摘要:

The authors present the reconstructive technique for complex cheek defects using the composite cervicofacial flap and study the possibilities, advantages, disadvantages, and results that can be expected. The design follows the classic outline of Mustarde's flap. The skin is undermined for 2 cm anterior to the ear, then after incision of the superficial musculoaponeurotic system (SMAS), undermining is continued below the plane of the SMAS, level with the facial nerve branches. It is continued forward to the facial vessels, which give rise to branches that ensure the blood supply of this composite flap and contribute to its high reliability. In the cervical region, undermining is done beneath the platysma, which is transected transversely in the lower cervical region to allow good upward mobility and satisfactory transposition of the flap. The flap is adapted to the defect and the medial suture line is placed as near as possible to the medial limit of the cheek aesthetic unit. The authors carried out a retrospective study of 7 patients with complex facial reconstruction after excision of malignant lesions. The defects measured from 4 x 4 cm to 9 x 7 cm. In 4 patients excision included the periosteum, and in 1 patient excision involved the entire thickness and removed the entire anterior half of the cheek. In 4 patients reconstruction involved the cheek and eyelid. In spite of the advanced age of the patients (88, 69, 91, 67, 70, 82, and 59 years), there was no distal edge necrosis. The only complication was a single case of facial paresis, which resolved spontaneously. The results were considered very good in all 7 patients. The authors conclude that the composite flap increases the possibilities of the cervicofacial flap. It is more mobile, more reliable, thicker, and more adaptable. It can be used in complex cheek defects that involve the periosteum, or even in full-thickness defects. The quality of the results obtained using this flap represents a considerable advance in facial reconstruction.Delay E, Lucas R, Jorquera F, Payement G, Foyatier J-L. Composite cervicofacial flap for reconstruction of complex cheek defects. Ann Plast Surg 1999;43:347-353

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A muscle bow traction method was developed for dynamic facial reanimation utilizing the masseter muscle and a fascial sling. The principle of this method is that the sling around the muscle pulls the oral commissure laterally and backward by the restoring force of the muscle from its relaxed position to its contracted position. The surgical procedure is simple. The sling is passed around the anterior half of the muscle so that the muscle can be bowed anteriorly at its center by the sling. One end of the sling is sutured to the center of the orbicularis oris and the dermis in front of the nasolabial fold, and the other end is sutured to the lower lip and oral commissure. This method was applied to 3 patients with facial palsy and to 1 patient with oral cancer. The restored motion of the oral commissure ranged from 5 to 8 mm when clenching the jaws. The concept of this method differs from those of other muscle transposition methods for facial reanimation in that the force acts at a right angle to the muscle contraction. The advantage of this method is that it is less invasive to the muscle and is a simpler procedure than other conventional muscle transposition methods.Maegawa J, Saijo M, Murasawa S. Muscle bow traction method for dynamic facial reanimation. Ann Plast Surg 1999;43:354-358

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Arteriovenous malformations (AVMs) are high-flow lesions. More than 50% of all AVMs are located in the head and neck region. They represent a therapeutic challenge because of their hemodynamic characteristics and their modality of growth. AVMs have a tendency to recur and often require radical resection, making surgical ablation and reconstruction difficult. AVMs require angiography not only for diagnostic purposes but as an initial therapeutic step in the form of embolization. Surgical ablation, which follows a few days after embolization, is facilitated by the reduction in vascularity and shrinkage of the lesion, both of which are afforded by the embolization. These benefits allow for less blood loss at the time of ablation, and less extensive resection. The authors report their experience with 16 patients with extracranial AVMs of the head and neck examined over the last decade.Seccia A, Salgarello M, Farallo E, Falappa PG. Combined radiological and surgical treatment of arteriovenous malformations of the head and neck. Ann Plast Surg 1999;43:359-366

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Soft-tissue reconstruction of the hand needs to cover the vital structures with flaps. It is usually difficult to maintain function and form with minimal morbidity. Local tissue is preferable but it is also very valuable. Especially in the distal part of the upper extremity, flap coverage is a challenging problem because of limited reconstructive alternatives. On the dorsum of the hand, flaps can be designed based on the paraneural vascular network of the cutaneous sensory nerves. These paraneural vascular networks send branches to the surrounding tissues. The branches to the skin are known as neurocutaneous perforators. The authors used eight reversed neurofasciocutaneous flaps based on the superficial branches of the radial nerve. Six flaps were based on the branch to the index finger and two flaps were based on the branch to the thumb. All flaps survived completely, and successful flap coverage was achieved in all patients with minimal morbidityCoşkunfirat OK, Velidedeoğlu H, Küçükçelebi A. Reversed neurofasciocutaneous flaps based on the superficial branches of the radial nerve. Ann Plast Surg 1999;43:367-373

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Twelve cases of tuberculosis of the upper extremity over a 5-year period are presented. The average time to diagnosis was 5 months. All patients were treated with a regimen of combination antituberculous chemotherapy for a minimum of 6 months, initial splinting, and intensive physiotherapy. The indications for surgery were limited, with biopsy being the most common procedure. Patients with tenosynovitis underwent tenosynovectomy, and nerve decompression was performed when indicated clinically. Large abscesses were drained. No patient had bony debridement or early arthrodesis to control the infection. The pre- and posttreatment range of motion was recorded, with a mean follow up of 25.4 months. Employing this regimen resulted in resolution of infection and an improved range of motion in 11 patients.Skoll PJ, Hudson DA. Tuberculosis of the upper extremity. Ann Plast Surg 1999;43:374-378

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Vibrio species, specificallyVibrio vulnificus,are known to be endemic to warm saltwater environments. As a human pathogen they are capable of causing severe, progressive, necrotizing infections. The lesions are bullous in nature and often require wide surgical debridement due to the aggressiveness of this organism. The literature supports prophylactic antibiotic therapy for those with preexisting hepatic dysfunction or immunocompromise. The authors routinely implement prophylactic antibiotic coverage with doxycycline 100 mg every 12 hours for vibrio in patients with wounds exposed to or acquired in saltwater. In addition, they institute topical therapy with 0.025% sodium hypochlorite solution (modified Dakin's), based on their in vitro study of vibrio sensitivity to antimicrobials. Over the past 2 years, the authors have treated 10 patients with this protocol for cutaneous vibrio infections confirmed by quantitative cultures. None of these patients experienced progression of infection requiring operative debridement—contrary to the aggressive nature of this organism documented in other reports.Wilhelmi BJ, Calianos II TA, Appelt EA, Ortiz M-E, Heggers JP, Phillips LG. Modified Dakin's solution for cutaneous vibrio infections. Ann Plast Surg 1999;43:386-389

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

One of the important features of correction of prominent ears involves the creation of an antihelical fold in the ear cartilage. The precise and symmetrical location of this fold is crucial for the aesthetic result. This study investigated the use of the fissura antitragohelicina, a constant anatomic landmark, as a guide to the correct line for the new antihelix. In the first part of the study, 16 cadaveric ears were dissected. The fissura antitragohelicina was present in each specimen, and measurements of the distance between the fissura antitragohelicina and the helix and the antihelix were recorded. Based on this study, a clinical series of 20 consecutive prominent ear corrections were performed using the fissura antitragohelicina as a guide for the creation of a new, symmetrical antihelical fold. The aesthetic results were satisfactory by subjective assessment in every one of this group of patients. This study showed that the fissura antitragohelicina was a constant, reliable, and simple guide to the creation of the antihelical fold in patients with prominent ears.Ghosh MM, Shaaban H, Knight SL. The fissura antitragohelicina: an anatomic aid to the correction of prominent ears. Ann Plast Surg 1999; 43:390-392

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Between 1982 and 1997, 29 patients with congenital absence of the vagina underwent modified Mclndoe vaginoplasty at the Division of Plastic and Reconstructive Surgery, Ege University Medical School, Izmir, Turkey. As a modification, an X incision was utilized instead of a straight-line horizontal or sagittal incision. During the first postoperative week, a perforated Pyrex rigid mold was used. This was replaced with an unperforated mold at the end of the first week. These patients' medical records were reviewed retrospectively. Complications encountered included infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, and vaginal stricture. All complications were treated except the stress urinary incontinence, and the final results were satisfactory.Ozek C, Gurler T, Alper M, Gundogan H, Bilkay U, Songur E, Akin Y, Cagdas A. Modified Mclndoe procedure for vaginal agenesis. Ann Plast Surg 1999;43:393-396

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The return of sensation to skin grafts is often suboptimal. Although the reinnervation of skin grafts has been examined by a number of authors during the past century, studies in humans have left a number of unanswered issues, whereas animal studies have been largely confined to histological work and a few electrophysiological studies. Based on knowledge that rats exhibit a reflexive flick of the back skin in response to stimulation, the authors hypothesized that it should be possible to develop a noninvasive model for assessing return of sensation in experimental skin grafts. Full-thickness skin grafts were created, one per animal, on the dorsa of male Sprague-Dawley rats. Sensory testing was performed using a hand-held pinprick device designed to deliver a stimulus of reproducible force. A positive response was observed as a flick of the dorsal skin—a very reliable reflex involving the cutaneus trunci muscle. The stimulus was delivered to each of 25 sectors of the graft on days 9, 13, 16, 20, 40, 60, and 110 postoperatively. Results were analyzed regarding the percentage of grafts responding at each time point as well as the topographical pattern of sensory return. Evidence of sensation was first detected at day 13 at the margins of the skin grafts and then progressed centrally until homogenous reinnervation (94% of the graft surface) was observed at day 40 and was maintained through the end of the study. Growth Associated Protein (GAP)-43 immunostaining was used to document reinnervation of the skin grafts histologically.Williams WG, Cameron A, Robson MC, Herndon DN, Phillips LG. A model for the assessment of sensory recovery of experimental skin grafts. Ann Plast Surg 1999;43:397-404

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID