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At least 433 records · Page 24Linked to original sources
PubMed1994

Endoscopic facial rejuvenation: endoforehead, the functional lift. Case reports.

Endoscopic techniques have only very recently been applied to aesthetic plastic surgery procedures, especially in carpal tunnel release, in forehead plasties, and in breast augmentation operations. The author briefly outlines his experiences with endoscopic forehead lifts, first reported at surgical conferences in Los Angeles and Buenos Aires in 1992, and now totaling 61 cases performed in the 11 months just prior to the submission of this article. This endoscopic approach to forehead lifting has provided similar and comparable results to conventional coronal forehead lift operations, by means of small incisions made in the scalp area with minimal and fewer complications.

Adult↗
PubMedDate not supplied

Endoscopic plastic surgery: the endoscopic evaluation of implants after breast augmentation.

There is an ongoing discussion about the possible connection of gel-filled silicone implants for breast augmentation and the development of connective tissue disease. In the absence of any proven link and irrespective of the difficulty to prove such a causality, these discussions lead to great concern for the hundreds of thousands of women who underwent breast augmentation with silicone gel implants. As a consequence there are voices that call for regular checks of the implants with regard to their integrity. All the external methods of judging an implant, including MRI, can--if at all--detect only marked lesions or ruptures. Direct visualization of the implant up to now has been the only safe method. Direct visualization can be carried out by reopening the previous incision or by endoscopic inspection. Endoscopic evaluation needs the dexterity of all endoscopic plastic surgery procedures, but with sufficient training and experience it is a very safe, quick, and highly compliant procedure for the patient and can be combined with endoscopic biopsies and other endoscopic operations such as capsulotomies.

Breast Implants↗
PubMed1997

[Plastic surgery defect coverage in the area of the pelvis and trunk].

Complex defects of the trunk and pelvic region are rare, but are mostly the sequelae of serious conditions. Stable soft tissue coverage after radical debridement of all avital tissue may be of vital importance for the patient. The article will demonstrate the options of plastic surgery procedures that should be known by the general surgeon to be eventually integrated into a interdisciplinary therapeutic concept.

Abdomen↗
PubMed2005

[Management of iatrogenic lesions of the spinal accessory nerve].

Lesions of the spinal accessory nerve are usually iatrogenic, especially after lymph node extirpation on the neck. Between 1994 and 2003, 31 patients were operated on in the Neurosurgical Department of the University of Ulm for iatrogenic lesions of the XIth cranial nerve. Of 31 patients, 22 had undergone a previous lymph node extirpation, 2 had been injured during a selective peripheral denervation for spasmodic torticollis, and the other 7 patients by different causes. The neurosurgical intervention was performed 0-19 months after trauma (mean 7.2 months). All patients showed paresis/atrophy of the trapezius muscle, and the abduction of the shoulder was markedly reduced. Additional neck and/or shoulder pain was present in 29 of 31 cases. In seven cases, the nerve was compressed by scar tissue and subsequently treated by external neurolysis. Ten patients underwent an end-to-end anastomosis; autologous sural nerve grafting was necessary in 13 cases. After a mean follow-up of 12.6 months, 7 of 31 patients completely recovered. Of 31 patients, 19 experienced partial relief of pain and weakness. Only five patients remained unchanged. The clinical findings after autologous nerve grafting, end-to-end reconstruction, or external neurolysis did not show any significant differences. Microsurgical reconstruction of iatrogenic injury of the spinal accessory nerve is very promising if the interval between trauma and surgical revision is less than 6 months. Up to 12 months, partial recovery can be achieved. Outcome after longer delay is unsatisfactory.

Accessory Nerve↗
PubMed2000

Comparison of eccentric and concentric screw placement for hamstring graft fixation in the tibial tunnel.

Interference screw fixation of four-strand hamstring grafts for ACL reconstruction has recently been introduced. By this method, the interference screw is placed in the tibial and femoral tunnels eccentric (adjacent) to the bundled limbs of the graft. In order to maximize the graft to tunnel contact to promote biological fixation, it is proposed to place the screw concentrically in the tunnel, in the middle of the four limbs of the graft, pressing each limb of the graft into the tunnel wall. This would be difficult to do in the proximal, folded end of the four limb graft situated in the femoral tunnel but can be done easily in the tibial tunnel. The purpose of this study was to evaluate the effect of screw placement on the stiffness, yield load, and ultimate load of hamstring graft fixation in the tibial tunnel. Five pairs of human knees were used for the study. Pull out tests were performed using an MTS system, pulling along the axis of the tibial tunnel. Tibial fixation stiffness was greater using concentric screw placement (P < 0.05) although there was no statistical difference in yield load, slippage, or ultimate load.

Anterior Cruciate Ligament↗
PubMed2001

Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study.

We examined the arthroscopic appearance of the anterior cruciate ligament (ACL) attachment site on the femur in five fresh-frozen cadaver knees. First, the ACL was cut out, leaving a footprint of ligament-fibers with a length of 2 mm intact. The ACL was consistently found to insert on the lateral wall of the notch. No fibers were found to attach high in the roof of the notch at the 12 o'clock position. Secondly, we tried to reach the anatomical attachment site with a femoral aiming guide through a correctly placed tibial tunnel. This proved to be impossible. The closest position that could be reached was at the margin of the anatomical attachment site. Investigation of the distal femur after complete dissection confirmed these arthroscopic findings. Femoral aiming devices for use through the tibial tunnel aim for an isometric placement of the femoral tunnel, they do not aim for an anatomical position of the graft.

Anterior Cruciate Ligament Injuries↗
PubMed2001

Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons.

We retrospectively reviewed 87 anterior cruciate ligament reconstructions using autogenous hamstring tendons with the Endobutton technique to investigate the relationship between bone tunnel enlargement and clinical outcome and to identify factors that contribute to the enlargement. The clinical outcome was evaluated using the Lysholm score and KT-1000 arthrometer. The location of the femoral tunnel with respect to Blumensaat's line, the tibial tunnel with respect to the tibial plateau, and the angle between the femoral tunnel and Blumensaat's line (femoral tunnel angle) were measured. Bone tunnel enlargement was observed in 32 patients (37%). Enlargement occurred in 22 of the femoral tunnels and 26 of the tibial tunnels. Enlargement of both tunnels occurred in 16 knees. There was no statistical difference in Lysholm scores or KT-1000 arthrometer measurements between the enlarged group and the unenlarged group. The femoral tunnel was placed more anteriorly in the enlarged femoral tunnel group than in the unenlarged femoral tunnel group. The tibial tunnel was placed more anteriorly in the enlarged tibial tunnel group than in the unenlarged tibial tunnel group. The femoral tunnel angle was significantly smaller in the enlarged femoral tunnel group than in the femoral unenlarged group. Gender, patient age, intraoperative isometricity, and graft size were not significant factors. Bone tunnel enlargement was not correlated with the clinical outcome measures. We conclude that the main factor associated with tunnel enlargement are the locations and angles of the tunnels. The windshield-wiper motion of the graft may be enhanced by changing tension in the graft due to tunnel malposition. An acute femoral tunnel angle may increase the mechanical stress on the anterior margin of the femoral tunnel.

Adolescent↗
PubMed2003

Limb salvage for malignant bone and soft-tissue tumours of the shoulder girdle.

We treated 15 patients with malignant bone and soft-tissue tumours of the shoulder girdle using limb salvage operations involving resection of the proximal humerus, scapula and clavicle. The oncological and functional outcomes were evaluated in all patients after an average of 5 (1-13) years. Oncological evaluation revealed that in 11 patients with adequate surgical margins six were continuously disease free and two had no evidence of disease. Three patients with marginal surgical margins had all died. We suggest that only where adequate surgical margins can be obtained should operations be performed. Forequarter amputation is still indicated in patients with complicated neurovascular involvement. Functional evaluation showed that scapular resections, especially glenoid resections, provided poor results (mean score 54%) in comparison with patients without such resection (mean score 82%).

Adolescent↗
PubMed2005

Mycobacterium cheloneae infection after breast augmentation.

Augmentation mammaplasty is one of the most commonly performed plastic surgery procedures. Infection, still one of the most feared complications of the procedure, usually is caused by skin commensal organisms. A wide variety of other organisms also may be responsible for these postoperative infections, including atypical mycobacteria. A case of a prosthetic breast implant infected with Mycobacterium cheloneae is presented, and the presenting signs and symptoms, diagnosis, and treatment options of such an infection are discussed. The importance of promptly isolating the pathogen for potential salvage of the prosthesis also is stressed, as well as the operative intervention necessary when conservative therapy fails.

Adult↗
PubMedDate not supplied

Can a picture really paint a thousand words?

Plastic surgeons require a three-dimensional appreciation of form and function in order to meet reconstructive challenges. The popular perception that plastic surgeons must be artistic was tested in an observational study of sketch illustrations in plastic surgery case notes. Only in the trunk and breast category of illustrations could career plastic surgeons demonstrate superior artistic skill to non-career plastic surgeons and there was little correlation between the artistic merit of a diagram and the likelihood of its meaning being understood by an independent observer. Simple but accurate outline sketches are as capable of leading an observer to the correct diagnosis as complex works of art, while illustrations with low diagnostic scores are not only misleading but may also have medico-legal implications.

Art↗
PubMed2000

Contribution to the history of plastic and reconstructive surgery from Dubrovnik and split during the fourteenth to sixteenth centuries.

Medieval contracts for medical treatment are, without doubt, evidence of proper and adequate insight into the quality of operations performed centuries ago. Historical archives in Dalmatian cities have preserved a certain number of such contracts. Their contents assist in better understanding our historical heritage. This paper submits contracts, kept in Dubrovnik and Split, for the operation of inguinal hernia. A case depicting a defective palate treated by Amatus Lusitanus, who lived in Dubrovnik from 1555 to 1558, is also presented.

Croatia↗
PubMed2005

[Cause and repair of a corneoscleral fistula in two patients].

BACKGROUND: A slowly progressing bulbar hypotension with maculopathy in a male patient as well as an endophthalmitis in a female patient both required surgical repair of posttraumatic leaks. PATIENTS AND METHODS: In a 32-year-old male patient, a filtration bleb leak occurred 4 months after a penetrating stab wound in the corneoscleral region. Persistent bulbar hypotension demanded microsurgical revision, revealing a 1 x 1 mm scleral defect. The leakage area was close to the limbus. In a 75-year-old female patient, signs of endophthalmitis occurred 4 years after extracapsular cataract extraction with posterior intraocular lens implantation. The place of entry of the inflammation was a 1 x 3 mm subconjunctival fistula in the corneoscleral scar. In both cases the leakage areas were repaired by an autologous 4 x 4 mm scleral graft obtained from the pars plana region in the same eye. RESULTS: The postoperative course was without complications, the intraocular pressure was back to normal within a few days in both cases. Two weeks after surgical repair in the first patient, normal ocular fundus and normal visual acuity were observed. In both cases complete and permanent leakage closure was achieved. CONCLUSIONS: There are various surgical possibilities for the repair of scleral defects. Patching the defects with autologous scleral grafts has several advantages. Dissection of the graft in the pars plana region is relatively simple. The graft comprising 30% of the scleral thickness is sufficiently firm and supple and there is no danger of infection transmission or of rejection.

Adult↗