摘要:

A free flap derived from the ascending helix of the ear has been used to reconstruct an anatomically diverse set of defects of the distal nose in 6 patients. Our cadaver injection studies have demonstrated that the blood supply to the auricular flap is via small, consistent branches from the superficial temporal artery. The patients were carefully selected, and most had failed prior attempts at reconstruction. The auricular flaps were used to reconstruct the nasal tip, ala, columella, and sill. The donor vessels were anastomosed either to the facial artery and vein or to vessels in the neck, via vein grafts. The flaps survived in all cases, but all patients required minor subsequent revision. The auricular donor site was closed by rotation and advancement of local tissue. This flap is presented as a surgical option for selected patients with complex defects of the distal nose, where excellent match of color and contour, predictable outcome, and avoidance of central facial donor site are desired.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Two cases using composite auricular free flaps, based on the superficial temporal vessels, in the reconstruction of full-thickness defects of the nose and ear are reported. This composite free flap can be based on either the superficial temporal or the posterior auricular vessels depending on the defect to be reconstructed. The superficial temporal vessels can also be used in reversed flow to obtain a vascular pedicle of sufficient length for microvascular anastomosis. The anatomical vascular features of the flap make it possible to reconstruct various facial defects with freedom of design.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The records of 101 patients who had undergone chest wall reconstruction both with and without stabilization of the chest wall by Marlex mesh were reviewed to see if Marlex reduced ventilator dependence and hospital stay, and to determine whether the use of Marlex was associated with any increased risk of infection. In 40 patients in whom Marlex was used, the mean number of days on postoperative ventilator support was 0.8, and mean hospital stay was 9.7 days. In 6 1 patients in whom Marlex was not used, the mean number of days on ventilator support was 4.9, and mean hospital stay was 17.5 days. These differences were statistically significant (p=0.03,p=0.006). Two patients in the Marlex-stabilized group (5%) developed wound infections, but these were preceded by ischemic necrosis of overlying flaps. None of the patients without Marlex developed wound infections. That difference was not statistically significant. We conclude that the use of Marlex in chest wall reconstruction does not significantly increase the risk of wound infection, provided that overlying tissues are properly vascularized and remain viable, and that synthetic mesh does improve chest wall stability and reduce ventilator dependence and overall hospital stay.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Reliable postoperative monitoring in microvascular surgery is necessary to improve the low success rate of reexploration after vascular compromise. The use of laser Doppler flowmetry has been evaluated in this study. From November 1985 to January 1988, 79 microvascular operations were monitored postoperatively. These consisted of 45 replants and revascularizations in 34 patients, as well as 34 free vascularized tissue transfers. In the replant and revascularization group, a statistically significant difference in laser Doppler flowmetry readings has been demonstrated between well-vascularized and circulatory impaired patients (p<0.001). In this study a reliable critical (alarm) value could be defined for replants and revascularizations with a sensitivity of 93% and a specificity of 94%. This critical alarm value can be adjusted according to the individual surgeon's attitude toward reexploration. Similar laser Doppler flowmetry characteristics were seen in patients with free vascularized tissue transfers; however, the numbers in this part of the study were too small to define reliable critical alarm values. The laser Doppler flowmeter is recommended for the postoperative evaluation of tissue after microvascular anastomoses, as it indicates vascular occlusion at an early stage where reexploration is worthwhile.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A modification of the standard tensor fascia lata myocutaneous flap, namely, the tensor fascia lata V—Y retroposition flap, is a reliable, durable, efficient, well-tolerated, and technically straightforward procedure. Indications include trochanteric pressure ulcers, nonhealing, failed hip arthroplasties, and soft tissue defects after regional tumor excisions. In 70 TFL V—Y retroposition flap reconstructions performed, the overall postoperative complication rate was 23%, with 4 total flap failures. Sixty-three percent of complications were treated with local wound care, thus avoiding repeat surgery. Rerotation of this flap is not only possible, but also just as reliable as the initial procedure. The tensor fascia lata retroposition flap offers advantages over many of the other tensor fascia lata flap variations.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

During recent years, sliding flaps have had great popularity owing to their advantages in terms of reliability, ease of execution, and good morphofunctional results. The limits of these flaps are related to the capacity of excursion in the advancement. To improve these limits, we describe in this article a personal modification of the flap that extends the possibilities of coverage in the distal areas, reducing the tensile distress. We report our experience with 19 patients, treated with this modified flap in various areas of the body, with good results and without noticeable complications.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A long-term follow-up study of 26 patients with 28 replanted digits was performed with respect to circulatory, sensory, and motor function. Peripheral circulation in the replanted digits was comparable with corresponding uninjured digits on the opposite hand. Excellent sensory recovery was observed in the territories supplied by 30 of the 36 repaired digital nerves. Best functional results were noted with the thumb and with fingers amputated through the middle phalanx. By objective criteria, 21 of the 28 replanted digits demonstrated satisfactory function. Subjectively, however, only 1 patient was dissatisfied with the outcome.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Our experience in the management of necrotizing and suppurating wound complications after major upper extremity replantation is presented. Seven patients underwent wound debridement and coverage with flaps. Of these, 6 were reconstructed with latissimus dorsi flaps and 1 with the scapular flap. In 3 of these patients, concomitant hemorrhage (2 patients) or thrombosis (1 patient) was simultaneously corrected by vein grafting. In all cases there was survival of both the flap and the replanted extremity.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study examines the effect of application of basic fibroblast growth factor (bFGF) on the wound healing impairment seen in streptozotocin-induced diabetic (SD) rats compared with control nondiabetic (NL) animals. Under general anesthesia, a 6-cm dorsal incision was made through the skin and panniculus carnosus. Both the NL and SD wounds were injected with 0.1 ml of one of the following three solutions: saline, vehicle, and 10 μg of bFGF. The wounds were closed with interrupted sutures of 4-0 nylon. The animals were returned to their cages and sacrificed at 7, 10, 14, or 21 days later. Breaking strength of the wound was analyzed by using an Instron Tensiometer 4201 to assay for relative collagen maturation. Data among groups were compared using an analysis of variance. At 7 and 10 days, all NL wounds were stronger than all SD wounds. By 14 days there was no statistically significant difference in breaking strength between the bFGF-SD wounds and all subgroups of NL wounds. The bFGF-SD subgroup was statistically significantly stronger than the saline-SD (p< 0.02) and vehicle-SD (p< 0.01) wounds. At 21 days the bFGF-SD wounds were statistically significantly stronger than the vehicle-SD wounds to a confidence level ofp< 0.001. These findings indicate that application of bFGF may reverse the impairment seen in diabetic wound healing.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Semmes–Weinstein monofilaments (SWMs) are standard measures used to assess hand sensibility. The purpose of this study was to evaluate the effect of varying contact time on the measurement of cutaneous pressure thresholds. Thirty-two healthy adult subjects were evaluated with a 20-filament SWM test kit. The index finger of the dominant hand was assessed with the following four distinct monofilament contact times: 0.5, 1.5, 5.0, and 30.0 seconds. With increased duration of monofilament contact time, there was a significant increase in the cutaneous pressure threshold measures (p<0.05). That is, to perceive a stimulus for a longer period of time, a heavier filament was required. With increasing age, significantly higher pressure thresholds were obtained particularly for the sustained contact time (>5.0 seconds). Pressure thresholds vary significantly with SWM contact time, emphasizing the importance of maintaining a consistent SWM application protocol.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID