Ferimentos e Lesões , Humanos , Projetos Piloto , Cirurgia Plástica/métodos , Telemedicina/estatística & dados numéricosRESUMO
This article reviews the important developments, recent and historical, in burn fluid resuscitation. Modern managements, debates, and research directions are discussed, with a key question of how to transcend the current therapeutic plateau.
Assuntos
Queimaduras/complicações , Hidratação/métodos , Ressuscitação/métodos , Choque Traumático/terapia , Queimaduras/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Ressuscitação/mortalidade , Medição de Risco , Choque Traumático/etiologia , Choque Traumático/mortalidade , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Composite tissue allotransplantation (CTA) represents a surgical technology whose risks and benefits are unclear. This is problematic for clinicians with respect to patient selection and counseling, and for policy makers in evaluating its merits. Our analysis represents a mathematical approach to risk and benefit estimation in CTA. METHODS: A Markov model was created to represent clinical and immunological outcomes after CTA. Esthetic outcomes were incorporated into the model by creating a disfigurement-related-disability severity score index based on existing literature. Composite tissue allotransplantation in a 30-year-old male was used as a base case analysis. We compared CTA against autogenous reconstruction as competing strategies. Sensitivity analyses were performed on the effect of preoperative esthetic morbidity and postoperative esthetic outcome. RESULTS: Our base-case showed CTA to be the preferred strategy-conferring a benefit of 4.47 esthetic-outcome-adjusted life years. Sensitivity analyses showed CTA to be the preferred strategy if the preoperative disability severity score was greater than 5, and if the severity score after autogenous reconstruction was greater than 7. CONCLUSION: Our model estimates a theoretical risk-benefit threshold for CTA. The model itself can be refined as clinical experience with CTA grows and can incorporate economic and quality-of-life parameters.
Assuntos
Transplante de Tecidos , Humanos , Cadeias de Markov , Matemática , Qualidade de Vida , Medição de Risco , Sensibilidade e Especificidade , Transplante de Tecidos/efeitos adversos , Transplante Homólogo/efeitos adversos , Resultado do TratamentoRESUMO
Now that partial face transplantation has been performed, attention is focused on likely functional, aesthetic and immunological outcomes, and full facial transplantation is the likely next step. Facial transplantation has been the source of ethical debate, a key part of which focuses on valid informed consent. We review the process of informed consent in health settings, assessing how applicable the current standards are for facial transplantation. The factors which need to be assessed during the screening programme are outlined. We conclude that both individual and process factors are important in obtaining consent for radical new procedures, and outline our own gold standard for ensuring informed consent in facial transplantation.
