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At least 289 records · Page 16Linked to original sources
PubMed2003

Versatility of temporalis myofascial flap in maxillofacial reconstruction--analysis of 30 cases.

Temporalis myofascial flap holds great promise for the reconstruction of various defects of the maxillofacial region-either congenital or surgical. The dependable blood supply through the middle and deep temporal arteries, proximity to the maxillofacial region, possibility to mobilize it to the oral cavity through the under surface of zygomatic arch and its fanned out nature permits the surgeon to use this flap for the reconstruction of various maxillofacial defects and even as an interposing tissue. In this series of 30 cases, we have used the temporalis myofascial flap for the reconstruction of different types of maxillofacial defects and as an interposing material in TMJ surgeries. We found that this flap is very valuable in maxillofacial reconstruction.

Ankylosis↗
PubMed2000

Reconstruction following radical maxillectomy with flaps supplied by the subscapular artery.

The authors present their experience of 27 cases with repairs of defects following radical maxillectomies with free flaps. A total of 28 flaps were used (five latissimus dorsi, six scapula, 16 combination flaps of scapula and latissimus dorsi and one combination of scapula, latissimus dorsi and serratus anterior flap). Only one scapula flap was completely lost and in three cases where a combination of scapula and latissimus dorsi flap was used, partial necrosis of one component occurred. The authors first choice for reconstruction is a scapula bone flap raised on the angular artery combined with the latissimus dorsi flap. The combination of flaps with a long pedicle and of the bony and muscular components provides the surgeon with the option of customizing the flap to meet individual patient needs. For intraoral closure the authors prefer the latissimus dorsi muscle which rarely requires secondary procedures for prosthesis placement following epithelialization and atrophy. The main disadvantage of the flap is the difficulty of two teams working simultaneously, thus increasing the average operating time. All postoperative corrections and prosthetic rehabilitation should be postponed for at least 2 months following surgery because of postoperative swelling.

Adolescent↗
PubMed1988

Relative risk: mortality probability and plastic surgery.

Recent publications indicate an increasing interest in the description and assessment of risks related to medical and surgical treatment. The law may come to require fuller disclosure of therapeutic risks than was formerly the case. Against this background the mortality risks of plastic surgery procedures are considered in relation to other well documented mortality probabilities. The possible implications for clinical practice and "informed consent" are discussed.

Adolescent↗
PubMed2005

[Amniotic membrane transplantation for oculopalpebral and reconstructive surgery].

INTRODUCTION: Amniotic membrane has been used for many years for ocular surface defects. It is also commonly used in laboratories for cellular growth. Amniotic membrane has antiadhesive properties, can promote epithelialization, and decrease neovascularization, inflammation, and fibrosis. There is no histocompatibility problem, as amniotic membrane has no HLA antigens. In this study, amniotic membrane transplantation was used for oculopalpebral and reconstructive surgery as an alternative to the oral mucous graft, particularly in the reconstruction of the conjunctival fornices after inflammatory disease, burns, conjunctival tumors, and enucleation with orbital implants. MATERIAL AND METHOD: Forty-eight interventions using amniotic membrane transplantation were done on 44 patients. In 16 cases conjunctival fornices were created or reconstructed, allowing the installation of an ocular prosthesis; 14 had reconstruction of fornices for inflammatory disease, or chemical or thermal burns; 11 had palpebral skin and conjunctival reconstruction (malformations or skin tumours); and seven cases had conjunctival reconstruction after conjunctival tumor excision. RESULTS: Thirty-nine cases presented good functional and cosmetic results. One case had no follow-up. Eight cases gave poor results: four cases of conjunctival fornix refection (with two irradiated cavities), three cases of fornix reconstruction after chemical burn, and one case in whom palpebral reconstruction partially failed (coloboma). DISCUSSION AND CONCLUSION: Functional and cosmetic results were good for 39 cases, allowing ocular prosthetic equipment when necessary. In nine cases, two complete fornix retractions and two partial fornix retractions were observed; one palpebral reconstruction for malformation partially failed; and four cases (two with amniotic membrane and two with oral mucus graft) required a second surgery to obtain a satisfactory result. Amniotic membrane transplantation is an excellent alternative material to oral mucous membrane in oculopalpebral and reconstructive surgery except when graft rigidity is necessary. Its use is more difficult in cases of chemical burns or after orbital irradiation.

Adolescent↗
PubMed2001

Management of eyelid anomalies associated with Blepharo-cheilo-dontic syndrome.

PURPOSE: To describe the previously unreported management of the eyelid anomalies associated with blepharocheilo-dontic syndrome. Blepharo-cheilo-dontic syndrome is a syndrome of congenital cleft lip/palate, oligodontia, euryblepharon, eyelid ectropion, and lagophthalmos. METHODS: Case report. A 3-month-old male presented with bilateral upper and lower eyelid ectropion with eyelid retraction, marked euryblepharon, severe lagophthalmos, and a right side cleft lip/palate. Lateral tarsal strips, lower eyelid retractor disinsertion, myocutaneous advancement of the cheek and eyelids, and lateral tarsorrhaphy were performed. RESULTS: Correction of the ectropion, eyelid retraction, euryblepharon, and marked improvement in his lagophthalmos were achieved postoperatively. No recurrence of the ectropion or euryblepharon has been noted after 6 months of follow-up. CONCLUSION: Appropriate reconstructive surgery of the eyelids reduces the morbidity associated with the eyelid anomalies and provides an excellent cosmetic result for patients with blepharo-cheilo-dontic syndrome.

Cleft Lip↗
PubMed2003

A comparison of cyclizine, ondansetron and placebo as prophylaxis against postoperative nausea and vomiting in children.

Nausea and vomiting is a relevant and common problem with unfavourable sequelae in children undergoing some plastic surgery procedures. There is a lack of anti-emetic trials performed in children, with only a few investigating the roles of the older anti-emetic agents such as cyclizine compared with newer ones such as ondansetron. This randomised, controlled, double-blind study examined the effectiveness of a single dose of ondansetron (0.1 mg x kg-1), cyclizine (20 mg) and placebo (normal saline) in the prevention of postoperative nausea and vomiting in 150 children (mean age 3.6 years) undergoing plastic genitourinary procedures. Rates of previous postoperative nausea and vomiting and motion sickness were comparable across the groups. Postoperative vomiting was significantly reduced with ondansetron prophylaxis (p = 0.006) but there was no detectable anti-emetic effect with cyclizine. Furthermore, cyclizine caused pain on injection (p < 0.001).

Analgesics, Opioid↗
PubMed2005

Anterior capsulolabral reconstruction for traumatic recurrent anterior shoulder dislocation.

The anterior capsulolabral reconstruction (ACLR) has been shown to yield satisfactory results predominantly in overhead athletes with atraumatic anterior shoulder instability. The purpose of this study was to assess the clinical results of patients who underwent ACLR for recurrent traumatic anterior shoulder dislocation. A retrospective review of 41 patients, mean age 29 (range: 16 to 55 years) who underwent ACLR for traumatic recurrent anterior shoulder dislocation was performed. All patients reported a traumatic anterior shoulder dislocation with subsequent recurrent instability. Seven patients had undergone previous shoulder stabilization surgery which had failed. The mean number of previous dislocations was 4.5 (range: 1 to 15). There were 31 males and 10 females, and the dominant arm was involved in 24 patients. In all cases, the capsulolabral complex was detached from the glenoid rim. The mean follow-up was 3.6 years (range: 15 to 80 months). All patients were evaluated by physical examination. The mean modified Rowe score was 93.6 (range: 65 to 100). There were 32 excellent, 5 good, 1 fair, and 2 poor results. Instability was eliminated in 38 patients (93%). Of 25 patients who engaged in recreational sports, all were able to return to their previous level of participation. One patient sustained a traumatic redislocation and underwent revision surgery. Two patients reported atraumatic recurrent subluxation with one requiring revision surgery due to persistent symptoms of instability. There was no loss of range of motion in comparison to preoperative values. Of the seven shoulders that had undergone previous surgery, all remain stable. These results indicate that a glenoid-sided capsulolabral reconstruction can restore shoulder stability in patients with recurrent traumatic anterior shoulder dislocation. Success rates comparable to those of other open anterior shoulder repair procedures can be achieved.

Adolescent↗
PubMed2006

Long-term results after mandibular continuity resection in infancy: the role of autogenous rib grafts for mandibular restoration.

Reconstruction of mandibular defects after tumor resection in infants is a particular challenge. Although autogenous rib grafts have no relevance nowadays for restoration of mandibular bone defects after ablative tumor surgery because of limited bone stock and the availability of other donor areas, they are a useful surgical alternative after tumor surgery in infants. We here report on a 6-month, 5-year, and 10-year follow-up of three children who were diagnosed with benign tumors of the mandible with osseous destruction at the ages of 4 months, 6 months, and 2 years, respectively. Histologic diagnoses were melanotic neuroectodermal tumor, hemangioendothelioma of the mandible, and ameloblastoma. After continuity resection of the mandible, latero-mandibular bone defects were restored using autogenous rib grafts. Both clinical and radiologic follow-up visits in all children were performed to assess growth of the facial skeleton as well as the mandibular growth. Cephalometric measurements on Panorex films and three-dimensional computed tomographic scans revealed slight vertical growth excess and transversal growth inhibition of the reconstructed mandible in comparison with the nonoperated side. Although further growth of rib grafts is difficult to predict and occlusal disharmony may occur because of physiologic maxillary growth and growth of the unaffected mandible, we think that autogenous rib grafts can be ideally used for restoration of mandibular continuity defects in newborns and young children. Clinical follow-up visits on a yearly basis and orthodontic controls are useful for early orthodontic treatment of growth deficits. Further corrective surgery with bone augmentation or osseous distraction is required after completion of growth of the facial skeleton.

Ameloblastoma↗
PubMed2002

A population based assessment of the use of orthopedic surgery in patients with rheumatoid arthritis.

OBJECTIVE: To describe the use of orthopedic surgery, including joint replacement surgery, in a well defined population based cohort of patients with rheumatoid arthritis (RA) and to identify characteristics that predict such use. METHODS: A retrospective medical record review was performed of cases of RA incident in Rochester, MN, during the years 1955-85. Patients were followed until 1998. All joint surgeries were recorded, including joint reconstructive surgeries, total joint arthroplasty (TJA), and other joint reconstructive procedures (JRP) such as tendon transfers and resections, joint fusions, and surgeries for fractures and infections involving joints. RESULTS: Of the total 424 RA incident cases, 148 (34.9%) patients underwent one or more (maximum of 20/patient) surgical procedures involving joints during their followup (median 14.8 yrs, range 0.2-42.8 yrs). Overall, this RA cohort had 9.7 surgeries per 100 person-yrs of followup. The estimated cumulative incidence of surgical procedures for RA at 30 yrs was 52.7% +/- SE 4.2. Surgeries for arthritis related joint disease of RA included: primary TJA 76 patients (31.3 +/- 4.1); JRP joint fusion 78 patients (29.4 +/- 3.5); JRP soft tissue 92 patients (29.8 +/- 3.3); and cervical spine fusion one patient. Non-RA (trauma and other) joint surgeries included TJA 26 patients (13.5 +/- 3.4) and arthrotomy for septic arthritis 8 patients (2.4 +/- 0.9). Based on Cox proportional hazards regression, the risk of having a disease related joint surgery for RA is increased in patients who are younger (p < 0.001), have positive rheumatoid factor (p = 0.01), and those with rheumatoid nodules (p < 0.001). There was a borderline significant increase in the risk of first joint surgery in women (p = 0.09). Women also had significantly more joint surgeries (11.5/100 person-yrs) than men (4.9/100 person-yrs; p < 0.001). Survival of patients who had surgery for RA related joint disease was similar to those who did not. CONCLUSION: This is the first population based assessment of joint surgeries performed in patients with RA. Reconstructive surgeries were common, and women had significantly more surgeries than men. Survivorship among patients with RA undergoing surgeries was similar to that of the RA patient population at large.

Adult↗
PubMed2005

[Long-term surgical results for congenital aural atresia and hearing reconstruction].

OBJECTIVE: To evaluate the stability of hearing results and complications in long-term following-up who underwent reconstruction surgery. METHODS: Six hundreds and seventy five cases (700 ears) of congenital aural atresia were reviewed from January 1984 to January 2001 at the Department of Otorhinolaryngology Head and Neck Surgery, Tongren hospital. Except 40 ears undone hearing reconstruction, 635 cases (660 ears) underwent long-term following-up for 3 to 19 years, with an average of 7.9 years. RESULTS: Stenosis and recurrent infection of the external auditory canal (EAC) were the most frequent complications. Stenosis was seen in 120 ears, and 2 ears re-atresia, with an incidence of 18.48% (122/660). Recurrent infection of the cavity and canal skin happened in 6 ears. Closure of the air-bone gap (ABG) post-operation were gained in all cases, and ABG gains 20 dB or more occurred in 512 ears (77.57%), but 30 dB or more in 231 ears (35%). Following-up results: Stable hearing results gained in 450 ears over the length of following-up; the hearing worsened than that of 3 weeks postoperatively occurred in 160 ears, including 2 ears with sensorineural hearing loss. Hearing deteriorated more than 20 dB happened in 35 ears, and 10-15 dB in others cases but still be improved compared with that of preoperation. CONCLUSIONS: Atresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results in 68.2% (450/660), with a low incidence of complications; the initial improved hearing deteriorated gradually over the first 6 months post-operation, which are related with the stenosis and infection of canal. Cavity adhesion, bony EAC re-growth, ossicular chain re-fixation or displace may affect the hearing results in some cases. Even unilateral aural atresia may benefit from the reconstruction surgery and achieve serviceable hearing results.

Adolescent↗
PubMed1987

Body contouring surgery after weight reduction.

I reviewed the cases of 50 consecutive patients who had a total of 75 plastic surgery procedures after weight reduction. The average weight loss was 126 lb. There were 28 women and 22 men. The 75 operations were abdominoplasty (24), face-lift (18), reduction mammaplasty (ten), blepharoplasty (eight), mastopexy (eight), thigh reduction (five), and arm reduction (two). Twenty-one patients also had adjunctive nonplastic surgery. The average hospital stay was 5.3 days. Seromas were encountered in 42% of the abdominoplasty group as the most frequent complication. Response to a questionnaire showed that 39 patients (82%) believed the surgical results improved their self-esteem; 35 (72%) stated that plastic surgery did not provide an incentive for maintaining their weight reduction.

Body Weight↗
PubMed1980

Department of Defense--Implementation of the Civilian Health and Medical Program of the Uniformed Services; Amendment No. 4. Final rule.

This amendment extends benefits under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) for abortion services, and adds an exclusion in the provisions for cosmetic, reconstructive, and/or plastic surgery procedures. This amendment also implements language contained in Public Law 96-154, Department of Defense Appropriations Act of 1980, and Public Law 96-173, effective October 1, 1979, which deletes the CHAMPUS exclusion of benefits for Military Service-connected disabilities.

Abortion, Legal↗
PubMed2005

[Orbital stabilisation with suprabrow myofascial transposition flaps].

BACKGROUND: Common reasons for orbital defects are midfacial traumas or defects following tumor resection within the sinu-orbital region. In these cases, reconstruction of the medial or inferior orbital wall often is required. Common materials for orbital reconstruction, such as titanium-mesh, are used where epithelialisation problems are frequently encountered. METHODS: Three patients with extended resection of malignomas of the medial and inferior orbit wall were reconstructed with a myofascial transposition flap from the suprabrow region. RESULTS: Orbital tumor infiltration was present in 11 of the 54 patients treated from 1997 to 2003 for tumors of the nasal region. In three cases, tumor extension to the medial and caudal orbital wall required extensive tissue resection, including the periorbit. In these cases, we created a new horizontal fascial flap from the suprabrow-region which stabilized the bulbus by fixation to the lateral maxilla. Follow-up 12 months after surgery showed good epithelialisation of the reconstructed region without functional deficits. CONCLUSION: This previously undescribed fascial suprabrow-flap constitutes a valuable method in the reconstruction of large combined defects of the medial and caudal orbit wall profiting particularly from the autologous material used.

Facial Muscles↗
PubMed1999

Microvascular anastomosis in oral reconstructive surgery: a comparative study of recipient vessels between Japanese and German patients.

Specimens of recipient vessels were obtained from the oral and maxillofacial regions when carrying out microsurgery and the condition of the vascular wall was analyzed histopathologically. This study was performed in both Japan and Germany and the results were compared. A higher percentage and a more advanced abnormality of the recipient vessel seemed to exist in the German patients as compared to the Japanese patients. This difference could be due to the preoperative multimodal chemo- and radiotherapy more often applied in Germany and the higher incidences of systemic diseases such as hypertension and diabetes in the German population. The success rate of the surgery is, however, the same in both countries. It could be concluded that the viability of the flaps was not affected by preoperative damage to the recipient vessel.

Adult↗
PubMed2005

Navigational maxillofacial surgery using virtual models.

Ablative tumor surgery and orbital and midface reconstruction, as much as orthognathic surgery, requires detailed planning using computed tomography (CT) or magnetic resonance imaging (MRI). These techniques also allow simulation of complex surgeries preoperatively. Proper reconstruction depends on reliable information to choose the correct type of grafts and to predict the outcome. This study evaluates the benefit and indications of computer-assisted surgery in the treatment of 107 patients who underwent craniomaxillofacial surgery. Based on a CT or MRI data set, an optical navigation system was used for preoperative planning, intraoperative navigation, and postoperative control. Surgery could be preoperatively planned and intraoperatively navigated. Preoperatively, it required that soft and hard tissues were measured using the mirrored data set of the unaffected side; the size and location of the graft were chosen virtually. Intraoperatively contours of transplanted tissues were navigated to the preoperatively simulated reconstructive result. Computer-assisted treatment was successfully completed in all 107 cases. Preoperatively outlined safety margins could be exactly controlled during tumor resection. Reconstruction was designed and performed precisely as virtually planned. Image-guided treatment improves preoperative planning by visualizing the individual anatomy, outlining the intended reconstructive outcome, and by objectifying the effect of adjuvant therapy. Intraoperative navigation makes tumor and reconstructive surgery more reliable by showing the safety margins, saving vital structures, and leading the reconstruction to preoperatively planned objectives.

Adolescent↗
PubMed2005

Current concepts and challenges in ocular surface reconstruction using cultivated mucosal epithelial transplantation.

Ocular surface disorders wherein corneal stem cells are deficient result in total conjunctivalization leading to severe visual dysfunction and blindness. Treatment of these diseases requires reconstruction of the ocular surface using epithelial transplantation to provide a smooth refractive corneal surface and biologic and physical barriers against a variety of destructive factors. Recently, regenerative medicine focusing on tissue-engineered techniques has been developed and established as a new clinical field. In particular, cultivated mucosal epithelial transplantation using well-differentiated, stratified epithelial sheets on amniotic membrane allows a rapid re-epithelial cover over the entire corneal surface, resulting in early reduction of inflammation and cicatrization. This surgical approach dramatically improves the prognosis of severe ocular surface diseases, especially severely inflamed corneal stem cell deficiency. This new approach not only provides early epithelialization but also allows reconstruction of the corneal surface using autologous cultivated epithelium including the cornea and oral mucosa from a small number of cell sources after amplification. Tissue-engineered strategies using autologous corneal or oral mucosal epithelial sheet transplantation avoid the risk of rejection and complications associated with immunosuppressive treatments. In addition to new cellular transplantation, combined automated lamellar therapeutic keratoplasty provides better refractive stromal interference and contributes to performance and safety of cataract surgery in severe corneal opacity cases. Although long-term prognosis and cell biologic behavior of tissue-engineered epithelium after transplantation should be carefully monitored, these recent surgical treatments have opened a new field for ocular surface reconstruction.

Corneal Transplantation↗
PubMed2006

[Overactive bladder syndrome. Are there indications for surgical therapy?].

Conservative therapeutic options are considered the gold standard in therapy of overactive bladder syndrome. However, surgery may be beneficial in selected cases. Neuromodulation is well established in clinical practice. If conservative or minimally invasive therapy fails, augmentation techniques or urinary diversion may be considered. This review presents the current knowledge about surgical treatment options for idiopathic overactive bladder.

Cystectomy↗