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Plastic surgery - part 6

Thứ cấp để nút khu vực di căn Điều trị a. Nonoperative i. Ưu tiên trong hầu hết các trường hợp và nhiều bệnh nhân được quản lý khá tốt ii. Độ cao và hỗ trợ đàn hồi là những trụ cột điều trị - máy nén liên tục có thể có lợi ích iii. | 5. Secondary to regional node metastases 4. Treatment a. Nonoperative i. Preferable in most circumstances and many patients are managed quite well ii. Elevation and elastic support are the mainstays of therapy intermittent compression machines may be of benefit iii. Use of steroids controversial iv. Benzopyrones may be of benefit in high protein lymphedema V. Antiparasitic medications are indicated when appropriate vi. Systemic antibiotics and topical antifungal medications are often required b. Surgical management i. Ablative procedures usually involve excision of tissue and closure with a flap or skin graft ii. Attempted re-establishment of lymphatic drainage by microvascular techniques has shown early improvement but is prone to high late failure rate. May offer hope for patients with secondary lymphedema in the future CHAPTER 7 BIBLIOGRAPHY LOWER EXTREMITY 1. Heller L. and Levin S.L. Lower extremity micro surgical reconstruction. Plast Reconstr Surg. 2001 108 1029-41. 88 CHAPTER 8 THERMAL INJURIES Thermal destruction of the skin results in severe local and systemic alterations. This destruction can occur from thermal energy chemical reactions electricity or the response to cold. The management of the patient with a major thermal injury requires understanding of the pathophysiology diagnosis and treatment not only of the local skin injury but also of the derangements that occur in hemodynamic metabolic nutritional immunologic and psychologic homeostatic mechanisms. I. BURNS A. Pathophysiology Amount of tissue destruction is based on temperature 40 C and time of exposure Fig. 8-1 B. Diagnosis and prognosis 1. Burn size of total body surface area TBSA burned a. Rough estimate is based on rule of 9s Fig. 8-2 b. Different charts are required for adults and children because of head-chest size discrepancy and limb differentials for ages birth to seven years Fig. 8-3 and 8-4 Fig. 8-1 89 Fig. 8-2 90 BURN SHEET NAME NUMBER BURN RECORD ACCS - BIRTH -7 Vi DATE OF .