摘要:

The gross anatomy of varicose veins is one of the most important factors in the study of varicosity. Because of wide variations in the extent of involvement and degree of severity of varicose veins, it is difficult to obtain live and intact specimens of varicose veins. With good illumination and magnified monitor viewing, the varicositic main channel, its tributaries, and the incompetent perforating veins can be dissected and visualized clearly during endoscopic surgery. Thus, the whole range of varicosities can be observed directly in situ. Characteristic features of the varicosities of 350 limbs have been recorded by video and photographs for study and classification. These features include: 1) poor contractility of varicose veins; 2) dilated and tortuous changes of varicose veins; 3) saccular or lateral bulging deformities of vein walls, or both; 4) uniformly dilated and tortuous deformities of a long vein; 5) varicositic changes of the accessory vein; 6) anatomic abnormalities of varicose veins, such as supernumerary tributaries, varicositic clusters, and a crowded relationship among the long saphenous vein, perforating vein and tributaries; 7) various conditions of the perforating veins; and 8) the close relationship among the long saphenous vein, perforating veins, and the saphenous nerve. These data provide valuable information for the study and management of primary varicose veins.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Because bacterial colonization of medical devices may result in clinical infection, it is conceivable that antimicrobial impregnation of tissue expanders may reduce the rate of infection. The objective of this in vitro study was to examine the spectrum, durability, and shelf-life antimicrobial activity of minocycline/rifampin-impregnated silicone tissue expander shells. The impregnated devices exhibited zones of inhibition at baseline againstStaphylococcus epidermidis,Staphylococcus aureus, andEscherichia coli. The impregnated devices exhibited strong residual activity againstS. epidermidisandS. aureusafter suspension in serum at 37°C for 4 weeks. There was no significant decrease in the size of zones of inhibition after storing the impregnated devices at room temperature for 1 year. These results indicate that minocycline/rifampin-impregnated tissue expander shells provide broad-spectrum and durable antimicrobial activity and that the shelf-life antimicrobial activity exceeds 1 year. These findings prompt future exploration of the anti-infective efficacy of these antimicrobial-impregnated devices.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

To obviate or lessen the long period of use of orthodontic appliances after distraction for hemifacial microsomia in the mixed dentition patients, simultaneous maxillo-mandibular distraction osteogenesis has been performed in 10 patients aged 7 to 12 years with hemifacial microsomia. In these patients, there were two cases of type I, five cases of type IIa, and three cases of type IIb. A uniplanar internal distraction device was used in all cases. After maxillary Le Fort I osteotomy and mandibular ramus osteotomy, a uniplanar internal distraction device was attached to the mandible. On days 5 to 6 after surgery, distraction of 1 mm per day was started. Rigid intermaxillary fixation (IMF) using soft wires was performed at the distraction and was retained for 1 hour. Except for this period, rigid IMF was released. Distraction length ranged from 10 to 21 mm. After the distraction, a slight lateral crossbite in one case and a slight occlusal change in two cases, which did not necessitate the particular orthodontic treatment, were noted. Postoperative follow-up ranged from 16 to 40 months. The postoperative clinical course was uneventful thereafter. Maxillary growth impairment after the osteotomy has been obscure because of the short postoperative period. This procedure is effective for obviating or lessening the long duration of use of orthodontic appliances in the mixed dentition period of 7 to 14 years of hemifacial microsomia.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors present a series of 16 unstable phalangeal fractures (13 patients) treated by open reduction and internal fixation using the eight-hole titanium miniplate system from Synthes (Paoli, PA). Thirteen fractures were finger fractures whereas three were thumb fractures. Most fractures (n = 15) were crush injuries with concomitant soft tissue trauma. Six patients with finger fractures had good to excellent range of motion (total active motion ≥180). Two patients with thumb fractures had moderate range of motion (range of motion 70–97), whereas the remaining patient with thumb fracture had poor motion because the interphalangeal joint was destroyed. Complications included two cases of plate exposure because of insufficient soft tissue cover. Although no malunion occurred in this series, there was one case of delayed union. Three patients had extensor tenolysis to improve motion. The eight-hole miniplate system adds to the versatility of the many options available for fixation of unstable phalangeal fractures. Rigid fixation using this system is particularly helpful in initiating early motion in severely crushed fingers with concomitant soft tissue injury.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Infected wounds after total hip arthroplasty can be limb threatening. Management strategies are designed to eradicate infection, to obtain stable wound coverage, and to preserve the prosthesis. However, there is no general consensus for optimal management. The authors reviewed their 7-year combined orthopaedic and plastic surgical experience to provide a protocol for management. Ten patients (six women and four men) with a mean age of 60 years (range, 41–82 years) were studied. Primary hip diagnoses included arthritis (n = 8) and avascular necrosis (n = 2). Wound analysis included the size, depth, and infection as well as exposure of bone, joint capsule, and prosthetic components. Follow-up ranged from 1 to 6 years (mean, 3.9). Primary plastic surgical operations included a pedicle muscle flap (n = 4), debridement and local wound care (n = 3), and delayed wound closure (n = 3). Salvage of the total hip arthroplasty was achieved in 6 of 10 patients. Complete wound healing was achieved in 9 of 10 patients. The authors conclude that salvage of the infected hip prosthesis is accomplished best via early recognition, irrigation, debridement, and plastic surgery consultation. Management strategies include muscle flap coverage for complex wounds associated with exposure of prosthetic components, bone, or hardware; debridement with delayed closure or skin graft for large superficial wounds without deep structure involvement; and local wound care for small superficial wounds, poor surgical candidates with clean wounds, and when surgical options are not possible.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The groin flap was designed to improve the conventional repair of the donor site of the anterolateral thigh flap. The modification method was applied successfully to cover the defects of donor sites of anterolateral thigh flaps in five patients. An ideal color match and a stable and completed composition for the donor sites were obtained. Little morbidity of the donor sites occurred. Cosmetic and functional rehabilitations of the donor sites were achieved. These results suggest the potential and novel method to improve the repair of the donor sites of anterolateral thigh flap.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Resurfacing of the medial canthal region and bony nasal dorsum is a problem frequently encountered after tumor excisions. Traditional flaps used in this region from the glabellar and frontal areas are bulky, and donor site scar may be unsightly. A medial pedicled orbicularis oculi myocutaneous flap is an alternative. A total of 12 flaps have been used to resurface the defects secondary to basal cell carcinoma excisions, with a mean follow-up of 10 months. All flaps survived. The flap elevation is easy and fast, and the flap can be extended to the contralateral site when needed. The skin match is good and donor morbidity is minimal.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Thirteen patients underwent reoperation for recurrent blepharoptosis using the orbicularis oculi muscle flap or the frontalis musculofascial flap. The orbicularis oculi muscle flap and the frontalis musculofascial flap are a modification of direct transplantation of the frontalis muscle to the tarsal plate. This is based on an anatomic study showing that the frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the eyebrow region. The patients’ previous blepharoptosis operations were frontalis muscle suspension with autogenous or alloplastic material. Their follow-up period ranged from 6 months to 10 years. The average interval between the patient's first frontalis suspension to their reoperation was 8.09 years. The selection of the muscle flaps was based on the extent of levator function of the patient. When the eyelid excursion was moderate (>4 mm), the orbicularis oculi muscle flap was used. For patients with minimal or weak eyelid excursion (<3 mm), the frontalis musculofascial flap was used. Eleven patients (91.6%) gained levator excursion of more than 7 mm and reduced the height difference of both palpebral fissures by less than 2 mm after the reoperation. After an average follow-up of 20 months, 11 patients (14 eyelids) recorded satisfactory results. This is based on the criteria of Souther, and Jordan and Anderson. The overall results were more than satisfactory. Even though 2 patients reported poor results, there was no complete failure in this series. The authors’ technique offers several advantages over conventional frontalis muscle suspension: it is a simple technique that has a good operative field, there is no donor morbidity and less complications, and asymmetrical supratarsal folding, eyelid notching, lagophthalmus, and abnormal eyebrow position that can occur after a frontalis muscle suspension can be avoided. In summary, the orbicularis oculi muscle flap or the frontalis musculofascial flap are considered for patients with recurrent blepharoptosis after frontalis muscle suspension.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors compared the postoperative speech and swallowing function of six patients who underwent free radial forearm flap reconstruction after hemiglossectomy with that of six control patients who underwent primary closure of the defect. Clinical speech pathologic evaluations included the Fletcher time-to-time maximum repetition rate of syllables, multiple rhyme test, and overall quality and intelligibility of the patients’ speech. Evaluation of swallowing included the duration of deglutition, bolus volume, and ingestion rate. Speech quality, including intelligibility and articulation, was better in patients with primary closure. However, the bolus volume and ingestion rate in deglutition were better in those with flap reconstruction. These results suggest that the flap adds bulk, thus improving pharyngeal clearance by maintaining the tongue-to-mouth roof contact that is necessary in the swallowing process. The nonfunctional flap, however, hinders articulation by restricting the mobility of the remaining portion of the normal tongue.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID