摘要:

&NA;The outcome of 75 consecutive bilateral breast reduction procedures on 73 patients (65 inferior pedicle and 9 superior pedicle with inverted‐T closure, and 1 ultrasonic‐assisted lipoplasty) is evaluated. Fifty‐six surveys at an average follow‐up of 35 months, 36 standardized examinations at an average follow‐up of 31 months, 52 paired preoperative/postoperative photographs, and 73 chart reviews comprise the data. Mean age at surgery was 32 years. Of the patients surveyed, there were 51 whites, 18 blacks, and 4 other races. The majority of survey respondents reported improvement in breast appearance (93%), self‐esteem (85%), posture (84%), and activity level (77%). The percentage of patients free of back pain rose from 9% preoperatively to 59% postoperatively. Some decrease in nipple sensitivity was noted by survey in 34 nipple‐areolar complexes (31%), and clinical examination detected decreased sensitivity in 16% of nipples. Thirty‐one percent of patients reported improvement in their intimate relationship postoperatively and 65% reported no change. Ninety‐five percent felt they had made the right decision in having breast reduction surgery. Physical examination revealed excellent maintenance of shape and impressive fading of surgical scars over the years in the majority of patients. The postoperative aesthetic result depends on several important preoperative factors, including skin tone, breast shape, and degree of ptosis. Adverse sequelae included infection (1.3%), nipple cyanosis (1.3%) but no nipple‐areolar necrosis, and wound dehiscence (4.0%) but no skin flap necrosis. Late complications included underresection requiring reoperation (4.0%), fat necrosis (2.7%), hypertrophic scars (6.7%), and pseudoptosis (12.0%). Breast reduction surgery results in a good outcome for most patients, with high patient satisfaction. Patients are accepting of the large T‐pattern scar that fades surprisingly well with time in exchange for symptomatic relief and substantial improvement in breast size and shape.Mizgala CL, MacKenzie KM. Breast reduction outcome study. Ann Plast Surg 2000;44:125‐134

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;During secondary breast reconstruction with a transverse rectus abdominis musculocutaneous (TRAM) flap, the native breast skin between the mastectomy scar and inframammary crease is usually left intact, excised, or deepithelialized. The authors have developed transposition flaps utilizing this skin and subcutaneous tissue in selected patients. This technique is most useful in patients who present for secondary reconstruction whose remaining lower breast skin may have contracted or in patients who should have a vertically inset TRAM flap but do not have a wide enough flap relative to the length of the inframammary crease. Although the authors use this technique infrequently due to additional scars placed on the breast, it is a useful technique to add to the armamentarium of the reconstructive surgeon.Revis DR, Caffee HH. An alternative technique for managing the lower breast skin during secondary breast reconstruction with a TRAM flap. Ann Plast Surg 2000;44:135‐142

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;After breast augmentation, separation of breast tissue from the implant is common, especially in patients with well‐formed preoperative breasts. This problem is enhanced to a marked deformity in cases of scar contracture with firm, fixed implants. This paper addresses this problem preoperatively and therapeutically in secondary correction of double‐bubble and waterfall deformity. The author classifies and explains double‐bubble deformity in patients in whom the implant is below the normal crease, with glandular breast tissue superior and anterior to the implant. In “waterfall” deformity (a term suggested by the author), the glandular breast tissue droops over the implant and is inferior and anterior to the implant. Treatment used consists of opening the breast tissue from its posterior surface using radial incisions to accommodate the implant. This allows the two structures—the breast tissue and the implant—to blend as one unit with satisfactory results. The technique is easy to perform and teach. Complications are similar to those of regular breast augmentation. Strangely, radial incisions have not increased complications, and there have been no cases of seroma or hematoma to date.Massiha H. Augmentation in ptotic and densely glandular breasts: prevention, treatment, and classification of double‐bubble deformity. Ann Plast Surg 2000;44:143‐146

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Abdominal wall reconstruction of ventral hernia defects with loss of visceral domain and inadequate soft‐tissue coverage presents a surgical challenge. Four patients with large, skin grafted ventral hernia defects were treated by staged abdominal wall reconstruction. During the initial stage, tissue expanders were placed under the skin and subcutaneous tissue lateral to the defects. After adequate interval expansion, the second stage was performed. The expanders were removed, the visceral contents reduced easily, and the fascia reapproximated with polypropylene mesh. The expanded skin was closed easily over the fascial repair. All four patients were reconstructed successfully without complications. Tissue expansion can restore abdominal domain and allow soft‐tissue closure in complicated ventral hernia defects.Carlson GW, Elwood E, Losken A, Galloway JR. The role of tissue expansion in abdominal wall reconstruction. Ann Plast Surg 2000;44:147‐153

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Fixation of the injured mandible to the maxilla is a proven method of stabilizing mandibular fractures and ensuring proper occlusion. The authors report their results with new specialized intraoral bone screws (IMF Screw System; Howmedica Leibinger, Inc., Carrollton, TX) that are designed for the purpose of achieving intermaxillary fixation (IMF). Nineteen patients were placed into rigid IMF using IMF screws alone. Indications were nondisplaced mandibular fractures; symphyseal, body, and angle fractures; midfacial fractures requiring temporary IMF; and edentulous patients with any of these fracture types and an adequate prosthesis. All procedures were performed with the patient under general anesthesia. The authors found that the operative time was markedly shorter than with standard IMF techniques, patient satisfaction was high, and there were no infections related to the screws. All 19 patients remained in stable, accurate occlusion and had adequate healing. One patient continues to have paraesthesias in the mental nerve distribution after screw removal. Although there is the potential for tooth and nerve injury when screws are placed improperly, the IMF Screw System seems to be a safe and reliable method of achieving secure mandibular fixation.Schneider AM, David LR, DeFranzo AJ, Marks MW, Molnar JA, Argenta LC. Use of specialized bone screws for intermaxillary fixation. Ann Plast Surg 2000;44:154‐157

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The peroneus brevis is a small muscle with a Mathes‐Nahai type II vascular pattern found in the lateral compartment of the leg. It is supplied by branches of the peroneal artery and it maintains its muscular component to the lateral malleolus, allowing it to be transposed to cover small distal third defects. The authors describe their experience with eight peroneus brevis flaps covered with split‐thickness skin grafts utilized to cover lateral malleolar fractures with exposed hardware or bone and one case of exposed Achilles' tendon. Seven flaps were successful and one (in a diabetic) underwent partial necrosis, requiring a small fasciocutaneous flap. The peroneus brevis flap provides limited coverage of the distal third of the leg but can be quite useful for problematic wounds of this difficult area.Lyle WG, Colborn GL. The peroneus brevis muscle flap for lower leg defects. Ann Plast Surg 2000;44:158‐162

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;By applying pipe flow rate mechanics, the authors have developed a simple and inexpensive device that can measure oral and nasal airflow and pressure quantitatively. It allows clinicians to document objectively the degree of velopharyngeal incompetence and nasal airway obstruction. This device is a modified U‐manometer with a Y‐connector to a collection bag. This prototype is being used in the authors' cleft palate clinic and they have found it useful in documenting quantitatively the amount of nasal air escape from either nostril with the corresponding pressure and flow. The primary measurement, which is reproducible and reliable, is the product of a cross‐sectional area of oronasal communication and the pressure differential between the oral and nasal cavity. With some modifications, this device can be adapted to estimate the size of the oronasal communication.Realica RM, Smith MK, Glover AL, Yu JC. A simplified pneumotachometer for the quantitative assessment of velopharyngeal incompetence. Ann Plast Surg 2000;44:163‐166

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;This is a retrospective review of 6 patients treated for lacrimal duct injuries between December 1994 and October 1997. Four patients had inferior canalicular lacerations, one had a superior laceration, and one had a combined inferior and superior laceration. Associated injuries included facial fractures (1 patient), multiple facial lacerations (2 patients), and avulsion of the medial canthus (1 patient).All patients were repaired with Crawford tubes using a semicircular technique. The mean time of lacrimal intubation was 4.2 months (range, 3.6‐4.5 months). One tube fell out at an undetermined time during the follow‐up period. Visible anatomic restoration was considered excellent in all patients. There were no instances of persistent epiphora or other complications.Although there are several techniques available for treating lacrimal duct injuries in the course of dealing with general facial trauma, the semicircular technique using a Crawford intubation system yielded consistently reliable results with minimal or no complications.Lindsey JT. Lacrimal duct injuries revisited: a retrospective review of six patients. Ann Plast Surg 2000;44:167‐172

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Manipulating tip projection and rotation is among the greater challenges in aesthetic surgery. Among common current techniques such as columellar struts and projecting tip grafts, all have considerable failure rates and/or complications. Powerful static and dynamic forces act on the tip, and unfortunately their magnitude and direction vary greatly from the time of surgery when decisions are made to the postoperative period. Traditional techniques have not taken sufficient advantage of the one neighboring stable structure—the septum. Through direct straddling, the medial crura on the septum or the more commonly applicable septal extension graft, tip placement at the end of surgery will vary minimally postoperatively.Hubbard TJ. Exploiting the septum for maximal tip control. Ann Plast Surg 2000;44:173‐180

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Axillary scar contracture is observed frequently after severe burn insult and is usually accompanied by injuries to the adjacent area. Although many therapeutic methods, including skin grafting, Z‐plasties, local flaps, island flaps, and free flaps, have been established, each technique has its own advantages and disadvantages in specific situations. The decision regarding which technique to use can only be made after consideration is given to the merits of the individual case. We applied thoracodorsal perforator‐based cutaneous flaps to 5 patients with axillary burn scar contractures and damaged adjacent tissues. In 1 patient both axillae were involved. Elevated flaps as large as 11 × 27 cm in size were used. All flaps survived completely even when raised in scar tissue. The donor sites were closed primarily except one, which needed a skin graft. Three patients obtained satisfactory release with more than 160 deg shoulder abduction. In 2 patients, release was incomplete with only 110 deg shoulder abduction, but neither one required a second release. The range of motion in terms of shoulder abduction was improved preoperatively (30‐90 deg) to postoperatively (110‐170 deg). The thoracodorsal perforator‐based cutaneous flap presents a very useful reconstructive method for the treatment of axillary defects.Kim DY, Cho SY, Kim KS, Lee SY, Cho BH. Correction of axillary burn scar contracture with the thoracodorsal perforator‐based cutaneous island flap. Ann Plast Surg 2000;44:181‐187

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID