摘要:

The authors describe an original technique of abdominoplasty aiming at correcting ventral muscles, hypotonia, and relaxation, especially in formerly obese patients, pluriparae women, and patients with neuromuscular impairment. The technique encloses regular dermolipectomy, laparocele or hernia reduction (if existing), ventral fascia plication on the midline, and suprafascial application of a purposely built polypropylene mesh. The mesh consists of three continuos segments: two lateral, wider, rectangular segments to be fixed on the ventral area and one central and narrower (like a belt) segment to be inserted posteriorly into the deep subcutaneous tissue above the dorsal muscles and the spine. The vehicle of inserting circumferential mesh includes introducing a smooth, hollow rod through a small lateral skin access. Then, the two lateral segments are extended and criss-crossed over the abdominal muscles and are fixed to the iliac periosteum. This allows the dorsal and ventral muscles to be contained and supported by the mesh during prolonged standing and exercise.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This study analyzed trends in reduction mammaplasty at our institution using Atlas and Lastword databases for calendar years 1991 to 1998 and 1993 to 1998, respectively. Cases were identified by ICD-9-CM principle procedure codes. Patients were analyzed for length of stay (LOS), discharge disposition, complications, and readmission. Readmissions to the hospital within 120 days were analyzed. Of 705 patients, 628 patients had LOS more than 24 hours, and 77 patients had LOS less than 24 hours. There was no difference in case-severity analysis in any of the 8 years. There was a significant reduction in average LOS from 2 to 1.1 days over the 8 years (p< 0.001). There was a significant increase per year in number of patients with LOS less than 24 hours (p< 0.002). There was no significant difference in readmission rates between patients with LOS less than 24 hours and LOS more than 24 hours. Reduction mammaplasty is a high-volume, relatively safe, plastic surgical procedure. There was no relationship between LOS and complications or readmissions.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

In head and neck reconstructive surgery, the pectoralis major musculocutaneous flap is a major reconstructive tool, both in primary as well as secondary reconstructions. In a few cases the authors have been able to demonstrate that when the pectoralis major musculocutaneous flap is translocated to the mouth through a noncompromised neck tunnel, as is done for head and neck reconstructions, the taut lateral pectoral nerve is seen to compress the vascular pedicle of the flap, adversely affecting its vascularity, which can lead to partial or total necrosis of the flap. The authors explain this feature, very specific to this flap, with the help of a prospective series of patients.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The authors present a modification of the design for the classic cutaneous pattern of the rectus abdominis musculocutaneous flap for vaginal reconstruction after pelvic cancer surgery. The authors designed a paramedial and supraumbilical dermo-cutaneous flap with paraumbilical randomized vascularization, which was sutured to the classic cutaneous TRAM flap pattern and rotated around a longitudinal axis to form the neo-introitus. The use of this new cutaneous design allows for a perfect cylindrical shape all along the length of the new vagina, thus achieving a more anatomic reconstruction than those currently obtained with the classic cutaneous patterns, and with fewer tendencies to distal retraction, necrosis, and partial stenosis.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The medial circumflex femoralGRACILISperforator free flap has been previously used to capture the superior medial thigh skin territory. This can also be valuable as a local flap, especially for adjacent groin wounds that are not uncommon after vascular interventions. Uncomplicated healing without vascular compromise was achieved using this as a local flap in 4 recent cases. Because the gracilis muscular branches can be independently dissected from the musculocutaneous perforators, the muscle itself can be separately included to form a combined conjoint flap, where the muscle is specifically only used to wrap around and protect any exposed vascular structures while the cutaneous component simplifies skin wound closure. The axis of rotation of the medial circumflex femoral perforator local flap extends throughout the groin region and potentially to the lateral thigh. This is an ideal local perforator flap because the source pedicle has a consistent location already well known to most plastic surgeons, the boundaries of the potential skin territory are reliable and well defined, and the scar from closure of the donor site within the medial groin can be readily concealed by clothing.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Currently, the success of ulcer treatment is limited by the high recurrence and complication rates. Spasticity is an important contributing factor to ulcer recurrence, and intrathecal baclofen is an effective method to reduce spasticity. Spasticity creates friction, shear, and mobility impairment resulting in wound dehiscence, flap loss, infection, and hematoma. Spasticity can be managed pharmacologically and surgically; baclofen is the drug of choice. Baclofen inhibits spasticity by blocking excitatory neurotransmitters in the spinal dorsal horn. Intrathecal baclofen maximizes the dose delivered to spinal receptors and minimizes the side effects associated with oral baclofen. Case reports of intrathecal baclofen used in patients with pressure sores demonstrate the use of intrathecal baclofen to improve reconstructive outcomes in spastic patients.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Oral burn contractures in children present major reconstructive problem. Only few reports in literature discussed oral burns in children. Electrical, chemical, and thermal agents are the main causative agents for oral burns. Oral contractures can be classified into anterior, posterior, and total. Anterior contractures are usually caused by electrical burns and involve the oral commissure, lips, anterior buccal sulcus and surrounding mucosa, and anterior tongue. Posterior oral contractures are caused by caustic ingestion and involve the posterior buccal mucosa, posterior tongue, retro-molar area and oro-pharynx. Total oral contractures involve the lips, tongue, oral cavity, and oro-pharyngeal mucosa and are caused by lye caustic ingestion. This report reviews three children; one with posterior, two with total oral cavity contracture. All cases were managed by linear release of scar contracture and skin grafting followed by a prolonged intra-oral splinting with a fixed mouth-block and commissural splint. A successful outcome was observed in all cases.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Clinical observation indicates that patients undergoing transverse rectus abdominus musculocutaneous (TRAM) flap breast reconstruction surgery frequently experience postoperative nausea and/or vomiting (PONV). No controlled trials have evaluated the role of pharmacologic prophylaxis of PONV in this population. A prospective randomized, double-blinded, active-controlled trial comparing intraoperative intravenous droperidol 1 mg with dolasetron 50 mg was conducted. Seventy-one patients were included in the intention-to-treat analysis. The incidence of the primary end point of PONV within 24 hours after surgery was 81.8% versus 78.9% for droperidol and dolasetron, respectively (p= 0.8). No significant differences were detected in the time to onset of PONV, incidence of severe nausea or emesis, or incidence of emesis alone. Time to rescue antiemetic use was longer in the droperidol group (7.1 vs. 1.3 hours,p= 0.002). Adverse effects were similar between the two groups. No PONV-related complications occurred during the trial period. The incidence of PONV in TRAM flap breast reconstruction surgery patients remains high despite prophylactic intraoperative antiemetic administration.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

AbstarctThe effect of hyperbaric oxygen is known to increase survival of ischemic tissue but its mechanism is not fully understood. The purpose of this study was to evaluate the effect of hyperbaric oxygen on a rat musculocutaneous flap versus ischemia–reperfusion injury, focusing on the mechanism involving the expression of adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) of endothelial cells and CD18 of neutrophils. A transverse rectus abdominis musculocutaneous (TRAM) flap (6 × 5 cm) supplied by a single superior epigastric vascular pedicle was elevated in 100 Sprague–Dawley rats. The rats were divided into 4 groups: group 0, sham (n = 10); group I, 4 hours of ischemia followed by reperfusion (n = 30); group II, 4 hours of ischemia and hyperbaric oxygen (100% oxygen, 2.5 atm absolute, during the last 90 minutes of ischemia before reperfusion) followed by reperfusion (n = 30); and group III, 4 hours of ischemia followed by reperfusion and hyperbaric oxygen (100% oxygen, 2.5 atm absolute, after reperfusion for 90 minutes; n = 30). The study consisted of gross examination for flap survival, histology, immunohistochemical staining, myeloperoxidase assay, flow cytometric study of CD18, and Northern blot analysis on ICAM-1 messenger ribonucleic acid expression. Gross measurement of the flap showed increased survival in groups II and III compared with group I (P< 0.05). The leukocytes adherent to the endothelium were counted at 24 hours and on day 5. Group I leukocytes were significantly increased compared with groups II and III (P< 0.05). The myeloperoxidase assay of TRAM flaps at 24 hours revealed a significant increase in group I compared with groups II and III (P< 0.05). The expression of CD18 was similar between groups I, II, and III. Immunohistochemical staining for ICAM-1 and Northern blot analysis on ICAM-1 messenger ribonucleic acid showed decreased expression in groups II and III compared with group I. Throughout the analysis, groups II and III did not show any significant differences. These results suggests that hyperbaric oxygen reduces the accumulation of leukocytes in the TRAM flap, but not enough to prevent adhesion of neutrophils on endothelial cells; ischemia–reperfusion injury increases the expression of CD18 and ICAM-1 and causes increased adhesion of leukocytes on the endothelium; hyperbaric oxygen does not alter the expression of CD18 but decreases the expression of ICAM-1; and the point of application for hyperbaric oxygen, whether applied before or after reperfusion, did not show any differences in outcome. In conclusion, the application of hyperbaric oxygen against ischemia–reperfusion injury increases flap survival and the beneficial effect may be explained by a protective mechanism involving downregulation of ICAM-1 on endothelial cells.

ISSN:0148-7043    

出版商:OVID    

年代:2003

数据来源: OVID