- Email: [email protected]
Dermabrasion: As a complement to aesthetic surgery
1362
CURRENT LITERATURE
antrostomy/endoscopy to allow better visualization, and therefore, allow complete removal of soft tissues from the fracture site. Initially, the patient’s mucosa is decongested with oxymetazoline hydrochloride or 4% cocaine hydrochloride. Local anesthesia is inftltrated into the lateral nasal wall and the uncinate process of the affected side is removed for proper visualization of the ostium. Enlargement and antrostomy is followed by placement of the endoscope into the maxillary sinus. In the event of medial rectus entrapment, a limited ethmoidectomy is recomended, leaving the lamina papyracea intact. The authors then described the use of a standard transconjuctival approach for identification of the fracture and removal of bony fragments. A custom-made titanium mesh orbital implant was then placed to space the defect in the floor and medial wall. The endoscope was used to guide the implant into proper position away from the optic nerve and to ensure clearance of posterior orbital soft tissues. Subsequently, the implant was secured with screws and the incision was closed in a standard fashion. The authors’ suggest that endoscopic visualization of orbital floor fractures may facilitate safe and secure placement of orbital implants while ensuring no residual soft tissue incarceration, minimal extention of orbital incision, and decreased postoperative enophthalmos.-H. PATINO Reprints requests MO 63124.
to Dr Hartstein:
8729 Delmar,
Surgery.
Dermabrasion is a time-tested modality for facial skin resurfacing and should continue to be an important tool for every plastic surgeon. Dermabrasion is safe, efficacious, inexpensive, portable, and widely available. It does not require special safety equipment, does not pose a fire hazard, has a shorter erythema phase than for laser resurfacing, and minimal training is required for its use. Dermabrasion is simply the controlled mechanical abrasion of the epidermis and a variable segment of the upper dermis. It is indicated for perioral rhytids, acne scarring, traumatic facial scarring, and rhinophyma. Dermabrasion is performed in the operating room with anesthesia of the appropriate magnitude. Diamond-impregnated cylindrical fraises are most commonly used. They rotate at 12,000 to 15,000 rpm via an electrically powered hand-held motor driver unit. The operating room staff should be protected from airborne and aerosolized particles. The wound is created gradually by region, to the appropriate depth. A saline-moistened sponge is placed over the wound postoperatively to aid in hemostasis. A petrolatum-based ointment is then placed in a thin layer over the abraded surface. After 7 to 10 days, a moisturizer is substituted for the petrolatum dressing. Complications include hypertrophic scarring; infection by bacterial, viral, or fungal agents; hypopigmentation, and hyperpigmentation. Despite the continued demand for space-age laser technology, dermabrasion remains a safe and efficaciousmodality for the treatment of rhytids and scars.-R.H. HAUG
The Preoperative Benefit. Peterson 133:134, 1998
Plastic Surgery
Bleeding P, Hayes
Time TE,
Arkin
Associates,
PA, 1501 S
Test Lacks Clinical CF,
epidurai
anesthesia
given
to patients
receiving
oral anticoag-
ulants, they were anecdotal cases of spinal subdural bleeding; however, the preoperative bleeding time has not been uniformly prolonged in these cases. The authors concluded that the bleeding time test is not a useful predictor of the risk of hemorrhage associated with surgical procedure. The best preoperative screen to predict bleeding complications is comprehensive clinical history, which includes family and previous dental, obstetric, surgical, traumatic injury, transfusion, and drug histories. A patient with a history suggesting a possible bleeding disorder may require further evaluation.I.E. SHAMI Reprint request to: College of American Rd, NorthReId, IL 60093-2750.
Pathologists,
325 Waukegan
Suite 2W, St Louis,
Dermabrasion: As a Complement to Aesthetic Baker TM. Clin Plast Surg 25:81, 1998
Reprint requests to Dr Baker: MIamIAve, Miami, FL 33129.
tests of hemostasis. The authors reviewed the data concerning the of preoperative use of the bleeding time test and its prediction for hemorrhagic complications. In one study of 101 patients, only 2 out of 17 patients who experienced excessive bleeding were prospectively classified as high risk according to the result of bleeding time test. Another study by Amrein et al found no correlation between increased bleeding and a bleeding time greater than 10 minutes or an aspirin-induced prolongation of 4 minutes over baseline. Odom and Sih reported their experience with 1,000 cases of
et al. Arch
Surg
One to two million bleeding time procedures are formed each year in the US, making it one of the most widely used
Identikation of Obstructive Sleep Apnea in Patients who Snore. Tami TA, Duncan HJ, PBeger M, et al. Iaryngoscope 108:508,1998 This study examines a series of snoring patients who underwent home overnight sleep studies and completed extensive sleep related questionaires. The objectives of the study were to determine the incidence of obstructive sleep apnea (OSA) in patients presenting with socially unacceptable snoring and to develop a protocol to identify patients with OSA as a subset of patients who snore. Ninety-four snoring patients were recruited to determine the incidence of OSA in this highly selected population. The patients answered an extensive sleep questionaire to determine factors that might suggest a diagnosis of OSA and a home sleep study was performed on each participant. The overall incidence of OSA in this group was 72%. Severe sleep apnea with greater than 25 apneic events per hour was found in 42% of the patients. Moderate sleep apnea with 10 to 20 apneic events per hour was found in 30% of the patients. Twenty of the subjects with severe sleep apnea also underwent inpatient polysomnogmphy and the diagnosis was con6rmed in all cases. Conclusions drawn by the authors were that home sleep studies are an accurate and costeffective alternative to inpatient polysomnography.-J. BROKLOFF Reprint Center, 670528,
requests to Dr TamI: University of Cincinnati Medical Department of Otolaryugology, 231 Bethesda Ave, PO Box Cincinnati, OH 45267.
Minimal Head Trauma in Children Revisited: Is Routine Hospitalization Required? Roddy SP, Cohn SM, Moller BA, et al. Pediatrics 101:575,1998 Treatment of pediatric head injuries with a history of loss of consciousness or amnesia has been debated for years. More than 100,000 children per year sustain head injuries that warrant hospital admission, and 90% of them have Glasgow Coma Scales (GCS) of 13 or greater. Early diagnosis of intracranial hemorrhage has been shown to substantially
CURRENT LITERATURE
antrostomy/endoscopy to allow better visualization, and therefore, allow complete removal of soft tissues from the fracture site. Initially, the patient’s mucosa is decongested with oxymetazoline hydrochloride or 4% cocaine hydrochloride. Local anesthesia is inftltrated into the lateral nasal wall and the uncinate process of the affected side is removed for proper visualization of the ostium. Enlargement and antrostomy is followed by placement of the endoscope into the maxillary sinus. In the event of medial rectus entrapment, a limited ethmoidectomy is recomended, leaving the lamina papyracea intact. The authors then described the use of a standard transconjuctival approach for identification of the fracture and removal of bony fragments. A custom-made titanium mesh orbital implant was then placed to space the defect in the floor and medial wall. The endoscope was used to guide the implant into proper position away from the optic nerve and to ensure clearance of posterior orbital soft tissues. Subsequently, the implant was secured with screws and the incision was closed in a standard fashion. The authors’ suggest that endoscopic visualization of orbital floor fractures may facilitate safe and secure placement of orbital implants while ensuring no residual soft tissue incarceration, minimal extention of orbital incision, and decreased postoperative enophthalmos.-H. PATINO Reprints requests MO 63124.
to Dr Hartstein:
8729 Delmar,
Surgery.
