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PubMed2003

Effects of sealing the perforated sinus membrane with a resorbable collagen membrane: a pilot study in humans.

The effects of repairing the perforated sinus membrane with collagen membrane are unknown. The purpose of this pilot study was to clinically, histologically, and histomorphometrically evaluate the results of repairing the perforated sinus membrane with resorbable collagen membrane. A split-mouth design was followed in the current study. Five subjects requiring bilateral sinus grafting were included in the study, where one site was accidentally perforated during sinus augmentation procedures and the other site was not perforated. The perforated sites were repaired with a resorbable collagen membrane. Dental implants were placed at a second stage and biopsies were harvested from both sinuses. New bone formation was measured for all sites. Implant survival was recorded at second-stage surgery. Nonperforated sites demonstrated significantly more bone formation (34.40%) than perforated sites (12.80%) (P = .016). Implant survival at second-stage surgery was significantly inferior in perforated sites (54.5%) when compared with nonperforated sites (100%) (P = .0146). The study demonstrated that perforation and repair of the Schneiderian membrane can compromise new bone formation and implant survival rate.

Absorbable Implants↗
PubMed1997

Effect of septal perforations on measures of nasal resistance.

OBJECTIVE: The purpose of this investigation was to determine the effect of septal perforations on posterior and anterior rhinomanometric measures of nasal resistance in an analog model. DESIGN: The data were analyzed using a repeated-measures ANOVA. Nasal resistance was the dependent variable, while type of rhinomanometry, septal perforation size, and position of resistance (proximal vs. distal) were nominal scale independent variables. PARTICIPANTS: The analog model used in this study was similar to that described by Warren and Devereux (1966), except that the nasal cavities of the model were modified to create septal perforations. OUTCOME MEASURES: The main dependent measure was nasal resistance. RESULTS: An Important finding of this investigation was that septal perforations resulted in large differences (> 3 cm H2O/L/sec) between posterior and anterior nasal resistance values in the bilateral proximal resistor condition. CONCLUSIONS: Anterior rhinomanometry may underestimate true nasal resistance when a septal perforation is present, because the septal perforation prevents accurate measurement of nasopharyngeal pressure. Posterior rhinomanometric measures should accurately reflect nasal resistance despite septal perforations, because the perforation does not invalidate the estimate of nasopharyngeal pressure.

Adult↗
PubMed2000

Spontaneous early exposure of submerged implants: III. Histopathology of perforated mucosa covering submerged implants.

BACKGROUND: Spontaneous early exposure of dental implants could interfere with the early healing phase of dental implants. These exposures have been clinically classified according to degree of implant exposure from 0 (intact mucosa) to IV (complete exposure). The characteristics of perforated mucosa (Class I and II) covering submerged dental implants were examined histologically in this study. METHODS: Biopsy specimens of 34 Class I and II perforated mucosa covering submerged dental implants were examined histologically. Serial sections were evaluated from the periphery of the specimen to the center of each perforation lesion. RESULTS: Class I specimens presented hyperplastic epithelium characterized by hyperparakeratosis and acanthosis. Chronic inflammatory cells diffusely infiltrated the connective tissue. Sections closer to the perforation revealed gradual epithelial invagination; in the deepest aspect, there was a cyst-like structure in all Class I specimens examined. A thin layer of connective tissue containing necrotic material and debris formed the "cystic" wall proximal to the implant cover screw. Class II specimens presented the same epithelial patterns; however, the cystic structures were replaced by direct contact between the cover screw and the oral cavity via the perforation. CONCLUSIONS: Spontaneous early perforations are the sequela of either traumatic irritation or failure of the tissue flaps to produce primary healing. Most Class I perforations include epithelial invagination and the formation of a cyst-like structure. Necrosis of the base of the "cyst" or enlargement of the perforation results in direct communication between the oral cavity and the covering screw surface (Class II).

Biopsy↗
PubMed1982

Sonographic findings in perforation of the gallbladder.

The sonographic findings in 13 patients with proven gallbladder perforation are described. Two patients were scanned immediately before and after gallbladder perforation. The sonographic findings before gallbladder perforation were gallbladder distension (one case) and gallbladder wall edema (one case). Pericholecystic collections develop after gallbladder perforation. These collections have a varied sonographic appearance ranging from anechoic to complex collections, and their internal characteristics seem to depend on the duration of the pericholecystic process. The residual gallbladder lumen or calculi can be identified within or peripheral to the pericholecystic process. The most acceptable mechanism for perforation of the gallbladder is: (1) impaction of a calculus in the cystic duct; (2) gallbladder distension due to secretion into its lumen by mucous glands located in the walls of the gallbladder; (3) vascular impairment of the gallbladder due to distension of the viscus; and (4) ischemia, necrosis, and perforation of the gallbladder wall. Gallbladder perforation is a significant complication of acute cholecystitis associated with morbidity and mortality. Detection of this complication of acute cholecystitis by clinical means is difficult since the patient's symptoms are similar to those of uncomplicated acute cholecystitis. The inherent resolution of sonography offers an excellent display of the gallbladder and surrounding tissues allowing detection of pericholecystic collection secondary to gallbladder perforation.

Abscess↗
PubMed1992

Diagnosis of middle ear disease with eardrum perforation by a newly developed sweep frequency measuring apparatus.

Dynamic characteristics of an artificial middle ear model with and without eardrum perforations were measured with our newly developed sweep frequency measuring apparatus. Then, the dynamic characteristics of patients with chronic otitis media having eardrum perforations and with traumatic perforations were measured with this apparatus, and the results were compared with those of the artificial middle ear model with an eardrum perforation. The comparison leads to the conclusion that the middle ear condition of patients with eardrum perforations can be distinguished on the basis of their measurement results. Furthermore, the ossicular chain conditions of patients with eardrum perforations can be diagnosed after putting a paper patch on the eardrum perforation. Therefore, this apparatus seems to be highly useful in the diagnosis of both ossicular chain disorders and eardrum perforations.

Acoustic Impedance Tests↗
PubMed2002

Perforator flap breast reconstruction.

A perforator flap consists of skin and fat harvested from a donor site nourished by myocutaneous perforators while sparing the donor muscle for function and strength. This flap type has revolutionized microvascular free tissue transfer and the technique has been successfully applied to well-established donor sites for autologous breast reconstruction namely the lower abdomen, upper and lower buttock, the upper back, and the lateral thigh. Although these flaps are technically more demanding than conventional myocutaneous free flaps, their minimal impact on the donor site muscle function significantly reduces local morbidity, postoperative pain and hospital stay. Perforator flap breast reconstruction has an increased operating time because of the meticulous dissection of the perforators, the possible anatomical variation in their location and, once these are located, the difficulty in selecting suitable perforator(s) to base the flap on. Although it has been suggested that perforator flaps may have a higher incidence of fat necrosis and partial flap loss than conventional free myocutaneous flaps, this has not been borne out by clinical results. There is, however, a learning curve and careful patient selection is important. The role of perforator flap technique in breast reconstruction is evolving. While its indications are similar to those of free TRAM and gluteal flaps, it is clearly a better alternative to these. The choice of perforator flap depends on where the patient has the most abundant donor tissue and the surgeon's experience. These flaps may in the future become the standard of care in free flap breast reconstruction.

Journal Article↗
PubMed1991

[Autogenous dermal grafts for repair of temporomandibular joint disc perforations].

Perforations of the temporomandibular joints (TMJs) disc were made in the rabbits and repaired with autogenous dermal grafts. The healing process was investigated histologically. Twenty-one rabbits (forty-two TMJs) were divided into 3 experimental groups. Group 1. Six TMJs in which the superior aspects of the discs were exposed by the incision of the articular eminence. Group 2. Fifteen TMJs in which the discs were perforated. Group 3. Twenty-one TMJs in which the dermal grafts were sutured on the disc perforations. The results obtained were as follows: In group 2, all perforations were not repaired, except in one case. In group 3, 14/19 grafted disc perforations were repaired. One week after surgery, young, loose, collagenous tissue from the synovial membrane lined the margins of the perforations. Two weeks after surgery, vascularity from the synovial membrane and young collagen fibers were seen in the area of the repaired perforations. Four weeks after surgery, long and thick collagen fibers bridged the perforations.

Animals↗
PubMed1999

[Leg perforating veins].

Our knowledge of the so-called incompetent leg perforating veins remains questionable. Anatomic and hemodynamic studies show that perforators in a healthy subject do not always convey inward flowing blood. Are incompetent perforating veins more frequent with increasing severity of chronic venous disease? Answering this question is difficult as no consensus has been established on how to assess incompetent leg perforating veins and we have no gold standard to refer to. The number of incompetent leg perforating veins is generally greater in severe chronic venous disease although their frequency in clinical stage 4 to 6 (CEAP classification) is not statistically different. This means that incompetent leg perforating veins are not markers of severity of chronic venous insufficiency. When analyzing published series which take into account etiology (primary or secondary venous diseases) the frequency of incompetent perforating veins is variable. Is surgical management required when incompetent leg perforating veins are present? Angiologists and surgeons have not come to an agreement on this point. What can be recommended today? It is generally accepted that the more severe the disease the more worthwhile surgical treatment. Technically speaking, subfascial endoscopic ligature is a promising new method although long-term results are still lacking. We must watch carefully the prospective and randomized studies which have been started in different countries. A lot of questions, only a few reliable answers.

Catheterization↗
PubMed1999

[Perforating veins and venous insufficiency].

As communicating link between the deep and the superficial venous system the perforating veins are of special importance. With the introduction of the subfascial videoendoscopic dissection of the perforating veins the interest in anatomic and topographic aspects of the surgical treatment of insufficient perforators has increased. Different pathophysiological conditions can cause insufficient perforating veins. We can distinguish between a primary form and a secondary form caused by an advanced varicosis of the main superficial veins. A third entity consists in an insufficiency created by a postthrombotic alterations of the deep venous system. Primary insufficient perforators should be treated surgically. In the case of a secondary insufficiency the indication is dependent on the extent of the pathological findings. If there is an obstruction of the deep venous system which causes the insufficiency of a perforator the vein should not be divided. The videoendoscopic subfascial dissection of the insufficient perforating veins has several advantages compared with direct percutaneous exposure. The technique is easy to learn, however it requires profound knowledge about the compartmental spaces and the topographic anatomy of the perforating veins in the lower leg.

Endoscopes↗
PubMed2000

Recognized globe perforation during strabismus surgery: incidence, risk factors, and sequelae.

BACKGROUND: Inadvertent perforation of the globe is a well-recognized complication of extraocular muscle surgery. We evaluated the incidence, risk factors, and sequelae of this complication at our institution. METHODS: Medical records of patients who underwent extraocular muscle surgery at King Khaled Eye Specialist Hospital, Saudi Arabia, between September 1983 and April 1997, were reviewed for the occurrence of globe perforation. We documented preoperative visual acuity and refraction, surgical procedure, how the perforation occurred, and immediate management, as well as the sequelae of the perforation, its management, and final outcome. RESULTS: Recognized perforations occurred in 15 of 4886 procedures, for an overall incidence rate of 3/1000. Perforations were 3 times more common in myopic eyes (>-6.00 D, P =.05) and 2 times more common in eyes with previous extraocular muscle surgery. Perforations occurred during muscle reattachment (5 cases), placement of traction sutures at the limbus (4 cases with transient hyphema), muscle disinsertion (3 cases), and placement of sutures at the muscle insertion before disinsertion (3 cases). One patient had a large scleral laceration with uveal prolapse, necessitating scleral patch graft at the time of surgery, and later had retinal detachment surgery with loss of 2 lines of visual acuity. Endophthalmitis, cataract, glaucoma, and phthisis bulbi were not encountered in our review. CONCLUSION: The current incidence of globe perforation is low and only rarely associated with serious sequelae.

Adolescent↗
PubMed2000

Wound healing patterns following perforation sustained during laser in situ keratomileusis.

BACKGROUND AND PURPOSE: Corneal perforation during laser in situ keratomileusis (LASIK) may interfere with flap adhesion and wound healing. The purpose of this study was to investigate wound healing patterns following corneal perforation sustained during LASIK in rabbits. METHODS: Forty-two pigmented rabbit eyes underwent LASIK surgery with 5.0-mm excimer laser treatment under the corneal flap. Animals were divided into two groups: group I (n = 19) underwent the regular LASIK procedure with -10.0 D treatment, without perforation; in group II (n = 23), the cornea was perforated with the excimer laser. Treatment was discontinued once perforation was observed, and the corneal flap was replaced without sutures. Slit-lamp biomicroscopy, photography, and scatterometry were performed preoperatively and at 1 and 2 days, 1 week, and weekly up to 1 month, 2 months, and 3 months postoperatively. Animals were killed at 1 day, 1 week, 1 month, and 3 months postoperatively and processed for light microscopic, electron microscopic, and immunohistochemical examinations. RESULTS: In group I, the corneas remained clear throughout the experiment. In all eyes, the interface was not readily discernable clinically or histologically. Corneal wound healing was accompanied by minimal cell infiltration. Epithelial hyperplasia at the flap edge was noted at 1 week. Myofibroblast activation was found at the epithelial wedge where there was an epithelial basement membrane break. In group II, the anterior chamber was shallow with no iris incarceration at the end of surgery. The corneas were clear (n = 6) or showed mild to moderate edema (n = 12). Corneal edema peaked at 3.6 +/- 5.0 days and subsided thereafter. Corneal wounds healed similarly to those in group I except at the perforation site. The break in Descemet's membrane and endothelium was covered with a fibrin plug on day 1, which resolved thereafter. There was no statistically significant difference in the incidence of postoperative infection (p = 1.0) or flap displacement (p = 0.69) rates between the two treatment groups. The scatterometry index peaked at 2 to 3 weeks postoperatively and was significantly higher in group II than in group I (p < 0.001). CONCLUSIONS: Although corneal perforation during LASIK surgery may interfere with immediate postoperative flap adhesion, corneal wound healing following LASIK perforation may be similar to that after an uncomplicated LASIK procedure.

Actins↗
PubMed2000

[Color-flow duplex Doppler scanning study in the tram flap perforators: a report of 94 consecutive patients].

OBJECTIVE: To investigate the location of transverse rectus abdominis musculocutaneous (TRAM) flap perforators on abdomen skin and the peak systolic flow velocities of the perforators. METHODS: A series of 94 consecutive patient's TRAM flap perforators were detected by color-flow duplex Doppler scanning peroperatively. Perforator locations were tabulated on the abdomen skin according to their vertical position relative to the umbilicus and their lateral location relative to the abdominal midline. RESULTS: The perforators on both left and right side of TRAM flap were quite not symmetry. The peri-umbilical region contained 81.1% of the perforators. All perforators were detected with peak systolic flow velocities ranging from 5 to 81 cm/s. CONCLUSION: The preoperative color-flow Doppler localization of TRAM flap perforators improves the surgeon's ability to design the flap in order to capture the dominant vessels, and select single- or double-pedicle and free TRAM flaps based on each patient's individual characteristics.

Adolescent↗
PubMed2004

The changing pattern of coronary perforation during percutaneous coronary intervention in the new device era.

We report the incidence, management and clinical outcome of coronary perforations in 39 of 12,658 patients (0.3%) undergoing percutaneous coronary intervention (PCI). Coronary perforation occurred more frequently with debulking techniques than with non-debulking (percutaneous transluminal coronary angioplasty and stent) techniques (1% versus 0.2%; p<0.001). There were 8 type I (20.5%), 15 type II (38.5%) and 16 type III (41%) perforations. Importantly, fifty-one percent of the coronary perforations were guide-wire related. Major adverse clinical outcomes occurred more frequently in patients who experienced type III perforations. Conventional strategies to treat perforations (i.e., prolonged balloon inflation and reverse of the anticoagulated state) were used. There was one death (2.6%), two emergency surgeries (5.2%) and no Q-wave myocardial infarctions. Pericardial effusion occurred in 18 of 39 patients (46.2%), with cardiac tamponade occurring in 7 patients. In the current device era, the incidence of coronary perforation remains low; it occurs more frequently with debulking devices and is often a consequence of guidewire injury. Its outcome is not affected with the use of IIb/IIIa antagonists. Treatment of coronary perforation requires early detection, angiographic classification, immediate occlusion of coronary vessel extravasation and relief of hemodynamic compromise, reversal of heparin anticoagulation, platelet transfusion in those patients treated with abciximab and cover stents.

Angioplasty, Balloon, Coronary↗
PubMed1989

Complications of laser-assisted angioplasty: definition and classification of perforations.

Although laser-assisted angioplasty is becoming increasingly common, there has been no definitive report, drawing its data from a significant patient population, regarding the complications of this technique. To define and enumerate such adverse results, we collected data on 664 peripheral laser procedures performed in 349 patients over a 15-month period (February 1987 through April 1988). The complications proved similar to those of standard angioplasty: hematoma formation, 100 cases (15.0%); perforation/dissection, 38 cases (5.7%); acute thrombosis, 23 cases (3.5%); false aneurysm formation at the puncture site, 7 cases (1.1%); vascular spasm, 5 cases (0.8%); and embolism, 1 case (0.2%). Because perforation was the most significant complication during angioplasty, we devised a system for uniform documentation and reporting of perforations, based on both the arterial condition responsible for the laser probe's deviation and the clinical consequences of the aberration. According to this system, Class-I perforations are dissections that do not penetrate the adventitia; Class-II perforations are adventitial wall ruptures (true perforations) that do not require treatment; and Class-III perforations are adventitial wall ruptures with hemorrhage. In our series, we had no Class-III perforation, but had 21 Class-I (3.1%) and 17 Class-II (2.6%) perforations. Because prudent treatment of an evolving complication often can salvage the procedure, we discuss appropriate therapies, as well as preventive measures.

Journal Article↗
PubMed1992

The perforated tympanic membrane.

Tympanic membrane perforations typically result from trauma or acute otitis media. Most perforations do not cause more than a mild conductive hearing loss, aural fullness and mild tinnitus. Blood, purulent secretions and other debris should be carefully suctioned out of the canal and the perforation size and location described. Irrigation and pneumatic otoscopy should be avoided. A history of vertigo, nausea and vomiting and an audiogram showing a conductive hearing loss of more than 30 dB suggest disruption of the ossicular chain. Profound sensorineural loss may signify inner ear nerve damage. Mastoid radiographs and computed tomographic scans may be useful in cases of significant trauma and infection. Most small perforations resolve spontaneously. The affected ear should be kept dry. Oral and topical antibiotics may be prescribed for perforations related to acute otitis media. Otolaryngologic referral may be necessary to evaluate traumatic perforations associated with vertigo or significant hearing loss, perforations from chronic otitis media or perforations from acute otitis media that do not heal within one month.

Ear Diseases↗
PubMed1992

Medial calf perforators in venous disease: the significance of outward flow.

The role of medial calf perforators in the initiation or promotion of venous disease is incompletely understood. The purpose of this study was to define the direction of blood flow in the perforating vein of the calf in normal limbs and in those limbs of patients with venous disease under defined laboratory conditions. Both lower limbs of 57 patients, (32 women and 25 men, median age, 56 years; range, 40 to 62 years) were examined by duplex ultrasonography. In 10 patients no clinical or duplex evidence existed of venous disease. In 60 legs we found evidence of superficial venous insufficiency, complicated by lipodermatosclerosis in 29. In 15 limbs we found deep venous insufficiency. Finally, in 19 limbs no evidence existed of venous disease, but venous reflux was present in the contralateral limb. The direction of blood flow in the medial calf perforators was assessed during compression of the foot and calf, by a cuff that inflated to 60 mm Hg. Blood flow was also assessed during deflation of the cuff. We found that the direction of blood flow within medial calf perforators can be both inward or outward, even in limbs without evidence of venous disease. Outward flow could be demonstrated in 21% of perforators in normal limbs. Flow on release of distal compression occurred in 33% to 44% of perforators in limbs with evidence of venous disease but in none of the perforators in limbs without evidence of venous disease. We found that flow, during the relaxation phase, within medial calf perforators was associated with venous disease elsewhere in the limb.

Adult↗
PubMed2005

Coronary artery perforation during percutaneous coronary intervention: incidence and outcomes in the new interventional era.

BACKGROUND: Coronary artery perforation (CP) is a serious complication of percutaneous coronary intervention (PCI). We sought to define the incidence and outcome of CP given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa). METHODS: We retrospectively reviewed the records of patients who underwent PCI at our institution over a four-year period. The incidence of CP was derived from patient records and then confirmed by reviewing the angiogram. Perforations were classified as Type 1, 2, or 3, as previously defined. RESULTS: A total of 4,886 patients underwent PCI. Atherectomy devices were used in 329 patients and GP IIb/IIIa in 2,200 patients. Twenty-five CP were identified (0.5% incidence). Six were Type 1 (24%), 10 were Type 2 (40%), and 9 were Type 3 (36%). 13/25 (52%) of the CP were Type C Lesions, and 12/25 (48%) occurred in calcified vessels. All Type 1 perforations were caused by coronary wires and 4/6 CP occurred with the use of hydrophilic and extra stiff wires. Type 2 perforations were caused by coronary wires in 8/10 CP, and by stent deployment in 2/10. Two patients with Type 2 CP sustained a non-ST-elevation myocardial infarction. Type 3 perforations were caused by stent placement in 4/9 CP, 2/9 by atherectomy devices, and 3/9 by coronary wires. Four patients with Type 3 CP underwent pericardial drainage, 5 patients had a myocardial infarction and 2 patients died. CONCLUSION: Type 1 and 2 perforations are predominately caused by hydrophilic and stiff wires and do not require pericardial drainage or surgical intervention. Type 3 perforations are more often associated with stent and device use. A majority of Type 3 perforations can be initially managed by percutaneous methods.

Abciximab↗
PubMed2005

[Perforated peptic ulcer--incidence, localization, patients' age and gender].

Throughout last decades there was a noticeable change in the incidence and number of complications of peptic ulcer disease observed. The aim of our study was to determine the character of changes within the course of last 41 years in perforated peptic ulcer's incidence, localization together with patients' age and gender. To achieve that aim we analyzed the group of 784 patients admitted to 2nd Chair of Surgery of Jagiellonian University due to perforated duodenal and gastric ulcers from 1962 to 2002. To allow statistical analysis the collected material was subsequently divided into 4 periods: 1962-1971, 1972-1981, 1982-1991 and 1992-2002. There was no change in overall incidence of perforated peptic ulcers observed within analyzed period. We observed however marked rise in female percentage in the perforated duodenal ulcers group. Perforated gastric ulcers patients--regardless of gender--and females suffering from perforated duodenal ulcers were on average about 10 years older than males with perforated duodenal ulcers. Rise in age observed in the male and female groups treated due to perforated duodenal ulcers proved to be statistically insignificant.

Adolescent↗