sábado, 6 de junio de 2015

Cirugía Plástca / Plastic surgery

Embolismo graso como una complicación rara de liposucción de gran volumen en un paciente de cirugía plástica
Fat Embolism as a Rare Complication of Large-volume Liposuction in a Plastic Patient.
J Fu X, Gao S, Hu Z, Guo Y, Cai J.
Forensic Sci Med 2015;1:68-71
Fat embolism is a dreaded complication in of procedures of multiple disciplines including plastic surgery. As the popularity of liposuction increases, cases of pulmonary embolism after liposuction are increasingly reported. However, documents of cerebral embolism after liposuction are rarely presented. The degree of disability with respect to Fat fat Embolism embolism Symdrome syndrome (FES) is a Gordian Knot in the evaluation of legal medicine. Therefore, it is of great significance for us to that we report the case of a 30-year-old woman who underwent a large-volume liposuction that resulted in serious complications, especially cerebral embolism. Untypical symptoms of fat embolism hamper the clinical diagnosis, particularly after a surgical procedure such as liposuction. Such a seldom-seen case would easily trigger medical disputes, especially in countries like China suffering increasing claims of medical malpractice and, medical negligences and lawsuits. Detailed descriptions of this case are presented below along with the discussion of the clinical symptoms and the diagnostic approaches to fat embolism.
Keywords: Cerebral embolism, complication, fat embolism, liposuction
Revisión sistemática de los principios éticos en la literatura de cirugía plástica
A systematic review of ethical principles in the plastic surgery literature.
Chung KC, Pushman AG, Bellfi LT.
Plast Reconstr Surg. 2009 Nov;124(5):1711-8. doi: 10.1097/PRS.0b013e3181b98a9f.
BACKGROUND: This purpose of this study was to perform a systematic review to identify articles that discuss ethical issues relating to the field ofplastic and reconstructive surgery and to evaluate whether ethical issues are underrepresented in the plastic surgery literature. METHODS: Four medical databases were selected to search through the medical literature with specific inclusion criteria to disqualify irrelevant articles from the study. Appropriate articles were extracted, and their quality and validity were assessed by multiple investigators to maximize reproducibility. The data were then synthesized and analyzed for associations among the ethical principles. RESULTS: Of a total library search of more than 100,000 plastic surgery-oriented articles, only 110 clearly focused on ethical principles. Autonomy (53 percent) was the most common major theme, whereas distributive justice (15 percent) represented the least frequently emphasized ethicalprinciple. The proportions of each ethical principle were tested against each other for equality using Cochran's Q test; the Q test reached statistical significance (Q = 67.04, df = 3, p < 0.0001), indicating that the ethical principles were not discussed equally in plastic surgery literature, which was expected because autonomy represented 53 percent of the articles, whereas distributive justice represented only 15 percent of articles. When examining both major and minor themes, more than half of the articles (61 percent) addressed two or more ethical principles. Beneficence and nonmaleficence were strongly associated (Pearson's chi = 55.38, df = 1,p < 0.0001). CONCLUSION: Despite the extensive number of ethical issues that plastic surgeons face, a relatively small proportion of plastic surgery literaturewas dedicated to discussing ethical principles.
El caso contra la quimioprofilaxis para Prevención de Tromboembolismo Venoso y la Justificación de SAFEAnesthesia.
The Case against Chemoprophylaxis for Venous Thromboembolism Prevention and the Rationale for SAFEAnesthesia.
Swanson E.
Plast Reconstr Surg Glob Open. 2014 Jul 9;2(6):e160. doi: 10.1097/GOX.0000000000000116. eCollection 2014.
SUMMARY: The Venous Thromboembolism Prevention study concludes that anticoagulation is effective in reducing the risk of thromboembolism in patients who are identified as higher risk by Caprini scores. This report critically assesses the statistics used in the Venous Thromboembolism Prevention study, its method of data presentation, and its conclusions. The usefulness of risk stratification and the value of anticoagulation-both prevailing concepts in risk reduction today-are challenged. Actual data show that chemoprophylaxis has no proven benefit in plastic surgery. Complications of anticoagulation predictably include excessive bleeding and hematomas, which may be serious and life-threatening. Several large published series of patients undergoing elective plastic surgery under total intravenous anesthesia have shown a much reduced risk of thromboembolism. A SAFE (Spontaneous breathing, Avoid gas, Face up, Extremities mobile) anesthesia method is discussed as a safer and more effective alternative to traditional general endotracheal anesthesia and anticoagulation. The choice for plastic surgeons is not between a venous thromboembolism and a hematoma. The choice is between a thromboembolism and adjusting our anesthesia and surgery habits to reduce the risk to a baseline level.
Anestesia y Medicina del Dolor
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