摘要:

The use of the reverse latissimus dorsi muscle flap based on its paraspinous perforators for posterior trunk wound coverage has been described previously. However, few studies have reported its intrathoracic application. In this study the authors present their experience in treating 3 patients with various intrathoracic defects using the reverse latissimus dorsi muscle flap. There were 1 male and 2 female patients who ranged in age from 4 to 74 years (mean, 49 years). The etiology included an infected aortic graft, a bronchopleural fistula, and a recurrent congenital diaphragmatic hernia. Follow-up ranged from 2 to 24 months. Successful outcomes were achieved in all 3 patients, and there was no recurrence or wound complication identified. Their results demonstrate the versatility and reliability of the reverse latissimus dorsi muscle flap in treating low posterior intrathoracic defects.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Pectus excavatum has been most commonly corrected by either the sternal elevation or turnover methods. Both of these procedures require a long skin incision in the anterior chest wall. Endoscopic techniques have been introduced into the treatment of pectus excavatum since 1994 to minimize the skin incision to approximately 1 inch. Thirty patients with pectus excavatum (25 men and 5 women) underwent surgery employing the centimeter incision method assisted by the endoscope. The mean age at the time of surgery was 11.9 years (range, 4−45 years). The patients were classified as having one of three types of pectus excavatum: Type I (symmetrical and localized) was seen in 18 patients (60%), type II (symmetrical and diffuse) was seen in 5 patients (17%), and type III (localized or diffuse but asymmetrical) was seen in 7 patients (23%). Although the results of the thoracic cage correction achieved using our procedure were excellent overall, the results were best for type I, with clear improvement achieved in the funnel index—0.48 to 0.63. All of the patients recovered well without any severe complications, and both the patients and their families found the results obtained using this method to be quite satisfactory, especially because of the minimal postoperative scar.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The authors characterized the in vitro antibacterial properties of clinical doses of lidocaine on isolates of a variety of bacterial pathogens commonly encountered in the setting of nosocomial wound infection (Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, andStaphylococcus aureus) as well as a number of resistant strains of methicillin-resistant S. aureus and vancomycin-resistant enterococci. Time-kill studies were carried out on bacteria exposed to various clinical concentrations of lidocaine (0%, 1%, 2%, and 4%) with and without epinephrine (1:100,000). Minimum inhibitory concentrations and minimum bactericidal concentrations were determined for some strains using a broth macrodilution method recommended by the National Committee of Clinical Laboratory Standards. Lidocaine demonstrated a dose-dependent inhibition of growth for all strains of bacteria tested. The greatest sensitivity to lidocaine was shown by gram-negative organisms; the least sensitive wasS. aureus. The addition of epinephrine to the local anesthetic had no effect on the susceptibility of the bacteria to lidocaine. These observations suggest that the surgical benefit of local anesthesia may extend beyond its analgesic properties and may have a role in the prophylaxis and, in the case of methicillin- and vancomycinresistant bacteria, the treatment of surgical wound infection, mandating a wider application of this modality.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This prospective study was undertaken to assess the long-term stability of velopharyngeal perceptual speech ratings of patients with repaired cleft palate. All patients were evaluated and managed at the Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital. Patients alternately received palatoplasty with or without intravelar veloplasty. Two senior surgeons standardized their operative procedures and performed or supervised directly all operations. Perceptual speech and language evaluations were conducted by the same experienced speech pathologist when the children were 6 years old and 12 years or older. Data were analyzed from the 28 patients available for long-term follow-up. The intravelar veloplasty (N=14) and nonintravelar veloplasty (N=14) groups were similar with respect to cleft anatomy and mean age at palatoplasty and at the second perceptual speech evaluation. Evaluation of the 12-yearold and older ratings indicated that the overwhelming majority of patients improved or maintained clinical stability in perceptual ratings of velopharyngeal function. When assessing direction and magnitude of change (i.e., incremental improvement vs. deterioration), the intravelar veloplasty and nonintravelar veloplasty groups had a similar distribution of perceptual speech ratings at both the 6-year and 12-year or older speech evaluations. Results were consistent with previously published data from our center, that the intravelar veloplasty procedure did not affect demonstrably the incidence of postpalatoplasty auditory perceptual symptoms of velopharyngeal dysfunction.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A competent velopharyngeal mechanism is important for the production of normal speech, and the secondary procedure of a posterior pharyngeal flap (PPF) may be necessary in some patients to achieve this goal. A number of complications have been described in the literature following pharyngeal flap surgery. The purpose of this study was to examine short- and long-term complications after PPF surgery, and in particular the incidence and the end effect of nocturnal respiratory obstruction (NRO). All PPFs over a 17-year period performed at one institution and by the same surgeon were examined retrospectively. All medical records from the Commission of Handicapped Children of patients who had a PPF were reviewed. Patients with NRO were identified clinically, and sleep studies were administered with two or more of the clinical triad. During a 17-year period, 111 patients underwent a PPF to treat velopharyngeal incompetence. Twelve patients were identified with a syndromic association in addition to a clefting disorder, of which most (N=9) consisted of Pierre Robin syndrome. The median age at PPF performance was 6.0 years and the average follow-up was 7.4 years. The early postoperative complication rate was 10%, including a 7.2% incidence of respiratory obstruction and 0.9% postoperative bleeding. Twenty-one patients (19%) had late complications or unsatisfactory results. Twelve patients (10.5%) developed NRO, and patients with Pierre Robin syndrome were particularly prone—4 of 9 patients developed this complication. Nine of 12 patients with NRO had sleep studies performed with a minimum interval of 6 months postoperatively. Eight of the nine studies were normal. Of the NRO group, 3 patients had takedown of their PPF, including the patient with an abnormal sleep study. All 3 patients improved markedly and none developed recurrence of velopharyngeal insufficiency. NRO is not an uncommon finding in PPF patients, but NRO does not necessarily imply the presence of obstructive sleep apnea. The consequences of persistent NRO over the long term deserve further study.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Airway obstruction is frequent in patients with severe syndromic craniosynostosis, and must be treated for successful, complete care. The purpose of this study was to evaluate the incidence and the management of airway obstruction in patients with severe craniosynostosis. All patients with complex syndromic craniosynostosis at Chang Gung Craniofacial Center were evaluated retrospectively. Criteria for inclusion of patients were the presence of adequate follow-up and documentation. A total of 40 patients were included, of whom 13 had Apert's syndrome and 27 had Crouzon's disease. Clinical symptoms and signs related to airway obstruction and its treatment were evaluated carefully, and were verified further by telephone inquiry. The status of the airway was categorized into one of three groups: no obstruction; mild obstruction, for which positioning and medical treatment were needed; and severe obstruction, for which surgical intervention was needed. The results showed that 24 patients (60%) did not have airway obstruction, 11 patients (27.5%) had mild obstruction, and 5 patients (12.5%) had severe obstruction. There was no significant difference in the distribution of airway status between patients with Apert's syndrome and Crouzon's disease. Causes for the 5 patients with severe obstruction were midface hypoplasia, lower airway obstruction, tonsillar and adenoid hypertrophy, and choanal atresia. Tracheostomy was performed to control airway in 3 patients, and 1 patient died. Midface anterior distraction helped to decannulate 1 patient. In conclusion, airway obstruction was observed in 40% of patients with severe craniosynostotic syndromes. Most of them could be managed successfully with conservative or medical treatment, and surgical intervention should be considered on the basis of each patient's individual condition.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Primary repair of acute severed flexor tendons in zone II has replaced the “no-man’s-land” concept, which advocates secondary procedures. Primary repair can be difficult when there are severe soft-tissue and bony injuries, and may lead to unfavorable results. The authors describe a technique that is simple, quick, and safe, and eliminates the need for tendon harvesting or other secondary procedures. It can also be used when a flexor profundus tendon gap occurs due to the injury.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Improved shock therapy has extended the limits of survival in patients with massive burns, and nowadays skin coverage has become the major problem in burn management. The use of mesh skin grafts is still the simplest technique to expand the amount of available donor skin. However, very wide-mesh skin grafts take a very long time to heal, often resulting in unaesthetic scar formation. On the other hand, allogeneic cultured keratinocytes have been reported as a natural source of growth factors and thus could be useful to improve wound healing of these wide-mesh grafts. A clinical study was performed to compare the use of cryopreserved allogeneic cultured keratinocytes vs. the traditional cadaveric skin as a double layer over widely expanded autogenous skin grafts. This procedure was performed in 18 pairs of full-thickness burn wounds (with similar depth and location) in 11 severely burned patients. Early clinical evaluation was made at 2, 3, and 4 to 5 weeks. Parameters such as epithelialization, granulation tissue formation, infection, and scar formation were evaluated. Biopsies were taken to compare the histological characteristics of the epidermis, the epidermaldermal junction, and the dermis. Late evaluations were performed at 6 and 12 months regarding color, softness, thickness, and subjective feeling of the scar tissue. Aside from a faster (p<0.05) epithelialization in the keratinocyte group at 2 weeks, there were no statistically different results in any of the early evaluated parameters, neither clinically nor histologically. At long-term follow-up, clinical results and scar characteristics were not significantly different in the two compared groups. It is concluded from the results of this study that, during the early phase, epithelialization was faster with allogeneic cultured keratinocytes compared with cadaveric skin. However, taking into account the substantial difference in costs, the described use of cryopreserved allogeneic cultured keratinocytes as a double layer on meshed autogenous split-thickness skin grafts can hardly be advocated.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

As promising new therapy for congenital giant pigmented nevi, the authors investigated the potential use of an acellular autograft nevi-dermal matrix in combination with a split-thickness skin graft. To address whether the processed acellular nevi-dermal matrix from frozen skin could be reconstituted as a viable dermal base, the authors grafted it onto full-thickness skin defects in nude rats. Fibroblast infiltration and neovascularization into the acellular nevi-dermal matrix were observed. However, because the disappearance of the residual melanotic granules of the grafted dermis took 16 weeks, the authors excised with scissors the superficial layer of the acellular nevi-dermal matrix containing a large quantity of melanin. The apperance after using this method was relatively superior even compared with the fullthickness skin graft. The success of their experimental animal model using the acellular nevi-dermal matrix covered with splitthickness skin grafts confirms the potential value for the clinical application of this treatment for congenital giant nevi.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

During this experiment the authors investigated whether prolonged local use of verapamil or lidocaine prevents vasoconstriction and establishes better blood supply to the rat epigastric skin flap, hence reducing the necrosis that occurs otherwise. Abdominal wall skin flaps of 45 Sprague-Dawley rats, based on a single pedicle of the femoral vessels, were elevated. A subcutaneous pocket for the microport valve was created, and the adjacent catheter tip was sewn next to the femoral vessels. In the control and the two treatment groups, 0.5 ml saline or vasodilator solution respectively was injected through the microport every 12 hours for 5 days. On postoperative day 5 there was no statistical difference between the flap surfaces in all groups. The area of flap necrosis was significantly lower in the verapamil- (p=0.001) and the lidocaine-treated (p=0.012) groups vs. the control group as determined by analysis of variance with Bonferroni's post hoc test. In conclusion, topical application of verapamil and lidocaine solutions for 5 postoperative days decreased flap marginal necrosis significantly. Prolonged injection of vasodilators in the vicinity of the vascular pedicle prevents vasospasm and improves blood supply to the flap.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID