[Treatment of funnel chest using an RTV-silastic implant].
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Biomedical subjects
Publications and source records attributed to G Lemperle.
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Two cases are reported with anterior nasoethmoid encephaloceles. The clinical, radiological and surgical results are described. The significance of a primary intracranial and intradural treatment of the defect of the base of the skull is pointed out. Secondary extirpation of the encephalocele and plastic correction of the face is recommended. Interdisciplinary cooperation with related specialties in the treatment of anterior encephaloceles is emphasised.
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The funnel chest is no physiological but a psychological problem for the majority of patients. Only 5% suffer from pathological parameters which require a surgical elevation of the funnel. After these rather complicated operations, however, only 60-80% are followed by good long-term results. The described RTV-silicone implant is formed preoperatively directly in the funnel and appears to be a simple safe and lasting alternative for most patients with a funnel chest.
Silicone implants are suitable for correction of defects in the face. They are biologically inert, are retaining form, are available in each size and consistency, are easily inserted and later on corrected. Among 321 silicone implants in the face we found complications between 8% for chin augmentation and 55% for ear reconstruction. The overall-complication rate was diminished by a simple correction to less than 9%.
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The authors report on the experience in 27 patients with noses damaged by radiation. Different types of local flaps from the forehead and distant flaps from the neck and arm for reconstruction are described.
Six minor corrections in the face of children with Down's syndrome can clearly improve their facial expression. Reduction of macroglossia facilitates phonation. Augmentation of the bridge of the nose effaces the epicanthus. The lid axis, the hypotonic lower lip, and microgenia can be repaired. While the parents have been satisfied with the results of surgery, a positive effect on social behavior and mental development of the children has not yet been proven.
After radical mastectomy in some cases reconstruction of the female breast can be established. The plastic can only be performed as a staged procedure (2 to 5 operations). The timing to start reconstruction has to be individualized with regard to he psychical situation of the woman concerned and the TNM grade of the tumour. In case of a T1N0M0-tumour the reconstruction can already be begun after one year, that means after finshing adjuvant anticancer-chemotherapy. Till today there exist no criteria that early reconstruction of the female breast by pedicded flap and silicone prosthesis will veil local recurrences or promote metastases.
The method using synthetic skin substitute Epigard as a long-term coverage for donor sites in cross-leg-flap- and other plastic surgery procedures is described. The double-layered polyurethane/Teflon-material can be left on the wound for several weeks to avoid bacterial contamination during holding periods and to prepare regrafting of skin flaps. Experiences based on 32 cases are described.
In the years 1976--1978 we have treated in our hospital 5 patients with progressive hemifacial atrophie (Romberg's disease). To overcome the deformity we used two operations procedures. In three cases the atrophic area was filled out with Plastigel and the asthetic result was good. The advantage of this method can be seen in the simplicity of the operation procedure. Problematical is the mobility of this region of the body and occasionally the absence of subcutaneous tissue to cover the implant. 2 patients with hemifacial atrophy have been treated by a buried de-epithelized neck flap. After 3 operations we obtained a good result.
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