摘要:

Seventy-three plastic surgeons reported 60 early and late mammary implant infections among 54,661 implantations. Smooth, textured, and polyurethane-coated implants had similar infections rates (respectively, 0.06%, 0.16%, and 0.12% for augmentations and 0.6%, 0.4%, and 0.3% for reconstructions including revisions and expansions). Insertion routes and implant placements had no influence on infection rates. Causative bacteria included Staphylococcus aureus and S. epidermidis, Streptococci A and B, enterobacteria, Klebsiella, Pseudomonas, and mycobacteria. Most surgeons followed a regimen of topical and/or systemic prophylaxis. Some (˜20%) used the Dolsky insertion sleeve. Whereas smoking, obesity, and diabetes did not significantly predispose to infection, the following did: skin atrophy and scarring, corticosteroids in subglandular augmentation, additional simultaneous surgery, pregnancy, preceding lactation, and vigorous exercising, massage, and trauma postsurgically. Few late implant infections were recorded resulting from bacterial milk duct invasion or hematogenously from antecedent infection foci. The need for and the possibilities of preventive measures are critically discussed.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The use of intraluminal steroids in double-lumen breast implants is effective in preventing fibrous capsular contraction around the implant. This technique has not been accepted widely, however, and remains controversial primarily because steroid-related complications, including extrusion, late inferior migration, and atrophy of the skin, have been associated with their use. This nonrandomized retrospective study of 76 patients (146 breasts) who underwent submuscular augmentation of the breast through inframammary and periareolar incisions compares results after total musculofascial coverage of the implant with partial muscle coverage of the implant. In patients with partial muscle coverage of the implant, 7.8% steroid-related complications were observed. In the group with total musculofascial coverage of the implant, no steroid-related complications and no symptomatic contractions of the capsule were observed. Our study suggests that total musculofascial coverage provides a statistically significant margin of protection from steroid-related complications compared with techniques using only partial muscle coverage of the implant in patients who underwent cosmetic augmentation mammaplasty.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The influence of maxillary advancement by osteotomy on speech was examined in 10 patients with cleft palates (6 males, 4 females). Ages at the time of surgery ranged from 16 to 26 years (mean, 19.5 yr). LeFort I and II osteotomies were performed in 9 patients and 1 patient, respectively. Preoperatively and postoperatively, hypernasality, nasal emission on pressure consonants, and articulation disturbances were evaluated perceptually, and velopharyngeal function was evaluated by lateral cephalographic and nasopharyngoscopic studies. Hypernasality, which had been judged preoperatively to be absent or slight in 1 patient each, remained unchanged after surgery, whereas the remaining 8 patients showed increased hypernasality after surgery. Nasal emission showed a similar tendency. Articulation errors were not improved postoperatively. Lateral cephalograms recorded from the patients with increased hypernasality showed increases in the shortest palatopharyngeal length and in the soft-palate-length–to–pharyngeal-depth ratio. Also, deterioration in velopharyngeal closure was noted postoperatively compared with preoperatively by nasopharyngoscopy in the majority of patients with increased hypernasality.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Premature fusion of all major cranial and facial sutures, termed pancraniofacial synostosis by us, was first described as “Kleeblattschädel deformity,” but can also be found in anomalies such as Crouzon's disease, Apert's syndrome, Pfeiffer's syndrome, and severe forms of plagiocephaly. This rare craniofacial anomaly often presents an immediate threat to life right after birth. Early subtotal craniectomy frequently combined with frontoorbitofacial advancement must be performed to decrease intracranial pressure, preserve vision, and open up the blocked upper airway. Concomitant hydrocephaly is shunted preoperatively for internal decompression. Eleven patients with pancraniofacial synostosis underwent craniofacial surgery in infancy or early childhood. Only shunting of the hydrocephalus was done in 1 child. Two children died in the course of an emergency procedure and 2 children died after secondary operations for miniplate removal and revision of a valve shunting the hydrocephalus several months after the initial successful craniofacial surgery. The remaining 8 children have developed satisfactorily so far. Further corrective surgeries had to be performed in 2 patients. Good functional and aesthetic improvement could be obtained. In view of the high mortality especially after emergency procedures, we believe that early total craniofacial mobilization should be reserved for severe cases where the natural course is dismal without immediate intervention and temporary procedures such as shunting and tracheostomy are not sufficient. Elective surgeries after the age of 3 months can be performed safely in milder cases.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Sternal osteomyelitis is an uncommon but serious complication of the median sternotomy incision. Between 1982 and 1990, 160 patients with sternal osteomyelitis and wound dehiscence were treated with sternal debridement and pectoral muscle flap closure at The Toronto Hospital. Most of these wound infections were clinically obvious, and the need for surgical treatment apparent. In a small number of patients, however, the extent of the infection was more difficult to determine clinically. In this subset of patients, the interpretation of the bone–gallium scan was important in determining the presence or absence of bone infection and the probability of successful treatment without surgery. In this study, we review our findings at the time of surgery and compare them with the preoperative information available from the bone–gallium scan. The limited literature on this topic is reviewed. In this group of patients, we found the bone–gallium scan was not helpful in clinical management.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Although the surgical goals of phalloplasty in female-to-male transsexuals have repeatedly been described, the requests by the patients themselves have never been assessed and evaluated properly. To obtain information on their desiderata in this matter a questionnaire was sent to 200 subjects. The answers in the 150 returned questionnaires made us conclude that the 79 subjects (52%) who seek phalloplasty express the following requests as to their external genitalia: a scrotum (96%), a glans (92%), rigidity (86%), and an aesthetically appealing look either while wearing a tight swim suit (91%) or being nude (81%). All but 1 patient wanted to be able to void in a standing position. We add minimal disfigurement and no functional loss in the donor area as two of the goals of phalloplasty.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In phalloplasty, the use of transplants and implants to obtain sufficient rigidity allowing for sexual penetration is difficult and often has resulted in complications and failure. Resorption, curving, and fracture of autologous cartilage and bone transplants are reported, and rigid implants have a tendency to erode and extrude. Besides, a constantly rigid phallus may serve as a source of embarrassment to the patient. On the other hand, hydraulic prostheses frequently show mechanical failure compared with nonhydraulic implants. For these reasons, some authorities have their patients use external devices for erection. Others fully rely on edema, scar fibrosis, or congestion to give sufficient rigidity. In this review, the literature on baculum implantation—on the use of external devices as well as on the use of no stiffener at all—is discussed.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

An experimental study, in 20 rabbits, of free (i.e., nonvascularized) versus vascularized fat tissue transfer was undertaken. The purpose was to study the biochemical and histological changes in the two types of fat grafts compared with normal fat tissue over a period of 16 weeks. The left inguinal fat pad was transferred freely to the contralateral side; the right inguinal fat pad was transferred to the left side where the pedicle was anastomosed to the left femoral artery and vein. Macroscopically, at all postoperative times, the transferred free fat had a harder consistency, was more adherent to the surroundings, and was less pliable than the vascularized fat, which was similar to normal fat. Histologically, free fat tissue displayed near complete degeneration at 2 and 4 weeks, but recovered to essentially normal appearance by 16 weeks. Apart from some degeneration evident at 2 weeks, vascularized fat tissue retained a normal histological appearance to 16 weeks. Biochemical analysis demonstrated minor increases of collagen deposits in free fat grafts, but negligible changes were observed in the vascularized fat grafts. Free fat grafts were significantly dehydrated relative to the vascularized fat grafts and control fat (p<0.01). Based on these findings, we suggest that the clinical use of vascularized fat tissue transfer would be preferable in most circumstances to free fat transfer.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The study of preserved porcine skin was done by using splitthickness skin grafts of pigs weighing approximately 25 to 30 kg. The harvesting of split-thickness skin grafts was performed under aseptic and antiseptic conditions. The povidone-iodine solution and 0.25% acidified sodium hypochlorite solution were used before immersion of the skin in 90% glycerine solution. Prepared skin graft was stored in the freezer compartment of a home refrigerator. Serial studies of the bacteriology and the histology of specimens were performed monthly for 12 months. No bacterial organisms were found during the study. The integrity of the skin lasted up to 5 months, however, the property of the preserved skin was as good as the other biological dressing even after 6 months. This simple, low-cost procedure is useful for restoring allografts or even autografts in a hospital without conveniences or adequate facilities.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Steam presses pose an occupational hazard to workers in the dry cleaning industry. Three patients with thermal burns to the hand from steam press accidents were recently treated at this institution. Each patient sustained deep second and third degree burns to the dorsum of the hand. Two patients required split-thickness skin grafts and have retained full range of motion and returned to full employment. One patient sustained destruction of extensor tendons and required a groin flap for coverage. Late tendon reconstruction will be necessary. Investigation revealed that older steam press models do not have an emergency release lever in case of accidental closure on a worker's hand. Although newer models are equipped with a thigh-activated emergency release lever, a contact burn remains likely if the press closes on the operator's hands. Some of the newest models have an attached safety bar that prevents the press from closing on the operator's hands. It is recommended that older models either be modified with the attachment of a safety bar or replaced entirely.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID