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Objective: To evaluate the efficacy of the senior author's technique of staged reconstruction in patients with recalcitrant oronasal fistulas. Design: A retrospective review of the Pediatric Plastic Surgery Cleft & Craniofacial Surgery Database of cases from September 2013 to December 2018 was conducted. Patients: A total of 31 patients who had previously undergone >1 surgical attempt to repair a fistula or patients who have failed >1 attempt at bone graft were included in this study. All patients were referrals from outside facilities. Main Outcome Measures: Primary outcomes examined included fistula recurrence, infection rates, ability to proceed with second stage bone grafting after first stage fistula takedown and reconstruction, and bone graft loss. Results: Charts of 1053 patients were reviewed and 31 (2.94%) cases met inclusion criteria for this study. Nineteen (61.3%) of these patients proceeded with the second stage of reconstruction and 100% did not experience any graft loss. Seven patients who completed the first stage are undergoing orthodontic optimization prior to bone grafting. The remaining 5 are adult patients not interested in pursuing bone grafting. All 31 patients with recurrent and recalcitrant fistulas had successful fistula reconstruction with our approach, despite multiple previous failed reconstructions. Conclusions: The 2-staged reconstructive approach described herein effectively resulted in resolution of prior recurrent recalcitrant fistulas and resulted in eventual bone grafting. By employing this technique, we report successful fistula repair and bone grafting in patients who had previously undergone multiple surgical reconstructions. [ABSTRACT FROM AUTHOR]

Background: Opioid drugs have been a mainstay medication for the management of postoperative pain for several decades; however, in recent years there has been a push towards investigating alternative treatment options. Although ketorolac has been widely used by other medical and surgical specialties for analgesia, its utilization in plastic surgery has been widely debated.Objectives: The purpose of this study was to investigate the efficacy of ketorolac as an adjunct in postoperative pain management.Methods: The authors performed a retrospective review of patients who underwent implant-based breast reconstruction after mastectomy between January 2012 and December 2016. Other risk factors, such as chronic anticoagulation, aspirin, or coagulopathies, were documented as well.Results: There were 198 patients who met the inclusion criteria. The results demonstrated that patients who received ketorolac utilized significantly fewer narcotics than patients who did not: 80 mg vs 108.8 mg (P = 0.002), respectively. The results showed that patients who received ketorolac had a decreased length of hospitalization: 1.9 days vs 2.1 days (P = 0.04), respectively.Conclusions: Generous narcotic prescribing has received greater scrutiny in recent years. Aside from the risk of increased narcotic availability in the community, the side effects of nausea, puritis, and constipation delay patient recovery. These data show that patients who received ketorolac have a decreased length of hospital stay and lower narcotic use, suggesting ketorolac may be a safe and cost-effective adjustment to a multi-modal pain control regimen postoperatively.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of the senior author's technique of staged reconstruction in patients with recalcitrant oronasal fistulas., Design: A retrospective review of the Pediatric Plastic Surgery Cleft & Craniofacial Surgery Database of cases from September 2013 to December 2018 was conducted., Patients: A total of 31 patients who had previously undergone >1 surgical attempt to repair a fistula or patients who have failed >1 attempt at bone graft were included in this study. All patients were referrals from outside facilities., Main Outcome Measures: Primary outcomes examined included fistula recurrence, infection rates, ability to proceed with second stage bone grafting after first stage fistula takedown and reconstruction, and bone graft loss., Results: Charts of 1053 patients were reviewed and 31 (2.94%) cases met inclusion criteria for this study. Nineteen (61.3%) of these patients proceeded with the second stage of reconstruction and 100% did not experience any graft loss. Seven patients who completed the first stage are undergoing orthodontic optimization prior to bone grafting. The remaining 5 are adult patients not interested in pursuing bone grafting. All 31 patients with recurrent and recalcitrant fistulas had successful fistula reconstruction with our approach, despite multiple previous failed reconstructions., Conclusions: The 2-staged reconstructive approach described herein effectively resulted in resolution of prior recurrent recalcitrant fistulas and resulted in eventual bone grafting. By employing this technique, we report successful fistula repair and bone grafting in patients who had previously undergone multiple surgical reconstructions.