摘要:

The survival of bacteria was evaluated in custom-made saline breast implants with integral injection ports in vitro and in 10 New Zealand White rabbits forStaphylococcus aureus, Staphylococcus epidermidis, Pseudumonas aeruginosa, andSerratia marcescens. Pseudomonas and Serratiasurvived in vitro in saline-filled implants and multiplied 24-fold and 22-fold, respectively, from the initial inocula of 300 colony-forming units per cubic centimeter in 21 days.Serratiaalone survived in saline implants placed on the dorsum of rabbits, proliferated 80-fold in 7 days, and tapered to 10-fold at the end of 3 weeks. Chemical analysis revealed the presence of glucose in fluid from the implants in the animal study (mean, 1.2 mg per deciliter; standard error of mean [SEM], 0.6) after 21 days and from human subjects (mean, 3.8 mg per deciliter; SEM, 1.0) after 8 months to 10 years.Serratiaincubated in human breast implant fluid samples proliferated 7-fold to 30-fold greater than in the saline control in a nonaerated environment. We conclude that some bacteria are able to proliferate in saline in breast implants. Furthermore, their survival may be facilitated by a substance (i.e., glucose) that diffuses across the implant outer shell.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Recent anecdotal reports have indicated that a high percentage of saline implants harbor dangerous microbes. These reports have caused considerable alarm and fear to saline implant recipients. Reports in the literature of microbial growth in saline implants are infrequent. The expander implant offers an ideal opportunity to study the internal milieu of saline implants in vivo. The study shows that, if used properly, saline implants do not become infected. In this study, 45 expander implants were studied under clinical conditions. No evidence of microbial contamination of the saline was found.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Silicone breast implants have been used since 1962. Reliable methods to detect rupture and silicone get bleed are needed, even more so because of increasing concern about the possible hazards of silicone. In cases in which clinical examination is not conclusive, additional radiodiagnostic evaluation may be useful in diagnosing intracapsular and extracapsular rupture of mammary prostheses. In the series presented, combined ultrasound and mammography shows a sensitivity for prosthesis rupture of 64% and a specificity of 81%. Silicone gel bleed cannot be detected by means of clinical examination or by combined mammography and ultrasound.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

An analysis is made of 81 patients with severe blepharoptosis who underwent correction with autogenous fascia. In case of severe blepharoptosis, which means a levator function of less than 5 mm, correction by levator resection gives insufficient results. Better results are obtained by frontalis suspension, whereby the upper eyelid is connected to the frontalis muscle using fascia lata strips according to Crawford. The operative technique is described in detail. Particular interest has been paid to the width of the vertical lid fissure and symmetry between both upper eyelids after operation. The overall results were rated satisfactory to excellent with an average of 9 mm of postoperative vertical lid fissure. Comparison of the results of unilateral versus bilateral blepharoptosis correction revealed better results in the group of bilateral ptosis correction. In 76% of the bilateral patients, there was an asymmetry of less than 0.5 mm between both palpebral fissures, while in the unilateral group this result was achieved in only 35% of the cases. Symmetry is difficult to achieve in the unilateral group, especially when the vertical lid fissure of the nonptotic eye is 10 mm or more. In these eases, correction of both upper eyelids should be considered. The best time to operate on patients with severe congenital blepharoptosis is around the age of 4 to 5 years, because lagophthalmus after operation is better tolerated and the leg has developed sufficiently to provide an adequate amount of fascia. The correction of severe blepharoptosis by frontalis suspension with autogenous fascia shows a high rate of success and few complications.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The authors present a rhomboid design for the tubed inguinal flap mainly nourished by the superficial circumflex iliac vessels and the superficial inferior epigastric vessels. The length and width of the flap are mathematically determined based on the perimeter and length of the fingertip soft-tissue defect, respectively. The rhomboid tubed inguinal flap was used in the treatment of 21 patients with a variety of fingertip injuries. The thumb was involved in 12 patients and other digits in 9 patients. A complication, flap necrosis, occurred in one obese female patient and osteomyelitis of an amputated phalangeal bone developed in another. In all other patients, the rhomboid tubed inguinal flap healed uneventfully and provided satisfying results with minimal donor site morbidity. As a secondary procedure in thumb injuries, four neurovascular island flaps and one wraparound flap from the great toe were done for improved sensation. The precisely tailored rhomboid flap, with a safe and abundant vascular pedicle, allows for effective reconstruction of the fingertip with easy primary closure and minimal morbidity of the donor site.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Microvascular free tissue transfer has become a very reliable reconstructive technique. Occasionally, flap compromise will occur and will require urgent flap reexploration. In the setting of complete thrombosis of pedicle vessels, thrombectomy using Fogarty #2 and #3 catheters can be effective in restoring vascular patency. Seven flaps with arterial, venous, or both vessel thrombosis were managed with thrombectomy at the time of reexploration and anastomotic revision. Six of the flaps were completely salvaged and the seventh was partially salvaged. Promptness in reexploration increased the likelihood of complete flap salvage. The use of postthrombectomy heparinization was associated with a 50% complication rate in this series. Thrombectomy of free flap vessels can be safely performed and is associated with a low incidence of rethrombosis.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We have demonstrated previously that acute nerve compression produces ischemia/reperfusion injury in rat sciatic nerve. In this study, we evaluated the effects of deferoxamine, an antioxidant, on recovery from ischemia/reperfusion injury after nerve compression. The sciatic nerves of male Sprague-Dawley rats, 370 to 430 g, were subjected to 24 hours of compression with Silastic tubing. The control group received intravenous saline solution at the time of decompression. The therapeutic group received intravenous deferoxamine (50 mg per kilogram) at the time of removal of the Silastic tubing. Nerve tissues within and distal to the compression site were assayed for malondialdehyde (MDA) levels and for growth-associated protein 43 (GAP-43) expression, as markers of ischemia/reperfusion injury and nerve regeneration, respectively. In the control group (injury alone), the MDA levels were three times higher than normal during the initial 10 days and returned to normal by 14 days. In contrast, the deferoxamine treatment group had MDA levels that were not significantly different from precompression levels. In the control group, enhanced GAP-43 expression persisted until late in the recovery period. In the deferoxamine treatment group, the increased GAP-43 expression subsided early. The results suggest that the treatment of compressed peripheral nerve with deferoxamine at the time of surgical decompression reduces ischemia/reperfusion injury.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

It is well known that calvarial bone autografts are the bone grafts that are the least reabsorbant and have the best long-term evolution in craniofacial surgery. However, they do have certain limitations: (1) reabsorption results in repeated surgery and the need for new donor areas, (2) a limited amount of autogenous cranial bone is available (due to avoiding areas close to cranial sutures and venous sinuses, and because the temporal bone is very fragile and the cranium has not fully developed in children), and (3) graft extraction increases surgical time and morbidity. Because of this, we present an alternative to calvarial bone autografts: cryopreserved allografts. This paper is an experimental prospective study carried out on sheep with the following goals: (1) to assess the behavior of calvarial onlay bone grafts cryopreserved at −80°C, using fresh autografts implanted under the same conditions as controls; (2) to compare reabsorption percentages statistically over time; and (3) to study qualitatively any histological variations. The results obtained are (1) more reabsorption of allografts when compared to autografts (at 90 days, 21.97% versus 20.21% of grafted volume), although this difference is not statistically significant; (2) a reduction in height in all onlay grafts as a consequence of the loss of the diplöe; (3) the absence of any type of inflammation caused by a reaction to cryopreserved allografts; and (4) bone substitution performed using frozen allografts is histologically similar to that using fresh autografts.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The purpose of this study was to evaluate third-year medical students' knowledge of and exposure to cleft palate before and after a rotation in plastic surgery. A 26-item questionnaire was administered to 37 students before and after their 12-week rotation that included the evaluation and management of patients with cleft palate. The questions addressed various aspects of the disorder, including identification of the members of a cleft palate team. Students were also asked about their clinical and academic exposure to cleft palate. When the students' responses to the 19 basic information items about cleft palate and associated problems were compared before and after the rotation, positive changes were documented for 14 of the 19 questions, minimal negative changes for 4, and no change for 1 question. The overall percentage of students indicating any type of clinical or academic exposure to cleft palate increased significantly after the rotation. Findings from this study suggest that an undergraduate clinical rotation in plastic surgery can increase the knowledge of and exposure to cleft palate. It was clear that supplemental learning can occur in other settings outside the classroom through interactions between faculty and students without additional curricular time.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Penile skin inversion is the method of choice for vaginoplasty in male-to-female transsexuals. Rectosigmoid neocolpopoiesis should be considered only when penile skin inversion has become impossible or has not led to functional results. In this paper we describe our technique and the results of colocolpopoiesis in 7 male-to-female transsexuals.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID