摘要:

Twenty-seven patients who underwent postmastectomy breast reconstruction using the ipsilateral upper transverse rectus abdominis musculocutaneous (TRAM) flap are presented. We believe that there are several advantages in using this flap instead of the lower TRAM flap. The ipsilateral upper TRAM flap has a stronger and more predictable blood supply, involves easier and stronger abdominal wall repair and less operating time with less blood loss, and has a very acceptable donor site.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A rat sciatic nerve model of regeneration was assessed by multiple techniques to determine the relationship between parameters of neural regeneration in common use today. The results demonstrated significant correlation and internal consistency between electrophysiological and morphological parameters (i.e., conduction velocity and fiber diameter) but not necessarily a correlation between these physiological parameters and overall nerve function as assessed by a modified walking track technique. Guidelines for parameter selection are suggested based upon the specific question being investigated (e.g., sensory and/or motor function versus axoplasmic flow and/or neurotropism) rather than the nonspecific “neural regeneration.”

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The evolution of the technique of breast reduction using an inferior dermal pyramidal flap is discussed, including the changes we have found to enhance this procedure. The recommended use of a wide-based pyramidal breast parenchyma with a dermal pedicle nipple-areola flap is based on our 12-year study of 1,001 breast reductions in 519 patients ranging in age from 13 to 73 years; 37 of the patients underwent a unilateral breast reduction. The weight of tissue excised ranged from 207 g to 3,350 g from each breast. Occult carcinomas were found in two of the breast specimens. The longest sternal notch-to-nipple distance was 52 cm.The essential goals of predictability of the result, retainment of nipple sensitivity, excellent aesthetic results, and the possibility of lactation are satisfied by the use of this surgical technique. This technique appears to have continued application in younger women, in whom nipple sensation and lactation are particularly important.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Full-thickness excision wounds infected with Staphylococcus hyicus, a pig pathogen, or Staphylococcus aureus, a human pathogen, were produced in pigs. The inoculated wounds were kept occluded for 2 days and then exposed and biopsied at intervals for 9 to 12 days. The exposed lesions were edematous and exudative. The S. aureus model was experimentally advantageous because the infection remained localized to the wound without systemic infection or signs of discomfort. The S. hyicus infection caused a rash with skin blisters; thus, its use is discouraged. The concentration of S. hyicus in the wound on day 2 was log 8.6 ± 0.4 CFU/g (mean ± standard deviation). On day 4 the mean was log 9.2. For S. aureus the values were log 8.0 ± 0.9 on day 2 and 6.9 on day 4 (p < 0.05). Of the 50 individual values in the S. aureus series, 45 were above log 5. The inflammatory reaction was more pronounced after the infection with S. hyicus, whereas with S. aureus the fibroblast response came earlier and was more pronounced. The model parallels typical clinical courses of staphylococcal infection.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Bacteria from full-thickness excision wounds with staphylococcal infection in the pig were cultured quantitatively. The bacterial concentration increased with the size of the inoculum, and after 2 days it had already reached a stable, maximal level of approximately log 8 CFU/g in the tissue. The correlation coefficient was 0.753 in comparing concentrations from superficial and deep biopsy halves and 0.145 from “surface wash” and superficial biopsies. The “within wound” sample distribution was logarithmic. The gain in precision when assessing the mean bacterial concentration from three instead of one biopsy was 45%. The coefficient of variation of between wound and within wound determinations was in the same range (i.e., 7.1—12.5%). Paired observations from a sample population with 7 sites (wounds) were needed to determine a 10% change in the bacterial concentration at a significance level of p<0.05, and a similar change could be determined from unpaired observations based on two populations with eleven sites.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Proper management of highly contaminated traumatic wounds frequently requires delayed primary closure of healing by secondary intention to prevent subsequent infection. This animal study compares the efficacy of various wound debridement methodologies to prevent infection following primary closure of treated contaminated wounds.Forty-four Sprague-Dawley rats with uniform, paravertebral incisions were studied. Each wound was inoculated with a standard amount of Staphylococcus aureus bacteria and allowed to remain open for two hours. Each wound was treated before wound closure by one of four debridement methods: (1) surgical scrubbing, (2) high-pressure irrigation, (3) ultrasonication, or (4) soaking. The control animals' wounds were closed without debridement. At 7 days, each animal was evaluated for the presence of gross infection and wound induration.Ultrasound, with a 25% incidence of gross infection, compared with irrigation (75%), scrubbing (82%), and soaking (89%) provided significant protection from subsequent abscess formation. The control group uniformly developed infection (100%). The average amount of induration after ultrasonication (1.35 ± 0.56 cm) was also significantly less than irrigation (2.07 ± 0.75 cm), scrubbing (1.95 ± 0.34 cm), and soaking (1.73 ± 0.22 cm). Our data demonstrate that ultrasonic wound debridement has exciting potential as a new debridement technique for contaminated traumatic wounds.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

For 15 years, the latissimus dorsi muscle has enjoyed a consistent reputation with reconstructive surgeons as a reliable pedicle or free flap transferred with or without a skin island. Previous laboratory investigation has dehneated the neurovascular intramuscular anatomy.The segmental latissimus transfer makes use of the intramuscular anatomy such that a lateral segment of the muscle is denervated and transferred with the thoracodorsal vascular pedicle while the medial segment of the muscle remains in situ innervated normally and perfused by the dorsal perforating branches of the ninth, tenth, and eleventh intercostal vessels.In this article we report our results using segmental free flap transfer of the latissimus dorsi muscle in 11 patients. Electromyographic studies have been performed more than a year postoperatively to document the function of the residual latissimus left in situ. Our clinical observations show that the segmental free transfer of the latissimus dorsi muscle can be accomplished with little risk in those situations not requiring the entire muscle, and that the portion of the muscle not transferred continues to function well and improves the contour of the back.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Our experience with V-Y subcutaneous flaps for nasal tip closure after tumor resection in 10 patients is reported. This method has distinct advantages over previously used methods such as skin graft, rotation, or transposition flap. It allows primary closure of recipient and donor site without the formation of dog-ear or trapdoor deformity. It is easy to design, reliable, and offers good cosmetic results. This method is performed under local anesthesia as an office procedure. It is recommended to plastic surgeons for the closure of nasal tip defects.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The wound contraction model described in Part I was used to study topically applied, recombinant platelet-derived growth factor (rPDGF-BB) and wound contraction in normal and steroid-impaired rats. Circular wounds 4 cm in size were made on the dorsum of the rats with halothane anesthesia. Five groups of 20 normal rats each were treated with the vehicle alone and four concentrations of rPDGF-BB (0.5, 1.0, 3.0, and 10.0 µg/ml). Four groups of 20 steroid-impaired rats each were treated with the vehicle alone and three concentrations of rPDGF-BB (0.5, 1.0, and 3.0-µg/ml). The wounds were dressed with 2x2 gauze, Adaptic, 4x4 gauze, and Tubigrip. The investigators were blinded to the treatments until the completion of the experiment, and the treatments were applied in random order. Dressings were changed every 2 to 3 days for 14 days and the wound areas were determined, expressed as a fraction of the original, and plotted versus time. The areas under the curves and the means of the fraction open each day were compared between groups using Student's t-test.The treatment with 3.0-µg/ml rPDGF-BB accelerated the rate of wound contraction in the steroid-impaired animals (p<0.05).

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Since the early 1970s, the feasibility of transferring a muscle and having it survive and eventually function has been demonstrated both in research laboratories and clinically. Over a decade later, the factors influencing success are better understood. There have been significant contributions in concepts of muscle anatomy, muscle physiology, muscle reinnervation, and muscle's response to ischemia. Ischemia time, within reason, does not appear to be as influential as first thought. The potential for demonstrating the efficacy of postoperative exercise is but one of the areas that could benefit from further research endeavors.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID