摘要:

This research was of 133 plastic surgery patients over a 1.5-year period. Data compilation and assessment began with the initial consultation and continued through the postoperative period of care. Patients were categorized according to their similarity to the personality disorder descriptions found within theDiagnostic and Statistical Manual of Mental Disorders, third edition revised, of the American Psychiatric Association. In addition, each patient was evaluated on 13 separate psychological and social factors. It was found that many of the factors that precede a favorable plastic surgery experience, for both patients and physician, are the same characteristics disproportionately represented in various personality types. Objective assessments of surgical outcome were not found to be necessarily predictive of a patient's ultimate satisfaction. This research identified those personality types most likely to be dissatisfied, along with those personalities who tended to withhold their approval of an excellent surgical result. This research provided both statistical and qualitative analysis of the impact of personality, as well as several psychological and social variables, on plastic surgery. Numerous suggestions have been offered for successful patient care as derivative of personality type. The impact of patient and physician personality upon medical malpractice was explored. Reference summaries have been provided that describe and categorize patient behavior according to personality

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A study of 201 black American noses has led us to divide the black American nose into three groups, i.e., Groups A, B, and C, which we have called the “African,” the “Afro-Caucasian,” and the “Afro-Indian.” Belonging to the African group (Group A) were 44% of the noses, 37% were Afro-Caucasian (Group B), and 19% were Afro-Indian (Group C). Fifty-three percent of the African noses had a concave dorsum, whereas only 10% of the Afro-Caucasian and 8% of the Afro-Indian group had a concave dorsum. On the other hand, 36% of the Afro-Caucasian group had a hump as did 63% of the Afro-Indian group. Only 18% of the African group had a hump. The most common nostril types were type IV (20%), type V (27%), and type VI (25%), the distribution of which varied with the nasal type. Anthropometric measurements showed variations according to type, with the African noses being the shortest and widest, the Afro-Caucasian the narrowest, and the Afro-Indian being the longest. Cadaver dissection showed that the alar cartilages varied from small and thin in the African group to large and thick in the Afro-Indian. All were covered by a heavy layer of fibrofatty tissue. The value of this grouping in the evaluation and surgery of the black American nose is discussed.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Seventy consecutive patients treated for lawn mower injuries to the foot and ankle were reviewed to determine optimal treatment, functional results, and complications. Injuries were classified into 1 or more functional–anatomical zones (I, digits; II, dorsum; III, plantar nonweight-bearing surface; IV, heel; and V, ankle) for a total of 96 injuries. Thirty-one patients were available for follow-up. Mean age was 36.7 years and 84% were males. Most injuries (67%) involved patients >16 years old using a push mower; however, 18% involved children <5 years old, usually caused by riding mowers (70%). Primary closure after adequate irrigation and debridement was the preferred method of treatment except in patients with Zone IV injuries. Antibiotic prophylaxis was used in almost all injuries (93%). A 100% ambulation rate was achieved with 10% of patients requiring a prosthesis. Zone IV (heel) injuries had a 50% complication rate from chronic soft tissue breakdown. The wound infection rate per injury was 12.5% and did not vary significantly between closed (11.4%) and open (17.6%) treatment. Lawn mower injuries to the foot and ankle can be closed primarily after adequate irrigation and debridement without compromise of infection rate or function. Antibiotic prophylaxis is recommended. One-sixth of these injuries involve children <5 years of age and can be prevented.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The ability to penetrate skin permanently with posts of pure titanium has led to a dramatic breakthrough in the attachment of facial prostheses. The posts are attached to screws of titanium that are completely integrated in the underlying bone, without any intervening soft tissue. This precise and rigid fixation permits rehabilitation of patients with complex defects that would be otherwise untreatable.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This pilot study reports the 2-year follow-up on hydroxylapatite-coated nonscrew titanium implants (Integral) used for fixation of auricular and orbital prostheses. Fifty-four implants have been inserted in a two-stage procedure for auricular reconstruction in 12 patients and orbital reconstruction in 2 patients. Clinically solid integration has occurred with 51 implants in 13 patients, three implants being lost in previously irradiated bone where soft tissue coverage was never adequate. Early soft tissue reaction occurred in those younger patients and where multiple previous surgery had occurred in the same area. Conservative local treatment produced resolution of this in all patients. Stable retention of cosmetically acceptable orbital prostheses was achieved with bar–clip assembly or magnet arrangements.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Nonpalpable nodules in patients with breast implants may represent silicone granulomas, fibrocystic mastopathy, or cancer. We describe a modified technique for needle localization which facilitates the surgical excision of these nodules while minimizing the possibility of rupture.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Six patients with augmentation prostheses presented with a firm, painless, breast mass that could not be visualized by mammography. One lesion was demonstrated to be solid by ultrasound, and the remaining sonograms were nondiagnostic. The lesions were indistinguishable from carcinoma, by physical examination. All of the patients had fine needle aspiration biopsy despite close proximity to the implant. The patients all had silicone granulomas related to silicone leakage. Our experience suggests that fine needle aspiration biopsy is a useful technique to evaluate palpable breast masses that are not visualized by mammography in patients with augmentation prostheses.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In our experience digitless hands from frostbite injury are typically seen in young men as a result of an episode of intoxication. Such deformities occur bilaterally in 80% of cases and often lead to total loss of prehensile capability. Because of a uniformly high degree of motivation in this group of patients, toe-to-hand transfer carries an excellent prognosis. Microanastomoses in a frostbitten hand are as reliable as in a mechanically injured hand, provided the ulnar artery and its branches are intact. Because amputations occur at the level of the metacarpal heads, the preferred transplant is the combined second and third toe composite. However, a satisfactory thumb post is essential for proper function of the composite. Well-planned sharing of available toe resources is necessary for establishing optimum bilateral hand function, especially in the face of simultaneous toe frostbite. Squandering valuable foot resources bilaterally on behalf of a single hand makes reconstructing the opposite hand more difficult. Economy may be gained if two separate microvascular toe transfers are taken from the same foot or if a single block of toes may be applied to the hand as an opposable unit. Clinical management is described of 25 digitless patients whose frostbitten hands were treated by microsurgical toe transfer.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

One hundred three microvascular toe-to-hand transfers were performed on 66 pediatric patients with congenital and posttraumatic deformities. Techniques for dissection and transfer of individual and composite toes were elaborated, and adjunctive procedures were added when indicated.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Twenty-seven rabbits divided into 4 groups (2 control groups) received saline, standard heparin (400 IU both as anti-F Xa and activated partial thromboplastin time per kg of body weight), or low molecular weight heparin (lmwh) (Fragmin 560 IU as anti-F Xa and 140 IU as APTT units per kg of body weight). The figures represent the total dose given over 3 hours. The central arteries of the rabbits' ears were prepared and positioned in clamps. Platelets labeled with32P were injected. Arteriotomy/intimectomy was performed. After reestablishment of blood flow, arteriotomy bleeding times, platelet accumulation, patency, and weight of thrombotic materials were measured. The bleeding time in the Heparin Group was significantly prolonged compared with its control group. But the bleeding times between the LMWH Group and the control group were not significantly different. The patency rates were increased in both the Heparin Group (100%,p< 0.01) and the LMWH Group (73%,p= 0.078) compared with respective control groups (43–50%). The mean weights of thrombotic material in each artery were significantly lower in the Heparin Group and in the LMWH Group than in their control groups. The mean values of radioactivity in all groups increased up to 15 minutes after the vessels were reperfused. There were no statistical differences between the treated groups and control groups. It was concluded that standard heparin is a very powerful inhibitor of thrombosis during the most crucial hours after reperfusion of severely traumatized small arteries, without significant effects on primary platelet adhesion/aggregation. LMWH (Fragmin) appears to be less efficient than heparin in small arteries but a valuable antithrombotic agent in microvascular surgery, also without disturbing platelet activities, especially if increased bleeding is intolerable.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID