ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Aurel Rethi, in 1934, first described the transverse upper columellar incision for open rhinoplasty for resection of a portion of columella in cases of overly projecting nasal tip. The mid columellar incision has come to be known as the “Rethi” incision. Numerous variations of this approach have been popularized through the years. Recently, a great debate has raged over the criteria to be used in selecting patients for rhinoplasty. In this paper, we review 100 consecutive rhinoplasties and discuss our technique of labiocolumellar crease incision for open approach, and relate the criteria that we utilize to select patients for open rhinoplasty. There were 37 male and 63 female patients. Of these, 32 primary, 45 secondary, 18 cleft, and 5 reconstructive rhinoplasties were performed. Twenty-eight percent of primary, 62% of secondary, 78% of cleft, and 80% of reconstructive rhinoplasties were performed using the open approach via the labiocolumellar crease incision. There were no cases of circulatory compromise of the columella. The presence of a scar along the columella base (as with the C-flap in cleft patients) should be an indication for open rhinoplasty. Several myths about the labiocolumellar crease incision are dispelled. Adhering to principles of aesthetic subunits should guide the surgeon to place scars in a less noticeable position.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A complete upper face rejuvenation via blepharoplasty incisions is feasible. This technique is indicated in: (1) patients with male pattern baldness, (2) patients with a history of hair transplants, (3) patients with excessively high foreheads, (4) patients in which upper blepharoplasty is planned simultaneously with the brow lift, (5) patients with spastic frontalis syndrome, and (6) patients needing periorbital or bicularis muscle repositioning. Standard upper blepharoplasty incisions are made. Dissection is proceeded to the superior orbital rim. All the soft tissues, including the retro-orbicularis oculi fat (ROOF) pad, are elevated. A cuff of periosteum and the overlying subgaleal fascia is left. Superior dissection in the frontal area can proceed subgaleally or subperiosteally. In the latter case, the periosteum is entered about 1.5 cm above the orbital rim. In the temporal area, dissection is done in the subgaleal plane up to 1 cm above the zygomatic arch. This dissection is accurately and safely done with the aid of the endoscope introduced through the same incision. Resection of the procerus and corrugator muscles is performed via the eyelid incision, identifying and protecting the supratrochlear and supraorbital nerves. Extra-fine-tip cautery is used for hemostasis. Initial fixation consists of suturing the ROOF pad to the periosteum of the orbital rim (two sutures). The tail of the brow is sutured to the temporal fascia (third suture). The frontotemporal flap can be stabilized in an elevated position with an external tied-over dressing, percutaneous screws, or well-supportive contouring tape, depending on the clinical situation. The eyelids are closed in a standard fashion. This operation was performed on 14 patients-12 with the assistance of the endoscope and in 2 without the endoscope. However, the endoscope has made the operation more precise. Analysis of the brow position, frontalis and corrugator activity, and the aesthetics of the upper face reveal that this operation can give results similar to other techniques with comparable morbidity, more expeditiously and with fewer scars.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In extreme cases of breast hypertrophy, amputation of the nippleareolar complex and transplantation during reduction mammaplasty has been advocated to avoid nipple necrosis. We report our experience with 172 patients having inferior breast pedicle reduction without amputation of the nipple-areolar complex. Mean total weight of resected tissue was 1,946 g (548 to 5,100 g), with a mean nipple-areolar transposition of 10 cm (0.5 to 23 cm). Dividing patients into four groups by weight of resection, we compared complication rates. In this series, where nipple-areola amputation was avoided, there was a 99.6% survival rate of the nipple-areolar complex with 97.1% retention of nipple sensibility. Patients with extreme breast hypertrophy (3,000 g resected tissue) experienced no increase in complications when compared to smaller reductions. In most cases of gigantomastia, amputation of the nipple can be avoided using the inferior breast pedicle technique. Size of breast resection alone should not determine the fate of the nipple.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In previous studies, we were able to demonstrate baseline non-augmented cadaveric silicon tissue values as well as silicone-augmented breast capsular tissue silicon levels from various geographic locations in the United States. One of the limitations of these previous studies was the potential for intracapsular variations in the silicon level and whether a single measurement would be a valid comparison for the entire breast capsule. This study was then undertaken to measure the variations in tissue silicon levels from multiple sites within each breast capsule sampled. Four patients that underwent silicone breast and three tissue expander explantations were evaluated. All the women had silicone implants for breast augmentation and the placement of tissue expanders for reconstruction following mastectomy. A variety of reasons for explantation were noted. Each of the patient's breast capsules were divided into four quadrants (upper inner, upper outer, lower inner, and lower outer). All samples were harvested in a no-touch technique and were sent for silicon tissue assays. Silicon values ranged from 44 to 9,000 μg per gram of tissue and were consistent with our previously measured values. We conclude that random samples of breast capsules reflect the variations within the specimen samples, but can be used to measure elevated silicon values accurately. It is our belief that multiple samples do not need to be taken for each capsule measurement and that a previous potential limitation to the measurements has been eliminated.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Free transverse colon transfers based on the middle colic vessels were used to reconstruct a pharyngoesophageal defect in 9 patients. In all patients, cancer invaded up to the oropharynx. Resection resulted in a larger pharyngostoma than normally seen following standard total pharyngolaryngoesophagectomy. In such cases, it can be difficult to achieve good swallowing function after reconstruction using the free jejunal transfer. This mainly results from a significant discrepancy between the diameter of the pharyngostoma and that of the jejunum. Compared to the jejunum, the transverse colon has a larger diameter with a longer vascular pedicle and can provide a longer, straight intestinal tube, facilitating easy passage of a food bolus. In our series, all transfers survived well and all patients had good swallowing function postoperatively. We consider that a free colon transfer is more suitable than a free jejunal transfer for pharyngoesophageal reconstruction in patients with a large pharyngostoma.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Current evidence suggests that neovascularization is mediated by a wide range of angiogenic growth factors. Vascular endothelial growth factor (VEGF) appears to be one of the most important angiogenic factors in vivo. The aim of this project was to evaluate the efficacy of VEGF in augmentation of blood supply to skin flaps. Epigastric skin flaps were raised in 16 Sprague-Dawley male rats. In group A (N = 8), 5 μg of VEGF was injected into the epigastric artery after flap elevation. In the control, group B (N = 8), the artery was injected with saline. On the seventh day, the rats were photographed and the digital images were analyzed using imaging software (Image-Pro Plus 1.2). The blood flow in the flaps was measured with a percutaneous laser Doppler probe at specific locations. Histological studies of the flaps were done. Results showed that the mean percentage surviving flap area was 71.9% in group A and 53.7% in the control group, which is statistically significant (p< 0.001). Histological examination revealed increased density of the capillaries in the flaps treated with VEGF when compared to the control group. We believe the increase in skin survival is due to angiogenesis induced by the VEGF.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

More than 200 surgical techniques have been advocated for hypospadias repair and perfection is still eluding us. The purpose of this paper is not to comment on a surgical technique, but to highlight the importance of postoperative care on the eventual surgical outcome. Two hundred six children undergoing primary hypospadias surgery from 1984 to 1994 at Mount Vernon Hospital were analyzed. The mean age of surgery was 3.8 years (range, 8 months-17 years) and our mean follow-up was 6.1 years. Various surgical techniques were used. During 1989, we changed our postoperative regime and patients were mobilized early (within 48 hours) compared to the strict-bed rest-till-catheter-out regime before 1988. This significantly reduced our fistula rate from 22% to 9.8% (chi squaredp= 0.0016). Patient factors such as pulling on the catheter, urinary obstruction/blocked catheter, erections, straining due to constipation, and interference with dressings influence surgical outcome negatively. One of these patient factors was documented in all of our 33 patients who developed fistulas. In 6 patients (3.5%), a patient factor was present without any complication. This is highly significant statistically (chi squaredp< 0.0001). The type of urinary diversion, period of urinary diversion, type of dressing, catheter size, and anesthetic regime did not influence outcome significantly.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The most common complication of rhinoplasty is perioperative and postoperative hemorrhage. We present two patients who experienced intraoperative orbital hemorrhage during rhinoplasty. Patients with a history of previous nasal trauma, because of scarring/altered anatomy, may be more prone to this serious complication. A precise and well-placed osteotomy must be done to avoid aberrant anatomy and complications. The proposed mechanism for orbital hemorrhage is shearing or tearing of fibrovascular scar tissue involving the angular vessels during the surgical dissection. Prompt recognition and management of an orbital hemorrhage during or following rhinoplasty is necessary to prevent possible ocular injury and loss of vision. A management algorithm for orbital hemorrhage is presented along with a discussion of surgical techniques to prevent this complication. Surgeons performing rhinoplasty should be cognizant of this type of intraoperative complication along with its medical and surgical management.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID