摘要:

Although the advent of endoscopic technology is expanding the fields of reconstructive and aesthetic surgery in adults, there have been to date no reports of its use in the pediatric population. Because of its minimally invasive nature, yet wide range of exposure, endoscopic techniques have much appeal in this age group. Herein we present our initial experience with endoscopic pediatric plastic surgery. From February 1995 to December 1995, 41 patients were treated utilizing 5-mm and 10-mm endoscopes at Scottish Rite Children's Medical Center, Atlanta, GA. There were 19 males and 22 females. The mean age at surgery was 5.6 years (range, 7 months-15 years). The most common types of procedures performed were insertion of tissue expanders (N=19), excision of facial dermoids (N=7), torticollis release (N=5), and excision of vascular lesions (N=4). The remaining 6 patients underwent a variety of reconstructive procedures. The complication rate in the tissue expander group was 3 out of 39 expanders inserted (9.5%), and consisted of infection (N=2) and rupture (N=1). In the dermoid group, complications consisted of wound infection requiring reoperation (N=1), and transient frontal paresis (N=1). One patient in the hemangioma group had an incomplete resection necessitating open excision. The remaining patients all had satisfactory outcomes with no complications. The majority of the procedures were done on an outpatient basis. These results suggest that endoscopic techniques are eminently applicable in the pediatric population, providing the benefits of small and remote incisional wounds with complication rates that are comparable to those of conventional surgical treatment.Huang MHS, Burstein FD, Cohen SR, Simms Ca. Endoscopic Pediatric Plastic surgery. Ann Plast Surg 1997;38;1-8

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A retrospective study of 245 patients with 299 hemangiomas treated from May 1981 to April 1994 was done. A subset of 175 of these patients (58.5%) had hemangiomas of the head and neck. Six of the 175 (3%) required reconstruction following laser therapy. Tissue expansion was chosen for each of these reconstructions. Five females and 1 male underwent tissue expansion. The age of the patients at the time of tissue expansion ranged from 2.5 to 12 years, with an average of 6 years. Tissue expander sizes were 50 cc and 100 cc. Infection was seen during the course of expansion in 1 patient. Satisfactory results were achieved after reconstruction in all cases. Tissue expansion is the treatment of choice for reconstruction of head and neck hemangioma deformities following laser or other surgical procedures as well as involution.Chang C-J, Achauer BM, VanderKam VM. Reconstruction of head and neck hemangiomas with tissue expansion in the pediatric population. Ann Plast Surg 1997;38:15-18

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The use of the transverse rectus abdominis musculocutaneous (TRAM) flap has come to the forefront for breast reconstruction following mastectomy. Despite our ability to create surgically a supple breast mound, simulate the nipple with local skin flaps, and pigment the skin to create an areola, one of the last drawbacks has been the reestablishment of normal sensation. Some patients have anecdotally reported some sensory return in the reconstructed breast mound. We sought to quantitate the pattern of sensory return in TRAM flaps in 24 patients to identify factors that favor sensory reinnervation of the flap. Patients were recalled for sensory testing after unilateral or bilateral breast reconstruction following mastectomy for cancer or premalignant mastopathy. The interval from surgery varied from 3 to 41 months. Sensation was evaluated using the Semmes-Weinstein monofilament test, hot/cold recognition, and vibratory sensation measured in 16 segments of the reconstructed breast mound and compared to the opposite, unoperated breast or to volunteer controls. Thirty-four flaps were evaluated. The Semmes-Weinstein measurements demonstrated measurable sensation in 32 of 34 flaps with 2 flaps developing sensation equal to the control unoperated breast. The return of hot recognition occurred in 21 of 34 flaps, cold recognition in 22 of 34 flaps, and vibratory sensation in 26 of 34 flaps. Our findings suggest that excellent sensory return occurs in the majority of patients via nerve ingrowth into the flap from the mastectomy bed. It would appear that a natural breast reconstruction with some sensation can be a reality for the majority of patients in the absence of additional complex surgical maneuvers such as nerve preservation or nervenerve coaptation.Place MJ, Song T, Hardesty RA, Hendricks DL. Sensory reinnervation of autologous tissue TRAM flaps after breast reconstruction. Ann Plast Surg 1997;38:19-22

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

High-field magnetic resonance imaging (Magnetom 42 SP, 1.0 Tesla) was performed a mean of 22 months (range, 8-42 months) postoperatively on 29 women who had undergone unilateral breast reconstruction with a transverse rectus abdominis musculocutaneous (TRAM) flap (19 free and 10 pedicled TRAM flaps). Fifteen T1-weighed, cross-sectional spin-echo images of the abdominal wall were obtained using a surface coil. The free TRAM flap was elevated sparing the lateral third of the rectus muscle. In the pedicled TRAM flap the whole rectus muscle was used. The patient groups were demographically similar, with no statistical differences in age or body mass index. In the free TRAM group the mean (±standard deviation) area of the rectus muscle in the upper third of the muscle (first five slices) was smaller on the operated side (376 ± 135 mm2) than on the contralateral side (462 ± 78 mm2),p=0.02. The mean signal intensity (reflecting intramuscular fat content) of the upper third of the muscle was significantly higher on the operated side than on the nonoperated side,p=0.04. Intramuscular fat content was also estimated and graded using an arbitrary scale from 1 to 4. The fat content of the upper third of the muscle was graded higher on the donor side (median, 3) than on the contralateral side (median, 2),p<0.01. In pedicled TRAM flap patients, the remaining rectus was responsible for a mean of 47 ± 5% of the distance between the lateral muscles, leaving a mean of 63 ± 10 mm of the abdominal wall covered by fascia only. No hernias were detected in either group. This study shows that harvesting of a free TRAM flap seems to affect the quality of the donor rectus muscle over its whole length.Suominen S, Tervahartiala P, von Smitten K, Asko-Seljavaara S. Magnetic resonance imaging of the TRAM flap donor site. Ann Plast Surg 1997;38:23-28

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Cancrum oris is a disease process that has been described for centuries, but now presents primarily in developing countries. The disease is known to occur in association with poor nutrition and exanthematous infections. The acute disease occurs usually in young children, and the infectious process causes destruction of the involved orofacial tissues with variable degrees of tissue loss and scar reaction in those who are affected and survive. The chronic sequelae of the acute disease process often require reconstructive surgery. We present the natural history of the disease process and its causes, and demonstrate the wide spectrum of resulting defects that challenge the reconstructive surgeon. Because of the socioeconomic situation inherent with these patients and the volume of patients in need of treatment with this disease, innovative and efficient treatment is required. We have demonstrated methods of reconstructive surgery that differ from the multiple staged procedures described in previous studies by allowing for one-stage surgical reconstruction of even the most complex cases. This allows for treatment of the majority of patients in their native countries in a cost-effective and safe manner, and treatment of more severely afflicted individuals in modern medical centers without their having to spend a long time period away from their homes.Dean JA, Magee W. One-stage reconstruction for defects caused by cancrum oris (noma). Ann Plast Surg 1997;38:29-35

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Pulp loss of the fingers is frequently observed. When local advancement flaps are not sufficient to repair the defect, the homodigital monopedicled island flaps with “direct flow” are a simple and current reconstructive solution. Between 1991 and 1995, 32 homodigital neurovascular direct flow island flaps were performed for fingertip defects. We used a modified triangular Venkataswami flap for oblique amputations (26 patients) and the Mouchet-Gilbert island flap for tangential defects (6 patients). Our results (with excellent skin quality and good sensory recovery) lead us to consider these flaps as the first-choice reconstructive solution in patients with extensive but not complete pulp defects (<2 cm) of the fingers.Adani R, Busa R, Castagnetti C, Bathia A, Caroli A. Homodigital neurovascular island flaps with “direct flow” vascularization. Ann Plast Surg 1997;38:36-40

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The latissimus dorsi musculocutaneous flap can provide a large, reliable flap for reconstruction of various areas of the body. This flap can also be extended quite some way over the anterior and upper border of the muscle, although its width is limited to between 10 cm and 12 cm if direct closure of the donor site defect is required. This paper presents a sliding-shaped modification of the latissimus dorsi flap that enables the flap to be used efficiently in covering a wide defect as well as in correcting the donor site defect.Sawaizumi M, Maruyama Y. Sliding shape-designed latissimus dorsi flap. Ann Plast Surg 1997;38:41-45

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A widely held tenet in the reconstructive surgery literature is that muscle transplants undergo significant postoperative atrophy, contributing to progressive improvement in appearance of the reconstruction. In contrast, it has been our experience that muscle transplants retain the majority of their bulk following inset, and undergo minimal postoperative atrophy. Prospective evaluation of 20 patients undergoing muscle transplant reconstruction of Gustillo type IIIB lower limb wounds found minimal decrease in limb circumference at 6-month follow-up, as measured at the point of maximum transplant projection.Isenberg JS. What you see is what you get: lack of significant postoperative contour change in muscle transplants to the lower leg. Ann Plast Surg 1997;38:46-49

ISSN:0148-7043    

出版商:OVID    

年代:1997

数据来源: OVID