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At least 361 records · Page 20Linked to original sources
PubMed2002

The pedicled superficial temporalis fascial flap: a new method for reconstruction in otologic surgery.

OBJECTIVES: Our goal was to describe a novel fascial flap of the temporal region and its use for reconstruction in otologic and neurotologic surgery. METHODS: The superficial temporalis fascia has an axial blood supply derived from the middle temporal artery and can be raised independently from the overlying temporoparietal fascia or the underlying deep temporalis fascia. This flap was used on 15 consecutive patients to solve a wide variety of reconstructive problems after otologic procedures. RESULTS: No additional morbidity was observed from the use of this flap. There were no complications related to the reconstruction. Adequate exposure for raising this flap was obtained using standard incisions for the otologic procedures. Follow-up ranges from 2 to 25 months. CONCLUSIONS: This fascial flap provides a wide surface area of tissue on a narrow-based pedicle capable of a wide arc of rotation. It provides thin, pliable tissue that can be adapted to the needs of various reconstructive otologic/neurotologic problems.

Adolescent↗
PubMed2005

Hemodynamic effects of perioperative stressor events during rhinoplasty.

The hemodynamic effects of perioperative stressors, including preoperative patient anxiety, intraoperative local anesthetic/adrenaline infiltrations, and some painful interventions, have not been fully elucidated in plastic surgery procedures. The present study was designed to determine the hemodynamic effects of perioperative stressor events in American Society of Anesthesiologists class I patients undergoing rhinoplasty procedures under general anesthesia. The study included 50 healthy patients, 18 to 51 years of age (mean age, 27 +/- 7 years), who underwent a rhinoplasty procedure in the authors' department. All patients were connected to a digital ambulatory Holter recorder for 24 hours starting on the day before the operation and continuing throughout the procedure. All of the patients received 10 ml of 2% lidocaine with 1:80,000 adrenaline 15 minutes after intubation. Observations consisted of heart rate, noninvasive blood pressure, and power spectral heart rate variability analyses, the latter of which is indicative of the sympathovagal balance of the patients. The majority of patients developed a persistent, moderate sinus tachycardia before the induction of anesthesia. After the infiltration of lidocaine/adrenaline, a mild to moderate and short-lasting tachycardia was detected. A similar increase in pulse rate was also noticed during lateral osteotomies. No significant blood pressure changes attributable to perioperative stressors (with the exclusion of general anesthesia induction, intubation, and extubation) were observed. Sympathetic activity was found to be responsible from marked tachycardia before the induction, which was attributable to preoperative anxiety. The authors' study has demonstrated that there are three hemodynamically unstable periods causing tachycardia for rhinoplasty patients that directly concern the plastic surgeon: immediate preoperative anxiety, local anesthetic/adrenaline injection, and lateral osteotomies. The authors conclude that these patients would benefit from routine use of premedications and that a lidocaine/adrenaline combination is a safe adjunct to general anesthesia in young rhinoplasty patients. In addition, a deeper anesthesia during local infiltration and osteotomies would be appropriate.

Adult↗
PubMed2006

Masticatory and swallowing threshold performances with conventional and implant-supported prostheses after mandibular fibula free-flap reconstruction.

STATEMENT OF PROBLEM: Significant strides in microvascular surgical techniques allow predictable restoration of bony and soft tissue orofacial defects. In combination with prosthetic rehabilitation, varying degrees of improvement in esthetics, speech intelligibility, and swallowing have been noted; however, the relative impact of conventional and implant-supported prostheses on restoration of masticatory function are not known. PURPOSE: The purpose of this study was to determine whether conventional or implant-supported dental prostheses and current surgical reconstructive procedures restore patients' masticatory function to presurgical levels. MATERIAL AND METHODS: Of the 46 subjects enrolled in this study, 23 (7 edentulous and 16 partially dentate) completed conventional prosthesis (CP) treatment and masticatory evaluation, and of these, 15 (3 edentulous and 12 partially dentate) completed treatment and evaluation with an implant-supported prosthesis (IP). Standardized masticatory performance tests with peanuts and carrots as the test food were made on the defect and nondefect sides. Tests of swallowing threshold performance were made with carrots as the test food. Statistical analysis included repeated-measures analysis of variance (ANOVA) with post hoc Tukey HSD tests (alpha=.05). RESULTS: Masticatory function at entry was markedly compromised. Further performance declines were noted following surgery (PS) on both the defect and nondefect sides. Restoration with CP and IP produced improvements (significant for defect side only, P<.05) in performance over the PS interval and were not significantly different from performances at entry prior to surgery. In addition, the performance on the defect side with the IP was significantly greater than the performance with the CP (P<.001). CONCLUSION: Impairment in masticatory ability remains following free-flap reconstruction prior to prosthetic rehabilitation. Both CP and IP may provide improved masticatory ability, permitting patients to regain the functional level they possessed prior to surgical intervention. The IP may contribute to greater support and stability of the prosthesis, resulting in increased use for mastication and superior performance on the defect side compared to the CP.

Bone Transplantation↗
PubMed2003

Scientific justification and technique for anterior cruciate ligament reconstruction using autogenous and allogeneic soft-tissue grafts.

The DLSTG is the strongest and stiffest autogenous graft source available for reconstruction of the torn anterior cruciate ligament. Harvest morbidity is low compared with other autogenous graft sources, such as the patellar bone-tendon-bone graft. Soft-tissue allografts provide an excellent alternative for patients requiring revision surgery or for patients who want to avoid any morbidity associated with autogenous graft harvest. Successful use of any soft-tissue graft source, however, relies on precise placement of the tibial and femoral tunnels to prevent roof and PCL impingement and to restore tensile behavior in the graft tissue similar to the native ACL. The use of high-strength, high-stiffness fixation devices that secure the graft at the end of the tunnel promote tendon tunnel healing, restore stability without high graft tensioning, and allow safe, aggressive rehabilitation. The Bone Mulch Screw/WasherLoc screw system provides the surgeon with a consistent, reproducible technique that restores stability and function to the ACL-deficient knee using a soft-tissue graft in both males and females.

Anterior Cruciate Ligament↗
PubMed2002

Comparative efficacy of acustimulation (ReliefBand) versus ondansetron (Zofran) in combination with droperidol for preventing nausea and vomiting.

BACKGROUND: Antiemetic drugs are costly, are associated with variable efficacy, and can produce unwanted side effects when used for prophylaxis against postoperative nausea and vomiting. This clinical study was designed to compare the efficacy of transcutaneous electrical acupoint stimulation using a ReliefBand to ondansetron (Zofran) when utilized alone or in combination for preventing postoperative nausea and vomiting after plastic surgery. METHODS: A single-center, randomized, double-blind, placebo- and sham-controlled study design was conducted to compare three prophylactic antiemetic treatment regimens in 120 outpatients undergoing plastic surgery procedures with routine low-dose droperidol prophylaxis: (1) ondansetron (n = 40), 4 mg intravenous ondansetron and a sham ReliefBand; (2) acustimulation (n = 40), 2 ml intravenous saline and an active ReliefBand; and (3) combination (n = 40), 4 mg intravenous ondansetron and an active ReliefBand. The incidences of postoperative nausea and vomiting, as well as the need for "rescue" antiemetics, were determined at specific time intervals for up to 72 h after surgery. The outcome variables assessed included recovery times, quality of recovery score, time to resumption of normal diet, and patient satisfaction with the prophylactic antiemetic therapy. RESULTS: Use of the ReliefBand in combination with ondansetron significantly reduced nausea (20 vs. 50%), vomiting (0 vs. 20%), and the need for rescue antiemetics (10 vs. 37%) compared with ondansetron alone at 24 h after surgery. Furthermore, the ability to resume a normal diet (74 vs. 35%) within 24 h after surgery was significantly improved when the ReliefBand was used to supplement ondansetron (vs. ondansetron alone). Finally, the quality of recovery (90 +/- 10 vs.70 +/- 20) and patient satisfaction (94 +/- 10 vs. 75 +/- 22) scores were significantly higher in the combination group the ondansetron group. There were no significant differences between the ReliefBand and ondansetron when administered as adjuvants to droperidol for antiemetic prophylaxis. CONCLUSIONS: The ReliefBand compared favorably to ondansetron (4 mg intravenously) when used for prophylaxis against postoperative nausea and vomiting. Furthermore, the acustimulation device enhanced the antiemetic efficacy of ondansetron after plastic surgery.

Acupressure↗
PubMed2004

Surgery without skin resection for eyelid entropion.

The previously reported surgical methods for eyelid entropion are basically manipulations of the skin or the conjunctival surface. When entropion is marked, manipulations also involve the tarsus. In the most widely used method, the eyelashes are directed outward by horizontal wedge resection of an appropriate amount of the excessive skin in the ciliary vestibule. This method is simple and effective but sometimes causes recurrences, conspicuous scars due to tension of the resection site, or lagophthalmos due to excessive resection. We speculated that partial swelling of the orbicularis muscle at the front of the tarsus is one of the main causes of pediatric eyelid entropion and found that correction of entropion is possible by partial resection of this muscle without skin resection. Eight patients with congenital entropion were treated by this method, and good results were obtained.

Child, Preschool↗
PubMed2005

Cervicofacial and cervicothoracic rotation flaps in head and neck reconstruction.

BACKGROUND: Compound cervicofacial and cervicothoracic rotation flaps are highly versatile flaps that may be applied to a variety of defects of the cheek, orbit, periauricular region, and neck. These rotation advancement flaps should be a staple of the head and neck surgeon's reconstructive armamentarium. METHODS: This is a retrospective review of medical records at a university-based head and neck cancer center. RESULTS: Thirty-three patients were identified, with a mean age of 66 years. Primary or recurrent skin neoplasms made up the most common indication for surgery, followed by primary parotid tumors and cervical lymphatic metastases from upper aerodigestive tract malignancies. Defects of the cheek, orbit, periauricular region, and neck were reconstructed with cervicofacial or cervicothoracic flaps, with larger wounds requiring variable extension of the incision onto the chest wall. Other reconstructive modalities were used in 18 cases to increase tissue bulk or provide internal lining. Minor wound complications occurred in 13 patients. There was no statistically significant association between wound complications and smoking or previous radiation therapy. CONCLUSIONS: Compound cervicofacial and cervicothoracic rotation flaps provide a straightforward, reliable, and efficient means to reconstruct complex defects of the face, lateral skull base, and neck, with the potential for excellent cosmetic results.

Adult↗
PubMedDate not supplied

Reconstruction of skull base defects after minimally invasive endoscopic resection of anterior skull base neoplasms.

BACKGROUND: The endoscopic resection of the cribriform plate during minimally invasive endoscopic resection (MIER) of the anterior skull base neoplasms may result in large anterior skull base defects. The objective of this study is to describe techniques for the management of skull base defects after MIER. METHODS: Retrospective analysis was performed on patients undergoing MIER and skull base reconstruction between April 2000 and August 2005. RESULTS: Fourteen patients underwent endoscopic resection of anterior skull base tumors and reconstruction during the study period. The mean age was 57.4 years (range, 26-84 years). The sex distribution was eight men and six women. The specific indications for resection included 11 malignant and 3 benign neoplasms. Ten patients received adjuvant therapy, and in two instances this occurred before surgery. In all instances, the dura was exposed; however, only 10 cerebrospinal fluid (CSF) leaks were encountered intraoperatively. Reconstruction of the skull base was successfully performed, most commonly in a multilayer fashion, using an array of materials including cartilage, fat, acellular dermal graft, and mucosal free grafts. Lumbar drain placement was used in seven cases for an average of 5.6 days. No postoperative CSF leaks occurred. The mean follow-up was 18.0 months (range, 1-56 months). CONCLUSION: This report describes methods for the reconstruction of the skull base after MIER. Reconstitution of the skull base barrier can be achieved through application of principles for surgical repair of CSF rhinorrhea.

Adult↗
PubMedDate not supplied

Implant reconstruction of the jaws and craniofacial skeleton.

Full oral rehabilitation with a high degree of success is now possible with osseointegrated implants. Osseointegration is a direct connection between living bone and the titanium implant at the level of the light microscope. Osseointegrated implants are currently used to replace single teeth, support fixed bridges and stabilize full dentures. These implants can also be placed extraorally for attachment of facial prosthesis. The surgical technique used to place implants intraorally into jaws or facial skeleton is performed in two stages using a local anesthetic and/or conscious sedation. During stage I surgery, holes are placed into the jaw using a series of gradually larger diameter burs until the desired diameter and depth of the bony preparation is achieved. The implant is then placed. The implant must remain undisturbed for 4 months for osseointegration to take place. Stage II surgery is then required to remove the mucosa over the implant and place the transmucosal abutment. After 1-2 weeks of healing, the restorative dentist can take an impression and fabricate the prosthesis. On occasion, it is necessary to augment the height and width of the atrophic jaw with autogenous or allogeneic bone grafts prior to implant placement. Bone grafts are sometimes placed on the floor of the nose or the floor of the maxillary sinus. Guided tissue regeneration is a technique used to generate bone within bony defects adjacent to implants. With long-term rates of success (5 years) of 99% for implants placed in the mandible and 95% for those placed in the maxilla, reconstruction of the jaws and cranial facial skeleton with osseointegrated implants has become the treatment of choice.

Bone Regeneration↗
PubMedDate not supplied

[Reconstructive-reparative operations in injuries of the urinary tract in obstetrical, gynecologic and abdominal surgery].

Different reconstructive operations were performed in 20 patients for intraoperative traumas of the urinary tract. 4 patients had injured ureter and urinary bladder. The damage was done in the course of obstetric operations (cesarean section, uterine extirpation). In 12 cases the ureter was injured in uterine extirpation for cancer (n = 4), myoma (n = 4), prolapse of the uterus, (n = 1), extirpation of uterine cervix stump (n = 1), ureteral electrocoagulation (n = 1) and adnexectomy (n = 1). In 4 cases ligation of the ureter complicated surgical interventions for cancer of the sigmoid colon (n = 1) and rectum (n = 1), diverticulosis of the colon (n = 1) and portal cirrhosis of the liver with evident cirrhosis (n = 1). Surgical policy in the treatment of intraoperative urinary tract injuries was organ-saving. Only in 3 patients with severe acute pyelonephritis surgery was two-staged with prior nephrostomy. In the rest cases primary reconstructive operations were made. Two patients with bilateral injury of the ureters after uterine extirpation have undergone transabdominal bilateral reimplantation of the ureters by Boari in Gregoir's modification. Reconstruction of pelvic ureter was often made by using a urinary bladder graft (Boari's technique). In 1 female patient with extensive vesicovaginal fistula resultant in detruzor corrugation sigmocystoplasty was made with a good result. Serious complications after the reconstruction were absent. Urinary fistulas formed in 4 cases. In 3 of them they closed without surgical intervention. In 1 patient, to close urinary fistula complicating ureterocystoanastomosis Boari's operation was conducted with a favourable outcome. Reconstructive operations saved the kidney function.

Abdomen↗
PubMed2000

Use of nonpreserved human amniotic membrane for the reconstruction of the ocular surface.

PURPOSE: To describe the use of nonpreserved human amniotic membrane (NP-AMT) as an alternative to preserved human amniotic membrane (AMT) for the reconstruction of the ocular surface in several diseases. METHODS: NP-AMT was used in the treatment of five patients with the following diseases: noninvasive conjunctival squamous cell carcinoma, corneal persistent epithelial defect, severe alkali burn, near total limbal deficiency secondary to multiple surgeries, and ocular cicatricial pemphigoid. In some cases, a limbal autograft or allograft was employed simultaneously, sutured on top of the NP-AMT. All sutures were made with 10-0 Nylon and were removed at two weeks. RESULTS: Ocular surface was satisfactorily reconstructed, eyes were quiet, and patients were comfortable despite prolonged deepithelialization in some cases. There was a case of a limbal autograft ischemia--in the burned patient--that caused partial corneal conjunctivalization. Initially, the NP-AMT looks thickened but thins around the fifth day and looks similar to AMT. CONCLUSION: Results using NP-AMT are similar to those of AMT. It is a good alternative and it is easily obtained in places were AMT is not available or is too expensive to procure.

Adult↗
PubMed2000

Scar remodeling after strabismus surgery.

PURPOSE: We sought to investigate abnormal scar lengthening after strabismus surgery. METHODS: Patients with overcorrection after strabismus surgery or undercorrection after extraocular muscle resection underwent exploration of previously operated muscles. Abnormal findings were documented by inspection and photography, and repair was undertaken at first with absorbable sutures and later with nonabsorbable sutures. RESULTS: Lengthened scars, consisting of amorphous connective tissue, were repaired on 198 muscles in 134 procedures by excision of the scar and reattachment of the muscle to sclera; absorbable sutures were used in 64 procedures, and nonabsorbable sutures were used in 70 procedures. Thirty-one procedures were followed by partial recurrence of the original overcorrection; 7 of these had documented restretching. The use of nonabsorbable sutures decreased the recurrence of strabismus from 42% to 6%. Factors that distinguished patients with stretched scars from patients with classic slipped muscles included minimal or no limitation of versions, less separation of the tendons from sclera, and thicker appearance of the scar segments. CONCLUSIONS: A lengthened or stretched remodeled scar between an operated muscle tendon and sclera may contribute to variability of outcome after strabismus repair, even years later. Definitive repair requires firm reattachment of tendon to sclera with nonabsorbable suture support.

Adolescent↗
PubMed2003

Use of magnetic abutments for short endosseous implants following a fibula bone graft in an oral cancer patient: a case report.

Dental implant treatment is an indispensable portion of oral rehabilitation in patients who are to undergo reconstructive surgery following the removal of an oral cancerous lesion. However, ideal dental implant treatment cannot be achieved easily in patients who have undergone mandibular reconstruction with a free vascularized flap, usually because of the limited length, height, and width of the bone graft. Shorter implants (< 10 mm in length) therefore are occasionally used in vascularized fibula graft sites. In such cases, however, shorter implants tend to be overloaded, thereby endangering its longevity. In this article, we discuss how a magnetic abutment system was introduced for such a patient. This was designed to discourage overloading of the mandatory short implants. The outcome was successful without overloading 1.5 years after the placing of the mandibular overdenture.

Bone Transplantation↗
PubMed2000

Neuronal structure of microvascular transplants with and without neuronal anastomosis.

OBJECTIVE: Latissimus dorsi transplants have little neuronal regenerative capacity without neuronal anastomosis. Histologic differences between transplants with and without neuronal anastomosis and 2 distinct types of neurosurgical reanastomosis are highlighted in this study. PATIENTS AND METHODS: Fifty-four patients with squamous cell carcinomas of the oral cavity (T4) were treated by tumor resection and homolateral neck dissection. The defect was covered with a microvascular latissimus dorsi transplant. In 15 patients, no neuronal anastomoses were performed. In 21 patients, the thoracodorsal nerves were used for microneurosurgical reanastomosis, whereas in 18 patients, the cutaneous branches of the intercostal nerves were used for microneurosurgical reanastomosis. The transplant was examined during surgery and 9 months after surgery by means of a histologic examination of a biopsy specimen. The number of fascicles, the degree of fibrosis, and the myelination were examined. Furthermore, a neurosensory examination was performed 9 months after surgery. RESULTS: Overall, our patients had an average of 12.1 fascicles during surgery. After surgery, patients without neuronal anastomosis showed an average of 4.9 fascicles, patients with nerve anastomosis to the cutaneous branches of the intercostal nerve showed an average of 6.2 fascicles, and patients with anastomosis to the thoracodorsal nerve showed an average of 9.6 fascicles. In cases of nerve anastomosis, a lesser degree of fibrosis was found, together with good myelinization. The clinical examination showed the best neurosensory function in the transplants with anastomosis to the thoracodorsal nerve and the worst function in those without neuronal anastomosis. CONCLUSION: Neuronal reanastomosis led to more surviving neuronal structures in the postoperative histologic specimen. The highest density of fascicles was found in the well vascularized thoracodorsal nerve. The neurosensory function agrees with the histologic result.

Adult↗
PubMedDate not supplied

Meniscal repair compared with meniscectomy for bucket-handle medial meniscal tears in anterior cruciate ligament-reconstructed knees.

BACKGROUND: Repair of meniscal tears is generally preferred over meniscectomy. HYPOTHESIS: Repair of unstable bucket-handle tears of the medial meniscus leads to better outcomes than partial meniscectomy. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: We reviewed the records of 155 patients who had isolated bucket-handle medial meniscal tears and anterior cruciate ligament tears. Fifty-six menisci were repaired; 99 that were degenerative and crushed beyond repair were removed. Patients were evaluated at a mean follow-up of 6 to 8 years after surgery with the International Knee Documentation Committee examination and a modified Noyes questionnaire. RESULTS: The mean subjective scores were similar for patients in both the repair (N = 51) and meniscectomy (N = 87) groups. However, in the repair group, the mean subjective score of 93.9 for nondegenerative menisci was significantly better than the 87.1 for degenerative menisci. Objective grades for 25 patients in the repair group were normal or nearly normal in 22 patients (88%) and for 51 of 56 patients (91%) in the removal group. Radiographic subscores for the repair group were normal or nearly normal in 23 patients in the repair group and 49 in the removal group. CONCLUSION: Outcomes from meniscal repair were not superior to those from partial removal. Patients with repaired degenerative tears had significantly lower subjective scores than those with nondegenerative tears.

Adolescent↗
PubMed2005

[Minimally invasive otoplasty].

OBJECTIVE: We have further developed a method, first published in 1967 by Kaye but not widely used later, to correct protruding ears. To our knowledge, clinical experience with a closed otoplasty technique based on a large number of patients has not yet been published. SUBJECTS AND METHODS: Of 442 ears in 4.5 years, 385 (200 patients, 15 one sided) were corrected using the minimally invasive technique. The key part of this technique to such otoplasty is the creation of a naturally appearing antihelix by combining permanent buried sutures and a conservative cartilage-breaking technique, both applied without extensive skin incisions and excisions. RESULTS: A total of 154 of the patients (i.e., with six one sided corrections, 302 ears) could be examined at least 3 months after surgery. Complications were revisions for either a partial recurrence or a still insufficient correction in the opinion of the patient (30/302, 9.9%), reactions to the suture material (26/302, 9.3%), early infections (2/385, 0.7%), prolonged sensitivity (2/302, 0.7%) and one hypertrophic scar in the lobule (1/302, 0.3%). There was no bleeding, hematoma, hypesthesia, sensitivity to temperature or skin reactions in the auricle. CONCLUSIONS: Minimally invasive otoplasty is a surgical technique that allows the correction of most protruding ears. Very strong cartilage or a very high lateral conchal wall set the limits to such an approach. We found the cosmetic results and complication rates to match those of open methods. Since patient comfort seems to be higher, the method is better accepted.

Adolescent↗
PubMed2004

Reestablished circulation after free radial forearm flap transfer.

New circulation in the free flap reestablished at the recipient site is the key to successful microvascular reconstructive surgery. This study is the first evaluation of long-term circulatory changes in nine free radial forearm flap transfers. Postoperatively, color Doppler studies revealed that the flow volume through the arterial pedicle increased rapidly during the first 3 days, gradually increased until day 14 (exceeding flow volume through the facial artery of the unoperated contralateral side), then decreased slightly until the sixth month. The pulsatility index, representing vascular resistance downstream, decreased successively. Ohm's law explains that this flow increase is caused by reduced vascular resistance downstream, attributed to changes in the vascularity of the transferred flap and in the recipient bed. The authors believe the circulatory changes are determinants of the clinical properties of the flap. This study addresses the importance of clarifying the events that transpire at the macroscopic circulatory level in the transferred free flap.

Blood Flow Velocity↗
PubMed2002

Bilateral one-stage rotation advancement technique for Saudi children with isolated bilateral incomplete cleft lip: low revision rate despite multiple imperfections.

The author is unaware of any article published in the English literature during the past 25 years that addresses specifically the results of surgery in isolated bilateral incomplete cleft lip deformity. The current study presents the outcome and investigates the surgical revision rate in 10 consecutive Saudi children with this deformity. Surgery was performed by the same surgeon using the bilateral one-stage rotation advancement technique. No primary nasal correction was performed in any of the patients. There were no immediate postoperative complications. Only one patient was offered a revision, but the parents refused and stated that they were happy with the result. No secondary lip or nasal correction was suggested or planned for any of the other patients. A panel of 10 medical students was asked to assess the surgical results using a 10-point scale. The one patient who was offered a revision obtained the lowest grade (mean score, 7.5 points). The remaining patients had a mean score that ranged between 7.9 points and 9.3 points. It appears that the multiple imperfections and asymmetries observed in the postoperative photographs were not thought to be severe enough to warrant surgical revision.

Child↗