摘要:

It is frequently reported that early repair of the soft palate induces narrowing of the remaining palatal cleft and thus facilitates later hard palate closure. However, to the best of our knowledge, there have been no comparative studies to test this hypothesis. The purpose of this retrospective study was to evaluate the change of palatoalveolar morphology following primary lip repair and posterior palatoplasty. Dental plaster models of patients with complete unilateral cleft of lip and palate (UCLP) were used to measure the width of the cleft and palatal arch. Twenty-six patients received simple posterior palatoplasty (PP group) simultaneous with primary lip repair, and 20 patients did not (NPP group). The dental models included one preoperative cast at 2 months (Tl) and two or three casts at 6 (T2), 12 (T3), and 18 (T4) months before final palate closure. The linear measurements performed were width of alveolar cleft (Ca); width of palatal cleft between the canines (Cc), molars (Cm), and tuberosities (Ct); the palatal arch distance between the canines (Dc); the widest distance between molars (Dm) and the tuberosities (Dt); and the palatal height between the canines (Hc) and tuberosities (Ht). The raw measurements and the calculated cleft-to-arch ratios of Cc/Dc, Cm/Dm, and Ct/Dt were compared between the two groups. The results showed gradual narrowing of the width of cleft from Tl to T4. Narrowing of alveolar cleft width (Ca) from Tl to T2 was dramatic. The palatal arch (Dc, Dm, Dt) showed no change to mild increase in width. The cleft-to-arch ratios decreased with time. The palatal height remained the same or slightly increased over time. There were no significant differences observed between the PP and NPP groups among these measurements except for the Ct and Ct/Dt at T4. In conclusion, after initial lip repair, there was a decrease of the width of cleft in patients with complete UCLP during the 18-month period, and simple posterior palatoplasty did not further narrow the cleft nor influence palatal arch development.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Degloving injuries range from the occult, easily missed injury to obvious massive tissue damage. The serious nature of these wounds is exacerbated by mismanagement. It is generally accepted that the degloved tissue should be excised, defatted, fenestrated, and reapplied as a full-thickness skin graft. Dressings are required that provide gentle, evenly distributed pressure and avoid shear stress to the newly grafted skin. Numerous types of dressings have been devised but all are cumbersome and time-consuming. We have found the Vacuum-Assisted Closure device to be a rapid, effective, and easy-to-use alternative to traditional methods. The authors examine their experience using a vacuum-assisted closure device to treat nine degloving injuries in 5 patients and discuss the important aspects in using this technique.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Free flap reconstruction of the foot has been widely performed in the last 20 years, but choice of a free transferred substitute for the soft tissue of the particular defect remains controversial. The authors present a series of 77 free flaps to the foot performed in 68 patients during October 1976 and September 1997. Longterm follow-up ranged from 12 months to 18 years (median, 44.4 months). Seventy-three flaps were transferred successfully (95%). The indications for a specific flap depended on the localization and extension of the foot defect. In weight-bearing areas the authors favored the use of a muscle flap covered with a split-thickness skin graft; the latissimus dorsi muscle was used primarily. This study shows a lower ulceration rate in muscle flaps covered with split-thickness skin grafts than in fasciocutaneous flaps in weight-bearing areas (27% vs. 60%). In nonweight-bearing areas, fasciocutaneous flaps were the best choice. In this series, the lateral arm flap was applied most often. The authors recommend free fascial flaps (serratus fascial flap or radial forearm fascial flap) covered by split- or full-thickness skin grafts for coverage of the malleolar region as well as coverage of exposed tendons of nonweight-bearing regions. Proper tailoring of the flap and postoperative care are very important to maintain a result without ulceration, as is avoiding having the suture line cross a weight-bearing area. Tactile sensation does not seem to be essential.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Laserbrasion is essentially skin deepithelialization. The continuous-wave carbon dioxide (CO2) laser has a long history during which this capability to ablate the epidermis has been used in multiple clinical applications. The “improved” UltraPulse CO2laser has been advocated as a safer method, primarily for skin resurfacing. The authors show in Sprague-Dawley rats by gross and histological examination that the UltraPulse CO2laser can also be used effectively to achieve skin deepithelialization, with efficacy in clinical simulations without untoward effects on wound healing. The advantage of the UltraPulse CO2laser appears to be less destruction to surrounding tissues.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The diagnosis of brachial plexus nerve compression is controversial due to the subjective nature of patient symptoms and the lack of objective, quantifiable tests. It has been hypothesized that quantitative sensory evaluation of sensory threshold is the most sensitive method of evaluating nerve compression, particularly in the early stages. This study evaluated the sensitivity and specificity of vibration thresholds for detection of brachial plexus nerve compression. A multiple-frequency vibrometer was used to evaluate 40 control subjects and 35 patients with brachial plexus nerve compression. Calculated sensitivity values were modest (0.49 at 63,250, and 500 cps) with high specificity values (0.98 at 8 cps) for individual frequencies using a fifth percentile criterion. The low sensitivity values indicate that this instrument is not adequate as a screening device.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Responsiveness is an important property of an outcomes questionnaire. It can be defined as the ability of an instrument to capture important changes in a patient's health status over time. The authors previously designed the Michigan Hand Outcomes Questionnaire (MHQ), a hand-specific outcomes instrument that contains six distinct scales: (1) overall hand function, (2) activities of daily living, (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction with hand function. In the first study, the authors demonstrated that the MHQ is a reliable and valid instrument for the hand. The purpose of this second study is to assess the responsiveness, or sensitivity, of the MHQ to clinical change in patient status. A total of 187 consecutive patients with chronic hand disorders completed a baseline MHQ prior to receiving treatment at a university plastic surgery clinic. Approximately 6 to 18 months after completing the first questionnaire, patients were sent a follow-up MHQ by mail. The second questionnaire was identical to the first, with the exception of one additional question added to each of the six MHQ scales. This additional question asked patients to rate the change in their hands since completing the last questionnaire using a seven-point response scale. Spearman's correlation coefficient was used to correlate the responses from patients' self-assessment questions with the actual score change (after score — before score). The response rate for the second administration was 49% (92 questionnaires returned—a fairly good rate of return for mail surveys. There were no significant differences in gender, race, education, and income between responders and nonresponders. When patients' self-assessment of change was correlated with the change in the six scale scores over time, all six correlations were statistically significant, withp> 0.05. The correlations ranged from 0.25 for the aesthetics scale to 0.43 for the pain scale. The MHQ was responsive using patients' self-assessment of their clinical change. Future studies will evaluate the responsiveness of the MHQ compared with objective physiological measures such as grip strength, range of motion, and the Jebson-Taylor test. Additionally, research is underway to assess the responsiveness of the MHQ for specific procedures, including metacarpophalangeal arthroplasties for rheumatoid arthritis and microvascular toe-to-hand reconstructions.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Septic arthritis of the small joints of the hand is not reported frequently. Twenty-eight patients were treated during a 15-month period, from November 1992 to January 1994. Prompt surgical drainage, antibiotics, and early postoperative mobilization (within 24 hours) were the cornerstones of management. Nineteen patients were available for a median follow-up of 10 months. Patients who presented after 10 days all had a poor result. Patients who presented earlier achieved a good result unless they defaulted from treatment or had sustained an associated severe traumatic joint injury. Ten of the 19 patients obtained a good result. Good functional results can be obtained with early post-operative mobilization.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The gracilis muscle is commonly utilized by reconstructive surgeons in a variety of applications as a pedicled muscle or musculocutaneous flap, and as a free tissue transfer for soft-tissue coverage or as a functioning muscle transfer. The muscle anatomy has been well documented in the past. The aim of the present study was to study comprehensively the intramuscular neurovascular anatomy as it relates to segmental neurovascular functioning muscle transfer. The study was carried out in a series of 14 human cadavers. Each cadaver was injected with a lead oxide, gelatin, and water solution through the femoral arteries (200 ml per kilogram). The overall length of the musculotendinous unit was 44 ± 2 cm, and the tendon comprised up to 6 ± 2 cm of the length. The main arterial supply to the muscle entered 10 ± 1 cm from the attachment to the body and inferior ramus of the pubis (diameter, 1.5-2.5 mm). The distal portion of the muscle was supplied by one to three small arterial branches of the superficial femoral artery. Venous drainage was noted to be through paired venae comitantes. The motor nerve arises from the obturator nerve and enters the muscle in association with the major vascular pedicle. The nerve then splits within the muscle and runs longitudinally in two or three major branches within the muscle parallel to the arterial branches and muscle fibers. The neurovascular anatomy of the gracilis muscle was found to be remarkably consistent from specimen to specimen, varying only in the length of the muscle and tendon, and the number of minor pedicles supplying the distal portion of the muscle. This study confirms the suitability of the gracilis for segmental functional muscle transfer.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A mild, persistent umbilical hernia that does not cause any functional problem is often ignored. The authors have devised a new technique to treat the mild, protrusive deformity of the umbilicus without associated complications. In this report, the new operative procedure is introduced. The authors have treated 72 patients with this method and have obtained good results.

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Since 1996, 72 patients (66 women and 6 men) have undergone endoscopic upper and midface rejuvenation. Sixteen of these patients had concomitant lower face rejuvenation at the same time. The patients were operated using a personal endoscopic technique, including biplanar endoscopic dissection (subgaleal and subcutaneous) at the forehead and temporal regions, excision of a galeal strip approximately 1 cm in thickness (to achieve a stable forehead lift), and a lower blepharoplasty incision for midface lifting and fixation of the malar fat pad. This approach helps to prevent midface widening—a concern of most surgeons. Regarding patient satisfaction, 51 patients had excellent results, 16 patients had good results, and 5 patients had an improved appearance of the mid and upper face. Complications included 11 incidences of temporary numbness in different regions of the upper and mid face, three incidences of temporary lower lid retraction (which did not require additional revision), three relapses of eyebrow elevation (which were reoperated), and unbalanced eyebrows in 2 patients (which were corrected during secondary revisional procedures).

ISSN:0148-7043    

出版商:OVID    

年代:1999

数据来源: OVID