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At least 325 records · Page 18Linked to original sources
PubMed2003

Anterior cruciate ligament reconstruction with allograft tendons.

Allograft tissue allows reconstruction of the ACL without the donor site morbidity that can be caused by autograft harvesting. Patients who must kneel as a part of their occupation or chosen sport are particularly good candidates for allograft reconstruction. Patients over 45 years of age and those requiring revision ACL surgery can also benefit from the use and availability of allograft tendons. In some cases, patients or surgeons may opt for allograft tendons to maximize the result or morbidity ratio. Despite advances in cadaver screening and graft preparation, there remain risks of disease transmission and joint infection after allograft implantation. Detailed explanation and informed consent is vitally important in cases in which allograft tissue is used.

Anterior Cruciate Ligament↗
PubMed1999

Endoscopic subcutaneous surgery: a new surgical approach.

The purpose of this experiment was to develop a minimally invasive endoscopic technique that utilizes the assistance of carbon dioxide gas insufflation to perform reconstructive and aesthetic procedures within the subcutaneous, fascial, and muscular tissue planes. A standard laparoscopic setup, like that used for laparoscopic cholecystectomy, was utilized to dissect within the subcutaneous, fascial, and muscular tissue planes of swine. Specific instrumentation adapted to this technique includes blunt-tip inflatable ring trocars, a balloon tissue dissector, an ultrasonic scalpel (harmonic), and an endoscopic retrieval bag. The fundamental steps of Endoscopic Subcutaneous Surgery (ESS) were developed by performing reconstructive and aesthetic procedures on swine. Dissection is easier and more precise with this ESS approach because of improved visualization and flexible tissue manipulation. The blunt-tip inflatable ring trocars maintain tight portals of entry, preventing loss of gas and collapse of the functional optical cavity. The ultrasonic scalpel improves visualization by avoiding electrocautery smoke. When compared with endoscopic techniques that use external mechanical retraction devices or primary balloon dissection to perform ESS, this approach offers several advantages, such as (1) it creates a dome-shaped functional optical cavity, not a tent-shaped cavity; (2) it frees the hands of the surgeon and assistant to allow for less cumbersome and more precise dissection; (3) it improves visualization by avoiding instrument crowding; (4) it is less traumatic to the overlying and dissected tissues; (5) it eliminates time-consuming adjustment of external supporting devices; (6) it utilizes the skin's intrinsic elasticity to create a larger functional workspace, (7) it uses carbon dioxide insufflation to delineate the proper plane of dissection; and (8) it utilizes endoscopic equipment and instrumentation that are generally available at most medical centers.

Animals↗
PubMedDate not supplied

[Plastic surgery in the treatment of primary cutaneous melanoma].

Surgery is still the most effective treatment modality of skin melanoma. The margins of excision are determined by the thickness of primary tumor. From January 1999 to December 2001, 99 patients (57 male and 42 female, of the average age 55), were surgically treated at the Clinic for Plastic Surgery and Burns of the Military Medical Academy. The most usual localization of the primary tumor was the back (23.23%), followed by the forearm, and the lower leg. Regarding the clinical type of the melanoma, nodular melanoma dominated (62.62%). Microscopic staging of the melanoma (classification according to Clark and Breslow), showed that the majority of patients already suffered from the advanced primary disease, which called for radical excision and the choice of reconstructive methods in the closure of post-excision defects. The reconstructive plastic surgical methods enabled the closure of post-excision tissue defects, regardless of their size, structure, and localization. During the closure of post-excision defects, direct wound closure or split skin draft was performed in 76.76% of patients. Flaps were applied in 19.19% of patients with the primary melanoma of the head, face, foot, and hand. The sufficiency of the available reconstructive procedures makes plastic surgery irreplaceable in the surgical treatment of the primary melanoma of the skin.

Female↗
PubMed2004

[Keratolimbal allografts and multilayer amniotic membrane transplantation in the treatment of ocular surface disease due to chemical burns].

PURPOSE: To analyze the functional effect and to present the technique of keratolimbal allograft and multilayer amniotic membranetransplantation for the treatment of ocular surface disease after heavy chemical burn. MATERIAL AND METHODS: Treatment comprised 3 eyes of 2 patients suffering form ocular surface deficiency after chemical (acid) burn. Surgeries were provided under local anesthesia. After circumferential peritomy and removal of fibrovascular layer, stem cells in the fashion of keratolimball crescent allograft, following by multilayer amniotic membrane transplantation were performed. RESULTS: 3 months after surgery the corneal surface was covered with fully differentiated epithelium in all patients. In two of three patients, improvement of the visual acuity was also observed. However, in one eye despite good epithelium maintenance the stroma was still not transparent. CONCLUSION: Keratolimbal allograft with multilayer amniotic transplantation is interesting method of ocular surface reconstruction. Combined procedure with use of two different tissues seems to be relevant among patients with bilateral ocular surface dysfunction with complete destruction of stem cells after chemical burn.

Amnion↗
PubMed2006

[Microdialysis of cutaneous free flaps to monitor results of maxillofacial surgery].

The development of in vivo microdialysis has made it possible to monitor cutaneous free flaps in maxillo-facial surgery. A microprobe inserted in the free flap dermis collects a microdialysate enabling measurement of dermal metabolites such as glucose, lactate, pyruvate, or glycerol. The monitoring curves are predictive of ischemia-related tissue injury. Hourly measurements provide a reliable method for early diagnosis of venous or arterial thrombosis. Revision surgery can then be undertaken if needed to repair microanastomoses before clinical alteration. This technique has been compared with validated flaps monitoring systems such as temperature probe, transcutaneous oxygen tension monitoring, and laser Doppler flowmetry. Microdialysis has several advantages: objective measurements, different curves for venous and arterial thrombosis, early diagnosis. Accessibility to oral cavity or pharyngeal flaps requires careful clinical analysis (microprobe fixation, anatomy and choice of flap).

Humans↗
PubMed2006

Ceravital reconstruction of canal wall down mastoidectomy: long-term results.

OBJECTIVE: To describe long-term outcomes of external auditory canal wall reconstruction using bioactive glass ceramic (Ceravital) after canal wall down mastoidectomy. DESIGN: Retrospective review of a case series over a 21-year period, with a mean +/- SD follow-up of 13.1 +/- 6.7 years (range, 0.2-20.5 years). SETTING: Private otologic practice. PATIENTS: The study population comprised 20 consecutive patients aged 12 to 60 years, who had previously undergone canal wall down mastoidectomy. INTERVENTION: Reconstruction of the canal wall with bioactive glass ceramic. MAIN OUTCOME MEASURES: Incidence, cause, and timing of reconstruction failure; need for additional surgery; change in hearing; frequency of outpatient visits; and incidence of surgical complications. RESULTS: Prosthetic walls have remained intact in 16 patients followed for more than 5 years. One had remained intact at 3 months after surgery, but the patient was lost to follow-up. Prosthesis removal was required in 3 patients (because of infection, displacement, and cholesteatoma in 1 patient each). The only perioperative complications were otorrhea in 4 patients and a 5-dB sensorineural hearing loss in 1 patient. Of the 16 intact patients with long-term follow-up, 4 required no further surgery, while 11 underwent an average of 2 subsequent middle ear procedures each (range, 1-3), including 4 planned reexplorations. The mean +/- SD air bone gap improved 11 +/- 16 dB as of the most recent audiogram (mean +/- SD, 7.7 +/- 5.8 years after operation). CONCLUSION: Canal wall reconstruction using bioactive glass ceramic is a useful option for patients who desire freedom from the frequent mastoid bowl debridements and activity restrictions that may result from canal wall down mastoidectomy.

Adult↗
PubMed1983

[Comparison of the psychosocial benefits of augmentation and reduction mammaplasty in women. Retrospective study of 122 women].

Plastic surgery procedures are being increasingly used on the female mammae. Our study involved procedures for reduction or augmentation of breast size in 83 and 39 noncancer patients, respectively. In order to answer the question of whether more psychosocial benefits are to be expected in reduction or augmentation operations, the following aspects were explored in patient interviews: social, personality/psychological, sexual satisfaction, professional and leisure time, and honest evaluation of the results. These data should have bearing on focussing the preoperative explanation of the operation to the patient.

Breast↗
PubMed2005

Oxidized titanium implants in reconstructive jaw surgery.

BACKGROUND: Rehabilitation with implant-supported bridges in patients with insufficient bone volumes may require bone reconstructive procedures in conjunction with or prior to implant placement. Clinical follow-up studies using turned titanium and bone grafts have demonstrated higher failure rates than when used in nongrafted patients. Improved bone integration has been demonstrated for oxidized titanium implants; however, their clinical performance in bone reconstruction situations is not known. PURPOSE: This study was performed to analyze the survival and stability of oxidized titanium implants placed in patients subjected to reconstructive jaw surgery at one clinic. MATERIALS AND METHODS: Two hundred oxidized titanium implants (Mk III, TiUnite, Nobel Biocare AB, Göteborg, Sweden) were placed in 47 patients in conjunction with or secondary to six different reconstructive procedures owing to insufficient bone volume. In all six groups, implant stability was assessed by resonance frequency analysis and manually checked for rotation stability at implant insertion, at the time of abutment connection, and after a minimum of 12 months of loading of the prosthetic construction. Periapical radiographs were taken after a minimum of 12 months of loading (mean 21 months) for evaluation of the marginal bone levels. The mean clinical follow-up period was 30 months. RESULTS: Of the 200 implants, 199 were considered osseointegrated at the time of abutment surgery. At the 12-month postloading follow-up, another two implants were considered not stable. Three implants (1.5%) were ranked as unsuccessful. CONCLUSION: Clinical experience with 200 consecutive oxidized implants in various reconstruction situations shows a successful outcome, with only three failures (1.5%) during a mean follow-up period of 30 months.

Adolescent↗
PubMedDate not supplied

Soft tissue and tendon reconstruction after achilles tendon rupture: adipofascial sural turnover flap associated with cryopreserved gracilis tendon allograft for complicated soft tissue and achilles tendon losses. A case report and literature review.

Soft tissue and tendon reconstruction after Achilles tendon rupture:Adipofascial sural turnover flap associated with cryopreserved gracilis tendon allograft for complicated soft-tissue tendon losses.A case report and literature review Achilles tendon rupture is often complicated by skin substance loss around the tendon, which is a poorly-vascularized site. Treatment may be conservative or surgical, but the former is not generally accepted by the orthopedic community and is reserved for selected cases, while surgery remains the most widely-used approach. Soft tissue repair at this site is a crucial reconstruction problem, and becomes very complex if skin reconstruction has to be associated with a complex tendon repair. The Authors describe a new approach to the repair of Achilles tendon substance loss compounded by a soft tissue defect, using a cryopreserved gracilis tendon allograft in combination with a distally-based adipofascial sural flap.

Achilles Tendon↗
PubMed1991

Reducing the need for intubation in plastic surgery.

Many plastic surgery procedures that have traditionally been performed under general endotracheal anesthesia may safely be undertaken using a ketamine-based intravenous sedation technique. General endotracheal anesthesia has many drawbacks, including lack of patient acceptance. Ketamine-based intravenous sedation technique includes the following steps: 1. The patient is placed in a dissociated state using sedative and narcotic agents accompanied by a subanesthetic dose (0.5 mg/kg) of ketamine. 2. A dilute local anesthetic solution (0.25% lidocaine with 1:2,000,000 epinephrine) is infiltrated into the involved tissues to provide anesthesia and hemostasis. 3. The patient is maintained in a tranquil state throughout the procedure by periodic titration of additional doses of sedative and narcotic agents. Advantages of the technique include reducing the need for intubation and its associated hazards, dramatically decreased blood loss due to use of dilute epinephrine solution, reduced recovery time, ability of patients to respond to commands during surgery, avoidance of positioning injuries and increased rapport between patient, surgeon and anesthetist. Disadvantages include respiratory depression and potential for hypoxia. Dissociative intravenous sedation combined with dilute local anesthetic provides a useful addition to the anesthetist's armamentarium.

Anesthesia, Endotracheal↗
PubMed2000

The Harrington reconstruction for advanced periacetabular metastatic destruction: good outcome in 32 patients.

We report the outcome in 32 patients operated on for advanced periacetabular metastatic destruction, where all but 2 had Harrington class III destruction. The patients were operated on using the Harrington reconstruction technique, where threaded pins and cement and a total hip replacement are used to reconstruct the acetabulum and ilium. The median survival was 11 (0-106+) months. 13 patients lived for a year or more. At follow-up after 1 year, 10 of the 13 were free of pain at rest and weight-bearing, 6 were walking with and 7 without support, and 11 lived outside a health care facility. 2 patients died within 2 weeks of surgery, both of excessive peroperative bleeding. 2 patients had dislocations, 1 developed a deep infection, and 2 patients deep vein thrombosis. There were no complications caused by erroneous pin placement or intraoperative thromboembolic incidents. There were no mechanical failures, or radiographic signs of loosening, of the pelvic components. The Harrington reconstruction technique is an effective and long-lasting method to relieve pain and restore function in patients with advanced periacetabular metastatic destruction.

Acetabulum↗
PubMed1994

Outcome audit in plastic surgery: the Cambridge Classification.

Plastic Surgery Outcome Audit has until now been limited to studies of individual conditions. The Department of Plastic Surgery at Addenbrooke's Hospital, Cambridge, has developed an objective outcome classification applicable to all plastic surgery procedures. The four end-result categories--aesthetic appearance; physical function; tumour clearance; and surgical complications--are each graded in clear stages from 1 (excellent result) to 4 (result requiring re-operation) in a system which is easy to apply to every patient. The development and potential use of this classification are discussed. The Cambridge Classification is used in conjunction with diagnostic codes, which can be simple like the Logbook codes used by British Trainees or more complex, such as Read codes.

England↗
PubMed2000

An experience of the Snow-Littler procedure.

This paper reviews the results of the Snow-Littler procedure performed in twelve hands with classical central longitudinal deficiency and in one hand with symbrachydactyly, cleft type. There were no instances of major flap necrosis although two flaps showed tip ischaemia. The width of the first web was, in the main, satisfactory but four webspace revisions were performed. Supplementary skin grafting at the time of surgery was necessary in complete and/or complex thumb index syndactylies and in the patient with symbrachydactyly. In eight cases, a transverse metacarpal ligament was reconstructed. In the five other cases, no clinical instability or radiological divergence of the index and ring fingers occurred, in spite of no transverse metacarpal ligament reconstruction. Three de-rotational osteotomies of transposed index fingers were performed in patients who had a transverse metacarpal ligament reconstruction. These results indicated significantly improved appearance and improved function following the Snow-Littler procedure.

Child↗
PubMedDate not supplied

The amniotic membrane in ophthalmology.

The amniotic membrane is the innermost of the three layers forming the fetal membranes. It was first used in 1910 in skin transplantation. Thereafter it has been used in surgical procedures related to the genito-urinary tract, skin, brain, and head and neck, among others. The first documented ophthalmological application was in the 1940s when it was used in the treatment of ocular burns. Following initial reports, its use in ocular surgery abated until recently when it was re-discovered in the Soviet Union and South America. Its introduction to North America in the early 1990s heralded a massive surge in the ophthalmic applications of this membrane. The reintroduction of amniotic membrane in ophthalmic surgery holds great promise; however, although it has been shown to be a useful and viable alternative for some conditions, it is currently being used far in excess of its true useful potential. In many clinical situations it offers an alternative to existing management options without any distinct advantage over the others. Further studies will undoubtedly reveal the true potential of the membrane, its mechanism(s) of action, and the effective use of this tissue in ophthalmology.

Amnion↗