摘要:

&NA;Endoscopic techniques are now an accepted part of the surgical armamentarium and are used routinely in a number of aesthetic and reconstructive procedures. Endoscopic techniques are now being used commonly by plastic surgeons in forehead and face lifts. In both craniofacial surgery and in neurosurgery, the application of endoscopy potentially allows the surgical team to perform wide dissection of the dura mater in a minimally invasive fashion, thereby potentially reducing the risk of dural and brain injury. Also reduced by this surgical approach is potential injury to the major venous structures, such as the sagittal sinus, along with overall reduced bleeding. After an extensive laboratory study of 10 cadaveric dissections, the authors have refined a new endoscopic technique for completing an endoscopic intracranial craniofacial osteotomy. This study was conducted in the Department of Pathology at the University of Brno (Czech Republic), and was performed as a cooperative multicenter project between the University of Palermo, the Albert Einstein College of Medicine/Montefiore Medical Center, the Hospital Infantil de Mexico, “Federico Gomez,” and the Medtronic Midas Rex Institute, (Fort Worth, TX). During this cadaveric anatomic study and using small trephinations and skin incisions the authors were able to develop several different craniofacial and endoscopic monobloc procedures. To accomplish intracranial and facial osteotomies, a new malleable high‐speed drill was designed for use in the endoscopic craniofacial approach. Using these newly developed cadaveric techniques and instrumentation, the authors performed two intracranial craniofacial procedures on children with congenital craniofacial anomalies. There would appear to be several significant advantages for the craniofacial patient as result of these new techniques: reduced surgical trauma, operative bleeding, surgical time, and hospitalization, along with a reduced risk of infection. It became quickly apparent, as a result of these cadaveric studies, that the learning curve for this endoscopic procedure is quite steep.Tutino M, Chico F, Tutino M, Goodrich JT, Ortiz Monasterio F. Endoscopic intracranial craniofacial and monobloc osteotomies with the aid of a malleable high‐speed pneumatic drill: a cadaveric and clinical study. Ann Plast Surg 2000;44:1‐7

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Several radiological methods have been utilized to assess velopharyngeal function. The more recent imaging technique, magnetic resonance imaging (MRI), which has a number of advantages over radiographic and computed tomographic imaging, has been used rarely for evaluating velopharyngeal insufficiency. In this study, 5 normal volunteers and 10 patients with surgically repaired cleft palate were examined with MRI using midsagittal, coronal, and axial images. Nasoendoscopy was also performed to complete and confirm the diagnoses. Complete and tight closure of the velopharynx and full backward and upward movement of the soft palate was observed in volunteers. In coronal images, medial movement of lateral pharyngeal walls could also be seen. Despite this, patients with surgically repaired cleft palate had some degree of motion of the soft palate, ranging from no movement to maximal movement. In most of the patients, short soft palates with restricted motion was seen. MRI visualizes the velopharyngeal sphincter in all planes and provides high‐resolution images of the soft tissues. Objective measurements can be made as well. In this study, MRI and nasoendoscopy were used together in the diagnosis of velopharyngeal insufficiency and gave satisfactory results.Özgür F, Tunçbilek G, Cila A. Evaluation of velopharyngeal insufficiency with magnetic resonance imaging and nasoendoscopy. Ann Plast Surg 2000;44:8‐13

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The high number of reconstructive dilemmas brought about by more aggressive treatment of congenital malformations and burns has created the need for large quantities of donor skin for local coverage. Tissue expansion with external ports has become part of the authors' surgical armamentarium. From January 1996 to November 1998 the authors placed 34 expanders in 28 patients to correct congenital malformations or burn sequelae. The average patient age at the time of operation was 6.3 years, the average time of expansion was 49 days, and minimal and maximal expansion volume was 60 and 600 cc respectively. Serial injection was carried out every 2 days until total expansion was achieved, and the expanded area was two to three times as wide as the recipient defect. No major complications occurred. The most serious complications of infection and erosion of tissue overlying the device occurred in 17.6% of patients. There are several advantages to this technique: less tissue dissection, painless injections, shorter operating time, and early detection of leaks.Lozano ST, Drucker MZ. Use of tissue expanders with external ports. Ann Plast Surg 2000;44:14‐17

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The deltoid muscle is a reliable source of well‐vascularized tissue for bulk to obliterate wounds that particularly involve the adjacent glenohumeral joint. A homologue of the gluteus maximus muscle, the deltoid muscle also has two independent dominant vascular pedicles, making this a type III muscle flap. Consequently, the muscle can be split vertically into two halves to form hemideltoid flaps, with the undisturbed portion still remaining innervated to preserve its function as a major arm abductor—an important point because this muscle as a whole is not usually considered expendable. Because of its short vascular pedicle, the are of rotation is limited so that larger defects of the shoulder are covered preferably with more traditional alternatives.Hallock GG. The hemideltoid muscle flap. Ann Plast Surg 2000;44:18‐22

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The authors describe the anatomic aspects and surgical technique of the depressor anguli oris musculocutaneous flap for reconstruction of the upper and lower lips. Twenty patients were submitted to surgical treatment, 19 for carcinoma and for upper lip scar deformity. In all patients the repair was performed with the depressor anguli oris musculocutaneous island flap. At the follow‐up, lip function was satisfactory in 19 patients and unsatisfactory in 1 patient. The aesthetic results were considered satisfactory in all patients. The depressor anguli oris musculocutaneous island flap is safe for upper and lower lip reconstruction, with good functional and aesthetic results, and can be added as a new flap for lip reconstruction.Neto MS, Castilho HT, Ferreira LM, Hochberg J, Toledo SR. Utilization of the depressor anguli oris musculocutaneous flap for lip reconstruction. Ann Plast Surg 2000;44:23‐28

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The authors compared different vascularized bone grafts in 15 patients with different oncological diagnoses that were treated with hemimandibulectomy in 9 patients, total mandibulectomy in 1 patient, resection of the mandible involving the anterior arch and the symphysis in 3 patients, 1 patient who underwent a segmental mandibular resection, and 1 patient in whom the entire hemimandible was reconstructed because of mandibular hypoplasia diagnosed during the resection of a parotid neoplasm. The flaps used included fibular free flaps in 11 patients, iliac crest in 3 patients, and a radial forearm osteocutaneous flap in 1 patient. Two patients had major complications and 1 patient experienced recurrence of the primary tumor. The fibular free flap was the preferred method in this series due to the size of the defect, which in most patients did not require extensive soft‐tissue reconstruction, and due to the nature of the bone defect involving the symphysis and condyle in 9 patients. The different vascularized bone grafts provided adequate osseous and soft tissue for oromandibular reconstruction.Rivas B, Carrillo JF, Granados M. Oromandibular reconstruction for oncological purposes. Ann Plast Surg 2000;44:29‐35

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The use of rigid fixation for fractures of the extremities has become commonplace. The short‐ and long‐term effects of rigid fixation on the growing hand, however, have not been studied thoroughly. In this project, the use of rigid fixation across metacarpal growth plates (physes) in growing primate hands was examined. The hypothesis to be tested was that long‐term placement of rigid fixation devices across physes during stabilization of mid‐shaft osteotomies will cause the physes to close prematurely. Fixation devices with screws placed in the epiphysis and left in place for 4 months or 1 year resulted in open physes, in support of the null hypothesis. However, in physes plated for 1 year, biochemical changes associated with increased bone differentiation were apparent. Findings suggest that rigid fixation across physes for as long as 1 year can be used appropriately in growing individuals when necessary. However, until additional investigation establishes whether the open physes are still capable of producing bone‐lengthening hypertrophic chondrocytes, caution should be used in long‐term placement of rigid fixation devices.Opperman LA, Drake DB, Kang P, Nakeeb SM, Gammas M, Morgan RF. A pilot study of short‐ and long‐term sequelae to rigid fixation across metacarpal physes in a baboon model. Ann Plast Surg 2000;44:36‐43

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Prefabrication of composite arteriovenous flaps with implantation of an autologous graft (cartilage) or an alloplastic material (porous polyethylene) was studied in 40 rabbits. Abdominal flaps based on bilateral epigastric pedicles were elevated. An ear cartilage graft or a porous polyethylene implant was inserted under the flap. Two weeks after the operation, 10 flaps with cartilage graft and 10 flaps with porous polyethylene were raised, converted to arteriovenous flaps, and resutured in place in the experimental groups. In the other 20 rabbits of the control groups, the flaps (10 with cartilage graft and 10 with porous polyethylene) were raised and resutured in place as conventional axial flaps. At the end of the second and fourth week postoperatively, samples were obtained from the flap tissues (including a part of the graft or implantation material) and were prepared for histologic examination in all rabbits. The viable areas of all flaps were assessed at the end of fourth week after the second operation. The mean survival rates were 99.4%, 99.7%, 99.5%, and 99.8% in the arteriovenous and control flaps prefabricated with cartilage graft and the arteriovenous and control flaps prefabricated with porous polyethylene respectively. The features of wound healing in the experimental and control groups were similar. The study showed that arteriovenous perfusion can nourish a prefabricated flap containing an implanted material (autologous or alloplastic) and these 2‐week delayed composite flaps have a similar survival rate to delayed prefabricated conventional axial flaps.Karataş Ö, Atabey A, Demirdöver C, Barutçu A. Delayed prefabricated arterialized composite venous flaps: an experimental study in rabbits. Ann Plast Surg 2000;44:44‐52

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Neurocutaneous flaps have been popularized recently in clinical reconstructive surgery. However, controversies exist concerning their anatomy and physiology. The particular role of neural vasculature in the survival of these skin flaps is also quite undefined in the experimental setting, and additional studies on this subject are necessary. The goal of this study was to describe a neurocutaneous flap in a rat model and to investigate its blood supply. Thirty male Sprague‐Dawley rats weighing 300 to 350 g were used in this study, which was conducted in two stages. During the first stage, the lower extremities of 10 rats were dissected for the anatomic study of the neurocutaneous flap. A constant cutaneous nerve innervating the anterolateral thigh skin was exposed. It arose either from the saphenous nerve or the superficial epigastric nerve and was accompanied by a constant longitudinal arterial plexus. The tiny neural vessels were conveyed by the superficial fascia along their course. A 30 × 30‐mm cutaneous island flap, which was based only on the cutaneous nerve with its accompanying vessels and a strip of superficial fascia, was raised on the anterolateral thigh skin using an operating microscope. The well‐perfused skin territory was marked after sodium fluorescein injection. The stained skin territory was located centrally and medially on the whole island flap, and it was approximately 10 × 20 mm. This finding was confirmed by the qualitative assessment of the vascularity for this skin territory in microangiography. After studying the pedicle anatomy and determining the optimal viable skin island, the second stage of the study was performed. The remaining 20 rats were divided into two groups. In the experimental group (N = 10), a neurocutaneous island flap (10 × 20 mm) was outlined on the anterolateral aspect of the thigh at its middle third. It was designed in such a way that its short and long axes lay in the center of the distance between the anterior superior iliac spine and the anterior aspect of the knee joint. After identification and dissection of the neurovascular pedicle, the flap was raised in a lateral‐to‐medial direction without including the deep fascia. At this point the flap remained connected only by the pedicle and a strip of superficial fascia surrounding it. It was sutured in the same place. In the control group (N = 10), the pedicle of the flap was severed and the skin island was sutured back as a composite graft. All the experimental flaps survived well. In the control group, none of the flaps survived except one that was partially viable. The flaps in the experimental group were reelevated as neurocutaneous island flaps on day 7 for microangiographic study, and specimens were processed for histologic staining. Microangiography revealed the extent of neural vasculature and vascularization of the skin through cutaneous perforators. Histologic investigation demonstrated the neural vessels that were related closely to the superficial fascia. The authors propose a neurocutaneous island flap model in the lower extremity of the rat in which the survival of the flap depended mainly on the neural arterial supply. It was also demonstrated that the superficial fascia played a role as a connective tissue framework for conveying tiny neural blood vessels to reach the skin. This model may serve as a reproducible and reliable neurocutaneous island flap model for additional studies in this field.Gürünlüoğlu R, Bayramiçli M, Sönmez A, Numanoğlu A. A neurocutaneous island flap model: an experimental study in rats. Ann Plast Surg 2000;44: 53‐58

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The authors emphasize the possible pharmacological enhancement of axonal regeneration using a specific growth factor/extracellular media incorporated in a biodegradable nonneural nerve conduit material. They investigated the early effects on nerve regeneration of continuous local delivery of nerve growth factor (NGF) and the local incorporation of hyaluronic acid (HA) inside a newly manufactured nerve conduit material from fresh human amnionic membrane. Human amnionic membrane contains important biochemical factors that play a major neurotrophic role in the nerve regeneration process. The process of manufacturing a nerve conduit from fresh human amnionic membrane is described. This nerve conduit system was used in rabbits to bridge a 25‐mm nerve gap over 3 months. NGF was released locally, over 28 days, at the distal end of the tube via a system of slow release, and HA was incorporated inside the lumen of the tube at the time of surgery. NGF/HA treatment promoted axonal regeneration across the amnionic tube nerve conduit (8,962 ± 383 myelinated axons) 45% better than the nontreated amnionic tube group (6,180 ± 353 myelinated axons). The authors demonstrate that NGF/HA media enhances additional axonal regeneration in the amnionic tube nerve conduit. This result is secondary to the effect of the amnion promoting biochemical factors, in combination with the NGF/HA effect on facilitating early events in the nerve regeneration process.Mohammad JA, Warnke PH, Pan Y‐C, Shenaq S. Increased axonal regeneration through a biodegradable amnionic tube nerve conduit: effect of local delivery and incorporation of nerve growth factor/hyaluronic acid media. Ann Plast Surg 2000;44;59‐64

ISSN:0148-7043    

出版商:OVID    

年代:2000

数据来源: OVID