摘要:

&NA;Midface aging is characterized by soft‐tissue ptosis with loss of cheek projection. Subperiosteal midface lifts may reposition the soft‐tissue mounds and improve the tear trough, but may not fill the lateral cheeks in patients with significant jowls or poor bony support. Correction with alloplastic implants is helpful, but may not be accepted by many patients. During subperiosteal midface lifts, the author often excises Bichat's fat pad to decrease the jowl and to diminish face fullness. He has modified this approach and used a vascularized Bichat's fat flap to aid lateral cheek projection while still improving lower face fullness and the jowl.For the last 4 years, close to 150 patients undergoing subperiosteal midface lifts have had vascularized Bichat's fat pad flaps. The jowls were marked preoperatively. All patients had complete cheek undermining either through a buccal sulcus incision or through a crow's‐foot incision, or through a muscle‐sparing limited lower blepharoplasty incision. Bichat's fat pad is identified in its pocket medial to the masseter tendon. Mobilization of Bichat's fat pad is done by blunt dissection, preserving its thin fascial envelope. The “hernial saclike” pocket, excluding Stensen's duct and the buccal branches of the facial nerve, is identified and protected. Suspension is accomplished by fixation with 3‐0 polydioxanone sutures either to the temporalis fascia (via the temporal incisions), to the arcus marginalis, or to the suborbicularis oculi fat pad. Fixation technique is dependent on where the fat pad is needed and the surgeon's preference. Fat pad repositioning is accomplished with a minor learning curve. The most common problems are tearing of the fat pad during fixation and temporary numbness of the long buccal nerve. Attention to leaving the capsule intact and gentle handling is essential to fixation. Nevertheless, in some patients with poor‐quality fat pads, fixation is extremely difficult. Four‐year results have been excellent. Further studies with magnetic resonance imaging of postoperative patients are necessary to assess longevity. Bichat's fat pad provides autologous vascularized tissue for midface fill. Placement may be lateral for cheek augmentation or medial for deep nasolabial folds. Jowl improvement also occurs with the removal of Bichat's fat pad from its pocket.Ramirez OM. Buccal fat pad pedicle flap for midface augmentation. Ann Plast Surg 1999;43:109‐118

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Abdominal scars play an important role in risk factors in transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction. In particular, vertical midline scars are a difficult problem to solve. Traditional techniques include the use of a single hemiflap (which may be insufficient to achieve an adequate volume), the transfer of a double‐pedicle flap (which causes major trauma to the abdominal wall), or more complicated procedures such as two free hemiflaps. Since 1991 the authors have used an innovative technique to improve vascularity in the contralateral side of a standard unipedicled TRAM flap. They call this flap therecharged TRAM flap.By means of their technique, the retrograde flow coming from the deep inferior epigastric vessels raised in continuity with a superiorly pedicled flap is used to “recharge” the contralateral rectus muscle harvested as a free flap. On the basis of hemodynamic studies, this procedure was carried out in patients with vertical midabdominal scars. This flap was named theparasite flapbecause the free unit survives on the vascular source of the pedicled unit—the superior epigastric artery supplying both flaps in a retrograde fashion. Sixteen patients with vertical midabdominal scars underwent this procedure. Total flap survival was observed in 15 patients. One patient developed a partial flap necrosis and 1 patient developed abdominal bulging on the pedicled side.According to the surgeons' evaluation, aesthetic outcome was considered to be good to excellent in all patients.Berrino P, Casabona F, Adami M, Muggianu M. The “parasite” TRAM flap for autogenous tissue breast reconstruction in patients with vertical midabdominal scars. Ann Plast Surg 1999;43:119‐126

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;The aim of this review was to assess the use of dilute adrenaline infiltration in reduction mammaplasty and to determine whether it had any associated complications. The closed technique for adrenaline infiltration was used with no reported infection. One hundred breast reductions in 50 patients were compared by dividing them into two groups of 25 patients each. Group A had 1:500,000 adrenaline in normal saline infiltration; group B did not. Both groups were matched equally for age and general health. Results showed that blood loss was less for group A when measured by the fall in postoperative hemoglobin (2.5 g per deciliter vs. 3.5 g per deciliter). This was statistically significant (p< 0.05). There was no significant difference in postoperative drainage (group A, 158 ml; group B, 182 ml). Group A required fewer blood transfusions (two vs. eight), without the risk of increased complications. Blood transfusions were given in the earlier part of the study, but currently are rarely needed. Adrenaline infiltration at this dilution is virtually free from any side effects. It decreases intraoperative blood loss and facilitates the operation without the need for blood transfusion.Thomas SS, Srivastava S, Nancarrow JD, Mohmand MH. Dilute adrenaline infiltration and reduced blood loss in reduction mammaplasty. Ann Plast Surg 1999;43:127‐131

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;There are few papers published on breast reconstruction after excision of phylloides tumor. Six patients who had reconstruction of the breast following excision of phylloides tumor are described. All underwent wide excision or subcutaneous mastectomy followed by immediate or delayed reconstruction with implants or autologous tissue. The mean follow‐up was 5 years (range, 2.5‐7 years). One patient died of metastases; the others survived without evidence of recurrence. The etiology, incidence, diagnosis, and treatment of these tumors are discussed. The aesthetic results in these patients is also described.Lai Y‐L, Weng C‐J, Noordhoff MS. Breast reconstruction following excision of phylloides tumor. Ann Plast Surg 1999;43:132‐136

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;When used in a defocused mode, the UltraPulse carbon dioxide laser causes skin vaporization at a subepidermal level with minimal surrounding thermal destruction, allowing early reepithe‐lialization from retained skin appendages. This attribute is of paramount importance if only skin resurfacing is desired. However, because the effect essentially is total removal of the epidermis, such a sequela can also be used advantageously to prepare a vascularized dermal bed prior to onlay of composite grafts or secondary overgrafting. This skin deepithelialization can be achieved in a bloodless field, permitting constant visualization of the depth of penetration, and an integrated computerized pattern generator scanner allows rapid, precise, and consistent desurfacing to the desired level. This preliminary investigation demonstrates that successful overgrafting is possible on a viable dermal plane exposed by the UltraPulse carbon dioxide laser, as another example of its role in skin deepithelialization.Hallock GG. Deepithelialization prior to onlay grafting using the UltraPulse carbon dioxide laser. Ann Plast Surg 1999;43:137‐141

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Magnetic resonance imaging (MRI) is a new method of evaluating velopharyngeal dysfunction. The anatomy of the palate and velopharyngeal closure can be visualized with MRI. Also, fast scanning with turboflash sequences allows surgeons to evaluate the speech mechanism during phonation. The dimensions of the velopharynx are another important factor in velopharyngeal closure, together with the functional performance of the soft palate during phonation. During this study, velopharyngeal anthropometric analyses were performed in cerebral MR images of 136 male and 141 female normal speakers who underwent cerebral MRI for reasons other than speech problems. Age‐dependent changes in velopharyngeal dimensions were evaluated. Although the growth of the soft palate was continuous throughout life, hard palate growth ceased by age 15. By using anthropometric data available from MR images taken on normal subjects for other reasons, a large database of age‐, gender‐, and race‐specific data on palatal and pharyngeal morphology was acquired. Comparative data of noncleft subjects in multiple age groups were obtained with MRI.Akgüner M. Velopharyngeal anthropometric analysis with MRI in normal subjects. Ann Plast Surg 1999;43:142‐147

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;A new genioplasty technique has been described and performed on 16 patients since 1995. The technique has been developed to avoid some undesired results of the current osseous genioplasty techniques and to achieve a more natural appearance in advancement genioplasty. According to the authors' technique, a rectangular part of the outer table of the mentum is split away from the mandible, and is advanced and fixated to the mandible. This technique can be used for advancement cases but not for reduction genioplasty. This technique was performed on 16 patients with only minor complications, including one case of wound dehiscence, one hematoma, and one case of osteomyelitis, which was managed with systemic antibiotic therapy. Aesthetic results were found to be satisfactory according to an evaluation by the authors. When the results were evaluated using pre‐ and postoperative photos, lip position and projection of the mentum were found to be natural in shape appearance. During the late postoperative period, the new bone formation between the advanced segment and the mandible was demonstrated radiographically. Advantages of the technique include having more contact surfaces for bony healing, a natural position of the lower lip, more natural projection of the mentum, tridimensional movement of the mentum, and improvement in the soft tissue of the neck. The disadvantages of the technique are the potential risk of infection due to dead space from the advancement, manipulation problems during surgery, and possible mental nerve injury. Splitting advancement genioplasty was found to be a useful technique for advancement genioplasty. Splitting advancement genioplasty is a more physiological osteotomy technique than most of osseous genioplasty techniques.Çelik M, Tuncer S, Büyükçayır I. Splitting advancement genioplasty. Ann Plast Surg 1999;43:148‐153

