摘要:

Currently, no documentation correlates histological changes with clinical signs of depth of the trichloroacetic acid peel. Obagi identified clinical signs of depth of injury following topical trichloroacetic acid application, employing prepeel conditioning and a method for slowing trichloroacetic acid action. A three-part study of 20 patients was undertaken to determine whether Obagi's visual and palpatory signs of depth correlated histologically with depth of peel. Also analyzed were physiological mechanisms associated with these signs. Patients were pretreated and biopsy specimens were harvested before and after modified trichloroacetic acid peeling. The results largely confirmed the validity of Obagi's observations regarding the method of trichloroacetic acid peel described. These clinical signs are verified by histology and correlated with some findings by electron microscopy. Differentiation of papillary from upper reticular dermal penetration is particularly useful. Physiological explanations for the phenomena observed are proposed. The specificity and safety of peels may be improved with these criteria.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Surgical delay is one method of enhancing the vascularity of the lower abdominal transverse rectus abdominis musculocutaneous (TRAM) flap. The outcome of 7 patients who underwent surgical delay (by ligating both superficial and deep inferior epigastric vessels bilaterally) a week prior to definitive TRAM flap elevation is described. Three patients were smokers, 3 were obese, and 1 was an asthmatic on medication. A satisfactory aesthetic result was achieved in all patients and the complications that occurred were minor. Two patients developed minor skin necrosis due to inadequate trimming of zone 4 on the contralateral side to the pedicle and there were 3 cases of fat necrosis, which occurred below Scarpa's fascia. Surgical delay is a useful technique of breast reconstruction. It allows the flap to be centered safely in the lower abdomen. In the high-risk patient, delay may prevent the need for microsurgery or the sacrifice of both recti.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although the vascular anatomy of the transverse rectus abdominis musculocutaneous flap has been well described, poor flap perfusion can lead to partial or total flap ischemia. To minimize the potential for flap loss, criteria have been developed to identify those patients who are deemed to be high risk. Some of these high-risk patients include smokers and those with previous abdominal surgery, obesity, and/or poor medical health. Despite our diligence in patient and operative selection, 2 patients with no preexisting risk factors have recently had venous congestion of their transverse rectus abdominis musculocutaneous flap, necessitating a delayed procedure. The cases are presented here and the potential etiology for this venous congestion explored.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In performing breast reconstruction with autogenous tissue, it has become useful to have accurate documentation of the weight and skin dimensions of the resected specimen. This enables the plastic surgeon to reconstruct a more natural and aesthetic breast. Oftentimes this information is not available and requires, at best, an estimate based on the size and shape of the remaining contralateral breast. To help take the guesswork out of an already artistic endeavor, this important information can make a substantial difference in the results obtained.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The effects of chronic compression of the cranial bone due to progressive expansion of the scalp have been investigated. Ten patients were studied, 6 adults and 4 children, who were treated for congenital (microtia) or acquired (burns or traumatic) deformities by chronic expansion over a 2-month period. All underwent computed tomography scans of the expansion site prior to introduction of the expansion device, immediately before removal, and at 9 months after the operation. A case of postburn alopecia was lost to the study, because the patient, who had ultimated scalp expansion, did not return for flap advancement. Instead, she came back 3 months later, without the expander, which had been removed at another institution following an automobile accident. In this case, because of slower healing, we performed computed tomography scans 18 months postoperation. During the second procedure (expander removal and flap transposition), bone samples for histological examination were collected directly underneath and along the perimeter of the expanders. Macroscopically, the bone appeared thinned and had a reduced convexity. This reaction, although temporary, appeared more intense in the children and in the posttraumatic cases. Histological examination showed osteoclastic activation, bony hypotrophy, and reaction (deposition of osteoid matrix) under the device, with consequent bone resorption and remodeling. A marked hyperplasia with a hyperostotic reaction was observed around the expanders. At 9 months postoperation, in most cases, a complete normalization was confirmed by computed tomography scans. Expansion of target (fontanellar and sagittal) areas of the skull in children, as well as previous trauma to both scalp and skull should be taken into consideration as a risk factor. Further investigations are suggested.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Experience with the surgical management of cranio-orbital neurofibromatosis in 14 patients is reported (age range, 6–40 years). The skeletal abnormality of the orbit that occurs in a small proportion (less than 1%) of patients with neurofibromatosis is, in essence, the absence of the membranous portions of the sphenoid and the adjacent bone forming the boundaries between the cranium and the orbit. The goal of surgery is tumor resection and reconstruction of the posterior bony defect by bone graft. Two additional procedures are also described that better enhance aesthetically—the mask lift and facial tissue expansion.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Microvascular reconstruction at the lower extremity for complex composite wounds has traditionally been predicated upon performance of the microanastamosis beyond the so-called “zone of injury.” Failure to do so was believed to account for increased rates of vessel thrombosis and transplant loss. Extensive vessel dissection and vein grafts were often employed in efforts to avoid the zone of injury. To further analyze the validity of this concept, we conducted a prospective evaluation of all patients undergoing microvascular reconstruction of composite lower limb wounds during a 5-month period at Los Angeles County Medical Center. There were 28 patients in this cohort. Twenty-six (93%) were judged Gustilo IIIB or worse preoperatively. Distance from the microanastamosis to the proximal bony osteotomy (zone of injury) averaged 45.7 mm. In no case was a vein graft required. All transplants healed uneventfully without any loss. A reassessment of the concept of zone of injury is urged with analysis of the quality of the recipient vessels and not their location being clinically important.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Successful salvage of Gustilo IIIB tibial fractures with microvascular transplantation has been documented in the young. Similar results from the application of these techniques to the elderly has not been demonstrated. An 8-year review located 12 patients 60 years or older who underwent soft tissue reconstruction of IIIB tibial fractures with microvascular transplants. Ten patients were available for long-term follow-up (average 43 months). To date, 80% remain ambulating with no secondary amputations or late infections reported.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The management of pitviper bites remains controversial. In order to better assess the efficacy of different treatment modalities, charts of 107 patients hospitalized for pitviper bites at University of North Carolina Hospitals between 1952 and 1992 were retrospectively reviewed. The series included 68 copperhead bites (64%), 8 cottonmouth bites (7%), 3 rattlesnake bites (3%), and 28 bites (26%) in which the snake could not be identified. First aid measures taken prior to hospitalization included cryotherapy (21%), incision and suction (22%), tight or loose tourniquets (32%), and moist heat (2%). After hospitalization, 29 patients (27%) underwent wound excision and 4 patients (4%) required fasciotomy. Antivenin was administered to 34 patients (32%) and 9 patients (26%) developed serum sickness. No patients died as a result of a bite injury and 84 patients (79%) recovered uneventfully. Complications of the injuries included coagulopathies (4%), infections (13%), tissue loss (12%), and permanent physical deformities (8%). No first aid measure significantly affected the outcome, although there was a trend toward increased complication rates in bites with moderate (grade II) or greater envenomation if cryotherapy or tourniquets were utilized. Wound excision after hospitalization was associated with a decreased complication rate in these significantly envenomated bites. Antivenin utilization did not improve outcome and there was a significantly higher incidence of tissue loss associated with its use. Therefore, no first aid measures are recommended for pitviper bites due to copperheads and cottonmouths except immobilization and elevation. Excision is efficacious for patients seen within 1 to 2 hours of bite injury. The risk of complications and questionable efficacy of antivenin outweigh any potential benefit for these patients. Data from the current series were insufficient to make definitive recommendations regarding rattlesnake bites.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This single-group prospective cohort study was conducted to define the efficacy and safety of single-portal endoscopic carpal tunnel release using the redesigned carpal tunnel release system (3M Healthcare, St Paul, MN). Eighty-six procedures in 69 patients were evaluated by objective motor/sensory testing and clinical outcome questionnaire at 10 days, and 6 and 10 weeks postoperatively. All cases were performed by the same surgeon using a similar local anesthetic technique. The subjective symptoms of carpal tunnel syndrome, including paresthesia, numbness, and pain, demonstrated substantial improvement by 10 days postoperatively, and less than 2% of the subjects remained symptomatic by 10 weeks. The percentage of patients with normal, static, two-point discrimination in the median nerve distribution, demonstrated significant improvement by 6 weeks postoperatively. Preoperative grip and three-point pinch strength were regained by 6 weeks postoperatively, while lateral pinch demonstrated substantial improvement in the same time period. Workers' compensation cases required a significantly longer time to return to work (mean, 40.8 days) than nonworkers' compensation cases (mean, 22.2 days). No difference, however, was demonstrated between workers' compensation and nonworkers' compensation cases with respect to the time of return to activities of daily living (mean, 13.5 days). There were no major neurovascular injuries incurred during the performance of the study. The most important complications included one mild reflex sympathetic dystrophy, three transient digital neuropraxias, and one superficial wound infection. In conclusion, the performance of single-portal endoscopic carpal tunnel release using the redesigned Agee carpal tunnel release system is both a safe and efficacious procedure.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID