摘要:

A variety of methods have been described for microvascular anastomosis. The continuous suture provides the same accuracy and versatility as the simple suture but can be significantly faster as well as much more hemostatic. The main argument against the use of the continuous suture is that it may narrow the caliber of the vessel lumen, and many surgeons have thus avoided its use. This technique has been used for arterial and venous anastomoses in 200 consecutive free flaps no matter what the size or the configuration of the vessels. One hundred ninety-four patients underwent 200 free tissue transfers and 410 anastomoses for a variety of oncologic-related reconstructions. A wide variety of different types of flaps, donor sites, and recipient sites were used. Of the 200 arteries (diameter, 0.5 to 5.0 mm), 90% were sutured end to end and 10% were sutured end to side. Of the 210 veins (diameter, 1.0 to 7.0 mm), 69.5% were anastomosed end to end and 30.5% end to side. There were 5 flap failures, yielding a success rate of 97.5%. Four of the failures were unrelated to the anastomosis. The reexploration rate for 200 flaps was 6.5%, with a 16.5% minor complication rate and 15.1% major complication rate. The continuous suture is a highly reliable rapid technique of microvascular anastomosis that can be used in vessels of all diameters. It is applicable for both the end-to-end and end-to-side anastomosis. It is particularly useful for vessels of disparate diameters. The success rate of reconstruction using this technique is comparable to that of most other large series using the simple suture and other methods.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The use of antibiotics and the timing of repair in the management of flexor tendon injuries of the hand have never been specifically addressed in the literature. In a retrospective study, 140 patients treated for simple open flexor tendon injuries were evaluated for postoperative wound infection. Patients were divided into four groups on the basis of early or late repair and use of parenteral perioperative antibiotic therapy. No significant differences were found among groups with respect to the low incidence of infectious complications observed. There is no evidence that mandates the use of prophylactic antibiotics and immediate repair in these types of injuries.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Of the many techniques advocated to correct nipples, all demonstrate a failure rate with a recurrence of the inversion. We report a technique to correct the recurrent nipple inversion in a simple and permanent fashion. This technique consists of releasing all scar tissue and any lactiferous ducts deep to the nipple and inserting a cartilage graft (rib or auricular) under the nipple. This cartilage graft serves to fill in any soft tissue defect and prevent recurrent contraction and nipple inversion. Although generally used for correction of recurrent nipple inversion, we have also used this technique successfully as an initial modality in patients with inverted nipples. We have found this technique to be simple, nondeforming, cosmetically acceptable, and permanent in the treatment of both inverted and recurrent inverted nipples.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The nasalis musculocutaneous sliding flap developed by Rybka and the myocutaneous axial flap with lateral pedicle reported by Martire and associates are extremely useful for reconstruction of the nasal tip and surrounding area, respectively. We have modified the method of Martire and associates into an operative procedure that can be easily employed. By confirming the blood flow of the lateral nasal artery preoperatively by Doppler probing, the lateral pedicle of the flap was made smaller to facilitate mobilization of the flap. Furthermore, this flap could be made into a reversed-flow flap when indicated.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We have employed the serratus anterior muscle vascularized rib (SARIB) composite flap for a variety of multifaceted reconstructive applications in which bone and soft tissues were needed. Seventeen patients have undergone this procedure for reconstructions of the upper extremity (5), lower extremity reconstructions (4), and reconstruction of head and neck defects (8). Sixteen of the reconstructions (89%) have been successful, with an average follow-up over 2 years. One patient had partial loss of a rib transferred to the head and neck for palatal reconstruction. One patient had complete flap loss of a maxillectomy reconstruction owing to a necrotizing infection. We have found this procedure to be applicable to a number of clinical reconstructive situations and recommend the SARIB procedure as a versatile operation that is successful in a high percentage of cases.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The aims of this study were to investigate the vascular communication between the superficial temporal artery (STA) and the posterior auricular artery (PAA) and to determine the vascular territory of various retroauricular flaps for flap design. A series of eight adult fresh cadavers were perfused with a mixture of lead oxide, gelatin, and water through the common carotid and femoral arteries. The full thickness of scalp and facial skin was removed with the STA and the PAA. A radiograph was taken of each specimen. After the retroauricular flap with the PAA from the posterior auricular and mastoid regions was elevated, another radiograph was taken of the specimen. Our radiographic assessment revealed two patterns of vascular anastomosis between the STA and PAA. The auricular anastomoses were found at the upper portion of the posterior surface of the ear, where some reticular anastomoses occurred between auricular branches derived from the STA and the PAA. The scalp anastomoses were located in the scalp superior to the ear, where some reduced caliber choke anastomoses or true anastomoses existed between the parietal branch and the terminal branches of the PAA. The results of this study will be helpful for better understanding of the vascular communication between the STA and the PAA and the vascular territory of retroauricular flaps. Our findings will also provide anatomic information and guidance for the design of reliable flaps.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Cartilaginous autografts, either from the ribs, auricular concha, nasal septum, or even the alar cartilages, are some of the most widely used materials in nasal surgery. Nevertheless, no comparative study exists on these four cartilages in which their physicoelastic properties are analyzed based on their histological architecture and their function within the organism. The studies that do exist on structure and classification of cartilages differ widely. In this study, cartilage specimens obtained from the nasal septum, rib, auricular pavilion, and alar of 7 fresh cadavers were analyzed. They were subjected to special tincturing to be able to histologically observe their architecture, cellularity, intercellular substance, the relationship between cellularity and intercellular substance, the primary components of the matrix, and the distribution of fibers. Many similarities were found among the septal, costal, and alar cartilages. All three exhibit little cellularity and much intercellular substance. The intercellular substance is made up of homogeneously distributed collagen fibers. Auricular cartilage has many cells and little intercellular substance, being made up of irregularly distributed elastic fibers. On the basis of these findings, we propose a simpler classification and make recommendations for the use of these four cartilages in nasal surgery.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Although the reliability of pressure sore surgery has improved with the advent of many different types of flaps, it is well known that the recurrence rate of pressure sores is still remarkably high in spinal cord-injured patients. This article reports the very low relapse rate of postsurgical pressure sores using air mattresses, which also helps relieve manpower requirements for care. We measured interface pressures at the sacrum for 18 spinal cord-injured patients with a ROHO air mattress (ROHO International, Inc, Belleville, IL). Based on the results, we used this mattress immediately after surgery for 19 spinal cord-injured patients with sacral pressure sores. Minimal repositioning was performed for each patient during the hospital stay. Minimal repositioning was similarly performed at home. All pressure sores healed, regardless of the type of surgical procedure, size, and degree of sore. No relapse has been found, with an average of 33.4 months after surgery. With this management, we could achieve a very low recurrence rate, require less manpower for postoperative management, as well as minimize stress for the patients.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Prostaglandin E1(PGE1) ointment has been shown to improve the survival of skin grafts. However, the mechanism of the effects of PGE1through topical application is unknown. A rat skin flap model was used to determine whether PGE1is absorbed through the intact skin. The prostaglandin concentrations in the flaps in the study group were greater than those in the controls. It is suggested that PGE1is absorbed through the skin.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Osteoblasts derived from sagittal sutures with premature synostosis, noninvolved coronal sutures, and normal frontal bone were harvested and cultured as cells in an attempt to determine if osteoblasts at the site of premature fusion exhibited altered in vitro cellular dynamics. Basal metabolic parameters of cellular growth and the production of metabolites, including osteocalcin, alkaline phosphatase, platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), PDGF-β receptors, epidermal growth factor (EGF) receptors, and fibroblast growth factor (FGF) were characterized. Osteoblasts harvested from sagittal sutures (sagittal osteoblasts) exhibited altered cellular growth and indices of cellular metabolism when compared with osteoblasts derived from patent coronal sutures (coronal osteoblasts) and frontal bone (frontal osteoblasts). Sagittal osteoblasts grew at a significantly increased rate and produced significantly more osteocalcin and less alkaline phosphatase than the coronal and frontal osteoblasts (p< 0.05). Significant variations in the production of EGF receptors were also noted between the sagittal osteoblasts and the coronal and frontal osteoblasts (p< 0.05). The osteoblasts from coronal sutures exhibited similarities in cellular growth and cellular metabolism, with the exception of PDGF receptors (p< 0.05), when compared with the osteoblasts obtained from the normal frontal bone. These results support a hypothesis in which a complex cell signaling mechanism regulates morphogenesis of the cranial vault at the sutural sites rather than a set of biomechanical tension forces that are exerted by the underlying brain.

ISSN:0148-7043    

出版商:OVID    

年代:1998

数据来源: OVID