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At least 379 records · Page 21Linked to original sources
PubMed2000

[Management of the temporalis flap donor site].

OBJECTIVE: To describe a technique of using a sterilized form of moldable cold cured acrylic, Cranioplastic, for camouflaging the depressed temporalis flap donor site, and to assess the long term morbidity and aesthetic results. METHODS: A retrospective clinical assessment of 50 consecutive patients who had temporalis myofascial flap surgery from 1988 to 1995. Any complications of healing, neurosensory deficit were recorded. The aesthetics of the temporal region was graded by subjective and objective methods. The histology of the tissues around the implant in one patient was examined under light microscopy. RESULTS: There was no major complications noted except immediate postoperative seroma formation and temporary paresis of the temporal branch of facial nerve. A satisfactory restoration of aesthetics at the temporal donor site was achieved with the moldable acrylic technique in 96% of patients. The capsular tissues surrounding the implanted acrylic consisted of hyalinized collagen fibres with scanty inflammatory cells. CONCLUSIONS: The use of moldable acrylic to restore the temporalis donor site is a simple, versatile and effective technique with minimal long term morbidity. The aesthetic result of the camouflage was satisfactory and the material exhibits good biocompability.

Acrylic Resins↗
PubMed2000

Reconstruction of lower lip defects after tumor excision: an aesthetic and functional evaluation.

We are presenting a new questionnaire to evaluate the functional and aesthetic aspects after reconstruction of defects of the lower lip resulting from tumor excision. The questionnaire is based on objective parameters with numerical values. The application of the questionnaire is carried out based on 2 different surgical techniques, which have been used in the Department of Oral and Maxillofacial Surgery of La Princesa University Hospital in Madrid. These techniques are used in the reconstruction of surgical defects and concern the location and percentage of the lip resection. These techniques are the rotation-advancement flap by Yu and the rotation-advancement in island flap by Colmenero et al. The defects are located laterally and they include 40% to 60% of the length of the lip, avoiding the commissure. There is also one case with a defect that is almost 100% of the length of the lip. According to the questionnaire, we conclude that in unilateral defects that exceed 50% (up to 70%), Yu's technique provides better results from an aesthetic and functional point of view than Colmenero's technique. In subtotal defects, bilateral Yu flaps provide optimum function, with good position of the scars. This is a technique to be considered when confronted with extensive defects of the lip that do not include the commissures.

Adult↗
PubMed2006

The early use of a perforator flap of the lateral lower limb in maxillofacial reconstructive surgery.

The development of perforator-based flaps led to new donor sites and enlarged the spectrum of recipient vessels using arteries and veins of very small calibres. Although these flaps, which are directly anastomosed at their terminal cutaneous branches, are becoming more and more important for reconstructions in other regions of the body, perforator-based flaps have not played an important role in maxillofacial surgery until now. This study reports the experience with 24 consecutive perforator flaps from the lateral lower limb for intra- and extraoral defect coverage. Septo- or myoseptocutaneous perforators from the peroneal artery served as the flap pedicle having a length of 4-7 cm and diameters of 1-2 mm. Indications were reconstructions of the floor of the mouth (10), soft palate (3), tongue (6), closure of perforating cheek defects (2) and reconstruction of the facial skin (3). Anastomoses were performed to the lingual, facial, temporal or thyroid superior artery. Except for 2 cases, all perforator-based flaps were healed well and the morbidity of the donor site was nearly negligible. According to the early experience in this study, perforator-based flaps from the lateral lower limb may have an indication if recipient vessels available are close to the defect and if very low donor site morbidity is important to the patient.

Aged↗
PubMed2001

The effect of precise reattachment of the mentalis muscle on the soft tissue response to genioplasty.

PURPOSE: This study compares vertical and horizontal profile changes of the lower lip and chin after genioplasty with or without precise reattachment of the mentalis muscle. PATIENTS AND METHODS: Ten patients in whom the mentalis muscle was isolated, identified, marked, and precisely reapproximated comprised the study group. Eleven patients treated without precise reattachment of the mentalis comprised the control group. Preoperative (3 to 6 days before the surgery) and postoperative (6 months after surgery) lateral cephalograms were analyzed to assess the horizontal and vertical soft tissue changes of the lower lip and chin area. RESULTS: All the significant changes in the present study were noted in the vertical parameters. In most of the study group, the length of the lower lip was either maintained or increased. In the control group, the lower lip length was either preserved or decreased. The mean vertical difference between the 2 groups was nearly 6 mm. Consequently, the study group displayed the same or less of the lower incisors postsurgery compared with the original presurgery exposure in the rest position. The opposite was true for the control group, in which the exposure of the lower incisor crowns at rest increased. Similar changes were noticed in the distance from the vermilion to the reference plane. The vertical position of the soft tissue supramentale remained unchanged in the study group, whereas in the control group the soft tissue supramentale was located in an inferior position (mean = 2.14 mm). The clinical expression of this phenomena is chin ptosis. CONCLUSIONS: Precise reattachment of the mentalis muscle during an intraoral surgical approach produces a superior result.

Adolescent↗
PubMed2003

Amniotic membrane transplantation for reconstruction of the conjunctival fornices.

PURPOSE: To describe the clinical outcome of amniotic membrane transplantation (AMT) for fornix reconstruction in a variety of ocular surface disorders. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Seventeen eyes in 15 patients with symblepharon. Four eyes had ocular-cicatricial pemphigoid, two eyes had symblepharon after pterygium excision, four eyes had chemical or mechanical trauma, two eyes had strabismus surgery, two eyes (one patient) had Stevens-Johnson syndrome, one eye had toxic epidermal necrolysis, and two eyes (one patient) had chronic allergic conjunctivitis. INTERVENTION: The subconjunctival scar tissue was dissected from the episclera, and the freed conjunctival flap was recessed to the fornix. A layer of amniotic membrane (AM) was applied to cover the exposed episclera. The fornical edge of the membrane was anchored with sutures passing through the full thickness of the lid. MAIN OUTCOME MEASURES: A deep conjunctival fornix, lack of motility restriction. RESULTS: The mean follow-up period was 37 +/- 24 months (range, 9-84 months). Complete fornix reconstruction was demonstrated in 12 of 17 eyes (70.6%), whereas 2 eyes had a partial success, and 3 eyes (3 patients) had recurrence of symblepharon with restricted motility. In eyes that demonstrated partial success or failure, the underlying etiology was either an autoimmune disorder or a recurrent pterygium. The most successful outcome was observed in eyes with symblepharon associated with trauma. CONCLUSIONS: AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders. Future modifications, including an epithelial cellular component on the AM (conjunctival autograft or ex vivo expanded epithelial stem cells) may improve the outcome of this surgical procedure.

Adult↗
PubMed1987

Music Rx: physiological and emotional responses to taped music programs of preoperative patients awaiting plastic surgery.

This study investigated the physiological and emotional responses of patients awaiting an elective plastic surgery procedure to a 30-minute taped music program. The study replicated in part the research study of Bonny entitled "Music Rx." Values for the physiological variables of systolic blood pressure, diastolic blood pressure, pulse rate, mean arterial pressure (MAP), and double product index (DPI) were obtained before and after the music listening. These data were analyzed via a repeated measures t-test using each subject as her or his own control. The convenience sample of 10 was nonrandomized. Emotional responses were evaluated by means of an open-ended, nondirective questionnaire developed around 5 categories of depression, sadness, and despair; psychological isolation and defensiveness; anxiety; difficulty of medical management; and preoccupation with pain. Process recordings and documented verbal and body language were used before and after the music to identify themes and mood states expressed by patients. Every physiological variable decreased in value at the less than .001 level of significance. The most significant emotional effect appeared to be an experienced shift in patients' awareness toward a more relaxed, calm state. The most critical conclusion is that music listening appeared to effect desirable pattern shifts in physiological and emotional states in the presurgical setting for those patients studied.

Blood Pressure↗
PubMed2004

Computer-navigated ACL reconstruction with the OrthoPilot.

Within the minimally invasive-operation techniques, small approaches are desirable in many fields of the surgery to reduce soft-tissue trauma; however, the risk exists that the surgeon will lose the general view of the topographic structures. The remedy lies in computer navigation with the OrthoPilot. This navigation system has already been used successfully for knee endoprosthesis. A special software was developed for use of the navigation-system, OrthoPilot, for ACL reconstruction. This system is capable of determining the exact optimum position of tunnel replacement by computer navigation. This determination is made by a high-precisive infra-red camera and rigid bodies fixed onto the patient. The experience gained in performing 150 ACL reconstructions to date demonstrates the ease of handling, reduction in extra operation time to a minimum of 10-15 minutes, and only minimal trauma by fixing the rigid bodies. In all cases, an optimum position was documented for the tunnel replacement. Furthermore, no expensive pre-operation x-rays (CT scan, nuclear spin) are needed. Use of the computer-assisted navigation system demonstrated that femoral and tibial tunnel replacement can be positioned precisely. Thus, a false position of the tunnel replacement, the main cause of' transplant-failure, can be avoided. The OrthoPilot is an important support system for both less-experienced and experienced surgeons when performing surgical ACL revisions.

Anterior Cruciate Ligament↗
PubMed2006

Outcome of skin graft versus flap surgery in the salvage of the exposed achilles tendon in diabetics versus nondiabetics.

BACKGROUND: Achilles tendon wounds pose a reconstructive dilemma because of the tendon's functional importance and the paucity of soft tissue surrounding the ankle. The currently accepted treatment is to repair the wound with a flap (local, pedicled, or free). In this article, the authors examine whether skin graft coverage of the exposed Achilles tendon is a viable option for reconstruction and whether the comorbidity of diabetes affects the outcome. METHODS: Forty-five consecutive patients presenting with wounds involving the Achilles tendon in 49 limbs were retrospectively evaluated from the authors' limb salvage registry from 1990 to 1999. RESULTS: After initial debridement, the method of reconstruction consisted of closure by secondary intention (n = 6), skin grafting (n = 27), and reconstruction with a flap (n = 10) or free flaps (n = 6). The primary success rate of each procedure was not significantly different: secondary intention, 83 percent; skin graft, 83 percent; local flap, 80 percent; and free flap, 83 percent. The overall wound-healing rate was 96 percent and the limb salvage rate was 98 percent. Six wounds eventually recurred in patients who had undergone skin grafting. All but one went on to heal with conservative therapy. There was no difference in any of the result parameters between diabetics and nondiabetics. CONCLUSIONS: This study demonstrates that, with a properly prepared wound bed, skin grafting can be as effective as local or free flaps in successfully healing Achilles tendon wounds. Diabetes should not be used as a contraindication to limb salvage in patients who present with Achilles tendon ulceration or gangrene.

Achilles Tendon↗
PubMed2000

The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery.

The lateral arm flap is well established in microvascular reconstructive surgery for covering small and moderate-sized defects both of the extremities and in the head and neck region. In the last 3 years 25 patients underwent a lateral upper arm flap for primary repair of tumour related defects of the tongue (n = 10), floor of the mouth (n = 7), mandible (n = 4), inner cheek (n = 2), oropharynx (n = 1) and lower lip (n = 1). Defects extended from the anterior floor of the mouth to the oral tongue in three cases and in four cases the defect reached the pharyngeal tongue. Two flaps had neurovascular anastomoses between the posterior cutaneous nerve of the arm and the lingual nerve. In all patients the donor defect was closed primarily. Twenty four lateral upper arm flaps healed uneventfully although six patients developed severe alcoholic delirium. One flap was lost on the fourth postoperative day due to venous insufficiency. There were no significant complications at the donor site. At the time of this report 16 patients were taking a normal diet while nine patients were taking pureed food. Among the advantages of this flap are anatomically reliable vascular supply, its good aesthetic quality, and position of the donor site. Furthermore the posterior radial collateral artery is a nonessential vessel of the arm. The flap is also potentially sensate. Among the disadvantages are smaller vessels for microvascular anastomoses. In conclusion, we believe that for repair of moderate-sized defects of the maxillofacial area the lateral upper arm flap can be recommended as the first choice.

Aged↗
PubMed2004

The thoracodorsal artery perforator flap: clinical experience and anatomic study with emphasis on harvest techniques.

The thoracodorsal artery perforator flap is a relatively new flap that has yet to find its niche in reconstructive surgery. At the authors' institution it has been used for limb salvage, head and neck reconstruction, and trunk reconstruction in cases related to trauma, burns, and malignancy. The authors have found the flap to be advantageous for cranial base reconstruction and for resurfacing the face and oral cavity. The flap has been used successfully for reconstruction of traumatic upper and lower extremity defects, and it can be used as a pedicled flap or as a free tissue transfer. The perforating branches of the thoracodorsal artery offer a robust blood supply to a skin-soft-tissue paddle of 10 to 12 cm x 25 cm, overlying the latissimus dorsi muscle. The average pedicle length is 20 cm (range, 16 to 23 cm), which allows for a safe anastomosis outside the zone of injury in traumatized extremities; the flap can be made sensate by neurorrhaphy with sensory branches of the intercostal nerves. Vascularized bone can be transferred with this flap by taking advantage of the inherent vascular anatomy of the subscapular artery. A total of 30 pedicled and free flap transfers were performed at the authors' institution with an overall complication rate of 23 percent and an overall flap survival rate of 97 percent. Major complications, such as vascular thrombosis, return to the operating room, fistula formation, recurrence of tumor, and flap loss, occurred in 17 percent of the patients. Despite these drawbacks, the authors have found the thoracodorsal artery perforator flap to be a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction cases.

Adult↗
PubMedDate not supplied

Sir Harold Gillies.

Explore the source record for details and available documents.

England↗
PubMedDate not supplied

A new era of discovery in facial plastic surgery.

OBJECTIVE: To review recent advances in our understanding of molecular biology and wound healing relevant to facial plastic surgery. DATA SOURCES: Recent basic science literature relevant to molecular biology and wound healing and its clinical implications. CONCLUSIONS: During the 21st century, we will experience a new biological and informational age that will have profound implications for facial plastic surgery. This modern era will be driven by discoveries in molecular biology and wound healing that will result in new diagnosis and treatment modalities.

Craniofacial Abnormalities↗