Dermabrasion is a time-tested modality for facial skin resurfacing and should continue to be an important tool for every plastic surgeon. Dermabrasion is safe, efficacious, inexpensive, portable, and widely available. It does not require special safety equipment, does not pose a fire hazard, has a shorter erythema phase than for laser resurfacing, and minimal training is required for its use. Dermabrasion is simply the controlled mechanical abrasion of the epidermis and a variable segment of the upper dermis. It is indicated for perioral rhytids, acne scarring, traumatic facial scarring, and rhinophyma. Dermabrasion is performed in the operating room with anesthesia of the appropriate magnitude. Diamond-impregnated cylindrical fraises are most commonly used. They rotate at 12,000 to 15,000 rpm via an electrically powered hand-held motor driver unit. The operating room staff should be protected from airborne and aerosolized particles. The wound is created gradually by region, to the appropriate depth. A saline-moistened sponge is placed over the wound postoperatively to aid in hemostasis. A petrolatum-based ointment is then placed in a thin layer over the abraded surface. After 7 to 10 days, a moisturizer is substituted for the petrolatum dressing. Complications include hypertrophic scarring; infection by bacterial, viral, or fungal agents; hypopigmentation, and hyperpigmentation. Despite the continued demand for space-age laser technology, dermabrasion remains a safe and efficaciousmodality for the treatment of rhytids and scars.-R.H. HAUG
The Preoperative Benefit. Peterson 133:134, 1998
Plastic Surgery
Bleeding P, Hayes
Time TE,
Arkin
Associates,
PA, 1501 S
Test Lacks Clinical CF,
epidurai
anesthesia
given
to patients
receiving
oral anticoag-
ulants, they were anecdotal cases of spinal subdural bleeding; however, the preoperative bleeding time has not been uniformly prolonged in these cases. The authors concluded that the bleeding time test is not a useful predictor of the risk of hemorrhage associated with surgical procedure. The best preoperative screen to predict bleeding complications is comprehensive clinical history, which includes family and previous dental, obstetric, surgical, traumatic injury, transfusion, and drug histories. A patient with a history suggesting a possible bleeding disorder may require further evaluation.I.E. SHAMI Reprint request to: College of American Rd, NorthReId, IL 60093-2750.
Pathologists,
325 Waukegan
Suite 2W, St Louis,
Dermabrasion: As a Complement to Aesthetic Baker TM. Clin Plast Surg 25:81, 1998
Reprint requests to Dr Baker: MIamIAve, Miami, FL 33129.
tests of hemostasis. The authors reviewed the data concerning the of preoperative use of the bleeding time test and its prediction for hemorrhagic complications. In one study of 101 patients, only 2 out of 17 patients who experienced excessive bleeding were prospectively classified as high risk according to the result of bleeding time test. Another study by Amrein et al found no correlation between increased bleeding and a bleeding time greater than 10 minutes or an aspirin-induced prolongation of 4 minutes over baseline. Odom and Sih reported their experience with 1,000 cases of
et al. Arch
Surg
One to two million bleeding time procedures are formed each year in the US, making it one of the most widely used
Identikation of Obstructive Sleep Apnea in Patients who Snore. Tami TA, Duncan HJ, PBeger M, et al. Iaryngoscope 108:508,1998 This study examines a series of snoring patients who underwent home overnight sleep studies and completed extensive sleep related questionaires. The objectives of the study were to determine the incidence of obstructive sleep apnea (OSA) in patients presenting with socially unacceptable snoring and to develop a protocol to identify patients with OSA as a subset of patients who snore. Ninety-four snoring patients were recruited to determine the incidence of OSA in this highly selected population. The patients answered an extensive sleep questionaire to determine factors that might suggest a diagnosis of OSA and a home sleep study was performed on each participant. The overall incidence of OSA in this group was 72%. Severe sleep apnea with greater than 25 apneic events per hour was found in 42% of the patients. Moderate sleep apnea with 10 to 20 apneic events per hour was found in 30% of the patients. Twenty of the subjects with severe sleep apnea also underwent inpatient polysomnogmphy and the diagnosis was con6rmed in all cases. Conclusions drawn by the authors were that home sleep studies are an accurate and costeffective alternative to inpatient polysomnography.-J. BROKLOFF Reprint Center, 670528,
requests to Dr TamI: University of Cincinnati Medical Department of Otolaryugology, 231 Bethesda Ave, PO Box Cincinnati, OH 45267.
Minimal Head Trauma in Children Revisited: Is Routine Hospitalization Required? Roddy SP, Cohn SM, Moller BA, et al. Pediatrics 101:575,1998 Treatment of pediatric head injuries with a history of loss of consciousness or amnesia has been debated for years. More than 100,000 children per year sustain head injuries that warrant hospital admission, and 90% of them have Glasgow Coma Scales (GCS) of 13 or greater. Early diagnosis of intracranial hemorrhage has been shown to substantially