摘要:

Patients with metastatic melanoma (AJCC stage IV) generally have a very poor prognosis (median survival, 6–8 months). Combination chemotherapy is often the treatment of choice. Despite the higher response rates of a number of new combination regimens, the median duration of response ranges from 6 to 9 months, with no significant survival advantage. To evaluate whether surgical resection of residual metastases after chemotherapy can improve survival, we conducted a retrospective analysis of all patients enrolled on various chemotherapy protocols for metastatic melanoma at Yale between March 1987 and March 1993. We identified 16 patients who underwent surgical resection of residual disease after receiving one to four cycles of combination chemotherapy. Sites of metastases included regional and distant lymph nodes, skin, subcutaneous tissue, lung, and liver. No patients had brain or bone metastases at the initiation of therapy and performance status (PS) was 0–1. Follow-up for these 16 patients ranges from 14 to 62 months (median, 35 months) from the start of chemotherapy. All 16 patients had either complete responses (CR = 3) or partial responses (PR = 7), or stable disease (SD = 6) after chemotherapy. Eleven patients are currently alive; 10 remain free of disease. A comparison group (control) of 14 patients was identified from the same retrospective analysis using similar clinical characteristics such as sites of metastases, PS, and cycles of chemotherapy. No patients underwent surgical resection either because of patient refusal or concomitant medical problems. None had evidence of disease progression (CR = 3, PR = 2, SD = 9) at the completion of chemotherapy. However, duration of survival in this group from the start of chemotherapy ranged from 4 to 45 months (median, 11.5 months). Twelve patients have died and 2 are currently alive, 1 of which has recurrent disease. Based on the comparison of these two groups, this report suggests that patients treated with neoadjuvant chemotherapy may benefit from surgical resection of residual metastases, and this approach should be studied further.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although conservative surgery should be the initial approach to pilonidal disease, there remains a select group of patients with recalcitrant disease who fail repeated interventions and for whom a more aggressive approach is justified. Use of a large gluteus maximus musculocutaneous flap to facilitate wide excision, to allow for primary closure with well-vascularized tissue, and to alter the anatomy of the gluteal cleft has been used in 5 patients with chronic recurrent recalcitrant disease. The use of this large muscle unit in these otherwise healthy adults has achieved control over their pilonidal disease with acceptable morbidity and no demonstrable functional sequelae.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A new experimental model of a vascular carrier to prefabricate a “secondary” island flap, the popliteal musculovascular pedicle, was developed in the rat. Using quantitative skin-surface fluorometry 30 minutes after sodium fluorescein injection and a flap survival area in the prefabricated 8 x 2.5-cm abdominal composite island flap, we compared the revascularization ability of our muscular carrier to nonrevascularized controls: the skeletonized arteriovenous pedicle and the fasciovascular pedicle. The free composite graft with no vascular carrier exhibited near-total necrosis. The skeletonized vascular pedicle demonstrated 15.2% 7.8% perfusion of normal skin on dye fluorescence index measurements and 50% flap survival. The fasciovascular pedicle exhibited better revascularization, with a dye fluorescence index of 36.2 15.5 (p< 0.01) and 90% 10% flap survival (p<0.001). India ink injection study and histological examination of our model provided visual evidence of revascularization from the musculovascular pedicle, along with preservation of the carrier's muscular architecture. The musculovascular pedicle is a reliable carrier for making new, vascularized composite flaps.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Endothelin-1, a peptide isolated from vascular endothelial cells, facilitates the constriction of vascular smooth muscle and various pharmacological actions including vasodilation, the proliferation of smooth muscle cells and fibroblasts, and the stimulation of arachidonic acid metabolism. In this study, plasma, urine, and blister fluid endothelin-1 concentrations were determined in burn patients and changes in vasoactive substances derived from endothelial cells secondary to burns were investigated. Plasma endothelin-1 concentrations in burn patients were significantly lower than those in healthy individuals at rest. However, extremely high blister fluid endothelin-1 concentrations were observed within 30 hours of a burn. The amounts of endothelin-1 excreted in urine by burn patients over 24 hours also were higher than those in healthy individuals. The finding of high concentrations of endothelin-1 in blister fluids suggests that endothelin-1 is produced at wound regions in burn victims. Clinically, it appears that endothelin-1 is involved in circulation at the wound surface or in the healing of burns.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We retrospectively reviewed all newborns with a diagnosis of myelomeningocele (MMC) admitted to our hospital between January 1990 and September 1994 to determine methods of soft-tissue coverage, complication rates, and results. Sixty-five patients underwent repair of thoracic, lumbar, or sacral MMCs. The average size of defect repaired measured 21.3 cm2(range, 2–80 cm2). Methods of repair included direct approximation of soft tissues with or without undermining (N = 48), Romberg-Limberg flaps (N = 8), gluteus maximus or latissimus dorsi musculocutaneous flaps (N = 5), fasciocutaneous flaps (N = 3), and V-Y advancement (N = 1). A total of 18 complications were recorded (27.7%). There were 5 major complications (7.7%) and 13 minor ones (20.0%). Major complications were defined as midline wound dehiscence overlying the neural elements or wound infection leading to meningitis or ventriculitis. All 5 major and 9 minor complications arose in patients undergoing direct soft-tissue approximation. Additionally, all major complications were recorded in defects >18 cm2. Based on this series, it appears that MMC defects <18 cm2can be closed by direct approximation of soft tissues without significant risk or major wound complication. Larger wounds may be successfully closed in this manner, but the risk of major complication is substantial.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We performed endoscope-assisted rectus abdominis muscle flap harvests on 2 patients with anterior chest wall defects. For the procedure, a spindle-shaped anterior fascia and the upper two-thirds of the rectus abdominis muscle were elevated endoscopically from an incision at the umblicus and transferred to the chest wall defect through a subcutaneous tunnel. Endoscopic harvest of the rectus abdominis muscle flap minimizes postoperative scarring caused by cutting off the flap, affording expectations of good cosmetic results. Furthermore, this surgical procedure is less invasive, relieves postoperative pain, and enables reduction of donor site morbidity.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Lunate excision alone is seldom utilized in the management of Kienbock's disease due to concerns about progressive carpal collapse following removal of this central carpal bone. We report a 32-year follow-up of a patient who underwent lunate excision only for treatment of Kienbock's disease with a successful outcome. Although lunate excision is thought to be associated with a high failure rate, a review of the literature suggests that success rates following lunate excision are comparable to those reported for other more conventional techniques such as radial shortening, ulnar lengthening, limited carpal fusions, and proximal row carpectomy. The current perception that lunate excision is associated with a high failure rate is not supported in the literature. As such, it may not be appropriate to assign this operation to the category of “historical interest only.”

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Congenital cleft of the earlobes is rarely seen among congenital ear anomalies. These clefts show a wide range of severity and localization, from simple notching to extensive tissue deficiencies. We developed a new technique that can be used in simple cases of earlobe cleft. For this technique, we use the anterior and posterior parts of the cleft as Y-V advancement flaps and achieve a three-dimensional construction of the lobe that is symmetrical with the opposite lobe.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Necrosis of skin and soft tissue as a complication of oral anticoagulation therapy is a rare condition with approximately 200 cases documented in the world. Coumadin-induced skin necrosis is a painful skin lesion, sudden, localized, initially erythematous or hemorrhagic, that becomes bullous and eventually culminates in gangrenous necrosis. It develops mainly in women around 50 years of age who are usually obese and have been treated for thrombophlebitis or pulmonary embolism. There seems to be a marked predilection for areas with increased subcutaneous fat content, such as breasts, thighs, and buttocks. The injury is so significant that plastic surgery is frequently required to repair the damaged tissue. The authors present four clinical cases of Coumadin necrosis, observed in two different institutions, and perform a literature review on the mechanisms that trigger the development of the disease. This condition still remains a diagnostic-therapeutic challenge.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID