ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A common detraction from the aesthetic results of breast reconstruction is the presence of a transverse mastectomy scar and the patch-like effect of the paler abdominal skin contrasting with the thoracic skin. The technique described involves a modified mastectomy approach in which the breast parenchyma and nipple are first mobilized through a periareolar incision and then removed, along with the axillary lymph nodes, through an axillary counter-incision. A de-epithelialized transverse rectus abdominis musculocutaneous flap is then used to fill the empty “skin brassiere,” effectively replacing the glandular defect, and a small patch of skin is exteriorized to match the areolar defect. Excellent symmetry can be attained usually without having to manipulate the opposite breast. After nipple—areolar reconstruction, the breast looks quite normal without the usual stigmas of mastectomy. In 21 breast reconstructions performed since 1991, there has been no incidence of skin flap necrosis or local recurrence

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

There is increasing demand for removal of silicone-gel and saline implants. We report our experience with reconstruction using autologous tissue after explantation. We used the dual-pedicle dermoparenchymal mastopexy, previously reported, and the deepithelialized transverse rectus abdominis muscle pedicle, both of which have produced satisfactory results. There have been no significant complications, and patients have expressed satisfaction with the lasting results of both techniques.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Bilateral secondary autologous breast augmentation with deepithelialized, pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps was performed on four patients with severe capsular contracture or implant rupture after breast augmentation. Results are satisfactory: The patients are pleased and have no limitation of their normal activities. Two patients underwent secondary liposuction to refine the abdominal contour. In one patient mammographic calcifications developed secondary to fat necrosis in one flap, which resolved spontaneously in 4 months. Rigorous patient selection, a highly motivated thoroughly informed patient, and substantial prior surgical experience with TRAM flaps are mandatory. Total capsulectomy as well as tunneling and positioning of the TRAM flap are performed through the existing inframammary scar. Shaping the breast is easier and faster than in postmastectomy patients. These patients have high aesthetic expectations; they must be gratified with the abdominoplasty aspect of the procedure. Because the flaps are buried, the surgeon must feel certain of their vigorous circulation. Only 200 to 300 gm are needed to augment each breast; therefore, only the best perfused periumbilical tissue is used. The TRAM flap, although a major procedure with significant risks, is the first effective technique of autologous breast augmentation and may have wider application.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We studied the safety and efficacy of laparoscopic jejunal free flap harvesting with total intracorporeal small-bowel anastomosis in an animal model. Eight dogs underwent laparoscopic resection of 8 to 15 cm of jejunum with endoscopic GIA anastomoses and jejunal segment harvesting through the periumbilical laparoscopic port. In six animals, the harvested jejunum was implanted subcutaneously and revascularized by anastomosis of the mesenteric artery and vein to the femoral vessels. Both the microvascular and intracorporeal jejunal anastomoses were studied at 10 days. Mean laparoscopic operative time was 2.9 hours, with the last five procedures all completed in fewer than 2 hours. Mean ischemic time was 1.9 hours. The laparoscopically performed small-bowel anastomoses were all successful. All dogs took regular diets within 1 day, with normal bowel function returning by the second day. Both clinically and histologically, the bowel wall and mesenteric vessels of all the segments harvested demonstrated no injury despite their laparoscopic harvest. Five of the free flaps remained fully viable at 10 days. One flap failed after prolapse of the flap resulting from inadequate fixation. Laparoscopic harvesting of the jejunal free flap is safe and efficacious and offers all of the potential advantages of laparoscopic abdominal surgery.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The use of liposuction began a trend toward less invasive abdominal contour surgery and resulted in a variety of techniques based on individual anatomy. An analysis of 170 patients was undertaken to determine which patients benefited from even less invasive techniques that evolved from these concepts. The selection criteria used were based on the physical examination of the skin, fat and muscle layers, and patients' goals, willingness to accept incisions, and tolerance for the recovery period. The options used for this new category of treatment were subtypes of the abdominolipoplasty system (type 1, suction-assisted lipectomy; type 2, miniabdominoplasty; type 3, modified abdominoplasty; type 4, full abdominoplasty) and included extended liposuction (type 1a); “open” miniabdominoplasty (type 2a); and endoscopically assisted or muscle access abdominoplasty (type 3a). Also included in this series were patients whose procedures were downstaged to a less extensive alternative and cases during which the abdominoplasty incision was used for access for another operation. All procedures resulted in smaller or fewer incisions. Results suggested that the current period (1991–present) is marked by less invasive treatment options, characterized by a preponderance of “closed” techniques (60% vs. 40%: 1986–1991). With the availability of technology to treat muscle and adipose tissue through inconspicuous incisions, judgment regarding the capability of the skin to recontour becomes the overriding physical factor in the decision-making process. The outcomes support the conclusion that minimal-access variations in abdominoplasty are appropriate alternatives, reflecting a philosophical alteration in the approach to patients.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Ptosis is a complication that can arise after blepharoplasty resulting in lid asymmetry. It should be recognized early and intervention directed at its underlying anatomical cause. Ptosis can be secondary to lid edema, hematoma, septal levator adhesions, septal suturing, supratarsal fixation, and levator complex injury. Injury to the levator complex can be rarefaction, dehiscence, or disinsertion. Evaluation of this condition involves assessment of the degree of ptosis and the amount of levator function. Severe ptosis with poor levator function requires re-exploration and repair of the levator mechanism. Mild or moderate ptosis may resolve spontaneously and can be managed expectantly. Chronic cases (longer than 3 months) may need exploration, and the procedure used is guided by the amount of levator function present.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Superficial suction lipectomy has been proposed for the treatment of flaccid skin and for irregular-appearing, peau d'orange skin. For the purposes of diagnosis and treatment, this represents two entities for which superficial suction lipectomy is applicable: type A and type B conditions. A series of 20 patients who had contour problems amenable to liposuction and either of these two skin conditions were evaluated concurrently. Results suggested that superficial suction lipectomy is a feasible extension of traditional liposuction using smaller cannulas as the subdermal fat layer is approached. It is likely that it represents an additional tool for specific situations seen in a spectrum of disorders that multiply and overlap with age rather than a replacement for dermolipectomies or a definite treatment for skin textural disorders.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID