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At least 343 records · Page 19Linked to original sources
PubMed2002

Temporoparietal osteofascial flap for head and neck reconstruction.

PURPOSE: This article describes the use of the temporoparietal osteofascial flap (TOF) for reconstruction of bony defects in the midface and mandible. PATIENTS AND METHODS: We reviewed the demographics, etiology, indications, surgical technique, radiographic evaluation, and final outcome of 11 patients with upper or lower jaw defects who underwent reconstruction using the TOF between 1994 and 1999. RESULTS: The TOF was used to reconstruct a defect of the mandible in 7 patients, the hard palate in 2 patients, the maxilla in 1 patient, and the zygoma in 1 patient. The defect was a result of tumor resection in 9 patients and of trauma in 2 patients. The defect size ranged from 3 to 6 cm. Ten flaps (91%) were successful and 1 flap failed. There was 1 donor site complication (small dural tear) that was repaired immediately without sequelae. One patient had osseointegrated dental implants placed in the bone with good results. Exploration of the construction area was performed in 1 patient 13 months after surgery because of recurrent tumor. It showed a fully integrated bone flap. CONCLUSION: This vascularized calvarial bone flap can be used for the reconstruction of small to medium-sized defects of the maxilla and lateral mandible with good functional and cosmetic results. It can be performed without special microvascular expertise and with minimal donor site morbidity. A full-thickness bone flap can support osseointegrated dental implants.

Adult↗
PubMed1980

Sterile topical lignocaine jelly in plastic surgery: an assessment of its systemic toxicity.

Topical local anaesthesia offers an important adjunct to several plastic surgery procedures, provided that it does not cause systemic toxicity or prevent the healing process. Absorption of a sterile topical lignocaine jelly was assessed in patients undergoing treatment of skin graft donor sites, flap donor sites and burns. There was a marked degree of absorption only in patients with thermal burns, in which case it depended on the surface area of the wound; although no toxic effects due to absorption were noted, caution in dosage is advisable. No complications of healing attributable to the preparation used were encountered.

Anesthesia, Local↗
PubMed2006

ACL graft constructs: In-vitro fatigue testing highlights the occurrence of irrecoverable lengthening and the need for adequate (pre)conditioning to avert the recurrence of knee instability.

The performance of ACL grafts in both the short and long term is only as good as the condition of the graft at the time of surgery. If the graft lengthens under load at the two fixation ends incorporation will take longer to occur. Previous studies have shown that the various grafts currently used are strong enough. However, data on strength came primarily from quasistatic single pull to failure tests with, in some cases, modest cycling to precondition the grafts. The present study examined the in-vitro biomechanical behaviour of model ACL grafts, which have been fatigue cycled to failure over a wide range of loads in physiological ambient conditions. Load/deformation curves and the stretch of the grafts was continuously recorded until final rupture. The grafts demonstrated typical creep-rupture like behaviour with elongation (non-recoverable stretch) and loss of stiffness leading to gradual failure. Some of the graft designs were consistently shown to elongate up to 20 mm in length within the first 2000 cycles at moderate physiological loads and a further 10 mm of elongation occurred between the initial preconditioned state and just prior to complete rupture. Not enough attention has been paid previously to the likely long term elongation patterns of ACL grafts post-surgery and even after the usual empirical preconditioning has been performed by the surgeon. Increased graft dimensions may result in recurrent knee instability and may also lead to failure of the graft to incorporate. Preconditioning in-vitro may still be a way to remove some slack and prepare the graft for its operational environment by stiffening in particular the tissue/fixation interface for those grafts that use soft polymer fixation ends.

Animals↗
PubMed1993

Hepatic vein reconstruction of the graft in partial liver transplantation from living donor: surgical procedures relating to their anatomic variations.

BACKGROUND: The surgical procedures to reconstruct the hepatic veins differ according to their anatomic variations to obtain the optimal graft volume for the recipient. This is an overview of the procedures used in our 25 living related liver transplantations. METHODS: The donor/recipient body weight ratio ranged widely from 1.2:1 to 9.6:1 (5.3 +/- 0.5:1, mean +/- SEM). RESULTS: The graft weight/recipient body weight was 2.40% +/- 0.21%. Graft components, which were determined by the optimal graft volume, and their drainage veins were the following: (1) segments 2 and 3 (S2+3) were used in 13 cases, 11 with the left hepatic vein (LHV) and two with the LHV and a partial drainage vein of S3; (2) S2+3 and a part of S4 in eight cases, seven with LHV and one with LHV and a partial drainage vein of S4; (3) S2+3+4 in three cases, with the common trunk of LHV and middle hepatic vein in all cases; and (4) S5+6+7+8 in one case with right hepatic vein. In two of three cases in which the graft had two drainage veins, the two vessels were reformed to have a common anastomotic orifice by the back-table plastic surgery procedure. In the other case in which the procedure could not be performed, two separate anastomoses of the individual vessels were performed successfully. Although stenosis of the reconstructed hepatic veins occurred four times in two cases at 3 months or more after transplantation, all incidences could be completely repaired by balloon dilation. CONCLUSIONS: These results show that, with careful consideration of the hepatic vein reconstruction, pediatric patients can receive optimal volume grafts from living donors.

Adolescent↗
PubMed2002

Color Doppler ultrasound for monitoring free flaps in the head and neck region.

The use of microvascular free flaps has become established as a very reliable reconstructive technique following tumor surgery or trauma in the head and neck region. Occasionally, flap compromise may occur which will require immediate re-exploration. Early diagnosis of vascular insufficiency is essential. Clinical signs are not always reliable. Numerous systems have been described for monitoring the viability of microsurgical free flaps. The authors consider that color Doppler ultrasound is one of the most useful diagnostic tools. Three cases are reviewed in which this technique aided the decision whether re-exploration was necessary.

Adult↗
PubMed1999

Single-or-two-stage laryngotracheal reconstruction; comparison of outcomes.

To compare single-stage laryngotracheal reconstruction (SSLTR) and reconstruction with tracheostomy and indwelling stent (two-stage LTR), a retrospective review was made of 69 patients undergoing laryngotracheal reconstruction for subglottic stenosis at Great Ormond Street Hospital for Sick Children. Pre-operative details recorded included grade and aetiology of subglottic stenosis, history of previous laryngeal surgery, sex of patient and age at reconstruction. As a measure of outcome, the total number of procedures including all endoscopy and further reconstruction was recorded as well as de-cannulation rate, and the need for more than one reconstruction. The patients undergoing two-stage reconstruction tended to have more severe stenosis (mean grade = 2.56) compared to the SSLTR group (mean grade = 2.14) and were more likely to have had previous laryngeal surgery. Inevitably, the outcome after reconstruction in the two-stage patients is therefore less favourable, and direct comparison of the two groups is not statistically valid. However, multiple regression analysis reveals that single-stage reconstruction does confer a significant independent advantage over the two-stage procedure in terms of average number of post reconstruction procedures (p = 0.006), and a significant advantage in de-cannulation rate (p = 0.03). No difference was noted in the requirement for further reconstruction between the two groups. Although a two-stage procedure is still required in certain cases such as those with very severe stenosis or respiratory insufficiency, the single-stage reconstruction is the procedure of choice for uncomplicated paediatric subglottic stenosis.

Child↗
PubMed1999

Cosmetic oral and maxillofacial surgery.

The dental specialty of oral and maxillofacial surgery over the last fifteen years has been intimately involved in not only altering the bony facial skeleton, but also the esthetic defects of the facial soft tissue drape. These procedures are currently being taught, in many of our residency programs, along side the art and science of dentoalveolar surgery. When one combines the modification of both the skeletal and soft tissues, the resultant effect can be greater than the sum of its parts. Should one take this a step further and add to the list, proper arch form as prepared by the orthodontist along with cosmetic shape and appearance of the dentition by the restorative dentist using the latest in cosmetic dental techniques, what transforms is a result that has never been seen heretofore in the annals of dentofacial care. To follow are a number of case reports illustrating some salient points.

Adult↗
PubMed2006

Variation in the length of the tibial tunnel in anterior cruciate ligament reconstruction: is it safe to use a 35-mm screw?

Tibial fixation is the key to success in anterior cruciate ligament (ACL) surgery using the hamstring tendon technique. Interference screws are popular intratunnel fixation devices not exceeding 35 mm in length. A mismatch between the lengths of the tibial tunnel and the interference screw can cause protrusion of the screw inside the knee or outside the anterior tibia, with a poor postoperative outcome. Our objective was to evaluate the safety length that exists with the use of a 35-mm screw in the tibial tunnel. For this purpose, 27 patients with ACL reconstruction were included. All measurements were performed directly during surgery. The lengths were recorded along with the patients' data. Our study group included 16 male and 11 female patients with an average age of 30.9 years. The average tibial tunnel length was 43.4 mm (range, 40 to 48 mm). This means that for a tibial tunnel drilled at a 55 degrees angle, its length will be at least 5 mm longer than the 35-mm screw. In the same way, the distance between the graft fixation and the articular surface will not exceed 13 mm if the screw is completely inside the tunnel.

Adolescent↗
PubMed2006

Application of computer-assisted design in craniofacial reconstructive surgery using a commercial image guidance system. Technical note.

The technology of digital image guidance systems has transformed many aspects of neurosurgery, including intracranial tumor surgery, functional neurosurgery, and spinal surgery. Despite the central role of imaging studies in diagnosis and treatment planning, intraoperative image guidance has so far had very limited application to the surgical correction of craniofacial deformities, particularly those associated with craniosynostosis. The authors report an example of the marriage of computer-assisted design methods to a commercially available neurosurgical image-guidance system in the treatment of a case of anterior plagiocephaly due to unilateral coronal synostosis. They discuss the steps that must yet be taken to make this technology applicable to the management of craniosynostosis in infants.

Child↗
PubMed2005

Fibrin sealant tissue adhesive--review and update.

The field of surgical tissue adhesives is rapidly developing, with multiple products now available. Fibrin sealant, the first widely available tissue adhesive, continues to be used in traditional as well as in new and creative ways. The product is now fully mature as a hemostatic agent in cardiac, liver, and spleen surgery. It is also useful as a sealant in a variety of clinical applications, including procedures such as colonic anastomosis, as well as in seroma prevention following soft tissue dissection. Newer uses such as reduced suture vascular and intestinal anastomosis, fistula closure, surgery in patients with hemophilia, and laparoscopic/endoscopic procedures are being studied in both laboratory and clinical settings. The most recent additions to the capabilities of fibrin sealant include the use of this tissue adhesive as a slow-release drug delivery system and as a substrate for cellular growth and tissue engineering. This article will review the basis of fibrin sealant effectiveness and will also cover the recent developments in the rapidly evolving employment of this material.

Algorithms↗
PubMed2002

Osteocutaneous posterior interosseous flap for reconstruction of the metacarpal bone and soft-tissue defects in the hand.

A vascularized bone segment of the ulna together with a posterior interosseous fasciocutaneous flap is harvested, including a cuff of the extensor pollicis longus muscle. The authors treated five male patients with metacarpal bone and soft-tissue defects of the hand using a distally based island osteocutaneous posterior interosseous flap. Their ages at the time of surgery ranged from 15 to 37 years (mean, 24 years). The bone defects were in the first metacarpal in three cases, the fourth metacarpal in one, and the fifth metacarpal in one. The length of the donated ulna ranged from 3 to 7 cm (mean, 5 cm). The follow-up period ranged from 5 to 92 months (mean, 39 months). All flaps survived completely. The posterior interosseous flap provides thin skin of good texture, together with vascularized bone, for a one-stage reconstruction of the metacarpal bone and soft-tissue defects in the hand.

Adolescent↗
PubMed2004

Cleft-orthognathic surgery.

For the cleft patient presenting in adolescence with a jaw discrepancy and malocclusion, misinformation and limited available surgical and dental expertise often prevents a favorable facial reconstruction and dental rehabilitation. A major advantage of the modified Le Fort I osteotomy is its ability to simultaneously close cleft dental gap(s), resolve oronasal fistulas, manage skeletal defects, stabilize dentoalveolar segments, and correct jaw deformities. When a thoughtful staging of reconstruction is undertaken, individuals born with cleft lip and palate can reach adolescence after undergoing only a limited number of operations and interventions, without negative attention being drawn to their original malformation.

Adolescent↗
PubMed1999

Presentation and outcome of sacral agenesis: 20 years' experience.

The underlying risk factors, presenting features, and outcome of 22 children with sacral agenesis and associated neuropathic bladder were studied retrospectively. The age of children at presentation was bimodally distributed, with peaks below 1 year and between 4 and 5 years of age. Ten patients presented after 1 year. The oldest was diagnosed at 12 years of age. In 12 children there was maternal diabetes, orthopaedic anomalies in 14, skin defects in 11, and anorectal/tracheooesophageal anomalies in three. Most children had persistent dribbling of urine on presentation associated with frequency, urgency, recurrent urinary tract infections, failure to respond to medication, and/or constipation. Twenty-one children had abnormal neurology in the lower limbs. Videourodynamics showed neuropathic vesicourethral dysfunction in all children and vesicoureteric reflux in 10. Nineteen had a history of urinary tract infections. Seven had renal scarring, with renal impairment in three at presentation. Clean intermittent catheterization was recommended for 20 of the children. Bladder or bowel surgery has been carried out in seven and neurosurgery performed in two. Twenty of the 22 children underwent operative procedures. Ten operations were performed before sacral agenesis was diagnosed. Over a third of the children have required psychological support. The combination of urinary symptomatology and any of the above risk factors should give rise to a high level of suspicion and low threshold to perform investigations to exclude sacral agenesis. All these children have abnormal bladder and urethral function which not only causes incontinence but puts the kidneys at risk. Early detection allows effective multidisciplinary input specifically aimed at continence, preservation of renal function, and adequate psychological support.

Abnormalities, Multiple↗
PubMed2006

Reconstruction of circumferential oro- and hypopharyngeal defects with U-shaped pectoralis major myocutaneous flap.

OBJECTIVE: The purpose of the study was to evaluate the effectiveness of a U-shaped pectoralis major myocutaneous flap (PMMF) to reconstruct a large circumferential defect involving the oro- and hypopharynx. STUDY DESIGN AND SETTING: Retrospective case series. RESULTS: Twelve patients with advanced oro- and hypopharyngeal cancer (stage IV) underwent surgery resulting in a circumferential defect of pharyngoesophageal segment (PES). Those defects were reconstructed using a U-shaped PMMF. Four pharyngocutaneous fistulas were observed postoperatively and healed spontaneously within 3 to 7 weeks. Eight patients were able to resume a regular diet. A voice prosthesis was functional in 5 patients. CONCLUSION: This preliminary study shows that this technique is a simple and effective method with acceptable morbidity rate and satisfactory functional results. We demonstrate that this procedure allows the reconstruction of large defects involving the oro- and hypopharynx in irradiated patients. This technique could be an interesting alternative for surgical teams suffering from the absence of a microsurgical team. EBM RATING: C-4.

Humans↗
PubMed2005

Use of adhesives in cleft palate surgery: a new flap fixation technique.

N-Butyl-2-cyanoacrylate (NB2C) is a synthetic tissue adhesive, and it has been used in many surgical procedures. This study was aimed at evaluating its efficacy in cleft palate repairs. Fifteen patients with soft palate and hard palate clefts had clefts repaired with the use of this synthetic adhesive. The ages at repair ranged from 11 months to 17 years, with an average of 2.4 years. Follow-up time ranged from 14 months to 24 months. No complications were found. The advantages of using NB2C were shorter operative time, more pushback gained, better hemostasis, early and well-tolerated feeding, tension-free closure, and better patient comfort. This study shows NB2C as a useful adjunctive material for affixing the mucoperiosteal flaps to the hard palate.

Adolescent↗
PubMed2005

Intraoperative mitomycin C and amniotic membrane transplantation for fornix reconstruction in severe cicatricial ocular surface diseases.

PURPOSE: To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis and fornix reconstruction in severe cicatricial ocular surface diseases. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Sixteen patients (8 female, 8 male; 18 eyes) with a mean age of 41+/-23.4 years (range, 3-79) and suffering from severe chemical/thermal burns (7 eyes), multiple recurrent pterygia and pseudopterygia (5 eyes), Stevens-Johnson syndrome (4 eyes), and ocular cicatricial pemphigoid (2 eyes) were consecutively enrolled. All except for 2 eyes had had prior surgical attempts of surgical reconstruction, including 6 eyes with a mucous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation. INTERVENTION: After excision of subconjunctival fibrovascular tissues, 0.04% mitomycin C was applied for 5 minutes in the deep fornix before amniotic membrane transplantation. MAIN OUTCOME MEASURES: Deeper fornix, noninflamed ocular surface, and full motility. RESULTS: The mean epithelial healing time was 4.2+/-1.9 weeks. During the follow-up of 14.16+/-5.2 months, all eyes showed a marked reduction of conjunctival inflammation, a deep fornix, and a continuous tear meniscus. Of 12 eyes with motility restriction, 2 eyes with multiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence of partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent penetrating keratoplasty (6 eyes). CONCLUSION: Intraoperative application of mitomycin C is an effective means to reduce chronic and deep-seated conjunctival inflammation, and helps amniotic membrane restore a deep fornix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear meniscus is an important prerequisite to achieve successful reconstruction by subsequent limbal stem cell transplantation.

Adolescent↗
PubMed2003

Recent advances in the rehabilitation of isolated and combined anterior cruciate ligament injuries.

The rehabilitation process begins immediately following ACL injury, with emphasis on reducing swelling and inflammation; improving motion; regaining quadriceps control; allowing immediate weight-bearing; and restoring full passive knee extension and, gradually, flexion. The goal of preoperative rehabilitation is to prepare the patient mentally and physically for surgery. Once the ACL surgery is performed, it is important to alter the rehab program based on the type of graft used and any concomitant procedures performed. This will aid in preventing several postoperative complications, such as loss of motion, patellofemoral pain, graft failure, and muscular weakness. The goal of this article has been to provide an overview of the application and the scientific basis for formulating a rehabilitation protocol following ACL surgery. For an athlete to return to competition, it is imperative that he or she regain muscular strength and neuromuscular control in their injured leg while maintaining static stability. In the past, rehabilitation programs attempted to prepare the athlete for return to sports by using resistance exercise alone. Current rehabilitation programs focus not only on strengthening exercises, but also on proprioceptive and neuromuscular control drills in order to provide a neurologic stimulus so that the athlete can regain the dynamic stability needed in athletic competition. We believe that it is important to use this approach not only possible causes that might predispose the individual to future injury.

Anterior Cruciate Ligament↗
PubMed2003

Respiratory function and cosmesis at maturity in infantile-onset scoliosis.

STUDY DESIGN: Retrospective review of patient records, clinical and radiographic, and patient recall for full pulmonary function studies and surface topography. OBJECTIVES: Assessment of outcome of treatment policy after age 15 during the previous 30 years to establish the efficacy of management protocols in a group that is too small and too varied for more formal assessment. BACKGROUND DATA: Spinal deformity presenting during infancy or early childhood poses a clinical problem caused by small numbers, long growth period, variable presentation and treatment methods, and, finally, the length of time that must pass before meaningful outcome results can be assessed. The aims of treatment are to preserve respiratory function and cosmetic appearance. MATERIALS AND METHODS: The records of patients with infantile onset, nonsyndromic, and noncongenital scoliosis were reviewed. Thirty two were at least age 15 years at the time of review and 21 of these agreed to attend for full pulmonary function testing (spirometry, lung volumes, gas diffusion) and surface topography, whereas two more had recent spirometry results available in their record. Treatment had been serial casting with Risser jacket, bracing, or surgery. RESULTS: Those whose scoliosis resolved or was stabilized by nonoperative means (N = 6) at an acceptable Cobb angle had normal cosmesis and pulmonary function (mean FEV1 = 98.7%, mean FVC = 96.6%). Those who were managed by casting or bracing and underwent surgery after age 10 (N = 6, mean age at surgery 12.9 y) had variable cosmesis and acceptable pulmonary function (mean FEV1 = 79%, mean FVC = 68.3%). Those whose deformity necessitated early surgery (N = 11, mean age at surgery 4.1 y) had recurrence of deformity and diminished respiratory function (mean FEV1= 41%, range 14%-72%, mean FVC = 40.8%, range 12%-67%). CONCLUSIONS: Although these are small numbers and treatment methods have changed since the beginning of the series, the results indicate that this condition is not simple to treat and for some children still has the risk for serious deformity and respiratory compromise. There is, as yet, no evidence that early surgical intervention in this group of patients with infantile scoliosis has altered their prognosis in any meaningful way.

Adolescent↗