ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Thirteen patients with mild and severe acne scarring have been treated with the Ultra Pulse carbon dioxide laser over a 24-month period. Nine patients had full-face and 4 patients had regional resurfacing. All patients were pretreated with a Retin-A preparation. The patients healed in an average of 7.3 days and erythema was gone in an average of 7.6 weeks. Eight patients with mild acne experienced a good (1 patient) or excellent (7 patients) result. Of the 5 patients with severe acne characterized by marked irregularity, deep defects, and atrophy, 2 patients experienced fair results and 2 experienced good results (1 patient was lost to follow-up). Thus, laser resurfacing for severe atrophic acne achieves only moderate results, while treatment for mild acne can provide excellent results.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Tissue expansion is a time-honored technique in plastic surgery. However, while it is possible to rectify quite severe problems, the technique is not free of complications (e.g., extrusion) and, moreover, it can be a lengthy procedure, often taking months. Endoscopy is increasingly being used in plastic surgery and has the advantage that large areas can be dissected using only small incisions. However, in endoscopic plastic surgery the main problem is the lack of an optical cavity. This means that special retractors are needed to keep skin and fat tissue lifted. This paper describes a technique for the placement of tissue expanders during endoscopy. Incisions are not made in the area that is to be expanded and, thus, there is no risk of extrusion and tissue expanders can be fully inflated intraoperatively. A further advantage is that the procedure reduces patient discomfort to a minimum.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The experience with endoscopic-assisted transaxillary extraction of lipomas on the upper back and shoulder region in 10 patients is reported. This technique enables tumor removal through a short skin incision placed in an inconspicuous region. In addition, hemostasis and complete removal of gross tumor are confirmed by endoscopic visualization. No complications or recurrences have been observed over a follow-up period of up to 2 years. The results were cosmetically satisfactory.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Exenterative pelvic surgery is commonly performed for advanced carcinoma of the cervix and selected cases of locally advanced colorectal cancers. Low-lying lesions that are locally invasive in contiguous organs require resection of the perineal body en bloc with the resected specimen. The resulting defect, both in the pelvis and the perineum, creates a difficult management problem. Dead space in the pelvis, especially with adjunctive irradiation, leads to delayed wound healing and prolapse of small bowel into the pelvis. Small bowel obstruction and/or fistula formation are the greatest sources of morbidity in the operative group. Fifteen patients underwent exenterative pelvic procedures (total exenteration, 1 patient; posterior exenteration, 8 patients; abdominoperineal resection, 6 patients). All patients were reconstructed by transpelvic placement of the rectus abdominis muscle (muscle only, 4 patients; muscle with skin grafting, 8 patients; musculocutaneous, 3 patients). Eighty-seven percent received radiation therapy. One patient had Crohn's disease and all others had carcinoma. Healing was complete in 12 of 15 patients at discharge. There were no complications related to pelvic dead space (i.e., bowel obstruction, perineal fistula), with a mean follow-up time of 24.3 months. Small bowel was effectively excluded from the pelvis to the level of the acetabular roof by computerized axial tomography scan. The transpelvic rectus abdominis muscle flap is effective in preventing major morbidity after exenterative pelvic surgery.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A variety of surgical techniques have been described for medial canthal tendon reattachment. They generally require technical skill and prolonged operating time. We have applied a new device, the Mitek Anchor System, in reattaching the medial canthal tendon to the medial orbital wall in 3 patients, and got excellent tendon fixation with this rapid and simple method. No complications, such as local infection or exposure, have occurred in any of the patients up to the present. Medial canthoplasty using the Mitek Anchor System has the advantage of being an easy technique with very accurate placement of the anchor and, consequently, reduced operating time. The operation can be performed through a small incision as well, and may not be so invasive as with other conventional procedures. This new technique of medial canthoplasty offers an excellent alternative to conventional techniques.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Facial aesthetics involve basic artistic that relate individual features to the face as a whole. These principles, such as balance and proportion, are key elements in the development of hair restoration surgery and can be applied to reconstructive procedures for the trauma or burn patient. This paper describes the application of anthropometric and artistic principles used in hair reconstruction. Attention has been directed to the procedures used to determine hairline contour and placement, and certain aspects of frontotemporal recession management. The frontal hair has a profound effect on facial balance because of the major role hair plays in framing and visually enhancing the face. The presence of frontal hair and facial framing also serves to retain a vital element of autonomy in appearance for the individual.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The purpose of this study was to determine the role of the fibular free flap in reconstructing lateral segmental defects of the mandible. Over the past 51/2 years, 17 consecutive patients underwent reconstruction of their lateral mandible with the fibular free flap. Patients included 12 men and 5 women, the mean age was 54 years (range, 29–76 years), and the mean length of the mandibular defect was 6.3 cm (range, 2.5–9 cm). The majority of patients with tumors (54%) were treated for recurrence and 92% received radiation to the operative field. The mean operative time to perform the microsurgery and bone plating was 4 hours. Postoperative morbidity occurred in 3 patients (18%) (plate fracture, malocclusion, orocutaneous fistula). Five patients (29%) required leg donor site skin grafting. Donor site morbidity included a minor cellulitis, a transient neuropraxia, and one case of leg swelling. None required additional surgery for donor complications. Thus far, 71% of the patients have received dental rehabilitation and 35% had osseointegrated implants placed in their bone flap. Eighty-two percent of the patients achieved both good or excellent aesthetic and functional results. Sixteen patients (94%) tolerate at least a soft diet and 65% are on a regular diet. Five patients developed tumor recurrence an average of 9 months postoperatively with a mean survival of 21 months. This study demonstrates that the fibular free flap is highly reliable for reconstructing the lateral mandible in a single stage, with low overall morbidity, and provides for excellent dental and speech rehabilitation. For most patients, the fibular free flap should be considered for lateral mandibular reconstruction even in those patients with a limited life expectancy.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The extended V-Y flap, a modified V-Y advancement flap, is very useful in closing relatively large defects on the face. Its extension limb is hinged down as a transposition flap on the end of the V-Y advancement flap to close the most distal portion of the defect. We applied this flap in closing a defect following excision of skin tumors on the face with excellent cosmetic results in 11 patients. However, this flap tended to make a distortion at the base of the flap in the primary closure site. By drawing figures, we concluded that the distortion was due to the characteristic of this technique as a V-Y advancement-rotation flap or V-Y advancement flap with rotation.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

In this study, a new classification of fingertip amputation based on the surgical treatment is reported. Specifically, the necessity for special procedures to prevent venous congestion in fingertip replantation at the nail bed level was studied. There are some reports of successful replantations without venous anastomoses. In order to avoid technical factors, clinical cases operated on by a single surgeon were evaluated to determine what treatment is necessary for amputations at various levels to avoid necrosis due to venous congestion. During the 5-year period from October 1987 to October 1992, 150 replantations in 137 patients were performed, including 49 fingertip replantations in 45 patients who were operated on consecutively by a single surgeon. The distal phalanx (DP) of the finger was classified as zone DP-I, HA, KB, and III from distal to proximal. This classification was based not only on the amputation level but also on the difference in surgical treatment. For amputations of zone DP-I, which extends from the fingertip to the most distal dividing point of the digital artery, the amputated fingertip is attached without vascular anastomosis and the whole finger is wrapped in aluminium foil and cooled in ice water for 3 days. For amputations of zone DP-IIA and KB, anastomosis of the digital artery is performed in the central portion of the palmar region of the finger, but Kirschner wire fixation is not performed so as not to disturb the venous drainage through the medullary cavity. For amputations of zone DP-IIA, special treatment is not necessary for venous congestion, and for those of zone DP-IIB partial resection of the nail is done if necessary. For zone DP-I I amputations, venous anastomosis must be performed for salvage. All patients were operated on according to the procedures based on this classification and final survival rate was 91.5%.

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID