摘要:

Cleft palate can be repaired by a palatal mucoperiosteal flap, but we have devised a new technique for cleft palate repair using a wide mucoperiosteal flap with an alveolar ridge mucosa and a cleft margin flap. This technique leaves the mucosa of the nasal cavity and vomer intact. The results include (1) good velopharyngeal competence and normal articulation, (2) few cases of fistula formation, and (3) minimal maxillary retardation.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Lower eye lid blepharoplasty is a frequent cosmetic procedure. The carbon dioxide laser transconjunctival approach is a popular alternative to conventional techniques. Eight hundred eighty-nine consecutive cases were studied retrospectively to determine the occurrence of complications. All cases were included. Complications were divided into intraoperative, immediate postoperative (days 1-7) and late postoperative (greater than 7 days). Complications encountered in this study of carbon dioxide laser conjunctival blepharoplasty were uncommon and not severe.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

An improved method for reconstructing injured tendons of the dorsum of the hand is presented. We transferred a two-layered temporal fascial flap to the hand and inserted the rolled, deep temporal fascia between the stump of the extensor tendons. This procedure can improve extensor tendon function with minimal scarring in spite of the limitation of available tissue.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Apex bending and torsional loading were utilized to study the effects of different plate design and thickness, and screw size and design on the rigidity and strength of seven different titanium mini- and microplates placed onto osteotomized proximal phalanges. One hundred forty-four fresh frozen human cadaveric proximal phalangeal bones underwent a mid shaft osteotomy followed by application of one of the following plates: (1) Synthes linear 1.5-mm five-hole plates, (2) Leibinger linear 1.2-mm five-hole or (3) 1.7-mm four-hole plates, or (4) Leibinger three-dimensional 1.2-mm four-hole, (5) 1.2-mm eight-hole, (6) 1.7-mm four-hole, or (7) 1.7-mm eight-hole plates. Three-point bending (apex dorsal or apex volar) and torsional loading were utilized for each plating configuration. Analysis of variance models of bone specimen width, depth, cortical thickness, and length revealed that increasing plate thickness was associated with increasing rigidity, but that the three-dimensional design yielded a higher relative rigidity except under apex volar loading.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Many procedures have been developed to correct the secondary cleft lip nasal deformity, including the depressed nasal tip, flaring nasal aperture, and a very short columella. The forked flap, cartilage graft, or strut and bony graft have been applied for many years. We propose the extended open-tip rhinoplasty with three V-flaps, which we have performed on 12 patients during the past 3 years. An extended incision for the nasal skin flap exposes all deformities to direct vision, makes the advancement and rotation of the nasal skin flap complete, and makes the corrective procedures easy and accurate. A large V-flap (with V-Y advancement for columellar lengthening) and two small V-flaps (with back-cut incisions on the nasal lining) are used to elevate and suspend the alar domes and cartilage to create two symmetrical and piriform apertures, and to ensure adequate columellar length. Columellar lengthening averaged from 2.5 mm preoperatively to 10 mm postoperatively. A protruded nasal tip with two delicate and small dimples over the alar rims, and a piriform aperture of the nasal nares were achieved in our series. No hypertrophic scar, nasal obstruction, or exposure of hairy nares were noted. No cartilage graft or strut and bone graft were required.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Auricular composite grafts were used to augment both nasal alar size and thickness in 8 patients who had alar hypoplasia. The grafts included large amounts of conchal cartilage and a small amount of elliptically shaped retroauricular skin. The width of the skin harvested was about one-third that of the harvested cartilage. The cartilage was used to augment the thickness and correct the shape of the ala, and the skin that was grafted to the alar groove was used to restore the covering defect. All grafts took perfectly and the aesthetic results were satisfactory except in 1 patient. The grafted skin provided both a good color and texture match for the nose, and the cartilage maintained the alar shape. This procedure is simple to perform and yields good results with minimal donor site deformities.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The timely detection of peripheral vascular disease (PVD) in spinal cord injury (SCI) patients is difficult because the usual symptoms of claudication and rest pain are absent. In fact, the initial manifestation of PVD in SCI patients is often advanced gangrene, so that healing, primarily or following major amputation, is either difficult and prolonged or impossible. In addition, sacral and ischial pressure sores common among SCI patients may be exacerbated and reconstruction made more difficult by PVD. Five SCI patients presented with lower extremity gangrene as the initial recognized manifestation of PVD at our institution between January 1992 and January 1994. All 5 patients had risk factors for PVD. Four out of ten limbs in these patients required amputation, either above the knee or below the knee. Three patients required concurrent vascular reconstruction of the aortoiliac segments, including an aortobiprofunda femoral bypass, an iliac embolectomy with femoral-femoral bypass, and iliac angioplasty. Three patients had ischial and/or sacral pressure sores that had recurred following multiple musculocutaneous flap reconstructions before vascular disease was recognized. The timely diagnosis of PVD involving the iliac segment in the SCI patient is sometimes overlooked and is often necessary to optimize the treatment of both lower extremity ulcers and sacral/ischial pressure sores common among these patients.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The latissimus dorsi musculocutaneous flap has proven utility in the reconstruction of defects of the breast, chest wall, head and neck, and upper extremity. As a free flap, the latissimus dorsi has become a mainstay for the coverage of severe traumatic tibial/fibular wounds. We describe a new and useful extension of the latissimus dorsi musculocutaneous unit that consists of a fasciocutaneous segment based on musculocutaneous perforators from the thoracodorsal artery. The vascular anatomy of the flap is described and illustrated with 6 fresh human cadaveric dissections. We also present 3 cases in which in vivo dissections of this flap were performed, 2 at the time of latissimus microvascular transfer and 1 approximately 5 days after microvascular transfer to salvage exposed fractured tibial bone successfully due to distal muscle loss. A pedicled or free latissimus dorsi musculocutaneous flap may be reliably extended and thereby rendered more versatile through the use of the perforator-based fasciocutaneous flap. Benefits and potential applications of the latissimus dorsi perforator-based fasciocutaneous flap are discussed.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The medial thigh flap is a perforator-based flap nourished with septocutaneous or muscle perforators originating from the femoral vessels. To date, 8 patients have been repaired with this flap and extended or connected flaps including this flap: 4 patients with lower leg defects and 4 patients with intraoral and neck defects. The advantages of this flap are (1) several pedicle perforators exist for this flap, which makes possible duplicated vascular anastomoses to establish reliable circulation of the transferred flap; (2) the flap can be extended or connected to other neighboring flaps in the anterior thigh, so that extensively wide defects can be closed in one stage; (3) the great saphenous vein can be simultaneously used as a vein graft or for venous drainage for the flap; (4) the anterior branch of the femoral nerve can be used for sensory potential; and (5) there is minimum morbidity of the donor defect and a large dominant vessel for the leg can be preserved. The suitable indications for this flap are defects after removal of skin cancer in the foot or lower leg and wide defects after resection of head and neck cancer, which can be reconstructed with the flap connected to neighboring skin flaps. The disadvantages of this flap are that it has a small, short vascular pedicle and the bulkiness of the flap's fatty tissue often requires thinning.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Desmopressin (1-deamino-8-D-argininevasopressin, DDAVP) is a synthetic analog of the antidiuretic hormone L-argininevasopressin. DDAVP has been shown to increase the plasma concentration of endothelial factor VIII, thus increasing coagulant activity. There is evidence from controlled clinical trials indicating that DDAVP can reduce blood loss and transfusion requirements for individuals with normal coagulation profiles undergoing various surgical procedures. This study was conducted to evaluate the efficacy of the DDAVP in reduction of blood loss during orthognathic surgery. Twenty patients, 15 females and 5 males, undergoing bimaxillary osteotomy were randomized into two groups of ten. Perioperatively, group I patients received 20 µg of DDAVP infused over one-half hour. Group II patients did not receive DDAVP. Hypotensive anesthesia (mean arterial pressure<60 mm Hg) was routinely employed for both groups. On average, the blood loss in group I patients was 144 ml less per patient than group II patients (p<0.50). Only 2 of 10 patients in group I lost in excess of 750 ml, while 6 of 10 group II patients experienced blood loss greater than 750 ml (p<0.20). The average postoperative hematocrit for patients in group I dropped by 6.17 of the preoperative mean hematocrit (p<0.001). The average drop in hematocrits among the group II patients was 11.61 (p<0.001). When collated, this hematocrit drop of 11.61 for group II and 6.17 for group I (recipients of DDAVP) proved to be significantly different (p<0.01). It is concluded from this study that patients receiving a standard dose of DDAVP prior to bimaxillary osteotomy would experience reduced intraoperative blood loss, providing that blood pressure is well controlled and fluid replacement is carefully managed. No significant adverse side effects of desmopressin acetate were observed.

ISSN:0148-7043    

出版商:OVID    

年代:1996

数据来源: OVID