Capsule thickness and breast firmness.
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Breast↗
Biomedical subjects
H H Caffee
Publications and source records attributed to H H Caffee.
In vivo diffusion of lidocaine through tissue expanders.
It has been suggested that the addition of lidocaine to the saline used to fill tissue expanders will reduce the pain often associated with the expansion process. In vitro experiments have shown that lidocaine as it is normally supplied will diffuse through an expander only at a very slow rate, which would probably be inadequate for a clinical effect. We found that the addition of sodium bicarbonate resulted in a substantial increase in the rate of diffusion. Studies in rabbits demonstrated that at a pH of 8.0, 75 percent of the lidocaine dose crossed the silicone elastomer membrane at 24 hours and greater than 95 percent had left the expander at 1 week. We have concluded that intraluminal lidocaine can be effective only when the pH is close to the pKa of lidocaine.
Animals↗
The conventional and low-bleed implants for augmentation mammaplasty.
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Female↗
Noninvasive assessment of implant capsules.
The assessment of implant capsular contracture has been imprecise and vulnerable to observer bias. Attempts to measure capsules with instruments that measure implant deformability are influenced by surrounding breast tissue, subcutaneous fat, and skin. Xeromammography, B-mode ultrasound, and CT were employed in an effort to provide a noninvasive and accurate method of capsule assessment. Through two study phases, implants were placed bilaterally in a total of 21 rabbits. At 4 months, animals underwent radiologic assessment and were then sacrificed for direct implant capsule measurements. Mammographic measurements, more than ultrasound-derived measurements, strongly correlated with laboratory measures of capsular dimensions and deformability. Cross-table lateral mammographic views were more informative than traditional views, providing measures of diameter and height that both strongly correlated with laboratory measurements. CT is theoretically the most accurate method to assess contracture, but it is impractical because of expense and time requirements. The results indicate that radiologic assessment, in particular by xeromammography, of implant capsules is accurate, practical, and noninvasive. Mammography strongly correlates with laboratory measures of implant capsular contracture and therefore could be used in the clinical setting to assess capsular contracture.
Animals↗
Textured silicone and capsule contracture.
An experiment was performed in rabbits to test the effect of a textured surface of a silicone implant on the incidence and severity of capsule contracture. Contrary to the hypothesis of this experiment, texturing of the implant surface resulted in an increase in the contracture problem rather than a reduction.
Animals↗
The efficacy of methylprednisolone in reducing flap edema.
It has been suggested that systemic steroids reduce postoperative flap edema. This has been poorly documented by several reports based on subjective clinical observations. In an effort to provide quantitative data on methylprednisolone and edema, a flap edema model in the rat was developed based on the inferior epigastric vessels. Significant edema developed after 48 hours. Differing intraoperative doses of methylprednisolone were studied, producing a dose-response curve. A single low dose of intraoperative steroid is effective in reducing flap edema; previously recommended doses are probably excessive.
Analysis of Variance↗
Polyurethane foam-covered implants and capsular contracture: a laboratory investigation.
Experiments were conducted in rabbits comparing polyurethane foam-covered implants with otherwise identical smooth silicone gel implants. Using five objective methods of measurement of capsular contracture, no significant difference could be identified. The foam-covered implants consistently developed capsular contracture, although in most cases this was of mild degree and would not have been clinically significant. In the two foam-covered implants with hard contractures, there was no evidence of hematoma or separation of the foam.
Animals↗
Reconstruction of the distal trunk of an African elephant.
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Amputation Stumps↗
Postoperative radiation and implant capsule contraction.
Occasionally radiation is required as adjunctive therapy following mastectomy for breast cancer. The effects of radiation on a developing implant capsule are unknown, but they are very important in relation to the increased use of immediate reconstruction. Experiments were performed on rabbits to study the effects of postoperative radiation therapy on capsule contraction and thickness. The results of these experiments suggest that radiation has no effect on implant capsules.
Abnormalities, Radiation-Induced↗
Breast cancer in a patient with silicone breast implants after 13 years.
The patient described in this article is a 45-year-old woman who developed an infiltrating ductal carcinoma in her left breast next to a Silastic mammary implant that had been used for augmentation some 13 years previously. She underwent a modified radical mastectomy and removal of the silicone prosthesis with an axillary lymph node dissection. Twenty-six axillary lymph nodes were negative for metastatic disease. The 165-gram silicone gel prosthesis was surrounded by a thin fibrous capsule with an attached 1-cm carcinoma that did not invade the fibrous capsule. It appeared that the capsule presented a barrier to the invading ductal carcinoma. The fibrous capsule surrounding the Silastic implant may have altered the spread of the breast cancer without being related to its genesis.
Breast↗
Experiments on the effects of hyperbaric oxygen on flap survival in the pig.
The use of hyperbaric oxygen has been advocated as a method of improving survival of ischemic flaps. Experiments were done in the pig using modern flap designs and hyperbaric oxygen protocols that have been reported to be effective in rodents. The results of these experiments indicate that hyperbaric oxygen is not effective in improving flap survival in the pig.
Animals↗
Peripheral aneurysms in children--a link to trauma.
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Aneurysm↗
Vitamin E and capsule contracture.
Vitamin E is known to inhibit the inflammatory phase of wound healing and to decrease wound tensile strength. For these reasons, vitamin E has been suggested for the prevention of breast implant capsule contracture. Experiments in rabbits demonstrated a reduction in capsule contracture that was significant statistically, but the improvement was minor, suggesting that vitamin E prophylaxis would probably not have a major impact on the clinical problem of capsule contracture.
Animals↗
Pulse oximetry for vascular monitoring in upper extremity replantation surgery.
Pulse oximetry as a postoperative monitor for replanted or revascularized digits was evaluated experimentally and clinically. The accuracy of detection of vascular occlusion was 100%, and arterial and venous occlusion could be differentiated by changes in pulse inflow and oxygen saturation. Digits demonstrating O2 saturations above 95% remained viable, those below 85% were associated with venous occlusions, and those with no saturation represented arterial occlusions. This method is simple, noninvasive, continuous, and accurate, and it reliably assesses revascularized digits and replanted parts.
Adult↗
The effects of hematoma on implant capsules.
Hematoma surrounding an implant is one of the many factors that have been suggested as possible causes for scar capsule contracture. In this study, experiments were designed to determine the influence of hematoma on the incidence and severity of capsule contracture in rabbits. Two implants were placed in each animal, 1 with a surrounding hematoma and 1 control. Capsules were evaluated subjectively and compared objectively with measurements of deformability, surface area, and capsule thickness. No differences were found with any of the objective criteria, which suggests that hematoma may not be a noteworthy cause of implant capsule contracture.
Animals↗
The influence of silicone bleed on capsule contracture.
The phenomenon of silicone bleed from breast implants has been recognized for several years, but its importance continues to be a source of controversy. Experiments were done in rabbits in which standard implants were compared with implants that had been modified to reduce silicone bleed. Contracture was seen with both types of implants, but both the incidence and severity were significantly reduced with the low bleed implants.
Animals↗
Bipolar coagulation in microvascular surgery.
In microvascular surgery and surgery of the hand, hemostasis must be accomplished very precisely to avoid injury to adjacent structures. Bipolar coagulation is one of the more precise techniques, since theoretically, current flows only through tissue that is held between the tips of the forceps. Experiments were done in rats to confirm that bipolar coagulation can be used to control vessel branches without disturbing the parent vessel or adversely affecting an adjacent anastomosis. However, the importance of the characteristics of the bipolar generator require particular attention. The generator used in these experiments produces a continuous-sine-wave current to minimize voltage. In addition, the equipment was designed to sense impedance and to automatically shut down at the point of desiccation, thus avoiding sparking, charring, and adherence of tissue to the forceps.
Abdomen↗
Computer applications in plastic surgery training programs.
In this article three simple applications for microcomputers in the training program setting are explained. All three are also useful in a private practice setting. The ability to conduct a literature search from your own office and the ability to manage lists of clinical cases have important research as well as educational advantages. The computerized in-service examination takes an already useful educational tool and adds a new dimension.
Computer-Assisted Instruction↗