ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The influence of air bags and other restraining devices on injury after motor vehicle collisions is not well defined. This study examined the relationship between the use of restraining devices and the incidence of extremity injuries in motor vehicle collisions. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990 through 1995. Criteria for submission included trauma patients who were admitted to the intensive care unit, who died during hospitalization, who were hospitalized for more than 72 hours, or who were transferred in or out of the receiving hospital. A total of 21,875 patients met these criteria. These patients were analyzed for the presence or absence of upper and lower extremity injuries and were compared based on their use of restraining devices. Restraining devices were categorized into four groups: air bag alone, air bag and seat belt, seat belt or carseat without air bag, and no restraining device. Statistical analysis was performed using the chi‐squared test of association. For contingency tables with small expected frequencies, Fisher's exact test was used. Study participants included 11,688 men and 10,185 women with a mean age of 38 ± 20 years. There were 16,033 drivers and 5,842 passengers. Air bags were deployed in 472 instances. In 297 of these cases, additional restraint was provided with a seat belt. In 6,632 cases, air bags were not deployed; however, patients were restrained with either a seat belt or a carseat. In 14,771 cases, patients were not restrained. When comparing restraining devices as a group vs. no restraint, there was a significant decrease in the incidence of upper (p= 0.018) and lower (p< 0.001) extremity injuries. Air bags, however, were associated with an increased incidence of both upper (p= 0.033) and lower (p= 0.002) extremity injuries when compared with no restraint or when compared among patients who were restrained. As a group, restraining devices decrease the incidence of upper and lower extremity trauma sustained by patients injured in motor vehicle collisions. Air bags, however, are associated with an increased incidence of upper and lower extremity injuries when compared with seat belts alone or when no restraining devices are used.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The delay phenomenon is sometimes relied on to increase survival of the transverse rectus abdominis musculocutaneous (TRAM) flap in high‐risk patients. TRAM reconstruction has then been performed traditionally 1 to 2 weeks after the delay procedure. The optimum time course from this surgical delay to flap elevation, as it relates to survival, has not been well studied— specifically whether the potential benefit of delay lessens at any particular time after the delay procedure. The authors examined the effects of varying time periods (up to 7 months) after delay, via division of the dominant bilateral superior epigastric vessels, on the viability of the TRAM flap in a rat model. TRAM flap survival improved significantly (p< 0.01) at all time points in delayed groups compared with a nondelayed control group. The benefit of delay in this model was maintained at all times, even long term. In conclusion, it may be possible to extend the delay period safely beyond the customary 1 to 2 weeks without compromising survival of the TRAM flap, which may prove to be more convenient.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The rectus abdominis muscle is a versatile muscle with many applications. The use of this muscle is often limited by its considerable donor site morbidity. This study reports a minimally invasive technique to harvest the rectus abdominis muscle. The described technique has been used successfully in 5 patients who required a superiorly based flap for reconstruction of a sternal defect. All patients have had long‐term flap survival and resolution of their sternal osteomyelitis. Although initially lengthy, harvest times have been less than 1 hour for the last 3 patients. Patients report minimal discomfort at their operative site. To date there have been no hernias or other complications. The rectus abdominis muscle can be harvested successfully endoscopically. With no other modification other than port site placement, this technique could be used to harvest free flaps or harvest inferiorly based rectus flaps. This technique is learned easily, is safe, and should reduce substantially the donor site morbidity associated with more traditional harvesting techniques.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Hydrodissection has long been used in plastic surgery to facilitate dissection. The addition of epinephrine to the solution is thought to add to hemostasis, whereas the use of local anesthetic reduces intraoperative pain. Removal of breast implants and the associated capsules can be a tedious procedure with adhesions between the capsule and the parenchyma brought about by the prolonged presence of the device. The use of a mixture of Ringer's lactate and lidocaine with epinephrine has been used in this group of patients. Its use is described along with the benefits and pitfalls of the technique.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;In 1990 the authors reported their preliminary study of the prevention of Frey's syndrome in 55 patients utilizing a superficial musculoaponeurotic system (SMAS) flap in parotid gland surgery. During the past 10 years, numerous studies have supported their original thesis that interposition of living tissue between the resected gland bed and the skin could prevent the development of this complication. The authors have expanded their own patient population and now consider this a definitive study on the prevention of Frey's syndrome. A total of 160 patients are presented with a follow‐up period of 5 to 22 years. All patients underwent subtotal or total parotidectomy performed by one of the authors. A history was acquired and testing for Frey's syndrome (Minor's starch iodine test) was performed. As a result of this approach, and in spite of the intensive search for it, no cases of Frey's syndrome were encountered. The hoped‐for secondary benefit of preventing the postparotidectomy retromandibular depression was somewhat less satisfactory, although most patients remain satisfied with their appearance. The debilitating symptoms in Frey's syndrome, which is reported to have an incidence of 5% to 50% in the typical parotidectomy patient, can be avoided with thoughtful preoperative planning. The authors favor an aesthetic incision followed by the development of an SMAS flap. The parotidectomy is then performed using the surgeon's preferred technique. The SMAS flap is then placed into the bed of the resected parotid gland. This institutes a protective tissue barrier guarding against the aberrant anastomotic communication between the postganglionic secretomotor fibers intended for the parotid gland, and the now adjacent sweat glands. Their patient population is large enough to provide significant evidence that Frey's syndrome can be prevented, compared with a meta‐analysis of parotid patients in multiple other studies in the literature. Assuming the patient's history and pathology does not preclude its use, the SMAS flap should be considered the standard of care for preventing Frey's syndrome in the postparotidectomy patient. If the SMAS flap is not available, a temporoparietal fascial flap has proved to be a good alternative.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Surgical procedures commonly associated with parenteral sedation or general anesthesia were completed in an office operating room with local anesthesia and oral medication. Diazepam and alprazolam were used in combination to produce a relaxed state, allowing local anesthesia to be instilled. Surgery was completed successfully in all patients, and no untoward effects were seen in the patients. Amnesia was associated with the drug combination, and a protective action of the long‐lived drugs against lidocaine toxicity is theorized.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Patency of the microvascular anastomosis is the most important requirement for tissue survival in free tissue transfer and in replantation. In efforts to improve on the standard suture method of microvascular anastomosis, new techniques such as limitedsuture sleeve anastomoses and histoacryl glue anastomoses have been employed experimentally. However, as a result of factors such as tissue toxicity and suboptimal outcome, cyanoacrylates have not enjoyed clinical use. In addition, sleeve anastomoses continue to utilize suture, increasing the risks of intimal damage, platelet adhesion, and thrombosis. In an attempt to surmount these problems, the authors investigated the use of a new 2‐octyl cyanoacrylate glue and a sutureless sleeve anastomosis. Anastomosis of 20 rat femoral arteries with a sutureless sleeve technique bonded with glue resulted in an 80% patency rate at 1 day to 3 weeks. Failures occurred in the first few attempts as the technique was evolving. These encouraging results suggest that 2‐octyl cyanoacrylate may have applicability in quick, sutureless microvascular anastomoses.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The rising popularity of autologous fat transfer (AFT) has raised the questions whether cryopreserved adipocytes are a suitable substrate for soft‐tissue augmentation, and which storage techniques may be most suitable for a maximally successful surgical result. An animal model of AFT was conceived using isogeneic Sprague‐Dawley rats. Suction harvesting of fat and subcutaneous implantation was performed with specimens stored at −16°C or 1°C for a period of 1 or 2 weeks, as well as a group that underwent immediate implantation. A histological comparison of the experimental and control groups clearly demonstrated a decrease in viable adipocytes and an increase in signs of inflammation and fat cell necrosis in those animals that received stored fat instead of immediate fat implantation. These changes became more severe with increased length of storage and the use of refrigeration over freezing. The authors conclude that the practice of storing harvested adipocytes for later injection is not supported by the experimental evidence and should be avoided.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Mandibular distraction osteogenesis (DO) has become an important technique to lengthen the hypoplastic mandible and to reconstruct osseous defects after ablative surgery. The hallmark of successful DO is the creation of new bone within the distraction gap. Several anecdotal reports have described alternating compressing and lengthening protocols (i.e., “pumping the regenerate”) to augment regenerate bone formation. The purpose of this experiment was to analyze formally the effects of an alternating compression/distraction protocol with a traditional distraction protocol. Ten adult male rats underwent unilateral mandibular osteotomy with placement of a custom distractor. After a latency period of 5 days, distraction was initiated at a rate of 0.25 mm twice daily. Animals in the control group (N = 5) were distracted to a length of 5.0 mm for 10 days at a rate of 0.25 mm twice daily. In contrast, animals in the experimental group (N = 5) were distracted to a length of 2.5 mm (at a rate of 0.25 mm twice daily) for 5 days, then compressed 1.0 mm for a 2‐day period, and redistracted to a length of 5.0 mm. Regenerate cross‐sectional area was evaluated by computed tomography performed after 5 weeks of consolidation. Gross examination and histological analysis were performed by a panel of experienced reviewers. Radiological as well as histological analysis of regenerate cross‐sectional area demonstrated no significant differences between experimental (i.e., “pumped”) and control groups. Both groups demonstrated excellent regenerate bone formation with no evidence of fibrous union. This study represents the first attempt to investigate the anecdotal technique of pumping the mandibular regenerate. The authors have demonstrated that pumping the regenerate leads to no substantial differences in radiological or histological appearance of regenerate bone formation.

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID