摘要:

Breast implants from 300 consecutive patients during the 35-month period from February 1, 1991 to January 1, 1994 were examined. Of these, 214 (71.3%) patients had disruption (frank rupture or severe silicone bleed or both) of one or both implants. Of the 592 implants removed, 376 (63.5%) had disruption. We found virtually no difference in disruption rates between those patients relating symptoms to their implants and those who did not (71.8% vs. 70.9%). However, disruption was directly related to time since implantation. We observed 103 of 142 patients relating various symptoms to their silicone implants. About half (52) reported improvement after implant removal. We found no direct correlation between disruption and repeated closed capsulotomy. Of 505 implants, 69 of 92 implants having had one or more closed capsulotomies were disrupted (75%). However, 245 of 413 implants never having had a closed capsulotomy also showed disruption (59.3%). We found mammography to be of very limited value in assessing disruption. Our study showed a low 16.2% sensitivity rate. The same was true with magnetic resonance imaging interpretation, especially in the diagnosis of severe silicone bleed. Although our series was quite small, magnetic resonance imaging interpretation was found to be an unreliable tool in our study. A Kaplan-Meier survival curve for mammary implants based on this study has proven very helpful and effective in communicating with patients and has served as a guideline in predicting the presence or absence of implant disruption. We have found and predict that most implants have lost or will lose the integrity of the silicone shell between 8 and 14 years, leaving free silicone, intracapsular or extracapsular, in the breast. On the basis of this information, O. Gordon Robinson recommends for his patients the removal of all gel-filled implants, preferably before 8 years from implantation.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

From January 1990 to August 1994, more than 600 patients with silicone-gel breast implants were clinically assessed regarding their implant status. Of these, 82 patients requested removal of their implants (150 implants). Of the 150 implants that were removed, 24 (16%) demonstrated calcified capsules. All 12 patients with calcification demonstrated this finding bilaterally. All calcified capsules demonstrated discrete calcified plaques on their inner surface. All 12 patients presented with Baker class IV contractures, with pain as their chief complaint. One patient demonstrated calcification on a routine chest radiograph. One patient demonstrated a stippled appearance on xeromammogram. Capsular calcification was related to the duration of implantation. All 6 implants that had been in place for 23 to 26 years were associated with calcification. These implants were all of the thick-walled Dacron-backed type. All thick-walled Dacron-backed implants that were removed in this study were associated with calcification. Of the 69 implants that had been inserted for 11 to 20 years, 18 (26.1%) were associated with calcification. Fifteen of these 16 implants were ruptured. None of the implants that had been in place for 10 years or less demonstrated calcification.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Topical silicone-gel sheeting has been shown to be beneficial in the treatment of established hypertrophic and keloid scars. Certain individuals and incisions in specific body sites appear to be at increased risk for the development of such scars. A simple, inexpensive, and preventive treatment in these individuals at increased risk could potentially minimize the extended period of pressure therapy and repeated steroid injections that are often required to optimize outcome. However, the effects of applying silicone-gel sheeting in the immediate postoperative period as a preventive measure have not been investigated to date. Because silicone-gel sheeting influences the remodeling and maturation phase of collagen formation, we believed it prudent to determine whether silicone-gel sheeting had any deleterious effect on early wound healing, as demonstrated by in vivo biomechanical testing of wound strength and histological assessment. To investigate the potential effects of silicone-gel sheeting on acute wound healing and its possible application for prevention of hypertrophic scars, a study was designed in the hairless guinea pig. In phase 1 of the study, bilateral dorsolateral incisions were made, allowing each guinea pig to serve as its own control. One wound was dressed with silicone-gel sheeting, and the control site was dressed with Nu-gauze dressing. Wounds were then assessed visually and with in vivo biomechanical analysis of wound strength at days 3, 5, and 7 postoperatively (n = 7 per group). Phase 2 of the study compared identical dressings in a similar animal model using a single dorsal midline incision, in which alternate halves of each wound served as the control. Each wound was assessed histologically at days 3, 7, and 14 (n = 5 per group). Despite an improved subjective appearance of those wounds treated with the silicone sheeting applied at the time of incision closure in the hairless guinea pig model, no significant adverse or beneficial effect on in vivo wound healing strength on days 3, 5, and 7 was demonstrated compared with controls when analyzed using a paired observation f-test (p= 0.35, 0.20, and 0.47, respectively). Blinded interpretation of histological specimens showed no difference on hematoxylin and eosin or trichrome staining between the test and control sites at any interval assessed in this study. We believe this information confirms the safety of applying silicone-gel sheeting at wound closure in this model and thus opens the door for subsequent clinical trials to assess the role of these products in preventing hypertrophic or keloid scars.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Three cases of striae distensae of the breast after augmentation mammoplasty are presented. The patients were all in their early 20s and nuliiparous. The striae developed in the first few months after surgery. A review of the literature on striae distensae is presented. To the best of our knowledge, striae distensae occurring after augmentation mammoplasty have not previously been described.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Velopharyngeal incompetence occurs in approximately 25% of cases after primary palatoplasty. There is controversy regarding the best method of surgical management of velopharyngeal incompetence. Between 1986 and 1993, 13 children with velopharyngeal incompetence after primary palatoplasty underwent Furlow Z-plasty repair. All children were assessed by a speech therapist and with videofluoroscopy pre- and postoperatively. The Furlow Z-plasty was performed at a mean age of 7.8 years (range, 4–12 years). Eleven children achieved normal resonance, and all 13 demonstrated improved velopharyngeal function on videofluoroscopy. The Furlow Z-plasty is effective treatment for children with velopharyngeal incompetence.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The blunt technique of suction-assisted lipectomy partially evolved while proving to be an efficient, albeit blind, method for the removal of lipomas. Larger or poorly encapsulated tumors were acknowledged to be at a greater risk for recurrence probably because of an unrecognized residua. Just as liposuction has enhanced body-contour surgery because of the potential for smaller and fewer scars hidden in strategically camouflaged locations, the identical advantages are possible for liposuction extraction of lipomas, with a greater assurance for their entire removal via direct visualization using a surgical endoscope.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Free vastus lateralis flaps for maxillofacial reconstruction were used in 30 patients. On the basis of its anatomy, this flap can be inserted as a musculocutaneous or musculofascial transplant in slim or normal-weight patients if extensive defects exist. The microvascular transfer is facilitated and accelerated by the long and high-caliber vascular pedicle and flap raising, which can be performed at the same time as tumor resection. We see indications for the musculocutaneous transplant in almost all sections of the oral cavity, particularly for tongue reconstruction; the vastus lateralis flap can be inserted in a purely muscular form for defect coverage on the scalp in connection with split skin. The donor defect is minimal functionally and aesthetically, and the success rate is approximately 90% for all flap transfers.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The relative merit of cartilage scoring versus suturing in otoplasty remains a subject of debate among leading plastic surgeons. We compared a variety of otoplasty techniques in 42 rabbit ears using anterior or posterior scoring, horizontal or vertical mattress sutures, and combinations of scoring and suturing. The ears were splinted with a right-angle fold for 10 postoperative days, and the animals were killed after 8 weeks. Suturing techniques, alone or in combination with scoring, maintained an angulation significantly closer to the desired. 90 degrees than anterior or posterior cartilage scoring (p< 0.05). The greatest accuracy and consistency were seen with horizontal mattress suturing, which provided an average angle (± SD) of 86 ± 8.5 degrees. Histological analysis demonstrated a significant increase in cartilage hyperplasia with suturing alone, whereas the other techniques achieved only mild to moderate increases. Our findings support the usage of horizontal mattress sutures to create the antihelical fold in otoplasty.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID