摘要:

During the past several decades, the standard of care for orbital reconstruction after trauma has been autogenous bone grafts. Complications of bone grafts, including donor site morbidities such as scar alopecia and graft resorption with delayed enophthalmos, have inspired an interest in the use of alloplastic substitutes such as titanium. Titanium’s role in orbital reconstruction was limited originally to small orbital defects, and as an adjunct to bone grafts. More recently, clinical studies have documented the sole use of titanium mesh to reconstruct large orbital defects. This study sought to document further the safety and efficacy of titanium mesh in reconstructing large orbital defects after facial trauma, with more extensive follow-up compared with previous studies. In the current study, 55 patients with 67 orbital fractures underwent orbital reconstruction with titanium mesh over a 5-year period. Associated fractures were reduced anatomically and fixed rigidly. For the analysis, 44 patients with 56 orbital fractures had adequate follow-up (mean, 44 months). An abscess developed in one patient who received high-dose steroids for 72 hours before reconstruction. She was treated with broad-spectrum intravenous antibiotics and bedside incision and drainage, and did not require removal of the titanium mesh. No patient in the current series required removal of the titanium mesh. A single case of uncorrected enophthalmos was treated with bone grafting rather than mesh revision. Large orbital defects can be reconstructed using titanium mesh with good functional results and minimal risk for infection. This study covered the authors’ first 5 years using titanium. They have now used titanium mesh in orbital reconstructions for more than 10 years, without any additional cases of infection.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Varicose veins of the posterior thigh, popliteal fossa, and calf area were managed with the assistance of endoscopic surgery in 136 patients. Patients were divided into four types according to the normal veins involved in varicosities. With good illumination and magnified monitor viewing by means of a surgical endoscope, the main channel, tributaries of varicosities, incompetent perforating veins, and healthy veins could be clearly visualized and identified. Even though these varicosities had aberrant and tortuous courses, they could be completely dissected, divided, and then removed through one or more access incisions (2.5–3.0 cm in length). The incompetent perforating veins were also dissected and divided. The mean number of access incisions for each lower extremity was 2.2, 1.9, 1.3, and 1.0 for types I, II, III, and IV respectively. In all cases, the mean number of incisions was 1.6 in each lower limb. The most frequent morbidity was maceration of the access incision. Three wounds in 3 patients required debridement and resuturing, but the other wounds healed satisfactorily. Transient discoloration caused by bruising and numbness may present at the dissected area. There was no hematoma formation. Ischemic change with bleb formation of the dissected skin occurred in 1 patient. Subsequent secondary healing resulted in slight scarring in this area. With the assistance of endoscopic surgery, all the varicosities and the incompetent perforating veins could be completely dissected and removed. Accomplishment of removal of varicosities was double-checked between the preoperative skin marks of varicosities and the endoscopic findings. There is very little possibility for recurrence, because there were no residual varicosities or incompetent perforating veins after this operation. There was no recurrence in follow-up at least 2 months postoperatively. Patients were satisfied with the minimal surgical scarring and the complete absence of disfiguring varicosities.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Free flaps transferred to the lower extremity have a higher risk of failure, which may be expected to increase further with the use of vein grafts. The results of 103 consecutive free flaps to the lower extremities of 98 patients who were operated from March 1994 to December 1999 were evaluated to assess the reliability of vein grafts in lower extremity reconstruction. Five flaps were lost and the overall success rate was 95.1%. Eighty-four free tissue transfers in 79 patients were performed for the reconstruction of traumatic cases, and 81 of these flaps were performed in a delayed manner, between 1 week and 4 months after the injury. Interpositional vein grafts were used primarily in 22 flaps—all in traumatic cases—and 21 of them survived completely (95.4%). Primary vein grafts were used both for arteries and veins in 15 flaps and for arteries only in 7 flaps. The most common cause of tissue loss in these patients was a crush injury in earthquake survivors, followed by electrical injuries, gunshot injuries, motor vehicle accidents, and chronic infections. Free muscle flaps in 13 patients, skin flaps in 4 patients, osseous flaps in 2 patients, and temporal fascial flaps in 2 patients were the flaps of choice in vein graft reconstructions. Although a higher incidence of flap loss has been reported with the use of interpositional vein grafts than with regular transfers, and the technical and pathophysiological problems in flap transfers are also high in the lower extremity, the success rate in vein-grafted free flaps did not differ from that of the simple free flap transfers in the current series. This appears to be the result of meticulous preoperative planning and proper selection of recipient vessels during optimal operative conditions.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Peroneal nerve decompression at the fibular head may be anticipated to be performed more often because lower extremity peripheral nerve surgery is used to restore sensation to the feet of diabetic patients. Although the basic concept of releasing the fascia of the peroneus longus is well-known, anatomic variants related to the peroneus muscle have been identified that must be included in the technique for decompression of this nerve. A comparison of these anatomic variants was done between a random selection of 29 cadavers (bilateral) and 65 patients who underwent unilateral peroneal decompression to treat symptoms of that compression. A fibrous band on the undersurface of the superficial head of the peroneus longus was found in 30% of the cadavers and it was found in 78.5% of the patients. The mean width of the band in cadavers was 9.1 mm and in patients it was 10.1 mm. A fibrous band on the superficial surface of the deep head of the peroneus longus was found in 43% of cadavers, and it was found in 20% of the patients. The soleus muscle origin was joined to the peroneus muscle origin in 9% of cadavers and it was noted in 6% of the patients. It is suggested that during surgical decompression of the common peroneal nerve at the fibular head, the surgeon be aware of these anatomic variants so that they may be released appropriately.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Treatment of painful neuromas in continuity of the median nerve at the wrist level is a challenging problem. Nine median nerve neuromas were covered with the pronator quadratus muscle preelevated as an island flap. Patients were followed for 10 to 60 months after surgery. Results showed a marked improvement in terms of symptoms in all patients. In particular, 6 patients had complete pain relief and 3 patients complained of mild intermittent pain.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The medialis pedis flap (MPF) has been used for the reconstruction of soft-tissue defects in the hand since 1990. From January 1997 through January 2000, 19 patients (15 male, 4 female) with hand injuries underwent microsurgical MDF reconstruction at Chang Gung Memorial Hospital. There were finger injuries in 16 patients and palm defects in 3 patients. The mean patient age was 32.6 years (age range, 16–58 years). Flap size ranged from 4.5 × 2 cm to 7 × 6 cm (mean, 6 × 2.8 cm). Only one flap had partial loss. The donor site was closed primarily in 9 patients, and was closed using a split-thickness skin graft in 9 patients and a full-thickness skin graft in 1 patient. At a mean follow-up of 13 months, the protective sensation was 16 mm using the static two-point discrimination test and was 10 mm using the moving two-point discrimination test. Based on this retrospective study the authors conclude that (1) the MPF has the advantages of thin and glabrous skin, (2) the size of pedicle is compatible with the recipient vessel in the hand, (3) there is low donor site morbidity, and (4) achieving protective sensation is possible.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors demonstrate successful cases of stepladder dorsal metacarpal V-Y advancement and rotation-advancement flaps for reconstructing defects on the dorsum of the finger and hand. One side of the flap is designed in a multilobed shape, and each lobed flap is designed on the dorsum of adjacent fingers. These flaps are supplied by dorsal metacarpal vessels. Consequently, this method has the elements of the stepped incision technique, in combination with the V-Y and rotation-advancement principle. All flaps survived completely. This technique may be a useful option for reconstruction of defects of the dorsum of the finger and hand.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Adipose tissue seems to be an ideal material for use as a permanent soft-tissue substitute in reconstructive surgery. However, knowledge of the behavior of the graft—in particular, its revascularization—is scarce. Therefore, the aim of the current study was to establish a novel model that allows for long-term in vivo quantitative analysis of revascularization of adipose tissue after transplantation. Hamsters (n = 8) were fitted with transparent titanium dorsal skinfold chambers. Immediately after en bloc harvest of adipose tissue from the left inguinal area, the graft was placed gently into the chamber. At days 1, 3, 12, and 21, red blood cell-perfused vessels were assessed in surrounding host tissue, in the border of the graft, and in its center (n = 6 areas each) using intravital fluorescent microscopy. The model allowed for permanent observations of adipose tissue and quantitative analysis of functional vessel density (FVD). At the border zone of the graft, an FVD of 2 ± 1 cm per cm2was measured at day 1. In this region FVD increased constantly and finally reached values (184 ± 10 cm per cm2; day 21) that were comparable with those of the surrounding host tissue. Revascularization in the center of the graft started at day 3 after transplantation (14 ± 3 cm per cm2). Here, FVD increased constantly, but lower values compared with the grafts’ border zone were measured (139 ± 10 cm per cm2; day 21). FVD data obtained from transplanted adipose tissue may contribute to understanding fundamental mechanisms of graft failure.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The heat shock response is known to have a protective effect against flap ischemia. It has been shown that heat shock protein (hsp) expression can be augmented in vivo with the administration of high-dose aspirin before heat treatment. The authors hypothesized that administration of aspirin before hsp induction through heat stress would enhance further the protective effects of the heat shock response against skin flap ischemia. They used a random dorsal skin flap model in 32 rats divided into four groups (N = 8 each): control, heat shock, aspirin plus heat shock, and aspirin. Before surgery, rats in the two heat shock groups were placed in a 45°C water bath until core body temperature measured 42°C, and they were maintained at 42°C for 15 minutes. Rats in the two aspirin groups received a single oral dose of aspirin (100 mg per kilogram) 1 hour before heat bath or surgery. Immunohistochemistry confirmed hsp expression in the two heat groups. Skin flap survival was improved significantly (p< 0.05) in the heat shock (55%), aspirin plus heat shock (58%), and aspirin (60%) groups when compared with controls (45%). Contrary to their hypothesis, aspirin combined with hsp induction did not offer greater protection from ischemia than hsp induction alone (p> 0.05). However, high-dose aspirin administration alone did improve skin flap survival when compared with controls. Future studies are needed to investigate further the role of pharmacological therapy combined with hsp induction in improving skin flap survival and to delineate the dose–response relationship between aspirin and hsp.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors investigated the expression of p53, p21WAF-1, Bax protein, and apoptosis to elucidate the cellular response to ischemia–reperfusion of skeletal muscle using the rat lower limb model. The rat left lower limb was dissected in the inguinal region, isolating the bony femoral muscles, and the femoral vessels were clamped to produce an ischemic condition. After 3 or 6 hours, the clamps were removed and the gastrocnemius muscle was resected at various times up to 72 hours after reperfusion. Five specimens of the muscle were obtained at each time point from 5 rats. When any rat died during the study, additional rats were used until 5 specimens could be obtained from 5 rats at each time point. The expression of three proteins was detected by Western blot analysis. The apoptotic cells were detected using terminal deoxytransferase-mediated dUDP (deoxyuridine[-5′]diphosphate) nick-end labeling assay. Histopathological study showed severe interstitial edema and leukocyte infiltration at 6 hours of ischemia compared with 3 hours of ischemia. Moreover, at 6 hours of ischemia, muscle fiber fragmentation was observed at 72 hours after reperfusion whereas no fragmentation was found at 3 hours of ischemia. At 3 hours of ischemia, p53 and p21WAF-1accumulated after reperfusion, and there was a time lag in the time of onset of elevation and the peak time point between these two proteins. The level of Bax protein did not elevate and the rate of apoptotic cells did not increase. At 6 hours of ischemia, p53 and p21WAF-1also accumulated, but the kinetics of p21WAF-1were similar to that of p53 in the time of onset of elevation and the peak time point after reperfusion. In addition, the level of Bax protein increased and apoptosis was induced. These results demonstrated that p53 and p21WAF-1accumulated after 3 and 6 hours of ischemia of skeletal muscle during reperfusion. Moreover, it was demonstrated that the kinetics of induced p53, p21WAF-1, and Bax protein differ between 3 hours and 6 hours of ischemia, and it is speculated that this difference plays an important role in determining the consequence of the cell exposed to ischemia.

ISSN:0148-7043    

出版商:OVID    

年代:2002

数据来源: OVID