摘要:

Functioning muscle can be transferred from one location to another using microneurovascular anastomoses. Reinnervation and useful muscle contraction are produced by suturing an appropriate motor nerve in the recipient area to the motor nerve of the transplanted muscle.Clinical experience and experimental investigations have led to an understanding of some of the important principles in extremity muscle transplantation. Successful deltoid and biceps reconstruction are reported.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

External septorhinoplasty affords direct exposure, which allows both the novice and the expert surgeon to treat the most challenging noses with a higher degree of assurance. Criticism of the external columellar scar is unwarranted. The technique is reviewed in detail, and complex cases are illustrated.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The importance of the research in skin flap pharmacology is two-fold. First, observations made from the vasoactive drug actions in the vasculature of skin flaps can provide insight into the regulatory mechanism of cutaneous circulation and the pathophysiology of ischemic necrosis in skin flap surgery. Second, there is the possibility that the aforementioned information may eventually contribute to the development of a drug treatment for the augmentation of skin blood flow and viability in acute skin flaps (i.e., to mimic the surgical delay mechanism). To this end, the objectives of this article are: (1) to present a brief review of the recent research progress in the pharmacological treatment of ischemic skin necrosis in experimental flap surgery, and (2) to attempt to identify the future directions and important areas of research to be pursued in the pharmacology of skin flaps.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The use of lidocaine as a local anesthetic has been limited to 7 mg/kg. The authors question whether amounts of lidocaine greater than the recommended dosage may be safely used in the patient undergoing lipoplasty of the torso and knees. Six patients were used as a sample and a wetting solution of 750 mg or 1,000 mg of a .25% lidocaine solution containing 1:400,000 epinephrine was injected into the surgical site. The ratios of milligrams of lidocaine to kilograms of body weight varied from 9.1 to 13.8. Serum lidocaine levels were measured at frequent intervals. Because of many factors, including poor vascularity of subcutaneous fat, vasoconstrictive effect of epinephrine, and aspiration of a portion of the lidocaine, blood levels of lidocaine in the patients never exceeded 1.0 µg%. We conclude that lidocaine, 9 to 14 mg/kg, results in peak serum lidocaine levels of only 0.5 to 0.8 µg%.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Crouzon's syndrome is one of many disorders that have been associated with acanthosis nigricans. Previously reported cases documenting this association have been reviewed, and additional cases that have been treated at the Institute of Reconstructive Plastic Surgery at New York University Medical Center have been added. Recommendations for the surgical management of this unique group of patients are presented.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Congenital sinuses on the lower lip in association with cleft lip, cleft palate, or both are rare and occur in four syndromes, namely Van der Woude syndrome, popliteal pterygium syndrome, orofacial digital syndrome, and the ankyloblepharon filiform adnatum. The most common and best studied among these—the Van der Woude syndrome—is believed to be due to an autosomally dominant gene with 80 to 100% penetrance and a variable expressivity. We present our study of 9 patients with congenital lower lip sinuses and the penetrance in their families. On the basis of our observations we conclude that this syndrome may have low penetrance among the populations studied.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A prolonged preoperative ischemic interval decreases the chances for successful replantation of an amputated limb. Skeletal muscle is especially sensitive to periods of prolonged ischemia. It is now hypothesized that significant tissue injury occurs during reperfusion, when oxygen-rich blood contacts anaerobic metabolites forming toxic oxygen free radicals. A replantation model, using the rabbit hind limb tibialis anterior muscle, was developed to assess muscle function and histological appearance following ischemic intervals of five and eight hours. Muscle strength five weeks after injury was used as a functional measurement of tissue damage. The effects of the superoxide free radical scavenger superoxide dismutase (SOD) and the hydroxyl radical scavenger dimethylsulfoxide (DMSO), administered systemically just before reperfusion, were studied. Muscle treated with SOD following five hours of ischemia had essentially normal strength and histological appearance; however, there was no protective effect after eight hours. DMSO treatment had no beneficial effects after five hours of ischemia, but after eight hours DMSO-treated muscle had significantly better function than untreated muscle. Histological examination confirmed the functional results. Clinical treatment of ischemic limbs with free radical scavengers before revascularization may aid in avoiding reperfusion injury and may improve survival and later muscle function.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Despite recent advances in radiation therapy and chemotherapy, surgical procedures remain the primary modality of head and neck cancer therapy. Adequate surgical resection frequently requires the removal of significant amounts of tissue. The primary concern of the reconstructive surgeon is the restoration of a functional aerodigestive tract. In addition to the prolongation of life, the quality of that life should be taken into consideration.The records of 25 patients undergoing oropharyngeal reconstruction for tumors stage 3 or 4 in the 4-year period from 1983 to 1986 were reviewed. After surgical extirpation, reconstruction was performed using either a pectoralis major musculocutaneous flap or a microvascular free flap.Results were evaluated with emphasis on both the intraoperative and postoperative course. The length of the procedure, time of initiation of oral feedings, time of decannulation, postoperative complications, time of discharge, and quality of life after discharge were considered. Those patients reconstructed with microvascular free flaps were able to tolerate oral feedings sooner and were discharged sooner than those patients reconstructed with pectoralis musculocutaneous flaps. In addition, the patients with pectoralis flaps were twice as likely to have local complications (e.g., superficial wound infection, fistula) as those with free flaps. The quality of the patient's life with respect to deglutition and intelligibility of speech was likewise better for those patients reconstructed with microvascular free flaps. The explanation of these results is presented.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The quantitative and morphological characteristics of microbial adherence of four organisms—Staphylococcus epidermidis, S. aureus, Escherichia coli and Candida albicans—to the surfaces of different breast prostheses were observed. Semiquantitative adherence studies based on a modification of Maki's roll culture technique even after short contact times showed (1) increased microbial adherence at higher concentrations of the organisms and (2) differences in adherence properties between gram-positive bacteria and other organisms tested, noted also at lower organism concentrations. Scanning electron microscopy (SEM) to identify microorganisms on foam-covered prostheses, however, revealed organisms in the interstitial spaces that were not recovered by the plating technique. Other features on SEM were extracellular “slime” produced by S. epidermidis, which appears to act as a cement by which bacteria are held against prosthetic surfaces. These in-vitro findings suggest that brief exposure of the prostheses to a few organisms, particularly gram-positive bacteria, at the time of implantation would be sufficient inoculum for bacterial adherence to prosthetic surfaces.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Two reliable techniques for the microvascular anastomosis of difficult-to-handle, thin-walled smaller vessels—“insert sutures first, tie later” and “loops on hanger”—are described.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID