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High-frequency jet ventilation was performed to 55 patients during reconstructive plastic surgery for tumour- or cicatrix-induced stenoses of the trachea and its bifurcation. Hemodynamic parameters and acid-base balance indexes confirm the efficacy of high-frequency jet ventilation.
The instrument for study of mechanical properties of tissue, in particular for definition of strengthening and elastoplastic properties of stomach mucous, umbilical artery, skin cicatrix is offered. The instrument can find application for multi-purpose biomedical studies in morphology, surgery, etc.
OBJECTIVE: To investigate the clinical application of skin soft-tissue expansion in repairing large cicatricial alopecia. METHODS: From January 1989 to December 2003, 38 cases of large cicatricial alopecia were repaired by expanding scalp. The scalp was expanded, the cicatrix area was resected and the mode of propulsive or rotary flap was adopted. The size of alopecia ranged from 15 cm x 7 cm to 23 cm x 15 cm. RESULTS: The cicatricial alopecia in all the 38 cases was repaired and the hair growth was excellent during 1-2 year follow-up. CONCLUSION: The soft-tissue expansion technique is the initiative choice and an efficient method for repairing large cicatricial alopecia.
Endometriosis remains a mystery because it has not yet been shown why these cells are viable in the abdominal cavity, although it has been thought that the immune system plays a role in implantation outside the intrauterine cavity by abasement in the regulatory capacity of natural killer cells, as well as peripheral and peritoneal immunologic cells. Among methods used to recognize this illness are laparoscopy, laparotomy, ultrasound, antibodies, and the histologic study. It has been observed that surgical scars can present cyclical inflammation and pain when affected with this pathology. We present the case of a patient with a second delivery who arrived at the Gynecology Service due to referring intense pain in the episiorrhaphy scar as well as superficial dyspareunia. One year after performance of the surgical procedure, pain did not allow the patient was unable to sit normally; in addition, during the last 3 months the area of the cicatrix augmented in volume during menstruation. Under peridural block and with surgical spindle excision, the abnormal tissue was dissected without complications; the surgery showed brittle tissue and with abundant new vascularity. The histologic diagnosis reported vulvar-tissue endometriosis. Was initiate complementary treatment was initiated with gestrinon once a week for 4 weeks, as well as danazol daily for 2 months to avoid possible persistence of endometrial tissue. The scar at present is minimal and is observed along the borders of the surgical union line, without an increase in size nor discomfort on digital pressure. We consider it necessary to assure cleaning of the episiotomy before initiating surgical suturing to diminish presence of endometriosis, despite the fact that incidence of this disturbance is low (0.03%). Advancement in knowledge of the physiopathology process will permit elimination of the remaining endometrial tissue with new therapeutic strategies, as well as clearing up the mechanism of ectopic implantation of endometrial cells.
Method of the wound suturing, guaranteeing the plain distribution of pressure toward the soft tissues displaced and maximal usage of their elastic properties, was proposed. II-figure sutures were placed on the both edges of the wound, from the beginning--on the flaps base, then--on the middle and at last--on the edges. On the wound there were placed interrupted, continuous and other cosmetic kinds of sutures, permitting to distribute the load while approximating the wound edges along all the flaps surface, to eliminate the tension from the proper cutaneous suture for creating favorable conditions for the cosmetic cicatrix formation. The method was applied in 15 patients with vast defect of soft tissues in maxillofacial region. There were closed the irregular form defects owing from 10 to 50 cm2.
Successful management of 26 normal deliveries has demonstrated a high diagnostic value of ultrasonic examination of the cicatrix on the uterus before, during, and immediately after delivery. Employment of this method to choose the strategy of labor management helped reduce the number of vaginal examinations in a number of cases and do without control manual examinations of the postpartum uterine cavity.
An experimental investigation of the ability of the chondroitinsulphate preparation produced from cattle tracheas, of rumalon and chonsuride to stimulate the regeneration of cutaneous coverings in case of their injury was carried out. A strength of the surgical cicatrix and its elongation at rupture in two weeks' injections of chondroitinsulphate increased in comparison with control. A stimulating effect of chondroitinsulphate to regeneration of flesh wound in case of local single action didn't differ essentially from the effect of chonsuride. In case of application of the preparations, an area of wound for the rats received chondroitinsulphate was already on the eighth day twice as less in comparison with the animals treated with chonsuride. Thus, a stimulating effect of chondroitinsulphate preparation to the regeneration of damaged cutaneous coverings by both parenteral and local administration was shown.
Postsurgical scars (cicatrixes) are the unwanted side-effects that each dermatosurgeon fears of. In dermato-abrasions of acne scars the important role in prevention of the scar occurrence has the adequate surgical treatment, in sense of the least possible traumatization and prevention of the secondary infections. Our experience shows that the 5% solution of calcium-permanganate, applied directly to freshly abraded skin, during 7-days period, followed by antibiotics and vitamins application, provide the best treatment effects.
Incisions for elective orthopedic procedures frequently result in scars that are unesthetic (wide and hypertrophied) and impeded function (are inelastic). The best cicatrix is obtained when the operation can be performed through an incision that follows the lines of skin tension (transverse exposure). If longitudinal exposure is required to gain access to the deeper structures, the best esthetic and functional result is obtained by the zigzag incision. Moreover, the zigzag incision affords a wider exposure than a long straight incision, thus greatly facilitating the operative procedure.
Healing process of operative cardiac wounds was studied histopathologically in 14 patients who died 28 hours to 5 years after the operation of cardiac valve replacement. Repair of wounds in aorta and free wall of atrium was characterized by production of neointima and proliferation of collagen fiber at adventitia of aorta or epicardium of heart. Adhesion with granulation tissue at left ventricular venting wounds was observed in the case of 18th post-operative day. Reticulofibrosis of surrounding intracardiac muscle played an important role in development of granulation tissue. Cicatrix with collagen fiber was appeared from one month after the operation. In spite of attenuation of ventricular scar, aneurysmal bulging could not be observed. The basic healing pattern of wound in atrial septum was production and thickening of neointima. Granulation tissue rarely developed at the septum. Adhesion between sutured edges of atrial septal endocardium could not be observed and the dead space there remained over a period of 7 months after the operation. These findings indicated the continuous presence of unexpected weakness of the sutured septum until sufficient thickening of neointima had developed.
+The results obtained from the study on thermal trauma were summarised on the base of histological, electron microscopic, immunologic and toxicological investigation methods. Shock during burning induces disturbances in the microcirculation. The great clinical significance of the alterations in lungs are stressed upon, manifested in a disorder of blood-gas barrier, permeability of the membranes of capillaries and cells, leading to acute pulmonary insufficiency. One of the probable mechanisms of anemia advancing after burns is described, that is due to the toxic effect of serum. Complement-fixation antibodies are found in the patients with burns, suggesting the involvement of autoimmune mechanisms in the course of the disease. The disturbed microcirculation has an unfavourable effect on the regeneration of wounds, leading to destruction of epithelial regeneration, disturbing the processes of revascularization of skin transplant, having an effect on the immune reactions of organism. Sepsis is discussed, with particular attention paid to that induced by Pseudomonas aeruginosa. In would cachexia some changes in the wounds are pointed to as well as sclerotic and atrophic processes in some internal organs, being usually irreversible. The reversibility if sclerosis in hypertrophic cicatrix and keloid is discussed, stressing on the cellular and extracellular mechanisms, involved in that process.
Left forelimbs of adult newts were repeatedly denervated prior to and following amputation. Limb amputations were performed at 7-, 14-, 21-, 27-and 45-day intervals after the initial denervation. Regeneration was found in the sham-denervated and control animals but did not occur in any of the experimental cases; instead cicatrix formation and dermal wound healing ensued. Soft-tissue dedifferentiation was evident, however. We conclude from these results that forelimb regeneration in the adult newt is completely nerve dependent (for growth).
BACKGROUND: Dermabrasion of facial scars 4-8 weeks after injury frequently completely eliminates visible evidence of scar formation. However, efforts to define the cellular and structural mechanisms by which this phenomenon occurs have been limited in their success. OBJECTIVE: We investigated wound healing after dermabrasive scar revision. METHODS: The surgical scars of seven patients were abraded 6-8 weeks after injury. Comparative electron microscopic and immunohistochemical studies were performed on punch biopsy specimens taken before and after the dermabrasion. Ultrastructural changes in the basement membrane components and dermal structures were evaluated. Monoclonal antibody staining techniques were used to observe the presence, location, and temporal expression of tenascin, epiligrin, cadherins, and integrin subunits. RESULTS: We observed: 1) an increase in collagen bundle density and size with a tendency toward unidirectional orientation of fibers parallel to the epidermal surface, 2) an upregulation of tenascin expression throughout the papillary dermis, and 3) expression of alpha-6/beta-4 integrin subunit on the keratinocytes throughout the stratum spinosum. CONCLUSIONS: The mechanisms by which dermabrasive scar revision alters the events of primary cicatrix formation include modification of extracellular ligand expression, thereby influencing epithelial cell-cell interaction, and reorganization of connective tissue.
Proteolytical preparation moricrasa was isolated from hepatopancreas of Paralithodes camtshatic. Moricrasa and its fractions were used for lysis of cicatricial tissue under in vitro conditions. It was found that moricrasa in concentrations 0.5 mg/ml and 2 mg/ml lysed the cicatrix during 72 and 14-16 hours, respectively. The fraction consisted of collagenolytic proteinase PC and trypsin revealed maximal activity of fraction of moricrasa was absent.
A patient with an unusual "compulsion" to induce syncope over a period of years by bilateral compression of the carotid arteries subsequently had recurrent seizures. The EEG showed patterns typical of cerebral ischemia during the syncope and epileptogenic foci in both temporal lobes after sleep deprivation. It is difficult to distinguish between seizure and syncope associated with involuntary movements when making a differential diagnosis. We hypothesize that the frequent self-induced ischemic insult to the brain caused a cicatrix to develop, which in turn caused the frequent seizure disorder; and that because this ischemia functioned as a stimulus to the reward site in the limbic system, the patient repeatedly induced it.
Late failure of a filtering cicatrix occurred in a patient who had had surgery to control the glaucoma associated with the iris nevus syndrome (Cogan-Reese). The internal surface of the filtration site, as well as the anterior chamber angle, proved to be lined by corneal endothelium that had laid down a new, thick basement membrane (Descemet). The new endothelium-basement membrane probably obstructed the flow of aqueous into the bleb. Endothelialization of a filtering bleb is not unique to the iris nevus syndrome; other causes are discussed.
Lower-eyelid tarsal ectropion is an unusual form of eyelid malposition in which the entire lid is everted. The cause is most likely the disinsertion of the lower-eyelid retractors. In 12 eyelids of six patients, a transconjunctival approach was used to reunite the retractors with the inferior tarsal border. In eight eyelids, a horizontal tightening procedure was also needed. The looping passage of fornix sutures through the full thickness of the eyelid created a vector force that helped rotate the lid margin inward. The subsequent formation of an inflammatory cicatrix induced by the absorbable sutures also contributed to maintain the lid in an upright posture. During follow-up periods ranging from 8 to 36 months, there were no instances of overinversion, recurrent ectropion, or suture abscess.
OBJECTIVE: To evaluate the use of topical mitomycin in choanal atresia repair to reduce the development of granulation tissue and cicatrix. DESIGN AND SETTING: Retrospective case series in 2 tertiary care centers. PATIENTS: Twenty patients with either unilateral or bilateral congenital choanal atresia underwent repair using the transnasal endoscopic approach, the transpalatal approach, or both. INTERVENTIONS: The surgeons favor the use of the endoscopic transnasal drillout technique for all unilateral cases of choanal atresia and for selected bilateral cases. We describe our experience and treatment paradigm for these 20 patients (15 with unilateral atresia, 5 with bilateral atresia). Topical application of mitomycin was used, and in some cases postoperative stenting, for a period of 1 to 2 weeks. In 8 cases, a second application of mitomycin was used. Follow-up ranged from 3 months to 2 years (mean, 9 months). OUTCOME MEASURE: The patency of the choanae without respiratory distress or nasal drainage, as assessed by endoscopic evaluation, determined a successful repair. RESULTS: Of the 20 patients, 17 retained patent airways. Three patients experienced improvement from a total atresia to a narrowed, stenotic choana. CONCLUSIONS: The use of mitomycin as an adjunct to the surgical repair of choanal atresia may offer improved patency with a decreased need for stenting, dilatations, and revision surgery. Newer endoscopic techniques with powered instrumentation further enhance the safety and efficacy in the repair of choanal atresia.