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Pediatric hand surgeons in Europe and North America are aware of the yearly “outbreak” of pediatric hand injuries on Halloween from carving pumpkins. This study reports another yearly “out‐break” of hand injuries—in Saudi Arabia from slaughtering sheep. During the 3 days of festivities following the Hajj ceremony, hundreds of thousands of sheep are slaughtered. Over 4 consecutive years, 298 patients attended the emergency room of Riyadh Central Hospital with injuries related to the slaughtering of animals sustained during the 3 days of festivity. Almost three quarters of patients (73%) were injured on the first day of festivity. The majority (92%) were nonprofessionals. Children accounted for 6.7% of patients. In adults, the female‐to‐male ratio was 1:7. The most common mechanism of injury was a knife cut (80.9%). Almost three quarters of injuries (73.5%) affected the hands, with more involvement of the left than the right hand. Only 7.7% of patients with hand injuries were admitted to the hospital for treatment. It was concluded that implementing safety measures while slaughtering, and educating the general population would be important in the prevention of these hand injuries in Saudi Arabia.Rahman MM, Al‐Zahrani S, Al‐Qattan MM. “Outbreak” of hand injuries during Hajj festivities in Saudi Arabia. Ann Plast Surg 1999;43:154‐155

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Frozen section analysis is used routinely to ensure complete removal of basal cell and squamous cell carcinomas of the skin, but the current emphasis on controlling costs raises the question as to which lesions should be evaluated with frozen section histology. A retrospective study of the clinical records and pathological reports of 51 patients selected randomly from a total of 225 patients was undertaken to determine the overall impact of frozen section analysis on the surgical management of skin cancers at this institution. The results indicate that frozen section analysis was performed on 76% of the 277 lesions evaluated, and that the results of frozen section examination were 91.1% accurate in detecting the presence or absence of tumor involvement at the surgical margins. The data also showed that the surgeons were able to estimate the margin of the skin tumor clinically and remove it entirely during the first excision 91.1% of the time. The lesions that had not been removed completely with the initial excision were those located on the periorbital region, forehead, and cheeks; were recurrent lesions; or were lesions that required more involved reconstruction than primary closure. This study shows that frozen section analysis is a valuable tool in selected situations, but routine use is not indicated for the majority of basal and squamous cell carcinomas of the skin.Ghauri RR, Gunter AA, Weber RA. Frozen section analysis in the management of skin cancers. Ann Plast Surg 1999;43:156‐160

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;This study evaluated the microcirculatory hemodynamics of a new chamber implantation technique. The cremaster muscle island flap was employed. Seventeen male Sprague‐Dawley rats were studied in two groups. In the control group, the standard cremaster muscle preparation with no chamber (N = 8) was used. After flap isolation, the muscle was preserved in the medial border of the hind limb and removed for observation after 24 hours. For the chamber group, the chamber was implanted after muscle isolation, and measurements were made 30 minutes postoperatively and at 24, 48, and 72 hours. The variables measured were microvessel diameter, red blood cell velocity, number of perfused capillaries, and the number of rolling, sticking, and transmigrating leukocytes in the postcapillary venules. The chamber group had a significantly greater number of perfused capillaries at 24 hours compared with controls (p< 0.05). The other variables did not differ significantly between groups at 24 hours. We can conclude that this cremaster muscle chamber model for chronic in vivo studies proved to be equal to the classic cremaster muscle preparation for chronic microcirculatory measurements for at least 24 hours.Siemionow M, Nanhekhan LV. Introduction of cremaster muscle chamber technique for long‐term intravital microscopy. Ann Plast Surg 1999;43: 161‐166

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID