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Kent V Hasen

Publications and source records attributed to Kent V Hasen.

5 recordsLinked to original sources
PubMed2003

Extended approach to the vascular pedicle of the gracilis muscle flap: anatomical and clinical study.

Dissection of the proximal gracilis vascular pedicle proceeds in a dark tunnel-like space deep to the adductor longus. With the application of a previously described technique for an extended approach to the lateral arm free flap, the authors describe a novel technique that improves observation and thus facilitates dissection of the proximal gracilis vascular pedicle. A retrospective review of data for 18 consecutive patients who underwent gracilis muscle free flap harvesting with this modified technique between March of 1999 and October of 2001 was conducted, to assess flap viability and patient outcomes. A cadaveric dissection was also performed, to study the anatomical features of the region in depth and to test the proposed flap modification. After the standard incision has been made, the dominant pedicle is exposed on the medial aspect of the gracilis muscle, running in a fascial cleft between the adductor longus and the adductor magnus. Intramuscular branches to the adductor longus are divided. A space is bluntly created anterior and lateral to the adductor longus by separating the fibrous connections to the surrounding adductor and sartorius muscles on both sides of the vascular pedicle. The gracilis muscle is then divided and passed deep to the adductor longus, into this space. With this new position, the final dissection of the pedicle can easily be performed. The confluence of the venae comitantes is frequently encountered, providing a larger-caliber single vein for microvascular anastomosis. The ages of the patients ranged from 9 to 70 years. The majority (14 of 18 patients) had traumatic wounds. The free flap survival rate was 100 percent. One minor complication of a seroma at the donor site was observed. One major complication of venous thrombosis was detected on postoperative day 3, with complete flap salvage. No other complications were noted. This technique is safe and permits direct approach to and excellent observation of the proximal aspect of the gracilis pedicle, without the need for headlights or deep retractors. An additional benefit is the frequent finding of a single larger vein from the merging of the venae comitantes close to the deep femoral vessels.

Adolescent↗
PubMed2003

An outcome study comparing intravenous sedation with midazolam/fentanyl (conscious sedation) versus propofol infusion (deep sedation) for aesthetic surgery.

The purpose of this study was to determine the differences in measurable outcomes following aesthetic procedures performed under intravenous sedation with incremental doses of midazolam and fentanyl and those performed under propofol infusion. The authors' hypothesis was that the differences in these outcome parameters are not significant between these intravenous sedation protocols. All intraoperative and perioperative records of 84 consecutive patients having aesthetic surgery under a conscious sedation protocol using incremental doses of intravenous midazolam and fentanyl were retrospectively reviewed and compared with the records of a second group of 85 patients having aesthetic surgery under a deep sedation regimen based primarily on propofol infusion. All procedures were hospital based and performed by two surgeons. Twenty-eight different parameters were examined by chart review. In addition, a patient questionnaire was used to assess patient satisfaction and patient recall of operative and perioperative pain, anxiety, nausea, and vomiting. Multivariate statistical analysis was conducted. The two sedation groups were similar with regard to aesthetic procedures performed and patient demographics. The mean duration of operative time was statistically equivalent (152 minutes and 153 minutes). In both groups, there were minor adverse intraoperative events reported but no significant complications. Transient hypotension was more common in the propofol infusion group (12.9 percent versus 2.4 percent, p = 0.018), but no patient required intervention beyond reducing the sedative agent or increasing intravenous fluids. The amount of supplemental fentanyl given intraoperatively was significantly higher in the group whose primary agent for sedation was propofol infusion than the group who received midazolam/fentanyl (209 mug and 143 mug, respectively). The overall questionnaire response rate was 80 percent for both groups. The midazolam/fentanyl sedation group had more recall of "unpleasant intraoperative events" (17 percent versus 3 percent, p = 0.007). However, both groups had low recall of intraoperative pain, anxiety, and nausea. The propofol infusion group experienced significantly more nausea in the recovery room (p = 0.002), nausea at the time of discharge (p = 0.009), and nausea the evening after the operation (p = 0.013). Greater than 90 percent of the patients in both groups would have the same anesthetic in the future rather than undergo general anesthesia. Patient safety, outcomes, and satisfaction are similar in plastic surgery procedures performed under sedation protocols using either incremental doses of midazolam and fentanyl or propofol infusion. All operative and postoperative outcomes for pain, anxiety, and vomiting were similar in the two groups except for immediate postoperative nausea, which was higher in the propofol infusion group. The overall satisfaction of patients undergoing plastic surgery procedures under these intravenous sedation protocols appears very high.

Adult↗
PubMed2002

Plastic surgery: a component in the comprehensive care of cancer patients.

Plastic surgery represents a small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more radically treat cancer, offering patients the best opportunity for cure. Although the most convincing data for improved psychosocial well-being through plastic surgery is in the setting of breast cancer reconstruction after mastectomy, it is reasonable to assume that all patients who undergo major reconstruction to minimize deformity due to cancer therapy feel some improvement in quality of life. This article will provide an overview of the role of plastic surgery in cancer treatment.

Breast↗