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Immediate Versus Delayed Mobilization After Cubital Tunnel Release Surgery: A Systematic Review and Meta-analysis 肘管释放手术后立即与延迟活动:系统回顾和荟萃分析
4区 医学 Q Medicine Pub Date : 2023-09-21 DOI: 10.1177/22925503231201631
Oluwatobi R. Olaiya, Minh Huynh, Tega Ebeye, Lucas Gallo, Lawrence Mbuagbaw, Matthew McRae
Purpose: It is unknown whether early mobilization after cubital tunnel decompression improves functional outcomes without increasing complication risks. This systematic review aims to evaluate the effectiveness of early mobilization compared to delayed mobilization of the elbow after ulnar nerve decompression. Methods: Randomized controlled trials (RCTs) and observational studies comparing adults who received early mobilization or late mobilization were included. Embase, MEDLINE, CENTRAL, PEDro, clinicaltrials.gov, and the World Health Organization database were systematically searched from inception to January 2023. Results: Of the 2183 studies identified and screened, five studies (two RCT and three observational) totaling 224 patients (232 elbows) were included in this review. Evidence from two RCTs (100 patients) suggests that early mobilization may result in a large reduction in the amount of time needed to return to work (mean difference 40.1 days, 95% confidence interval [CI] 16-64 days earlier, I 2 = 85%, low-certainty evidence) and little to no difference in grip strength (0 kg, 95% CI = −0.17 to 0.17, I 2 = 0%, low-certainty evidence). There was little to no difference in adverse events or range of motion (low to very-low certainty evidence). Pooled results from the three observational studies showed similar findings (very low-certainty evidence). There were no studies that evaluated upper extremity related quality of life. Conclusion: Immobilizing patients for periods longer than 3 days appears to delay patient's return to work with no appreciable clinical benefit.
目的:尚不清楚肘管减压后早期活动是否能改善功能预后而不增加并发症风险。本系统综述旨在评估尺神经减压后肘关节早期活动与延迟活动的有效性。方法:纳入随机对照试验(rct)和观察性研究,比较接受早期活动或晚期活动的成年人。Embase、MEDLINE、CENTRAL、PEDro、clinicaltrials.gov和世界卫生组织数据库从成立到2023年1月进行了系统检索。结果:在确定和筛选的2183项研究中,本综述纳入了5项研究(2项随机对照试验和3项观察性研究),共计224例患者(232例肘部)。来自两项随机对照试验(100例患者)的证据表明,早期活动可能导致恢复工作所需的时间大幅减少(平均差值40.1天,95%可信区间[CI]提前16-64天,i2 = 85%,低确定性证据),握力几乎没有差异(0 kg, 95% CI = - 0.17至0.17,i2 = 0%,低确定性证据)。不良事件或活动范围几乎没有差异(低至极低确定性证据)。三项观察性研究的汇总结果显示了类似的发现(非常低确定性的证据)。没有研究评估上肢相关的生活质量。结论:固定患者时间超过3天似乎会延迟患者重返工作岗位,没有明显的临床益处。
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引用次数: 0
Acellular Dermal Matrices in Prepectoral Breast Reconstruction—Do We Need It? 脱细胞真皮基质在乳房再造中的应用——我们需要它吗?
4区 医学 Q Medicine Pub Date : 2023-09-11 DOI: 10.1177/22925503231199769
Lucas Gallo, Oluwatobi Olaiya, Sophocles Voineskos, Mark McRae
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引用次数: 0
Invited Discussion: Excess Opioid Medication and Variation in Prescribing Patterns Following Common Breast Procedures 特邀讨论:常见乳房手术后过量阿片类药物和处方模式的变化
4区 医学 Q Medicine Pub Date : 2023-09-07 DOI: 10.1177/22925503231198091
Douglas J. Courtemanche
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引用次数: 0
Canadian Society of Plastic Surgeons / Société Canadienne Des Chirurgiens Plasticiens 加拿大整形外科医生协会/加拿大整形外科医生协会
4区 医学 Q Medicine Pub Date : 2023-05-18 DOI: 10.1177/22925503231177608
Steven Morris, Earl Campbell
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引用次数: 0
Groupe pour l’Avancement de la Microchirurgie Canada (GAM) 加拿大显微外科进步小组(GAM)
4区 医学 Q Medicine Pub Date : 2023-05-18 DOI: 10.1177/22925503231177609
Ronen Avram, Jennifer Matthews
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引用次数: 0
Preoperative pregnancy testing 术前妊娠检查
IF 0.7 4区 医学 Q Medicine Pub Date : 2012-08-01 DOI: 10.1177/229255031202000310
Background In up to 2% of all pregnancies, the need for general anesthesia in a nonobstetrical surgery arises. Surgery on a pregnant woman may have significant implications for the fetus, patient, physician and hospital. On review of the plastic surgery literature, the authors were unable to find current guidelines or recommendations for preoperative pregnancy testing in the plastic surgery patient population. Methods Literature regarding maternal and fetal risk during anesthesia and surgery, as well as preoperative pregnancy testing was identified by performing a PubMed, OVID and MEDLINE key word search. The current literature was subsequently reviewed and summarized. Results A report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation allows physicians and hospitals to implement their own policies and practices with regard to preoperative pregnancy testing. The overall frequency of an incidentally found positive preoperative pregnancy test ranges from 0.34% to 2.4%. Discussion Various studies have reported increased rates of spontaneous abortions, congenital anomalies, such as neural tube defects, and low and very low birth weight infants born to mothers exposed to anesthesia and surgery during pregnancy. Because the accepted practice is to postpone elective surgery during pregnancy, identifying these patients before surgery is critical. Conclusions Based on the current evidence, the authors' best practice recommendation for preoperative pregnancy testing is provided.
背景:在2%的妊娠中,非产科手术需要全身麻醉。对孕妇进行手术可能对胎儿、患者、医生和医院都有重大影响。通过对整形外科文献的回顾,作者无法找到整形手术患者术前妊娠检测的现行指南或建议。方法通过PubMed、OVID和MEDLINE关键词检索,对麻醉、手术及术前妊娠试验中有关母胎风险的文献进行检索。随后对目前的文献进行了回顾和总结。结果:美国麻醉医师协会麻醉前评估工作组的一份报告允许医生和医院在术前妊娠检测方面实施自己的政策和实践。术前妊娠试验偶然发现阳性的总体频率为0.34%至2.4%。各种研究都报道了自然流产、先天性异常(如神经管缺陷)以及在怀孕期间接受麻醉和手术的母亲所生的低体重儿和极低体重儿的发生率增加。因为公认的做法是推迟择期手术在怀孕期间,识别这些患者在手术前是至关重要的。结论基于目前的证据,作者提供了术前妊娠检测的最佳实践建议。
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引用次数: 0
Reporting disclosures to the reader in plastic surgery journal publications 在整形外科杂志出版物中向读者报告披露的信息
IF 0.7 4区 医学 Q Medicine Pub Date : 2012-08-01 DOI: 10.4172/PLASTIC-SURGERY.1000766
H. Sinno, J. Lutfy, Youssef Tahiri, Omar Fouda Neel, M. Gilardino
Background With the associations between investigators and funding sources becoming increasingly complicated, conflicts of interest may arise that could potentially cause biases in the reporting of results. Objective To determine the number of published plastic surgery articles that lack reporting of disclosures. Methods An online review of four major North American plastic surgery journal publications from January 1, 2007 to December 31, 2007, was performed. For identification and to provide anonymity, journals were assigned a letter from A to D. Results Of the 1759 articles reviewed, 726 (41%) were included. Disclosure was not reported in 368 (51%) articles: Journal A (n=10, 3%), Journal B (n=153, 85%), Journal C (n=193, 93%) and Journal D (n=12, 32%). Journals differed significantly in their reporting of disclosure (P<0.01). Conclusion In the plastic surgery journals reviewed, the lack of documentation of disclosures was frequent. To ensure identification of bias in plastic surgery publications, a section dedicated to disclosure statements is recommended for each published article.
随着研究人员和资助来源之间的联系变得越来越复杂,可能会出现利益冲突,这可能会导致结果报告中的偏见。目的确定已发表的整形外科文章中缺乏披露性报道的数量。方法对2007年1月1日至2007年12月31日北美地区4种主要的整形外科杂志进行在线综述。为便于识别和匿名,期刊编号为a ~ d。结果在1759篇综述文章中,726篇(41%)被纳入。368篇(51%)文章未报道披露:期刊A (n=10, 3%)、期刊B (n=153, 85%)、期刊C (n=193, 93%)和期刊D (n=12, 32%)。不同期刊对信息披露的报道差异有统计学意义(P<0.01)。结论在所查阅的整形外科期刊中,披露文献的缺失是常见的。为了确保在整形外科出版物中发现偏见,建议在每篇发表的文章中都有一个专门的披露声明部分。
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引用次数: 0
Revisiting Gavello's procedure for single-stage reconstruction of the earlobe: The vascular basis, technique and clinical uses 重述Gavello的单期耳垂重建手术:血管基础、技术和临床应用
IF 0.7 4区 医学 Q Medicine Pub Date : 2012-05-01 DOI: 10.1177/229255031202000210
Background Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello's procedure was one of the earliest. Objective To revisit Gavello's procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice. Methods The authors discuss the vascular basis of Gavello's flap, and describe the clinical application of the single-stage Gavello's procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe. Results Excellent cosmetic results have been achieved in all different clinical situations in the authors' experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area. Discussion Gavello's procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite. Conclusion The simple, century-old Gavello's procedure is still of great value for reconstruction of earlobe defects of diverse etiology.
耳垂畸形或缺失可能是先天性的,也可能是由于外伤、咬伤、烧伤或肿瘤切除而获得的。各种单阶段和两阶段的耳垂重建程序已被描述,其中加韦洛的程序是最早的一个。目的结合皮瓣的血管供应情况,回顾Gavello手术,探讨该技术在临床中的应用价值。方法讨论了Gavello皮瓣的血管基础,并介绍了单期Gavello手术在先天性耳垂缺失、烧伤后耳垂畸形和外伤性耳垂截肢等不同临床情况下的临床应用。结果根据作者的经验,在所有不同的临床情况下都取得了良好的美容效果,保留了耳垂的形状和体积,颜色匹配良好,供体区瘢痕隐藏良好。Gavello的手术是一种简单的单阶段手术,完全依靠局部组织进行耳垂重建;皮瓣有可预测的血管供应,不需要皮肤移植,该程序可用于较大的缺陷。耳后乳突区域上方完整的供体区域是先决条件。结论简单易行、已有百年历史的Gavello手术对多种病因耳垂缺损的修复仍有重要价值。
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引用次数: 0
Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome 尺短截骨治疗尺嵌塞综合征的疗效分析
IF 0.7 4区 医学 Q Medicine Pub Date : 2012-02-01 DOI: 10.1177/229255031202000112
C. Fulton, R. Grewal, K. Faber, J. Roth, B. Gan
Background Ulnar-sided wrist pain is a common problem in the upper extremity. It affects a broad patient population and can be difficult to treat. Ulnar impaction syndrome (UIS) is major cause of ulnar-sided wrist pain and a number of different operations have been used to correct it, including ulnar shortening osteotomy (USO). Objective To retrospectively review functional outcomes and complication rates of USO for UIS at the Hand and Upper Limb Centre (London, Ontario) over a two-year period. Methods Twenty-eight patients who underwent USO between 2007 and 2009 participated in the present study. Ulnar variance pre- and post-surgery was assessed using standard radiographic examination. Patient-rated outcomes were measured using a visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) survey for functional outcomes. Objective grip strength and range of motion were compared with the contralateral extremity. Results On average, USO achieved a 3.11 mm reduction in ulnar variance. Nonunion occurred in five patients and required a secondary bone grafting procedure. All USO eventually healed. Overall, pain improved by 47.2% and the mean DASH score after surgery was 37.21. Flexion, extension and supination range of motion decreased by 10° compared with the unaffected side. Eleven patients (39%) elected to undergo a second surgery for hardware removal. Patients receiving compensation from the Workplace Safety and Insurance Board experienced significantly higher residual pain (VSA 5.24 versus 1.97) and disability levels (DASH 60.23 versus 25.70). Smokers also experienced worse outcomes in terms of pain (VSA 4.43 versus 2.36) and disability (DASH 51.06 versus 29.67). In this cohort, smoking was not associated with a higher rate of nonunion. Conclusion USO is effective in reducing pain in UIS and improves disability, at the price of a small decrease in range of motion. Smokers and people receiving compensation from the Workplace Safety and Insurance Board, however, have significantly worse subjective outcomes (VAS and DASH), but similar objective outcomes (range of motion).
背景尺侧腕关节疼痛是上肢常见的问题。它影响广泛的患者群体,并且可能难以治疗。尺侧嵌塞综合征(UIS)是导致尺侧腕关节疼痛的主要原因,有许多不同的手术可以矫正,包括尺侧缩短截骨术(USO)。目的回顾性评价在安大略省伦敦市手上肢中心(London, Ontario)接受USO治疗的2年多来UIS患者的功能结局和并发症发生率。方法对2007 ~ 2009年间行USO手术的28例患者进行研究。术前和术后用标准放射检查评估尺侧变异。使用视觉模拟量表(VAS)测量疼痛,使用手臂、肩膀和手的残疾(DASH)调查测量功能结果。目的与对侧肢体握力和活动范围进行比较。结果USO术后尺侧方差平均减小3.11 mm。5例患者出现骨不连,需要进行二次植骨手术。所有USO最终都痊愈了。总体而言,疼痛改善了47.2%,术后平均DASH评分为37.21分。与未受影响的一侧相比,屈伸和旋后活动范围减小了10°。11例患者(39%)选择进行第二次硬体取出手术。从工作场所安全与保险委员会获得补偿的患者经历了明显更高的残余疼痛(VSA 5.24 vs 1.97)和残疾水平(DASH 60.23 vs 25.70)。吸烟者在疼痛(VSA 4.43 vs 2.36)和残疾(DASH 51.06 vs 29.67)方面也经历了更差的结果。在这个队列中,吸烟与较高的骨不连率无关。结论USO能有效减轻UIS患者的疼痛,改善残疾,但活动范围较小。然而,吸烟者和接受工作场所安全与保险委员会(Workplace Safety and Insurance Board)补偿的人的主观结果(VAS和DASH)明显更差,但客观结果(活动范围)相似。
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引用次数: 22
The medical information age 医疗信息时代
IF 0.7 4区 医学 Q Medicine Pub Date : 2003-06-01 DOI: 10.4172/PLASTIC-SURGERY.1000358
John R Taylor
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引用次数: 0
期刊
Plastic Surgery
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