Composite rhytidectomy.
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Biomedical subjects
Publications and source records attributed to P Candiani.
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Transaxillary subpectoral augmentation mammaplasty combines the advantages of an axillary located scar with those of a submuscular pocket. However, according to the classical technique, the caudal extension of the pectoral fascia prevents the prosthesis from filling completely the inferior breast pole, thus creating a double submammary fold and/or an excessive fullness of the superior quadrants. In order to overcome this limit Barnett (1990) proposed to disrupt the caudal extension of the pectoral fascia along with its insertions to the submammary fold, thus allowing the implant to lie in a submuscular plane superiorly and in a subglandular/subcutaneous one inferiorly. In this paper the authors present their clinical experience with this new surgical technique.
Endoscopic facial rejuvenation is a new technique which allows to greatly reduce the scar morbidity especially in the forehead region. Other advantages are its safety and accuracy due to the excellent magnification provided by the endoscope which enhances the visualization of muscles, nerves and vessels and shows clear surgical planes. Anyway, a sound knowledge of the distribution of the fascial system at the temporo-zygomatic region and of the relationships between the temporal fasciae, the interposed fat pads and the frontal branch are fundamental both in the prevention of nerve injury and in the successful result of the endoscopic procedure. In this paper an accurate account of the anatomical structures and their relationships encountered during a subperiosteal endoscopic facial procedure by dissecting 20 facial halves has been provided.
From an anatomical standpoint, the support of the inferior two thirds of the nose is ensured by the cartilaginous septum. Usually, the reconstruction of total loss of the quadrangular cartilage is performed with some success by means of camouflage procedures such as L-shaped struts or cantilever grafts. In this article we report on four patients who presented with severe collapse of the inferior two thirds of the nose. Although the cartilage was completely gone, the septal linings were intact on both sides. An anatomical reconstruction of the quadrangular cartilaginous septum was performed, harvesting a cartilaginous rib graft, carving it to reproduce the septal plate, and suturing it to the nasal spine. The short- and long-term follow-up showed satisfactory aesthetic and functional results, with good height of the nasal profile, adequate tip projection, and patency of the airways. No evidence of similar reports on this particular technique has been found in the literature.
Superior orbital fissure syndrome complicates zygomatic fractures either when the nerves that cross the fissure are damaged by bone fragments, or when the increased pressure in the orbit at the time of the injury compresses the nerves against the rim of the fissure. Oedema and bleeding may also have the same effect. We present a patient who was treated conservatively, and the ophthalmological problem subsided, although not completely, within a year.
A good success rate has been achieved using argon and CO2 laser in the treatment of port-wine stains. So far however only a few studies have been published concerning the long term histologic changes in the irradiated skin. In the present study we report our findings from skin biopsies in patients treated for port-wine stains with argon and CO2 lasers. The results show that in spite of the high level of selectivity of optical absorption of argon emission by hemoglobin, after 3-9 months there is histologic evidence of connective proliferation and reactive fibrosis of the necrotic dermis comparable with that resulting from CO2 emission.
The authors present the anatomical findings that have made an easier approach to composite rhytidectomy possible. The lower lateral border of the orbicularis oculi muscle (OOM) overlies the zygomaticus major muscle (ZMM), the upper third of which tightly adheres to the malar bone. The OOM is innervated throughout over its circumference by a plexus of small facial nerve branches. From its deeper surface, the ZMM is innervated by two to four branches in its upper third and middle third. These branches are jeopardized in an extended sub-SMAS dissection as this tends to go deep into the ZMM. The malar fat pad is superficial to the SMAS layer that invests the zygomaticus and levator labii muscles and, with age, tends to slide downward, medially deepening the nasolabial folds. An extended dissection beyond the OOM tends to remain superficial to the upper part of the ZMM, zygomaticus minor, and levator muscle complex. We have found that extending the suborbicularis dissection inferiorly and laterally offers three major advantages: (1) The correct deep subcutaneous plane just above the ZMM, zygomaticus minor muscle, and levator complex can be found easily, leaving all of the fat attached to the skin. The only structures at risk are some minor motor branches to the OOM that can be divided without any morbidity because of the extensive plexiform innervation.(ABSTRACT TRUNCATED AT 250 WORDS)
The surgical anatomy of the fascial layers and vascularization of the scalp was studied by means of 11 bilateral cadaver dissections. This article is organized as follows: first, a description of the layers and fasciae of the scalp and their relationships with the main vascular structures, and then a description of the histological structure of the subgaleal fascia (composed of multiple connective vascularized sheets that glide over one another) and of its blood supply. In our dissections, we found the constant topographic distribution of the major perforant vessels to the subgaleal tissues as follows: in the temporal region, perforant vessels from the superficial temporal artery near and 10 to 14 cm above the zygomatic arch, where the superficial temporal artery leaves the surface of the galea to enter the superficial subcutaneous tissue, and in the fronto-parieto-occipital region, many small perforant vessels evenly entering the subgaleal plane every 5 to 10 mm. These findings could lead to greater use of fascial or composite flaps from the scalp region.
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Bone lengthening by corticotomy, gradual distraction and stabilization with an external frame has proved to be effective in the repair of osseous defects in lower extremities. More recently this technique has been introduced also in the treatment of post-traumatic deformities and malformations of the upper limbs. From 1989 to 1992 we treated 38 patients (46 upper limbs) with bone lengthening of which 12 (16 upper limbs) affected by post-traumatic deformities and 26 (30 upper limbs) by malformations. We present herein our four year experience with malformed cases only. The results suggest that bone lengthening is a simple and reliable procedure to obtain good function, to correct angular deviations and, also, to give a better esthetic appearance. Satisfying results, low complication rates and simple execution recommend its use in the treatment of many congenital malformations of the upper limbs, usually in association with traditional techniques. However, we are now strongly selecting the indications in order to improve our future results. We stress in particular that the treatment of some malformations, as ulnar or radial club hands, could be radically modified by introduction of bone lengthening.
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This paper describes a case of recurrent postpartum urethrovaginal fistula. The extent of the vaginal tissue loss and the perilesional scarring made direct closure of the defect not practicable. After suturing of the urethra, the anterior vaginal wall was reconstructed with an island bulbocavernous musculocutaneous flap raised from the left labium majus. Seven months after surgery, the flap healed well, and cystography showed a regular voiding without periurethral suffusions. Healing of thedonor site also was aesthetically satisfactory.
In this study, 40 patients who underwent surgery for cerebro-vascular insufficiency were considered. Carotid endarterectomy was the procedure of choice in all of the patients; the arteriotomy was always closed using a PUR patch, a new material that, for its chemical and physical characteristics seems to be a good alternative to PTFE. All of the patients underwent surgery under loco-regional anesthesia, allowing a perioperative monitoring of the neurological status through the patient's active collaboration. During the postoperative period, non local or systemic pathology related to the use of the patch has been observed. During the short and half term follow-up, the patients underwent echo-Doppler of the supra-aortic trunks that didn't show either false aneurysms or thrombosis on the patch surface.
This paper describes the case of a recurrent post-partum urethrovaginal fistula. The extent of the vaginal tissues loss and the perilesional scarring made the direct closure of the defect non practicable. After suturing the urethra, the anterior vaginal wall was reconstructed with an island bulbocavernous musculocutaneous flap raised from the left labium majus. Nineteen months after surgery the flap healed well without peri urethral suffusion.
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Two patients presented with multicystic lymphatic malformations of the penis. These were congenital and progressive, and both were successfully treated by excision after injection of methylene blue.
The pectoralis major muscle or musculocutaneous flap is well suited to repair immediately wide defects following surgical removal of carcinomas or traumas of the cervicofacial and thoracic regions. Microsurgery has recently suggested exciting and successful solutions for the same purposes, but we think it is still important to reassess and perfect the flaps already known in order to achieve a better cost-benefit ratio. We examined the intramuscular vascular anatomy of 22 pectoralis major muscles using an image analyzer and a computerized measuring system to quantify the essential features objectively. The data show the segmentation of the pectoralis major muscle into two subunits, each provided with its own vascular supply. Slight anatomical differences and the presence of a well-developed intramuscular vascular supply makes the pectoralis major muscular and musculocutaneous flap a useful and safe procedure.