ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Toxic epidermal necrolysis (TEN), is an exfoliative dermatological disorder of unknown cause. A patient with TEN loses epidermis in sheet-like fashion, leaving extensive areas of denuded dermis that must be treated like a large, superficial, partial-thickness burn wound. Methods of coverage described in the English literature over the last decade include the use of several dressings such as fresh-frozen or cryopreserved cadaver allograft, porcine xenograft, and amnionic membrane. Successful use of the biosynthetie dressing, Biobrane, has been described after burn injuries and Stevens-Johnson syndrome; however, its use in TENS has not. We present three patients with TEN treated successfully in our burn center over the past 12 months using Biobrane. The patients were men aged 20, 58, and 77 years, with 58% to 95% total body surface area slough. Diagnosis was confirmed by skin biopsy on admission, and drug ingestion was implicated in each instance. Each patient was thoroughly debrided in the operating room shortly after admission, and denuded areas were covered with Biobrane within 24 to 48 hours of admission. Biobrane demonstrated greater than 90% adherence by 48 hours, and no wound sepsis occurred. Each patient demonstrated epithelialization within 9 days. Patients were ambulatory at 72 hours. Corticosteroids and prophylactic antibiotics were avoided. Enteral nutritional support and aggressive septic surveillance was routine. Hospital stay was between 13 and 30 days without mortality. Early use of Biobrane in patients with TEN appears to provide a reasonable means of wound coverage.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The treatment dilemmas and our institutional experience with head and neck hemangiomas and vascular malformations are reviewed. Fifty-eight patients (38 with hemangiomas, 20 with vascular malformations) aged from newborn to 78 years were treated from 1975 to 1993. Eighty-seven percent of patients provided up-to-date follow-up, yielding a median follow-up interval of 7.18 years from intervention. Only significantly sized tumors (minimum diameter > 4 cm) were studied. Sodium tetradecyl sulfate sclerotherapy (SDS) was a sole therapy in 12 patients (all with hemangiomas) and was used in combination with surgical ablation in 22 patients (16 with hemangiomas, 6 with vascular malformations). The minority of tumors from both categories were completely removed with ablative surgery (six hemangiomas [23%], eight vascular malformations [44%]). Significantly debilitating tumor postsurgical recurrence, which led to mortality in some patients, was unique to vascular malformations with high flow on the basis of increased arterial to venous shunting. Less alarming but significant functional and cosmetic challenges are created in primarily postadolescent patients with incompletely involuted hemangiomas and low-flow vascular malformations of the head and neck. We have had a favorable experience with the combined application of sclerotherapy and conservative ablative surgery in this group. Patient survey implied satisfaction with treatment in the majority: Nine indicated they benefited significantly (17%); 37 indicated they were generally improved (71%); and 6 stated they did not benefit (12%). Tumor-specific philosophy on ablative therapy, recurrence patterns, and associated complications are presented.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Massive hemangiomas and vascular malformations have been treated with lasers and adjunctive measures. Intralesional laser photocoagulation involves the direct penetration of a tumor by a yttrium-aluminum-garnet laser fiber with photocoagulation at various depths and levels to produce thromboses and controlled coagulation necrosis, thus shrinking and blanching the malformation. Seven children have benefited from intralesional laser photocoagulation as well as steroids, embolization, and excisional surgery. Intralesional laser photocoagulation has contributed to the initial shrinkage and fibrosis of these massive vascular tumors in preparation for surgery or as the only treatment in some cases.

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:

Twenty patients with nevus of Ota have been treated with the argon laser, Q-switched yttrium-aluminum-garnet (YAG) laser, or a combination of both lasers. The argon laser was originally used from 1975 to 1993 and has how been replaced by the Q-switched YAG laser. The Q-switched YAG laser mechanism of action is selective photothermolysis in which the pulse width of the laser beam is very short, thus allowing the melanocyte chromophore target to dissipate its heat without burning adjacent normal tissue. Satisfactory fading without skin scar or texture change was observed in 10 patients in this series who had completed treatment; treatment is in progress in the remaining 10 patients. Six patients who were initially treated with argon and then subsequently were treated with Q-switched YAG laser demonstrated improved results.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Ultrapulse carbon dioxide laser ablation of rabbit skin was investigated. Macroscopic and microscopic appearance of the ablation site was evaluated for 1 month. The Ultrapulse carbon dioxide laser was set in the ultrapulse mode and the parameters selected were 250 mJ of energy per pulse and 2 W average power with the 3-mm spot size collimated handpiece. Macroscopic investigation showed that ultrapulse carbon dioxide laser ablation removed rabbit skin precisely and bloodlessly without char formation. Skin re-epithelialization without scarring and perfect hair growth restoration within 3 weeks were impressive. Microscopic investigation demonstrated a layer of tissue thermal necrosis measured as 70 ± 10 ·m. During the first 2 weeks, laser ablation wound re-epithelialization begins with multiplying epidermal layers (from 2–3 cell layers to about 13 to 15 cell layers). There were marked fibroblastic reactions and capillary congestion within papillary dermis. By the end of 4 weeks, the thickened epidermal layer appeared normal. The repaired papillary dermal collagen showed a relative compact configuration and greater cellularity in Masson stain was found 2 to 3 weeks later and also was near normal 4 weeks after laser treatment. These findings suggest that Ultrapulse's delivery of short-duration, high-energy pulses may provide a new approach (laser dermal ablation) to damage selectively the epidermis and papillary dermis of rabbit skin in one single-pulse impaction with uneventful wound healing within 1 month.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

There is no ideal method for preoperative or intraoperative mapping of cutaneous perforators or for postoperative monitoring of blood flow in cutaneous flaps. To study the suitability of thermography for the mapping and monitoring of free transverse rectus abdominis musculocutaneous (TRAM) flaps for breast reconstruction, we performed thermography pre-, intra-, and postoperatively (eight patients). The temperature of the TRAM flap increased during the induction of anesthesia and was still higher than normal on the first and second postoperative days (p < 0.05). During the operation, the flap cooled, reaching its minimum temperature (3.62 ± 0.6°C below phase 2, p < 0.05) after ligation of both pedicles of the flap. When blood flow had been re-established, all parts of the flap warmed rapidly. The locations of perforators (“hot spots”) could be seen before, during, and after the operation. However, induction and cutting of both pedicles made the flap isothermic, and the perforators disappeared temporarily. Thermography is a potential method of mapping cutaneous perforators pre-, intra-, and postoperatively and of monitoring the flaps at bedside. The method is easy to use and the outcome can be seen immediately. Our results also showed that the temperature (blood flow) in free TRAM flaps is higher than in the tissue in its original position.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

On the basis of clinical empirical observations and classic theory of platelet aggregation, microvascular surgeons have held that platelet aggregation is more responsible for arterial thrombosis and fibrin clot formation is more responsible for venous thrombosis. This theory was tested in two models of thrombosis, one created in arteries and the other in veins, using systemic antithrombotic agents. The models were pair matched in rats, creating a crush-avulsion injury to the femoral artery on one leg and a crushing injury to the femoral vein on the conbalateral leg. There were four treatment groups (n = 15 per group): systemic heparin, aspirin and dipyridamole, both sets of agents, and dual controls (vehicle treated). One-day patency rates in the controls were 13.4% and 0% for the arterial and venous models, respectively. Heparin treatment caused an increase in arterial patency to 73.3% but had no effect on venous patency (6.7%). Aspirin and dipyridamole had a modest effect on venous patency (40%) but had no effect on arterial patency (6.7%). Administration of both sets of agents led to 100% and 86.7% patency in the arterial and venous models, respectively. Patency rates were maintained at the 7-day evaluation in the arteries; in contrast, all thrombosed veins were found to be patent 7 days postoperatively (100% patency in all groups). These findings are in contrast to classic thinking about microvascular thrombosis, but this reverse effect may be unique to the rat. The high rate of recanalization in thrombosed veins indicates a need for caution in performing experimental studies of patency in rat veins.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Locoregional recurrent and distant metastases from squamous cell carcinomas, despite multimodality therapy, remain troublesome clinical realities. Discrepancies in success rates of various surgery and radiation treatment regimens dealing with these problems are confusing to the clinician attempting to recommend the most beneficial treatments. There is a need for an experimental model to assess therapeutic effectiveness quantitatively from which guidelines for developing clinical trials may be suggested. In this study, we provide such a model. We injected DBA-2 mice with defined numbers of KLN-205 squamous carcinoma cells to obtain baseline growth characteristics; 216 animals had no previous irradiation. The remaining 131 received 30 Gy irradiation to the right leg 50 days before injection of the tumor cells. Tumor incidence, growth and number, and location of tumor metastasis were determined in both previously irradiated and nonirradiated groups. The data demonstrate a growth-retardant effect on tumor groups by the previous irradiation (tumor bed effect). The data also show that the incidence of hematogenously spread metastases was more frequent in mice in which tumors developed in previously irradiated tissue than in mice with tumors in nonirradiated tissue.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID