摘要:

A clinical study was designed in which 20 women who were to undergo bilateral McKissock reduction mammaplasties were requested to use a precut sllicone elastomer sheet over the scars of one breast, starting at the time of suture removal. The patients were instructed to use the silicone sheet for 12 hours each day for 2 months. Evaluatioe of the scars at 2 months revealed that 60% of the nontreated scars were hypertrophic and only 25% of the treated scars were hypertrophic. The difference was found to be statistically significant (p< 0.05). The use of the sheets was discontinued after 2 months and the beneficial effect remained at the 6-month evaluation.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This study compares the artifacts caused by eight different cranlofacial fixation devices in computed tomography (CT) images. Using a Teflon CT phantom model, part I of this study involved the quantitative evaluation of the X-ray absorption properties of each fixation device. Part II utilized a human cadaveric model to determine the degree to which the artifact interfered with the visualization of anatomic structures. In part I, each fixation device was secured to the surface of the phantom and then scanned. All artifacts were compared on the basis of standard deviation in CT number. The severity of the artifact was related to the physical size of the fixation device and its composition. Vitallium devices generated a greater degree of CT artifacts than titanium devices of comparable size. In part II, fixation devices were secured to the orbital rims of human cadaveric heads and then scanned. Visualization of specified anatomic structures was graded independently. The results revealed that titanium fixation devices did not cause significant bone or softtissue image degradation, whereas all vitallium fixation devices, except micro mesh and micro (1.0 mm) straight plates, generated an artifact that resulted in some image degradation. The extent of image degradation was related to the fixation device size. Only the thickest vitallium fixation device, mini fragmentation (2.0 mm), resulted in bony image degradation. The degree of soft-tissue image degradation decreased as the size of vitallium fixation devices decreased such that micro fragmentation (0.8 mm) and pan fixation (1.3 mm) devices interfered with soft-tissue visualization only in the immediate vicinity of the plate. The results of this study confirm the previous work of Sullivan and colleagues and Fiala and associates. The data indicate that when postoperative imaging is an important clinical consideration: (1) the fewest number of internal fixation devices should be used to achieve rigid bony fixation, (2) the proximity of fixation devices to the regions of interest should be considered at the time of fixation, (3) titanium implants produce less artifacts than vitallium implants of comparable size, and (4) vitallium micro mesh and micro (1.0 mm) straight fixation devices do not produce artifacts resulting in significant image degradation.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Impending gangrene of the hand or digits secondary to palmar or digital artery occlusion can be a devastating complication of upper extremity thromboembolic or atheroembolic disease. Over the past 7 years, 9 patients with severe unilateral hand ischemia and impending tissue loss secondary to distal forearm, palmar arch, and digital artery occlusion were managed with intra-arterial urokinase (UK) infusion. The etiology of the ischemia was thromboembolism in 3 patients, atheroembolism in 2, and traumatic ulnar artery occlusion (“hypothenar hammer syndrome”) in the remaining 4 patients. Initial high-dose UK was administered in 3 patients (240,000 U per hour for 2 hours) and all 9 patients were maintained on 80,000 to 120,000 U per hour until clot lysis occurred or until a minimum dose of 600,000 U had been given without clinical improvement. Following UK therapy, the 3 patients with thromboemboli had angiographic demonstration of clot lysis as well as complete resolution of ischemia. The 2 patients with atheroemboli showed no angiographic or clinical improvement, and both required surgical intervention. Angiographic improvement was demonstrated in only 1 patient with traumatic ulnar artery occlusion, although 3 of the 4 patients were clinically improved. A pericatheter thrombosis due to insufficient heparinization and a subcutaneous abscess at the femoral artery puncture site were the only complications of UK infusion. No hemorrhagic complications occurred and no adverse effects of lytic therapy were documented in patients who subsequently required surgery. UK is an effective treatment for recent thromboembolism, because it lyses unorganized thrombi. It is ineffective for treatment of organized thrombi or atheroemboli. Because the etiology of acute hand ischemia is not always obvious at the time of presentation, a trial of UK infusion is warranted, because it is relatively safe and its use may obviate the need for complex microsurgical reconstruction.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The free forearm flap is a reliable and versatile tool in head and neck reconstruction. However, the patency of the mlcrovascular anastomosis is difficult to monitor when the flap is buried in the reconstruction of the esophagus or orbital floor. We used a portion of forearm muscle on a branch of the radial artery and wein as a monitor flap. After the free forearm flap transfer, the monitor muscle flap was placed extemally through a small skin incision. Flap viability was assessed by observing the color of the bleeding elicited from the muscle flap. Monitor muscle flaps are raised easily during elevation of the forearm flap. This technique was used successfully in 5 patients. This monitoring method provides a simple and rellable assessment of viability when direct monitoring of the forearm flap is not possible.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In this study, peripheral microcirculatory response to arterial and venous cannulation was studied. Eleven Sprague-Dawley rats were evaluated in two groups. Group I was the control group and received no cannulation (N = 6). After cremaster muscle isolation, the following parameters were evaluated at the microcirculatory level: vessel diameters, red blood cell (RBC) velocities, capillary density, and leukocyte and lymphocyte behavior (rollers, stickers, transmigrating white blood cell [WBC]). In group II, vessel cannulation was performed (N = 5). Before cremaster muscle isolation, the right femoral artery was cannulated for mean arterial blood pressure measurements; the right carotid artery was cannulated for arterial partial oxygen pressure (PaO2), arterial partial carbon dioxide pressure (PaCO2), and pH measurements; and the left jugular vein was cannulated for central venous pressure evaluation. Microcirculatory measurements as in group I were also taken. In the cannulated animals, arterial RBC velocity was 18.1% faster, whereas venous RBC velocity was 15.7% decreased (p< 0.05). In addition, leukocyte activation Increased and was confirmed by a 254.6% rise in rolling leukocytes, a 59.7% increase in rolling lymphocytes, and a 67.2% increase in leukocyte “stickers‘’ (p< 0.05). In group II, functional capillary perfusion was decreased by 44.9%, and 4.8% higher endothelial edema indexes were found (p< 0.05). In conclusion, this study has proven that, despite its clinical importance during vital signs monitoring, cannulation procedures may significantly Impair peripheral microcirculatory hemodynamics. For this reason, cannulation procedures should be designed with caution and should be reported in experimental methods.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Linear (two-dimensional) and three-dimensional (3D) plating systems (Poly-Medics) composed of the resorbable copolymer of polyglycolic acid (PGA) and poly-I-lactic acid (PLLA) (Lactosorb) were studied in vitro. The plates were applied to osteotomized fresh frozen human cadaveric metacarpal bones that were then tested for torsional rigidity and three-point bending strength and rigidity. The results were compared to those from another study of two low-profile titanium plating systems (Leibinger and Synthes). Analysis of variance revealed that the linear-flat Lactosorb plate and screws had apex dorsal rigidity and force-to-displacement measurements equal to all but two of the titanium plates (3D). The 3D-flat Lactosorb plate had the highest torsional rigidity of the resorbable system, but it was only moderately rigid compared to the titanium plating systems. This in vitro biomechanical study of the copolymer PGA-PLLA plating system indicates that, in clinical applications, it may be better suited for metacarpal fractures rather than proximal phalangeal fractures due to the lower demands of torsional loading compared to apex bending.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although worldwide incidence is not well known, foreign-body injection is often attempted in order to increase the circumference of the penile shaft. Paraffin, Vaseline, and other materials are injected into the penile skin by the patient himself or by untrained persons who practice medicine fraudulently. Complications usually follow, such as penile deformity, skin necrosis, limited erectile function, and the inability to have intercourse. Definitive treatment of these patients includes the complete removal of skin and subcutaneous tissue infiltrated by the foreign material. Sometimes, complete removal of the foreign material may not be possible and may leave permanent foreign-body granuloma on the corpus cavernosum and/or corpus spongiosum. The remaining foreign material does not permit skin-graft coverage, which is a simple and effective method of resurfacing. In such cases, we tried a new technique comprised of bilateral scrotal flaps to provide for reliable and stable coverage. The scrotal skin, which has high elasticity, seems to be a good material for penile coverage, despite its hairy nature. In our experience, exclusively with Korean males, the scrotal hair has a low density and does not seem to cause serious problems, but patients with hirsute scrota may be contraindicated. Since 1993, 17 patients with penile paraffinoma have been treated using the bilateral scrotal flap method. All 34 flaps survived completely and the reconstructed penis had immediate postoperative tactile sensibility. The results were successful and without any major complications.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The authors fashioned vascularized island flaps using cryopreserved allogeneic vascular bundles as the vascular pedicles in rabbits. Auricular vessels of 8 cm in length were harvested and cryopreserved in liquid nitrogen for 30 days. The allovascular bundles were anastomosed into the recipients' native auricular vessels. Dorsal flaps (6 x 6 cm) in the recipient were raised on the implanted allovascular bundle. Eight days later, the flaps were elevated as vascular island flaps nourished by the allovascular bundle. Computed microangiography demonstrated the anastomoses between the vasculatures of the implanted vessels and the recipient sites 8 days after vascular implantation in the dorsal flap. Flap survival estimation, which was done 1 week after flap elevation, showed flap viability. Allogeneic vascular bundles proved their potential utility as vascular pedicles of autologous tissue transfer.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Seroma formation following mastectomy and axillary dissection remains a common and significant problem contributing to patient morbidity and health-care costs. Previous data have suggested that fibrin sealant (FS), a biological adhesive, is capable of controlling lymphatic leakage and assisting with skin graft adhesion. In this study, the use of an experimental, light-activated FS under development by CryoLife (CFS) was evaluated in a rat mastectomy model in order to reduce seroma formation. CFS is a premixed form of FS, containing an inactivator that is reversed in the presence of light, causing sealant to form. In this model, rats underwent mastectomy and extensive dissection of the axillary lymphovasculature. Next, 1 ml of saline or FS was applied to the operative site and the wound was closed. Three groups of animals were evaluated 5 days postoperatively by measuring the volume (in milliliters) of seroma able to be aspirated from the surgical site. The saline control group (N = 20) had a seroma volume (mean ± standard deviation [SD]) of 4.2 ± 2.9 ml, while a form of CFS containing human fibrinogen (80 to 100 mg per milliliter) and human thrombin (20 U per milliliter) (N = 20) had a significantly smaller seroma volume of 1.1 ± 1.6 ml (p< 0.001 analysis of variance). University of Virginia (UVA) FS, containing human fibrinogen (20 mg per milliliter) and bovine thrombin (500 U per milliliter) (N = 20), had a serorna volume of 2.0 ± 1.6 ml (p< 0.01, compared to control;p> 0.2, compared to CFS). Thus, this form of CFS significantly reduced seroma formation compared to saline control and also appeared to result in a smaller fluid accumulation than with UVA FS, although this trend was not statistically significant. These data suggest that the use of CFS may help to reduce seroma formation in humans.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Infiltrating the operative site prior to incision with an epinephrine solution will provide vasoconstriction and a dryer operative field. However, some surgeons fear that as the vasoconstrictive effects of the epinephrine subside, smaller vessels will rebleed and a hematoma may result. In this study, 51 rats were operated with two flaps. The ventral pedicled flap, based on the inferior superficial epigastric arteries, and the McFarlane dorsal skin flap were utilized. The perimeter of all flaps was infiltrated with one of the following test infusions: (1) no infiltrate (control group), (2) 1% lidocaine hydrochloric acid (HCI), (3) 2% Iidocaine HCI, (4) 1% Iidocaine HCI and epinephrine 1:100,000, and (5) 0.5% Iidocaine HCI and epinephrine 1:200,000. Flaps were replaced In their beds. Animals were sacrificed 24 hours postoperatively. Flaps were raised at 26 hours and the coagulum weighed. No statistically significant difference was found between the weights of the coagulum of the infiltrated flaps versus the noninfiltrated flaps. Statistical power calculations on the main study flap yielded values greater than 80%. This suggests that the difference in delayed bleeding between noninfiltrated flaps and flaps infiltrated with various combinations of Iidocaine and epinephrine was insignificant.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID