Colorado Needle Research Articles

Colorado Needle Assisted Cross-Leg Flap

Lower limb injuries are most commonly due to road traffic accidents which cause lower limb defects.The management of lower limb fractures is guided by the Gustilo-Anderson classification of injuries. Simple leg defects are covered by localflap and complex defects by free flap. Complex defects of the lower limbs which were unfit for free flap require management by conventional cross leg flap. Colorado needle allows meticulous dissection of flaps due to the sharp tip and increases the efficiency in raising the flaps.

Tonsillitis Index: Classification, Epidemiology, Prevention of Tonsillitis and Different Tonsillectomy Techniques for Recurrent Acute Tonsillitis

Tonsils function as a defense system and aid in keeping your body free of infections. About 5% to 40% of cases of tonsillitis are caused by bacterial infection, which is the most frequent cause of the condition. There are several different forms of tonsillitis, including viral tonsillitis and bacterial tonsillitis, which is brought on by bacteria like streptococcal pharyngitis. Tonsil redness and swelling are its symptoms. Tonsils that are covered in white or yellow patches or have a sore throat, swallowing problems, fever, swollen tonsils, etc. There are just a few treatment options, including surgery to remove the tonsils, medication such NASIDs and antibiotics, and home remedies. A tonsillectomy is a surgical procedure that totally removes the tonsil. Different methods are used to accomplish it. Any method of tonsillectomy is acceptable as long as the crypts are kept open and some tonsil tissue is left behind, including laser, radiofrequency, shaver, coblation, bipolar scissor, and Colorado needle. Even the finest surgeon will have a postoperative haemorrhage because bleeding is a possibility with all surgical methods. After cold dissection with ligature or suturing, there is the least chance of haemorrhage. A increased risk of late bleeding exists with all "hot" procedures using laser, radiofrequency, coblation, mono- or bipolar forceps. In seriously afflicted infants with recurrent tonsillitis, an antibiotic allergy, PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis), and peritonsillar abscess, total extracapsular tonsillectomy is still advised. It affects the patients' immunity.

Comparison of Colorado Needle Electrocautery and Traditional Scalpel for Upper Eyelid Blepharoplasty Incision: A Randomized Controlled Trial and Systematic Review.

A systematic review was performed to review the outcome with the conventional method (scalpel) and other methods in upper blepharoplasty procedures. Further, a prospective intraindividual randomized controlled trial was conducted to compare the efficacy of Colorado needle electrocautery and the scalpel in upper blepharoplasty. Study outcomes included scar quality at different times until 1-year postoperation, bleeding during incision, and postoperative ecchymosis. Five articles met the inclusion criteria for this systematic review. The prospective randomized controlled trial study included 30 patients; the average incisional time on the electrocautery side was significantly longer than that on the scalpel side, and the electrocautery side had less blood loss during incision than the scalpel side (2.4 versus 3.27 using average cotton bud sticks, respectively) (P < 0.001). Hypopigmented scarring occurred more frequently on the scalpel side; however, the difference was not statistically significant. Colorado needle electrocautery pure cutting mode can be an alternative to traditional scalpel for upper eyelid blepharoplasty skin incision because of long-term scar quality. Electrocautery use has hemostatic benefits, leading to a decrease in bleeding that can obscure the incision site. However, the incision time on the electrocautery side was significantly longer than the scalpel side, which may be owing to an adaptation of surgical technique.

A Technique for Minimizing the Need for Hemotransfusion in Non-Syndromic Craniosynostosis Surgery.

Surgery for craniosynostosis is associated with excessive blood loss, as well as morbidity and mortality risks. This study investigated the effectiveness of a surgical technique for nonsyndromic craniosynostosis intervention in controlling bleeding, assessed based on the volume of blood transfused. The cohort included 73 children who underwent nonsyndromic craniosynostosis surgery during a 3-year period. Retrospective evaluation of patient parameters included sex, weight, and age at the time of surgery; type of craniosynostosis; duration of surgery; hemoglobin concentration before and after surgery; rate of transfusion; and volume of transfused blood (mL/kg). The surgical technique involved skin incision and subgaleal dissection using electrocautery with a Colorado needle tip. The pericranium was not removed but instead kept in situ, and orbiectomy was performed using piezosurgery. Of the 73 children in the cohort, 75.3% underwent fronto-orbital advancement and were included in the analysis. The average age was 10.9 months (range: 4-96 months), with 68.5% boys and 31.5% girls (P < 0.001). The most common type of craniosynostosis was trigonocephaly (57.5%), followed by scaphocephaly (19.2%). The mean duration of the surgery was 2 hours and 55 minutes. Blood transfusion was needed in 56.2% of patients, with a mean volume of 8.7 mL/kg body weight transfused intraoperatively. No complications or fatalities were observed. These results suggested that meticulous, continuous control of homeostasis is paramount in minimizing blood loss during surgical repair of nonsyndromic craniosynostosis.

Comparison of Colorado Microdissection Needle Versus Scalpel Incision for Aesthetic Upper and Lower Eyelid Blepharoplasty.

Traditionally, eyelid skin incisions with electro-cautery devices have been avoided due to the concerns of aesthetically unacceptable scar formation. The purpose of this study is to compare ecchymosis, cosmesis, and histologic tissue damage of incisions made with a scalpel or Colorado needle in patients undergoing upper and lower aesthetic blepharoplasty. To the best of authors' knowledge, no previous study has been performed before to compare these 2 modalities in aesthetic blepharoplasty surgery. This is a multicenter, prospective, interventional, comparative case series. The study protocol was approved by Institutional Review Board in each institution. Patients underwent bilateral upper and/or transcutaneous lower blepharoplasty with 1 side randomly selected for skin incision with the scalpel, the other side with the Colorado needle. Ecchymosis was evaluated using a 10-point Likert scale and the wounds using a Hollander score. The margins of excised tissues were evaluated histologically. A total of 254 eyelids of 101 patients were included in the study. No significant difference was observed in ecchymosis on postoperative day 1 and 7 and scar cosmesis on day 30 and 180 between the 2 techniques. Histologically, necrosis was noted only with the Colorado needle sides (p = 0.001). No adverse events occurred on the Colorado needle side at any time after surgery. No clinical difference is noted between Colorado needle and scalpel incisions in terms of ecchymosis and scar cosmesis after aesthetic blepharoplasty.

Does Surgical Technique Influence Post-Tonsillectomy Haemorrhage? Our Experience

Introduction and objectivesTonsillectomy represents one of the main surgical procedures for the otolaryngologist, with haemorrhage being the most common postoperative. The objective of this study was to determine the post-tonsillectomy haemorrhage rate, and relate the surgical technique, diagnosis and patient age. MethodsThis was a retrospective study, from April 2012 to January 2014, covering 429 patients. We used the following surgical-dissection techniques: cold, Colorado needle and monopolar forceps. Haemostasis was carried out in every case with monopolar forceps and gauze compression. ResultsPost-tonsillectomy haemorrhage rate was 6.99%. According to the surgical technique used, with Colorado needle dissection, the bleeding rate we found was 7.07%; with monopolar forceps dissection, the rate was 20.4%; and with cold dissection, 2.9%. Of all haemorrhages, only 9 (2.09%) needed reintervention, of which 40% were performed with monopolar forceps dissection. The group with the largest bleeding rate was that of more than 14 years old. The diagnosis most associated with bleeding was peritonsillar abscess. ConclusionThe lowest bleeding rate was found with cold dissection and monopolar forceps haemostasis (2.09%). Consequently, based on our experience and the results obtained in the study, we consider that surgical technique does influence post-tonsillectomy haemorrhage.

¿Influye la técnica quirúrgica en las hemorragias postamigdalectomía? Nuestra experiencia

Introduction and objectivesTonsillectomy represents one of the main surgical procedures for the otolaryngologist, with haemorrhage being the most common postoperative. The objective of this study was to determine the post-tonsillectomy haemorrhage rate, and relate the surgical technique, diagnosis and patient age. MethodsThis was a retrospective study, from April 2012 to January 2014, covering 429patients. We used the following surgical-dissection techniques: cold, Colorado needle and monopolar forceps. Haemostasis was carried out in every case with monopolar forceps and gauze compression. ResultsPost- tonsillectomy haemorrhage rate was 6.99%. According to the surgical technique used, with Colorado needle dissection, the bleeding rate we found was 7.07%; with monopolar forceps dissection, the rate was 20.4%; and with cold dissection, 2.9%. Of all haemorrhages, only 9 (2.09%) needed reintervention, of which 40% were performed with monopolar forceps dissection. The group with the largest bleeding rate was that of more than 14 years old. The diagnosis most associated with bleeding was peritonsillar abscess. ConclusionThe lowest bleeding rate was found with cold dissection and monopolar forceps haemostasis (2.09%). Consequently, based on our experience and the results obtained in the study, we consider that surgical technique does influence post-tonsillectomy haemorrhage.

Tonsillitis and sore throat in children.

Tonsillitis and sore throat in children.

Percutaneous Electrocauterization (Electrosclerotherapy) to Treat Cutaneous Hemangioma- our experience in Apollo Hospitals Dhaka

Introduction Percutaneous Electrosclerotherapy technique for the treatment of cutaneous hemangioma is introduced as an alternative and minimally invasive treatment mode. The aim of the study was to evaluate the response of percutaneous electrosclerotherapy on cutaneous hemangioma, as monotherapy or in adjunct to surgery. Materials and Methods Fourteen patients with 10 females and 04 males underwent percutaneous electrosclerotherapy for the treatment of cutaneous hemangioma mostly on head and neck in Plastic and Cosmetic Surgery department of Apollo Hospitals Dhaka from January 2009 to June 2010. Percutaneous Electrosclerotherapy was applied through a Colorado needle with an intention to cauterize the bulk of the lesion at the tip of the needle but not burning the skin. Pre and post operatively the size of the lesions were measured to see the percentage of regression. Results Percutaneous Electrosclerotherapy was done in all 14 cases. Most of the lesions (78%) were smaller in size (&lt;5cm) and the site was mostly in head and neck (57%), more than half of the patients (57%) got significant benefit from this procedure. The regression of size is mostly in children &lt;10 years which is noted in about 65%. The only complication found was overlying skin necrosis due to burn in 35% of patients which was managed usually by simple dressing and antibiotics with complete healing. Conclusion Percutaneous Electrosclerotherapy is effective monotherapy for smaller hemangioma and prior to surgery to reduce the volume, operation time, bleeding, as well as post operative scar. It can be done easily with minimal hospital stay, less cost and complication DOI: http://dx.doi.org/10.3329/pulse.v5i2.20262 Pulse Vol.5 July 2011 p.26-30

Erkrankungen der Gaumenmandeln im Kindesalter

Die Operation an den Gaumenmandeln ist im Kindesalter eine der haufigsten, und oftmals ist es der erste chirurgische Eingriff bei einem kleinen Patienten. Seit der medienwirksamen Haufung an Todesfallen von Kindern nach Tonsillektomie in Osterreich 2006 kommt es langsam zu einem Paradigmenwechsel in Deutschland. Da jedoch klare Leitlinien fehlen, werden Eingriffe an den Tonsillen je nach Landkreis und Vorlieben sehr inhomogen gehandhabt. In einigen Kreisen werden 8-mal so vielen Kindern die Gaumenmandeln entfernt wie in anderen. Kinder unter 6 Jahren sollten nur noch bei andauernden bakteriellen Mandelentzundungen komplett tonsillektomiert werden. Die Teilentfernung der hyperplastischen Mandeln, die Tonsillotomie, ist wesentlich risikoarmer und der Tonsillektomie vorzuziehen. Die Blutungsgefahr und die postoperativen Schmerzen sind bei der Tonsillotomie deutlich geringer als bei der Tonsillektomie. Die Tonsillotomie kann mit dem Laser, Radiofrequenzgerat, Shaver, Coblation, bipolarer Schere oder monopolarer Nadel durchgefuhrt werden. Entscheidend ist, dass die Krypten offen bleiben und lymphatisch aktives Gewebe in der Fossa tonsillaris zuruck bleibt. Die Indikation zur Tonsillektomie besteht weiterhin bei rezidivierenden bakteriellen Infekten, Antibiotikaallergie, PFAPA Syndrom (periodisches Fieber, Apthen, Pharyngitis, Adenitis) und Peritonsillarabszess (einseitig). Bei den rezidivierenden Tonsillitiden kommt es auf die Schwere und die Haufigkeit an. Bei Kindern bis zum Alter von 16 Jahren sollte man sich an die Paradise Kriterien halten: Eine Indikation zur klassischen, kompletten Tonsillektomie besteht bei 5 oder mehr Tonsillitiden in mindestens 2 aufeinander folgenden Jahren oder bei 7 oder mehr Tonsillitiden innerhalb eines Jahres. Die Diagnose Tonsillitis kann klinisch gestellt werden. Sie besteht bei Schmerzen, tonsillarem Exsudat und Fieber>38,3°C. Wandernder Schmerz, niedrigeres Fieber und Husten lassen eher an eine Viruspharyngitis denken. Im Zweifel sollte ein Abstrich oder Antigentest angelegt werden. Beim Abstrich oder Antigen-Schnelltest muss aber berucksichtigt werden, dass Viren, Bakterien und Pilze zur transienten Mundflora gehoren und 10% aller Kinder klinisch inapparente, nicht behandlungsbedurftige Dauerausscheider von Streptokokken sind. Screeningtests mittels Antistreptolysintiter, Abstrichen oder Schnelltests (wie von manchen Kindertagesstatten gefordert) sind daher sinnlos und rechtfertigen keine Antibiotikatherapie. Die akute, bakterielle Tonsillitis sollte mit nicht steroidalen Antirheumatika (z. B. Ibuprofensaft), Betalactamantibiotika (z. b. Penicillin oder Cefuroxim) und bei Kindern und Jugendlichen auch oralem Steroid (z. B. Dexamethason) behandelt werden. Hinsichtlich der Verkurzung des Krankheitsverlaufes und der Reduktion der Symptome ist die Kurzzeittherapie mit Azithromycin (20mg/kg KG) fur 3 Tage oder Clarithromycin und einem Cephalosporin fur 5 Tage der Langzeit Penicillintherapie ebenburtig. Auch das fruhzeitige Absetzen der Penicilline nach 5 Tagen zeigte keine Nachteile im Krankheitsverlauf, der Rezidivrate oder der Resistenzbildung. Aber nur die empfohlene 10 Tage Antibiotikatherapie senkt die Inzidenz des rheumatischen Fiebers (derzeit 0,5 Falle pro 100 000 Kinder in Europa) und der Glomerulonephritis signifikant. Hauptproblem bei der Tonsillektomie ist, neben dem Schmerz, die gefurchtete Spatnachblutung. Diese kann bis zum kompletten Abheilen der Wunde (i. d. R. nach drei Wochen) auftreten und lebensbedrohlich sein. Grosere Massenblutungen kundigen sich oft durch kleinere, spontan sistierende Blutungen an. Daher muss jede Nachblutung ernst genommen und der betroffene Patient stationar aufgenommen werden. Die Patienten und die Eltern sind uber das korrekte Vorgehen bei Nachblutung idealerweise vor der Operation, aber spatestens bei Entlassung, schriftlich zu informieren. Das Informationsblatt sollte Adressen, Notruftelefonnummern und Ansprechpartner enthalten. Schwere oder letale Verlaufe entstehen meist durch falsches Management der Nachblutung. Eine besondere Lebensgefahrdung besteht bei Kleinkindern, die ein geringes Blutvolumen haben und relativ viel Blut unbemerkt schlucken konnen, bzw. aspirieren. Fur den Notarzt stellt die Intubation einer massiven Nachblutung nach Tonsillektomie eine extreme Herausforderung dar, welche oft nur mit einem geeigneten starren Tonsillensauger bewerkstelligt werden kann. Alle Operationstechniken haben ein Risiko der Nachblutung und selbst der erfahrenste Operateur ist nicht davor gefeit. Jedoch zeigte die „Kalte Dissektion“ mit Ligatur oder Umstechungen die geringsten Nachblutungsraten. Nach Laser-, Coblations-, mono- oder bipolaren Techniken kommt es signifikant haufiger zu schweren Nachblutungen. Kinder mit Gerinnungsstorungen bluten haufiger nach und konnen praoperativ unentdeckt bleiben. Eine standardisierte Blutungsanamnese (17 Punkte Checkliste), wie von den Fachgesellschaften fur Padiatrie, Anasthesie und HNO empfohlen, ist sensitiver und einfacher als das Screening mittels Gerinnungsparametern. In der Realitat zeigt sich jedoch, dass in Deutschland sehr viele der operativ-tatigen HNO Arzte weiterhin harte Laborwerte wie INR und PTT bevorzugen, obwohl diese den haufigen Von-Willebrand-Faktormangel nicht detektieren ­konnen.

Thermal Damage Influences Endonasal Dacryocystorhinostomy Success

Objective: To compare the success rates of two surgical methods of endonasal dacryocystorhinostomy (DCR) at the stage of ostium creation. In procedure 1, a Colorado needle is used to create the mucosectomy, while in procedure 2 no heated instruments are applied to the mucosa. Methods: A total of 173 patients (218 eyes) underwent endonasal DCR between 2006 and 2009. Efficacy was assessed by a fluorescein endoscopic test at 6 months of follow-up. Results: The success rate in group 2 was higher than in group 1 (91 vs. 81%, p < 0.05). Conclusions: We have found a significant difference, which supports that a ‘cold’ surgical technique may be better than the use of heated instruments.

Eyelid splitting and extirpation of hair follicles for treatment of trichiasis

Abstract Purpose To review the background for developing the surgical technique of eyelid splitting and extirpation of hair follicles for treatment of acquired trichiasis, to demonstrate the technique, and to highlight its indications, advantages and complications. Methods Personal experience is used to demonstrate the technique, its indications, advantages and complications. This includes the follow‐up data of 12 eyelids of 8 consecutive patients who were treated by splitting the eyelid margin using radiosurgical technique and others where the splitting of the lid margin was performed using CO2 laser or Colorado needle. This was followed by extirpation of the hair follicles of the trichiatic eyelashes using surgical microscope. Results Complete recovery of the trichiatic eyelashes at the site of the treatment occurred in most eyelids. There were no complications during or after healing of the surgical wound during the follow‐up period. Conclusion Eyelid splitting and extirpation of hair follicles provides a simple and relatively rapid modification of the surgical treatment for acquired trichiasis, with good functional results.

The short pulse carbon dioxide laser versus the colorado needle tip with electrocautery for upper and lower eyelid blepharoplasty

Various techniques for blepharoplasty have been described, including those performed with the assistance of the short pulse carbon dioxide laser and those performed with the assistance of the Colorado microdissection needle attached to an electrocautery unit. Although the superiority of the carbon dioxide laser to cold steel has been demonstrated for the performance of eyelid blepharoplasty, no studies have ever compared the carbon dioxide laser to the Colorado needle. This is a paired comparison study in which 12 healthy patients underwent bilateral blepharoplasty of their upper and/or lower eyelids by a single surgeon. For each patient, a short pulse carbon dioxide laser was used on one side, and a Colorado needle attached to an electrocautery unit was used on the other. Intraoperative times were recorded. At five post-operative visits patients were evaluated for post-operative healing parameters including edema, erythema, scar width, and bruising. Finally, excised tissue was assessed histologically for thermal damage. Comparing both techniques, no difference in patient or physician-measured parameters of healing were noted up to 1 month post-operatively. However, Colorado needle assisted blepharoplasty resulted in slightly shorter intraoperative times. It also resulted in less thermal damage on a histologic level, although these differences were not clinically significant. For the performance of blepharoplasty, the Colorado needle tip with electrocautery offers benefits equivalent to those of the short pulsed CO2 laser but has the advantage of shorter intraoperative times and lower cost.

Introduction to the special dermatology issue

Lasers in Surgery and MedicineVolume 40, Issue 2 p. 65-66 IntroductionFree Access Introduction to the special dermatology issue Richard E. Fitzpatrick MD, FAACS, Richard E. Fitzpatrick MD, FAACS Guest EditorSearch for more papers by this author Richard E. Fitzpatrick MD, FAACS, Richard E. Fitzpatrick MD, FAACS Guest EditorSearch for more papers by this author First published: 27 February 2008 https://doi.org/10.1002/lsm.20622AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1 White MW, Makin IRS, Slayton MH, Barthe PG, Gliklich R. Selective transcutaneous delivery of energy to porcine soft tissues using intense ultrasound (IUS). Laser in Surg Med 2008; 40: 67– 75. 2 Alvarez N, Ortiz L, Vicente V, Alcaraz M, Sänchez-Pedreño P. The effects of radiofrequency on skin: experimental study. Lasers in Surg Med 2008; 40: 76– 82. 3 Ash C, Town G, Bjerring P. Relevance of the structure of time-resolved spectral output to light-tissue interaction using intense pulsed light (IPL). Laser in Surg Med 2008; 40: 83– 92. 4 Fitzpatrick R, Bernstein E, Iyer S, Brown D, Andrews P, Penny K. A histopathologic evaluation of the plasma skin regeneration system (PSR) versus a standard carbon dioxide resurfacing laser in an animal model. Laser in Surg Med 2008: 93– 99. 5 O'Dey DM, Prescher A, Poprawe R, Gaus S, Stanzel S, Pallua N. Ablative targeting of fatty-tissue using a high-powered diode laser. Laser in Surg Med 2008; 40: 100– 105. 6 Barolet D, Boucher A. LED photoprevention: reduced MED response following multiple LED exposures. Laser in Surg Med 2008; 106– 112. 7 Dierickx CC, Khatri KA, Tannous ZS, Childs JJ, Cohen RH, et al. Micro-fractional ablative skin resurfacing with two novel erbium laser systems. Laser in Surg Med 2008; 40: 113– 123. 8 Gonzalez MJ, Sturgill WH, Ross EV, Uebelhoer NS. Treatment of acne scars using the plasma skin regeneration (PSR) system. Laser in Surg Med 2008; 40: 124– 127. 9 Park JM, Tsao H, Tsao S. Combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation among Asian patients. Laser in Surg Med 2008; 40: 128– 133. 10 Goldberg DJ, Berlin AL, Phelps R. Histologic and ultrastructural analysis of melasma after fractional resurfacing. Laser in Surg Med 2008; 40: 134– 138. 11 Karsai S, Pfirrmann G, Hammes S, Raulin C. Treatment of resistant tattoos using a new generation Q-switched ND: YAG laser: influence of beam profile and spot size on clearance success. Laser in Surg Med 2008; 40: 139– 145. 12 Chan HH, Yu CS, Shek S, Yeung CK, Kono T, Wei WI. A prospective, split face, single-blinded study looking at the use of an infrared device with contact cooling in the treatment of skin laxity in Asians. Laser in Surg Med 2008; 40: 146– 152. 13 Sõmucler R, Vlk M. Combination of ER: YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma. Laser in Surg Med 2008; 40: 153– 158. 14 Rokhsar CK, Ciocon DH, Detweiler S, Fitzpatrick RE. The short pulse carbon dioxide laser versus the Colorado needle tip with electrocautery for upper and lower eyelid blepharoplasty. Laser in Surg Med 2008; 40: 159– 164. Volume40, Issue2February 2008Pages 65-66 ReferencesRelatedInformation

Nonresective Shrinkage of the Septum and Fat Compartments of the Upper and Lower Eyelids: A Comparative Study with Carbon Dioxide Laser and Colorado Needle

Nonresective Shrinkage of the Septum and Fat Compartments of the Upper and Lower Eyelids: A Comparative Study with Carbon Dioxide Laser and Colorado Needle

Nonresective Shrinkage of the Septum and Fat Compartments of the Upper and Lower Eyelids: A Comparative Study with Carbon Dioxide Laser and Colorado Needle

Nonresective Shrinkage of the Septum and Fat Compartments of the Upper and Lower Eyelids: A Comparative Study with Carbon Dioxide Laser and Colorado Needle

Nonresective Shrinkage of the Septum and Fat Compartments of the Upper and Lower Eyelids: A Comparative Study with Carbon Dioxide Laser and Colorado Needle

The purpose of this article is to describe an alternative nonresective treatment of the fat-septum component of the eyelids during blepharoplasty, using shrinkage desiccation with two low-energy modalities: a carbon dioxide laser and a low-range grid of electrocautery with a Colorado microdissection needle. Thirty-six patients underwent a four-lid blepharoplasty. During surgery, after exposure (not opening) of the septum and assessment of the amount of bulging by gentle globe compression, a grid spray of electrocautery (right eye) and carbon dioxide laser (left eye) was applied over the entire septum until shrinkage and correction of the bulging was achieved. Preoperative, postoperative day 15, and 1-year follow-up photographs were evaluated using an objective grading system by blinded surgeons. For statistical analysis, the Wilcoxon matched-pairs signed-ranks test was used, with p < 0.05 indicating statistical significance. All the patients completed the 15-day evaluation, but only 32 completed the 1-year follow-up. No major eye or eyelids complications were observed. There were no statistical differences in surgical time and postoperative pain on either side. In this study, laser fat-septum shrinkage achieved substandard results compared with electrocautery when analyzed as a continuous variable, but it did not influence the categorical Strasser scale final result in the short- and long-term follow-up. The method described is simple and safe, and provides a subtle but long-lasting, adequate result. No statistical clinical differences were observed between the electrocautery and laser fat-septum shrinkage techniques.

Reduction of transfusion rates in the surgical correction of sagittal synostosis.

As public concern about the risks of blood transfusions increased in the mid-1990s, avoidance of transfusions became a goal of surgery for sagittal synostosis. This study was performed to confirm a hypothesized reduction in transfusion rates in recent years and to identify factors associated with both the need for transfusion and low postoperative levels of hemoglobin. Sagittal synostosis operations performed in children between 1986 and 1999 were reviewed retrospectively. Patients underwent a minimum of vertex strip craniectomy and parietal craniectomies. There were 118 patients whose median age at surgery was 4.2 months. The primary end point for analysis was defined as either the receipt of a blood transfusion or a postoperative level of hemoglobin less than 70 g/L. Forty-two percent of patients (95% confidence interval [CI] 31-52%) treated before 1996 and 11% of patients (95% CI 0-23%) treated from 1996 onward received blood. The reduction in the blood transfusion rate in later years was, in part, related to the acceptance of a lower postoperative hemoglobin level, often below 70 g/L. A univariate analysis showed that the only patient or surgical factors that correlated with reaching the primary end point in a statistically significant manner were the year of surgery and the extent of surgery. A logistic regression of the age and weight of the child, length of surgery time (from skin opening to skin closure), preoperative hemoglobin level, extent of surgery, and surgeon against the primary end point revealed that the best predictor of the need for a blood transfusion or the presence of a postoperative hemoglobin level lower than 70 g/L was the extent of surgery (beta = 1.4, standard error of the beta statistic = 0.44). Once the extent of surgery was accounted for in the model, no other covariates significantly improved the model. Techniques implemented to minimize blood loss since 1995 included the following: use of the Colorado needle for scalp incision, selection of the Midas Rex craniotome for cranial cuts, and application of microfibrillar collagen. Postoperative hemoglobin was allowed to decrease to 60 g/L if the child was stable hemodynamically, before blood was administered. There were no cardiovascular, wound healing, or infectious complications, and no surgeries were repeated for cosmetic reasons. Low blood transfusion rates were achieved using simple intraoperative techniques and by accepting a low level of postoperative hemoglobin.