摘要:

&NA;Previous studies have addressed the difficulties in training residents in aesthetic surgery. The purpose of this study is to analyze patient satisfaction with cosmetic surgery at an inner city teaching hospital as well as to evaluate referral patterns. The patients included in this study underwent aesthetic surgical procedures through the Kings County Hospital Plastic Surgery Clinic (KCHC) from January 1, 1997, to June 30, 1998. Patients were informed that the procedure would be performed by a plastic surgery resident with attending supervision. Data were obtained in a retrospective fashion using telephone surveys. Fifty‐five patients participated in the study, which accounted for 68 aesthetic procedures. Sixty percent of patients considered the results of surgery as excellent or good. On a patient satisfaction scale from 0 (unhappy) to 10 (exceedingly happy), patients' self‐reporting average was 6.59. This mean value may not be completely indicative of patient satisfaction. Eighty‐nine percent of patients would refer a friend and 78% of patients would have the same procedure performed again. Sixty‐nine percent of the patients had been referred by past KCHC patients. All of these numbers tend to convey a higher degree of patient satisfaction. The results of the study appear to convey the importance of developing residents' ability to accurately explain to patients the anticipated results of aesthetic surgery.Zweifler M, Glasberg SB. An outcome‐based study of aesthetic surgery in a clinic setting. Ann Plast Surg 2000;44:355‐360

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Five patients with avulsed scalps were treated with replantation between 1992 and 1998. All patients were women age 20 to 36 years. The percentage of the avulsed scalp ranged from 50% to 100% of the whole scalp. The vessels chosen for anastomosis were the superficial temporal artery, occipital artery, and superficial temporal vein. A vein graft harvested from the cephalic vein of the forearm was performed on the venous and arterial sides in 1 patient. Two patients experienced complete survival of the replanted scalp. Three patients showed 40%, 50%, and 80% survival areas, with the remaining defects resurfaced as splitthickness skin grafts. Six months later, the scar areas in the last 3 patients were reconstructed with an expansion of the normal or replanted scalp. The follow‐up period ranged from 1 to 7 years. In 4 patients a partial return of sensation in the replanted scalp and motor function of the frontalis muscle were observed. All patients were satisfied with the aesthetic results of their surgery.Cho BC, Lee DH, Park JW, Byun JS, Baik BS. Replantation of avulsed scalps and secondary aesthetic correction. Ann Plast Surg 2000;44:361‐366

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Cutaneous injuries of the inferior third of the leg and dorsum of the foot represent a great challenge for plastic surgeons. The poor vascularization and subsequent poor healing encountered in these regions demand detailed knowledge of the local anatomy to select the best surgical alternative for each patient. In patients in whom local or free muscular flaps are not suitable, the fasciocutaneous flaps seem to be a good alternative. The distal pedicled fasciocutaneous flap of the calf was used to cover skin defects of the leg and foot in 22 patients. In 4 patients the authors designed an island flap to prevent a large defect in the donor area and to decrease the time of hospitalization and recovery of the patient. In a severe defect, the flap was used as a cross‐leg flap. The results were satisfactory because the flap provided stable coverage for different defects with few complications. The island flap is a good option for achieving a better aesthetic result and can be used in select patients.de Almeida OM, Monteiro Jr AA, Neves RI, de Lemos RG, Braz JC, Brechtbuhl ER, Gemperli R, Ferreira MC. The distally based fasciocutaneous flap of the calf for cutaneous coverage of the lower leg and dorsum of the foot. Ann Plast Surg 2000;44:367‐374

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Typically the lateral antebrachial cutaneous nerve alone is used to innervate the radial forearm free flap when a sensate flap is required. The authors desired, by means of fresh cadaveric microdissections and by means of local anesthetic injections in living subjects, to map the sensory nerve territories of this flap. Eight radial forearm flaps were elevated and the medial antebrachial cutaneous nerve (MABC), lateral antebrachial cutaneous nerve (LABC), and superficial radial sensory nerve (SRSN) were dissected with the aid of an operating microscope (2.5‐10×) and traced to their dermal insertions. In the injection study, the MABC, LABC, and SRSN in eight forearms of 4 subjects were blocked sequentially with 2% lidocaine injections. The resulting sensory deficit from each injection was mapped on the skin and superimposed on the marked radial forearm flap territory. Distribution of the three dissected nerve regions and the sensory deficit after injection were determined by digital images and computer analysis. During flap dissections, mean nerve distributions of total flap area were as follows: LABC, 61.8% (range, 48.3‐71.6%); MABC, 33.8% (range, 30.5‐38.9%); and SRSN, 34.6% (range, 26.8‐44.1%). After nerve block the mapped sensory areas were as follows: LABC, 62.3% (range, 44.5‐88.5%); MABC, 19.6% (range, 8.0‐35.8%); and SRSN, 19.5% (range, 9.9‐26.3%). At least 40% of the total flap area was not innervated by the LABC as identified both by nerve dissection and sensory local anesthetic blockade. By including the LABC, MABC, and SRSN in the radial forearm flap, both the theoretical and the clinically determined useful sensory innervation of the radial forearm flap potentially would be increased.Boutros S. Yuksel E, Weinfeld AB, Alford EL, Netscher DT. Neural anatomy of the radial forearm flap. Ann Plast Surg 2000;44:375‐380

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Development of urethral fistulas is one of the most common late complications of hypospadias surgery. A total of 161 male patients who had 186 urethrocutaneous fistulas were first classified according to the fistula classification of Horton and colleagues and then treated with three types of procedures: simple closure, local rotation flaps, or tube graft reconstruction. With initial surgical intervention, 156 of 186 fistulas were treated successfully. The remaining 30 fistulas (16.1%) recurred during the follow‐up period. In the recurrent cases, immediate closure was not preferred, and an average of 6 months was waited before considering any additional surgical attempt. Distal cases had a higher failure rate, and the simple closure technique failed to show a success rate as high as local flap or tube graft repair. The high recurrence of distal cases was attributed mainly to the lack of adequate soft tissue adjacent to the fistula, which is vital for safe closure. In addition, the traction effect of erection on the skin and urethra, which is more prominent distally than proximally, is also believed to play an additive role. To increase success, the selection of appropriate treatment modality and customization of techniques for each patient cannot be overemphasized. However, the authors conclude that careful presurgical assessment of the patient, a 6‐month delay before any secondary surgical attempt, inversion of the urethral mucosa, avoidance of any overlapping suture lines, urinary diversion proximal to the repair site for 5 to 11 days, and usage of thin, absorbable suture materials are the main criteria that should be met for a satisfactory hypospadias fistula repair.Latifoğlu O, Yavuzer R, Ünal Ŝ, Çavuşoğlu T, Atabay K. Surgical treatment of urethral fistulas following hypospadias repair. Ann Plast Surg 2000;44: 381‐386

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Periprosthetic breast capsules composed of fibrotic collagenous material with increased collagen production are not dissimilar to other fibrotic conditions occurring in other organs. Fibrosis in the lung, liver, kidney, and skin has been associated with overproduction of the fibrogenic isoforms of transforming growth factor beta (TGF‐&bgr;1 and TGF‐&bgr;2). If periprosthetic breast capsules contained high levels of these cytokines, possibly new treatment approaches for capsular contraction could be proposed. Breast implant capsules of 35 patients harvested at the time of explantation were examined using indirect immunohistochemistry. Staining intensity for TGF‐&bgr;1 and TGF‐&bgr;2 was measured in all specimens. Immunohistochemical staining for TGF‐&bgr;1 and TGF‐&bgr;2 revealed that these two cytokines were present in all capsules analyzed. Minimal TGF‐&bgr;1 and TGF‐&bgr;2 were found in normal breast tissue. Levels of control vs. TGF‐&bgr;1 and control vs. TGF‐&bgr;2 were significant (p= 0.004 andp< 0.001 respectively). The presence of TGF‐&bgr;isoforms that are known to be fibrogenic may suggest new therapeutic approaches, which are being investigated for other fibrotic conditions.Kuhn A, Singh S, Smith PD, Ko F, Falcone R, Lyle WG, Maggi SP, Wells KE, Robson MC. Periprosthetic breast capsules contain the fibrogenic cytokines TGF‐&bgr;1 and TGF‐&bgr;2, suggesting possible new treatment approaches. Ann Plast Surg 2000;44:387‐391

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;In an effort to minimize the amount of autogenous tissue that is sacrificed in using a random skin flap, the authors, in a porcine model, implanted 3.0 × 7.0‐cm (median thickness, 1 mm) sheets of commercially available nonmeshed acellular dermal matrix (AlloDerm) subcutaneously. After a vascularization period of 2 weeks, the implants were elevated and used as turnover dermal flaps to cover adjacent 3.0 × 3.0‐cm full‐thickness skin defects. Sheets of autogenous cultured keratinocytes were used for epithelium. The AlloDerm‐cultured keratinocyte complex flaps healed without any complications. Measurements for percent contraction of the wound to determine the suitability of AlloDerm as a dermal flap showed that the wounds had contracted an average of 18 ± 3.6% at 24 weeks. Histological evaluation revealed multilayered keratinocytes and indurations between the cultured keratinocytes and AlloDerm. Fibroblast infiltration and the presence of luminal spaces surrounded by capillary endothelium characteristic of neovascularization of the matrix were also noted. This preliminary study may form the basis for developing other types of prefabricated flaps using AlloDerm and cultured keratinocytes.Tark K‐C, Chung S, Shin K‐S, Park B‐Y. Skin flap prefabrication using acellular dermal matrix and cultured keratinocytes in a porcine model. Ann Plast Surg 2000;44:392‐397

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Fetuses, as opposed to adults, are immature immunologically and it has been proved that they can tolerate allograft materials much better than adults. In this study the rejection phenomenon of nerve allografts was compared histologically in fetuses and adults. The study was performed in 60 New Zealand rabbits (30 pregnant and 30 nonpregnant), and allograft nerve segments were obtained from Chinchilla rabbits. The animals were divided into fetal and adult groups. Each group was studied at various time periods. Nerve allografts were placed under the panniculus carnosus in the interscapular region of the fetuses and adults. In both fetal and adult groups, the nerve allograft segments were assessed histologically after 1, 7, and 30 days. The criteria used during the evaluation were the degenerative findings in the myelinated axons (large, medium, and small axons), changes in Schwann's cells, and the quantity of infiltrating cells. The changes were graded microscopically from 0 (no change) to 3 (severe destruction and cellular infiltration). Cellular infiltration was more extensive in the adult groups than in the fetal groups. Earlier fetal groups showed minimal infiltration, but the response became more extensive in the later fetal groups. This is probably related to the removal of the fetuses from their intrauterine environment. When comparing fetal and adult groups, the results were significant (p< 0.05). The fetuses tolerated the nerve allograft segments better than the adults. This may be related to the immature immune system of the fetuses.Ağaoğlu G, Kayikçioğlu A, Sargon M, Erk Y, Mavili E. Comparison of immune response to nerve allograft segments in fetal and adult rabbits: a histological study. Ann Plast Surg 2000;43:398‐404

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Recently proposed procedures for in vitro generation of new cartilage may be difficult to perform in humans because so many chondrocytes are needed for tissue engineering. In this study the authors investigated new, efficient, low‐cost techniques for the isolation and culture of chondrocytes from the ear cartilage of the rabbit. They performed a low‐density monolayer culture with a low concentration (0.5%, 1%) of human platelet supernatant and observed cell proliferation (seeding efficiency, deoxyribonucleic acid synthesis), matrix synthesis (glycosaminoglycan synthesis), and the expression of type I and type II collagen (reverse transcriptase polymerase chain reaction). Seeding efficiency was increased in 1% of platelet supernatant‐treated cultures by two to three times compared with untreated controls. One percent platelet supernatant had increased the incorporation of [3H]‐thymidine by 1.9 to 2.5 times at 72 hours compared with controls. Glycosaminoglycan synthesis was increased in platelet supernatant‐treated chondrocytes at 96 hours compared with controls. Chondrocytes treated with 1% platelet supernatant showed a decreased expression of the type II collagen gene. Supplementation with a high concentration (10%) of the platelet supernatant provided the conditions for the in vitro chondrocyte mass formation. These results indicate that proliferation and matrix synthesis of auricular chondrocytes is stimulated by a low concentration of platelet supernatant. On the other hand, chondrocytes were immobilized by a high concentration of platelet supernatant. Platelet supernatant may be useful as an inexpensive autologous source of multiple growth factors to enhance chondrocyte proliferation, and also may play the role of scaffold for chondrocytes. Additional investigation is underway to generate culture conditions that promote the differentiation as well as the proliferation of chondrocytes.Yang SY, Ahn ST, Rhie JW, Lee KY, Choi JH, Lee BJ, Oh GT. Platelet supernatant promotes proliferation of auricular chondrocytes and formation of chondrocyte mass. Ann Plast Surg 2000;44:405‐411

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Chronic plantar and dorsal forefoot ulcer may result from injury, structural deformity, and abnormal sensation or circulation. It is not uncommon that the distal portion of the affected toes is deficient functionally in these patients. A filleted toe flap from the expendable functionless toe can provide a durable, stable, and sensate skin flap of 4 to 5.5 cm for coverage of the forefoot defect. In this report, five cases of dorsal forefoot defects and four cases of plantar forefoot defects due to ischemia (N = 3), trophic change (N = 2), and diabetes (N = 4) were treated with filleted toe flaps. One flap failed due to postoperative deep infection. The other eight filleted toe flaps survived but 2 patients underwent secondary amputations 7 months and 2 two years later because of secondary diabetic foot infections.Lin C‐H, Wei F‐C, Chen H‐C. Filleted toe flap for chronic forefoot ulcer reconstruction. Ann Plast Surg 2000;44:412‐416

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID