摘要:

Three aesthetic parameters, based entirely on nasal surface soft tissue morphology, can be used to formulate a practical rhinoplasty strategy. They are, in order of ascending importance (1) skin thickness and distribution, (2) tip lobular configuration, and (3) the balance between nasal base size and bridge height. These three parameters, chosen because of their broad ramifications for a successful rhinoplasty result, help determine the need and method for dorsal and tip reduction or augmentation, and recognize the constancy of preoperative skin sleeve distribution, particularly at the nasal base. The strategy is equally useful in primary and secondary rhinoplasty. Because their effects are regional, all other decisions (e.g., osteotomies, alar wedge resection, nasal shortening, valvular reconstruction) are secondary and can be made independently.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Eighty-five patients with augmentation mammaplasty were surveyed. Patients were polled about knowledge of risks, level of concern, awareness of media publicity, incidence of complications, and degree of satisfaction with breast implants. Sixty-one percent of the patients were satisfied or very satisfied with implants, whereas 32% were somewhat or very unsatisfied. Level of satisfaction was not related to knowledge of risks, but did correlate with having experienced side effects or complications. Virtually all patients were aware of recent media publicity about implants, and 90% of women perceived the publicity to be negative. Seventy-five percent of the patients expressed concern about implant safety. Even after exposure to negative publicity, however, <10% of those surveyed regret having had the surgery and only 6% indicated they would like their implants removed. Overall, patients with augmentation mammaplasty perceive the benefits of implants greatly outweigh the risks.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Just as a successful breast reconstruction cannot be achieved using a solitary method for every patient, no single surgical technique is a panacea for the final stage of nipple creation. For breast mounds with a thin subcutaneous layer, as commonly associated with the implanted breast, local flaps using a central subcutaneous core have strong advocates. The H-shaped local flap introduced here is a variant of the latter where large, well-vascularized side tabs provide adequate projection with minimal risk for flap slough. More importantly, a cylindrical shape geometrically identical to the norm avoids the bulbous appearance frequently resulting from many of the other central-core flap designs.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A retrospective statistical analysis of orbital hypertelorism correction was performed by comparing the preoperative and postoperative intercanthal distances of these patients with published age-matched normal values. Forty-five patients who had undergone surgery over a 15-year period with an average follow-up of 5 years (6 months to 14 years) were evaluated. Comparison of age-normalized preoperative and postoperative intercanthal distances revealed a significant difference for orbital hypertelorism patients as a group (p< 0.0001), patients with clefts (p< 0.0001), patients with nasoencephalocele (p< 0.01), and patients with frontonasal dysplasia (p< 0.05), but not for those patients with craniofacial dysostosis (p< 0.20). Multiple analyses of variance revealed a significant interaction existing between the extent of preoperative deformity and the cause of hypertelorism for both the postoperative deformity and the total amount of correction achieved, but not for the type of surgery or for the age at which the surgery was performed.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Use of the rectus abdominis muscle as a free or pedicled flap is generally well tolerated by patients and accomplishes its intended purpose with minimal morbidity. In chronic or nonacute situations, high rates of success of tissue transfer and low donor site morbidity is expected. We have reviewed our results in 26 patients undergoing inferiorly based rectus abdominis muscle flaps with particular attention to the donor site. Patients with multiple injuries, who have had recent abdominal laparotomy, have a significantly higher morbidity rate. Dehiscence of the abdominal wound in 3 patients and a mortal donor site infection in 1 patient after transfer of a rectus flap has led to a careful examination of the cause for these complications. Careless closure of the midline laparotomy wound with subsequent elevation of a rectus flap lends itself to ischemia of the fascia and potential dehiscence. This is especially true in seriously ill patients on ventilators with abdominal distention and nutritional compromise. Alternate sources of tissue should be used if practical in these patients.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

As our population ages and spinal cord injuries continue at their present rate due to motor vehicle accidents and handgun injuries, the development of pressure sores will most likely increase in frequency. The three major populations at risk to develop pressure sores include the elderly, long-term hospital patients, and neurologically impaired patients. The posterior thigh flap evolved during our experience with the lower extremity muscle flaps. We have used 22 posterior thigh flaps in 21 patients. We have found that it is a reliable flap with a dependable blood supply that can be used in the soft tissue coverage of trochanteric, ischial, and some sacral wounds. In addition, the posterior thigh flap can be used as a pedicled flap in the management of heel and foot wounds. In this review, the anatomy and application of the posterior thigh flap are elaborated.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The reverse flow island flap is one of the most versatile reconstructive procedures in the lower extremity. There are three major arteries, the peroneal, the anterior tibial, and the posterior tibial artery, and a reverse flow island flap pedicled by each vessel and its intermuscular cutaneous perforators is available. Twenty-five reverse flow island flaps were clinically applied for soft tissue defects in the lower leg (10 peroneal, 8 anterior tibial, and 7 posterior tibial flaps). We report a comparative study of the characteristics and indications of the peroneal, anterior tibial, and posterior tibial reverse flow flaps. We conclude that the anterior tibial reverse flow flaps are more likely, without venous anastomosis, to become congested and necrose than the peroneal and posterior tibial flaps.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Free tissue transfer and extremity replantation have been successfully performed in elderly patients. However, it is not known whether such procedures have an associated higher risk of failure in this patient population, nor is it known whether prolonged ischemia exacerbates the problem. This study used a senescent rat model to address these issues. Free groin flaps were raised in the syngeneic Lewis rat strain, using the following three age groups: young ( 2-3 months old), middle-aged (10-12 months), and old (20-22 months). Flaps were transferred to the groins of young recipients after a 72-hour period of cold (4°C) ischemia. Survival was followed for 7 days; 58% of the young flaps survived, whereas 42% of the middle-aged and only 26% of the old flaps survived. These differences achieved significance in comparing survival of young versus old flaps (p< 0.03). These results support the practice of free flap reconstruction in elderly patients, but suggest that there is less tolerance to prolonged ischemia with increasing age.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Venous flaps may become more versatile in reconstruction and offer different opportunities to reconstructive surgeons if the mechanisms of their viability is clarified. In this study, axial pattern flank flaps in rabbits were converted into venous flaps by dividing the cutaneous pedicles and ligating the artery. Fluorescein and radioactive tracer studies were performed to elucidate the mechanisms of possible circulation. It is hypothesized that the venous flaps do not have a capillary circulation, but veins transport the fluid out, which is drawn into the capillaries from the interstitium, and that the nutrients and oxygen for flap viability diffuse from the wound bed. Venous drainage plays an important role by draining the metabolites away until revascularization offers a more direct supply.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A girl born with a large vascular malformation of the face underwent successful resection in infancy with preservation of function and with improved appearance. Two years after surgery, the girl remains well with no expansion of the residual malformed channels.

ISSN:0148-7043    

出版商:OVID    

年代:1993

数据来源: OVID