摘要:

Two cases of endoscopic-assisted muscle harvest for lower extremity reconstruction are presented. Each case involved resurfacing the distal leg and dorsum of the foot with a split-thickness skin graft over a latissimus dorsi free flap. An endoscope with a video monitor and modified thoracoscopic instruments were used to assist in the muscle harvest. The principles of endoscopic muscle harvest include an incision long enough to remove the muscle, placed in the least conspicuous area that is within the reach of the instrumentation; retraction to optimize the optical cavity or visual working area; and use of video monitors to allow for coordinated assistance. The decrease in visible scarring is dramatic and represents the primary advantage over open techniques. We believe that the role of endoscopy will continue to expand as our experience increases and technology improves.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The improvement of endoscopic technology has revolutionized surgery, and endoscopy has become a trend in recent years. In plastic surgery, endoscopic release of the carpal tunnel and endoscopic face-lifting have been used clinically. However, no report has been noted that deals with the bone of the face. Using pigs as the animal model, endoscopic resection of the mandibular angles was undertaken. The result was satisfactory; it appears that it can also be effective in humans.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The use of prophylactic antibiotics in reduction mammoplasty has been random and its efficacy unproven. This study reviewed 106 consecutive inferior pedicle technique reduction mammoplasties. Two groups were identified; 47 patients received prophylactic antibiotics and 59 patients did not. The decision of who received prophylactic antibiotics was random based on resident rotation and resident preoperative orders. The demographics were equal between the antibiotic group and the control group. The wound infection rate and the rate of delayed healing were examined in both groups. There were no statistically significant differences in the infection rate or the rate of delayed wound healing in either the antibiotic group or the control group. Individual risk factors were also studied in each group. These risk factors included obesity, older age, smoking history, and large reductions. The use of prophylactic antibiotics did not reduce the infection rate in any of these high-risk groups. Comparing the individual risk factors for the remainder of the patient population showed that the infection rate was higher in obese patients but was unaffected by prophylactic antibiotics. Delayed healing was also higher in larger reductions but also was unaffected by the use of prophylactic antibiotics. We conclude that the use of prophylactic antibiotics in reduction mammoplasty is not efficacious in reducing the rate of wound infection or delayed healing.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Partial or total lower lid reconstruction implies the repair of three layers: the skin, the tarsus, and the conjunctiva. The method of reconstruction must, therefore, aim at three objectives: ensuring the stability of the lid by repairing the tarsoconjunctival layer, achieving an aesthetic result with the repair of the skin, and taking into consideration the primary role of the upper lid in the ocular protective system. We recommend a musculocutaneous flap, taken from the upper lid, with a single lateral or medial pedicle combined with a chondromucosal alar graft. During the last 10 years, 41 patients were operated on with malignant skin tumors requiring marginal, partial, and total lower lid reconstruction. The results were quite satisfactory from a functional and aesthetic point of view. We noticed two cases of partial flap necrosis and two cases of ectropion needing revision. We believe that the procedure described can be a tool in the armamentarium of the plastic surgeon involved in the field of the orbitopalpebral area.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We describe our technique for correcting a cleft lip nasal deformity using L-shaped iliac bone grafts to achieve additional structural support and the desired nasal projection and profile. Augmenting the nasal bridge creates the illusion of a narrower nose. Further, the columellar portion of the L-shaped graft provides stabilization, eliminating the “seesaw” effect of the bridge graft on the fulcrum of the bony bridge, which can lead to a depressed tip and loss of the root indentation. Clinical and radiographic observation has revealed that this method of correction has consistently produced satisfactory results.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Five patients with unilateral facial palsy with moderate to severe lagophthalmos (less than 70% eyelid closure) and duration of palsy expected to last more than 2 years were selected for the study. In all patients, a temporalis muscle-fascia sling was used to restore ocular sphincter function. A few modifications in the original technique as described by Gillies have been recommended: namely, harvesting of a narrow strip of temporalis muscle to avoid a bulge in the temporal region, submuscular passage of temporalis fascial strip in the eyelid to avoid eversion of the lid margins, and tenorrhaphy of fascial strips at the medial aspect of the lower eyelid to avoid webbing of the medial canthus. Average duration of follow-up was 3 years. All patients showed excellent eyelid closure. Advantages of the temporalis muscle sling, which is a dynamic procedure using autogenous tissue, are discussed.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Fat injection is being used for the correction of various soft-tissue defects. In this study, the manner of fat injection yielding the greatest transplant viability was examined. Autologous fat was obtained from the inguinal area of rats and subsequently reinjected to the nuchal region, an area naturally poor in subcutaneous fat. Before injection, the fat was processed by one or more of the following methods: suture of the recipient area, repeated washing to remove residual blood, and addition of insulin. Transplant status was evaluated by both macroscopic and microscopic examination of the recipient sites 2 weeks and 12 weeks after the injection. The results demonstrated that the injected fat remained in part as viable new fatty tissue in the nuchal area. No statistically significant improvement in the viability of the injection fat was noticed at 2 weeks and 12 weeks after its processing by the different methods just described. Significant positive correlation was demonstrated between the volume of the injected fat and the size of the bulging at the injection area only 2 weeks after the injection.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Allogeneic grafts have many advantages over autogenous grafts. An experimental rat model using the great saphenous nerve was developed to study the reconstruction of long peripheral nerve defects with vascularized allogeneic nerve grafts, and the effects of cyclosporine therapy on graft survival were assessed. In animals receiving short-term immunosuppression, the number of regenerated axons increased steadily during the treatment, but rejection began immediately after cyclosporine was discontinued. As the tissues transplanted with the nerves underwent necrosis, the grafts showed demyelination. In contrast, in animals receiving long-term cyclosporine therapy, nerve regeneration assessed in terms of the myelinated axon count was excellent until at least 12 weeks postoperatively but was less active than in vascularized autografts or conventional allografts. These results indicate that the short-term immunosuppressive therapy with cyclosporine cannot produce immunological tolerance of vascularized nerve allografts. In addition, even when administration of cyclosporine was prolonged, nerve regeneration did not exceed that in autografts.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

If a stable and reliable venous island flap can be elevated, it may enable us to make various flaps everywhere on the body surface by using subcutaneous veins. We have carried out an experimental study to investigate the possibility of increasing the survival area of a venous island flap by a delay procedure. In a proximally based venous island flap, survival area increased when a delay procedure was used, especially with ligation of the distal vein. In a distally based venous island flap, survival area increased when a delay procedure was used without ligation of the proximal vein.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In this article, one-stage repair of complicated cases of penile hypospadias when there is no penile skin available for safe reconstruction is described. An island of the most median hairless part of the scrotal skin around the median raphe was used as a skin flap based on its scrotal septal pedicle with an extended and free arc of rotation for repair of distant urethral defects. The bilaterally stretched, most median area of scrotal skin is almost hairless. This well-vascularized flap was used in reconstruction of 18 patients with recurrent, complicated, proximal, and distal penile hypospadias from January 1989 through July 1993. Of these, 17 patients were post pubertal and 1 was prepubertal. A maximum of 5 years and a minimum of 8 months follow-up showed no hair growth problems. Complications were sacculation of the reconstructed urethra in 1 patient, meatal stenosis in 1 patient, and urethral fistula in 1 patient. Technique refinements and encouraging results as well as complications are discussed.

ISSN:0148-7043    

出版商:OVID    

年代:1994

数据来源: OVID