摘要:

Can a breast-shaped skin envelope that is pendulous be formed through the use of a shaped expander? Once formed, can its shape be maintained following the exchange of the expander for a round implant? My colleagues and I set out to answer these questions by constructing a breast-shaped expander by altering a standard round expander. It was introduced through an inframammary incision while performing a Pennisi-Ryan type reconstruction. The expander was placed in a limited pocket beneath the pectoralis major muscle. The lower pole of the expander was left in the subcutaneous plane. The skin expanded into a mature, pendulous breast shape that exhibited a slight degree of ptosis. The shape was maintained following the exchange of the expander for a high-profile round implant. If contracture occurred, the distortion detracted from the initial pleasing shape. We present our experience with the first 15 reconstructions using this method. The best results were seen in delayed reconstruction cases. The method is of no value in cases of primary reconstruction. Lessons learned from this small series of cases are detailed, and complications are discussed. The follow-up for these patients is a minimum of one year from the beginning of expansion.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Forelimb buds of rat embryos at day 13 of gestation were cut and cultured in Dulbecco's modified Eagle medium. In the absence of serum, the epidermis did not cover the wound surface. In the presence of fetal calf serum or ultroser G, a serum substitute, epidermal wound closure appeared in a concentration-dependent manner within 1 day of culture. Cycloheximide, an inhibitor of protein synthesis, reversibly inhibited wound healing, demonstrating that protein synthesis was required for epidermal wound closure. Dialysis and fractionation of ultroser G indicated that high molecular weight factors (greater than 25,000 d) were required for epidermal wound closure.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Full-thickness skin grafts can be anchored to the recipient site using fibrin glue made from the patient's own blood and commercially available thrombin and epsilon aminocaproic acid. The technique works well for small grafts on irregularly contoured sites where suture fixation of a graft would be technically difficult. Full-thickness skin grafts anchored with autologous fibrin glue have been uniformly successful in 50 patients followed for a minimum period of four months.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A 3 × 10-cm dorsal rat skin flap contains a distal portion that is poorly perfused. The dorsal flap served as a useful model to test hemodynamic properties of the vasodilatory drug chlorpromazine. A control group of flaps were treated with saline and the test group with chlorpromazine (15 mg/kg intraperitoneally). Eight days postoperatively, the surface area of the flaps that necrosed was 27.3% for the treated group and 36.5% for the controls. Using Student's t-test this difference was significant (p <0.001). Nutrient blood flow determined by the penetration of fluorescein dye into the flap was consistently greater in the chlorpromazine-treated group compared with the control group in the first 24 hours postoperatively. The adenosine triphosphate (ATP) levels measured at 0 and 24 hours postoperatively were consistently lower in the distal parts of the flap, treated or control, compared with proximal parts of the flap (p <0.001, analysis of variance). However, there were no significant differences in ATP levels between treated and control biopsies at any one site on the flap. In conclusion, chlorpromazine had a beneficial effect on rat skin survival, and increased blood flow appears to be one of the major reasons.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The use of miniplate fixation in free flap mandible reconstruction was reviewed in a series of 27 patients. Flap donor sites included the radius, scapula, and fibula. The bone defect ranged from 5 to 16 cm (mean, 11.5 cm). The number of fixation sites per graft ranged from 2 to 6 (mean, 3.96). Three to 10 (mean, 5.51) titanium miniplates (Wurzburg) were used for fixation. All free flaps survived. In no patient did the plate pressure on the periosteum or the multiple screws through the bone compromise flap circulation to a critical degree. Nonunion occurred in 2 of 107 osteotomy sites. Wound healing problems that required plate removal occurred in 4 patients. In each patient the plates were retained until bone healing was complete. Intermaxillary fixation was not necessary for purposes of additional stability. Miniplates have the advantages of ease of application, decreased fixation time, and the lack of need for additional forms of fixation. Their small size and malleable nature allow precise graft contouring. This contributes to a superior aesthetic result.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The vast majority of hand fractures can be adequately treated with techniques such as closed reduction and external splinting or with a variety of internal fixation devices. Choice of stabilization methods depends on individual surgical preference, fracture location, and the geometry of the bony injury. Fracture stabilization that allows early mobilization is advantageous in achieving rapid bone healing and restoration of function by minimizing joint and tendon complications. Rigid internal fixation with miniplates and screws permits stabilization and compression of fracture segments, thereby permitting early bone loading and motion. Although the role of rigid internal fixation with miniplates and screws in hand fractures is well documented in the literature, in this article we present our preliminary experience with Howmedica's (Rutherford, NJ) Luhr vitallium miniplate and screw system in treating hand injuries.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We have been using Marumo's method for the surgical treatment of syndactyly. However, this method presents difficulties with incision designs, which we solved by devising a modified method. This method uses an angulated rectangular dorsal flap and a triangular miniflap made at the end of the dorsal flap. By rotating this miniflap proximally, the skin defect produced at the dorsal base of the digit after removal of the angulated dorsal rectangular flap becomes triangular. This triangular skin defect can be adequately covered by the triangular flap produced at the ventral side. In the article we describe this new operative method in detail and present cases to which the method has been applied.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Voluntary control of the bowel movements is a social necessity. Lack of control relegates one to psychological debility and the possible need for a permanent colostomy. Anorectal angle plays an important role in fecal continence. In the normal individual, this angle lies in the range of 60 to 105 degrees. Perineal colostomy, once proposed for patients who had received abdominoperineal resection (APR), has been abandoned because of frank incontinence.This study used a canine model. The anorectal angle, external sphincter, internal sphincter, and the puborectalis were all destroyed after APR. The colon was pulled through the perineal defect. Enteropexy, gracilis muscle transfer, and perineal colostomy were performed to restore the anorectal angle. Barium enema was performed preoperatively and postoperatively. The anorectal angle was reconstructed within normal ranges after abdominoperineal resection of the rectum and anus.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Congenital muscular torticollis (CMT) is a disorder characterized by a shortening of at least one of the cervical muscles and tilting of the head to the opposite side. The most commonly affected muscle is the sternocleidomastoid (SCM) muscle. An unusual case is presented here: a CMT patient with involvement of the trapezius muscle in addition to the SCM muscle who has recently been treated at North Carolina Memorial Hospital. This patient still has a slight residual deformity despite two surgical procedures, physical therapy, and splinting. A review of 41 CMT patients who presented to this institution from 1952 to the present demonstrates that the disorder is extremely variable in terms of severity of deformity and response to various types of therapy. The condition will resolve spontaneously in the majority of patients by the age of 1 year, and if the condition has not resolved by then, it is unlikely to do so without surgery. We therefore believe that surgery should be postponed until after 1 year of age. Most of the patients requiring surgery are effectively treated by division of the involved muscle in at least one area with or without lengthening of the SCM muscle. Splinting and physical therapy are recommended postoperatively. A few patients such as the unusual one with involvement of the trapezius muscle resist our most aggressive therapeutic efforts.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Absence of the right pectoralis major muscle and hypoplasia of the ipsilateral breast was observed in 3 females and hypoplasia or agenesis of the right pectoralis major muscle in 2 males of the same family. One member of this family, a 17-year-old girl, underwent a right latissimus dorsi muscle flap, placement of silicone-gel breast implant, and a right infraclavicular natural Y prosthesis. Although none of our 5 patients from this family had congenital upper limb abnormalities, we believe that they still qualify as having Poland's syndrome. This would distinguish them as being the fourteenth known family reported in the world literature with this diagnosis. A brief review of the history as well as hypotheses of etiological mechanisms are presented.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID