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At least 73 records · Page 4Linked to original sources
PubMed2001

Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor.

Introduction: In recent years a new perforated PDS (poly-p-dioxanon) foil (0.15 mm) has become available and has not yet been proven to be successful in reconstruction of the orbital floor after blow-out-fractures in randomized studies. The main aim of this clinical trial is to compare this new PDS foil with titanium dynamic mesh (0.3 mm) (TD), which is well established in reconstruction of the orbital floor. Patients and Methods: In a prospective multicentre randomized trial, conducted between 1997 and 1998, out of 42 patients with fractures of the orbital floor, 28 patients needing material for reconstruction were randomized to receive either PDS foil or TD. In a comprehensive preoperative and postoperative protocol patients were monitored by the surgeon, radiologist and ophthalmologist with a postoperative follow-up of least 6 months. Results: Maximum defects of the orbital floor were comparable in both groups (PDS group: 13.3 mm, TD group: 13.9 mm). In both groups the surgical procedure was well tolerated, and functional and cosmetic results were evaluated as satisfactory by all patients. Ophthalmological evaluation, performed up to 6 months postoperatively, revealed double vision or vertical strabismus in nine patients (five PDS group, four titanium group). This was not confirmed subjectively in each single patient. Also ex- or enophthalmos, registered in seven patients of the PDS and four of the TD group (mainly +/-1 mm) were not considered as relevant by the patients. Conclusion: The new 0.15 mm perforated PDS foil was comparable to 0.3 mm titanium mesh concerning functional and cosmetic outcome. Obviously, persisting ophthalmometric disorders were compensated very well in both groups. PDS foil is felt to be the preferred material since it is bioresorbable and more convenient to handle. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗
PubMed2003

Cranial epigastric perforator flap: a rat model of a true perforator flap.

The major advantage of a true perforator flap is the ability to capture the skin portion of what previously was a musculocutaneous flap, while totally excluding the muscle for function preservation. To understand better the physiology and dynamics of this flap subtype, a comparable and reliable animal model is essential. This has now been accomplished in the Sprague-Dawley rat using the same abdominal skin territory of the standard rat transverse rectus abdominis musculocutaneous flap, but differing in that all rectus abdominis fascial perforators are isolated via an intramuscular dissection back to the cranial epigastric artery source vessel. Hence, this has appropriately been termed the cranial epigastric perforator flap. From a series of eight rats to date, consistent survival of this flap was as predicted. The dissection itself can be somewhat tedious, but it became easier with experience, making this an excellent training model for learning proper technique in the elevation of any true perforator flap.

Animals↗
PubMed2003

The medial circumflex femoral (gracilis) local perforator flap--a local medial groin perforator flap.

The medial circumflex femoral(GRACILIS) perforator free flap has been previously used to capture the superior medial thigh skin territory. This can also be valuable as a local flap, especially for adjacent groin wounds that are not uncommon after vascular interventions. Uncomplicated healing without vascular compromise was achieved using this as a local flap in 4 recent cases. Because the gracilis muscular branches can be independently dissected from the musculocutaneous perforators, the muscle itself can be separately included to form a combined conjoint flap, where the muscle is specifically only used to wrap around and protect any exposed vascular structures while the cutaneous component simplifies skin wound closure. The axis of rotation of the medial circumflex femoral perforator local flap extends throughout the groin region and potentially to the lateral thigh. This is an ideal local perforator flap because the source pedicle has a consistent location already well known to most plastic surgeons, the boundaries of the potential skin territory are reliable and well defined, and the scar from closure of the donor site within the medial groin can be readily concealed by clothing.

Femoral Artery↗
PubMed2001

Surgical management of septal perforation: an alternative to closure of perforation.

The surgical closure of septal perforations remains a distinctive challenge to the otorhinolaryngologist. This is demonstrated by the modest success in most techniques. An alternative method, involving surgical enlargement of the perforation with posterior edge repair, is described and the outcome is investigated. Thirteen patients with perforations of up to 50 mm in size underwent this technique. A questionnaire interview was conducted and symptom scores were obtained. The length of hospitalization, follow-up period and post-operative complications were evaluated as were measures of morbidity. The results showed a significant improvement in the symptom scores for nasal crusting, epistaxis and overall discomfort. This technique is straightforward and is especially suitable for larger perforations. The successful improvement in symptoms and an associated low morbidity makes it a complement to alternative surgical closure techniques.

Adult↗
PubMed2000

The rate of hydrocele perforation during vasectomy. Is perforation dangerous?

BACKGROUND: Hydroceles are not uncommon, are often occult, and may be associated with an inguinal hernia. The rate of hydrocele perforation during elective vasectomy has not been reported in the medical literature. Our objective was to estimate the frequency and consequences of hydrocele perforation incidental to vasectomy. METHODS: We retrospectively reviewed data from a series of patients undergoing vasectomy using the no-scalpel technique for the incidence of complications. A supplementary chart review was done to determine preoperative conditions, and telephone contacts were made if needed to assess later morbidity. RESULTS: We noted 7 perforations in 150 vasectomies. Only one patient had a hydrocele documented preoperatively. Three had histories of inguinal hernia and herniorrhaphy. Five patients had evidence of minor swelling early on, but none had additional morbidity or long-term associated complications. CONCLUSIONS: This small case series of vasectomies had a 4.7% incidence rate of perforated small or occult hydroceles. Physicians should be aware of this potentially alarming but apparently minor phenomenon that may accompany vasectomy.

Acute Disease↗
PubMed2001

[Resurgence of vein perforation surgery: SEPS (subfacial endoscopic perforator surgery)].

The treatment of venous ulcers is a challenge even in this era of modern medicine. The role of incompetent perforating veins in the pathophysiology of venous ulcers has been well documented. Open surgical interruption of incompetent perforating veins (Linton's procedure) may be complicated by important wound healing problems, and has never gained widespread acceptance as a first choice treatment. Recently, an endoscopic technique of subfascial interruption of perforating veins has been developed. This new procedure, with smaller scars and faster recovery, gives promising midterm results. The authors summarize their initial experience with subfascial endoscopic perforating surgery (SEPS) during the last three years (25 cases). They obtained ulcer healing in all cases. At 16 month follow-up, 88% of patients remain ulcer free. Three patients developed a new minor ulceration in the era of lipodermatosclerosis. This less invasive technique is a promising tool in the management of patients with venous ulcer disease.

Endoscopy↗
PubMed2005

Identification and sequencing of Salmonella enterica serotype typhi isolates obtained from patients with perforation and non-perforation typhoid fever.

We describe the characterization of Salmonella enterica serovar Typhi, isolated from the blood of patients with perforation and non-perforation typhoid fever, by a combination of conventional microbiological tests, 16S rRNA gene sequencing, and flagellin gene and CDP-tyvelose epimerase (rfbE) gene sequencing. The 16S rRNA gene sequencing showed that there were four base mutations from perforation samples and only three from non-perforation samples. These findings indicated that the isolates were a strain of Salmonella enterica. The flagellin gene sequences from the two groups were 100% identical to that of the H1-d flagellin gene of serovar Typhi. Sequences of the rfbE from both groups were also 100% identical.

Adolescent↗
PubMed1989

Ehlers-Danlos syndrome complicated by eventration of the diaphragm, colonic perforation and jejunal perforation--a case report.

A case of a 61 year old woman with Ehlers-Danlos syndrome who developed recurrent gastrointestinal complications is reported herein. She has been followed by Kyoundo Hospital since 1965, when she originally underwent treatment for eventration of the diaphragm and a volvulus of the stomach at the age of 41. During the past 22 years she has experienced perforation of the colon three times and jejunal perforation once. This case was considered to be type II Ehlers-Danlos syndrome. We have found 12 other cases of Ehlers-Danlos syndrome with gastrointestinal complications in the Japanese literature. More thorough examination of Ehlers-Danlos syndrome cases may reveal more subclinical gastrointestinal abnormalities. We concluded from our experience and from the literature that when colonic perforation occurs in this syndrome, total colectomy and ileo-rectal anastomosis is reasonably indicated.

Adult↗
PubMed2000

Ileal perforation due to a Richter hernia at the drain insertion site following an operation for idiopathic rectal perforation: report of a case.

A case of a Richter hernia at the insertion site of the drainage tube following open abdominal surgery is reported. A 54-year-old man underwent an emergency operation for an idiopathic rectal perforation. A partial resection of the rectum and drainage using four 10-mm (outer diameter) drainage tubes with round cross sections was performed. Despite an uneventful early postoperative course, an emergency reoperation was required for peritonitis due to a bowel perforation 14 days after removing the drain inserted into the rectosacral space. A laparotomy revealed an incarcerated Richter hernia with ileal perforation through the 10-mm drainage site. The postoperative course after a partial resection of the ileum and drainage with Penrose drains was uneventful. This is the first report of a Richter hernia through the insertion site of a drainage tube in abdominal surgery. The possible occurrence of a Richter hernia in cases with postoperative drainage using large-size round drainage tubes should thus be considered in such patients.

Drainage↗
PubMed1992

Small bowel perforation associated with intraperitoneal and extraperitoneal bladder perforation caused by stab wound to the penis.

We report an unusual case of small bowel and bladder perforation caused by a stab wound to the penis with preservation of intact corporeal penile bodies and urethra. Diagnosis of bladder perforation was made by the urethrogram and diagnosis of small bowel perforation was made by clinical signs even though the initial physical examination suggested neither of these conditions.

Adult↗
PubMed1979

[Colonic perforation with special reference to spontaneous ileo-colic perforation].

Aetiology of colonic perforation is reviewed and discussed. 8 cases of "spontaneous" ileo-colic perforations observed between 1975 and 1977 are presented. Two of these patients had recently undergone appendectomy, and 4 others showed a simultaneous distal carcinoma of the large bowel. Histo-pathological evaluation did not reveal the cause of intestinal perforation. Operative treatment and results are given.

Adolescent↗
PubMed1997

[Intestinal perforation caused by chicken bone mimicking perforated colonic diverticulitis].

Intestinal Perforation can occur in less than 1% of cases of ingestion of foreign bodies. Clinical suspicion is very important to make the diagnosis since many medical conditions can simulate this pathology. We present a case of a 63 years old man who swallowed a chicken bone that perforated the sigmoid colon and produced a clinical picture mimicking a perforated colonic diverticulitis. At surgery, the bone was removed without any evidence of abscess formation. A Hartmann procedure was performed and we reanastomosed it 3 month later. The patient followed an uneventful postoperative course. We demonstrated that early detection and opportune surgical treatment decrease the risk of developing complications such as abscess formation, intestinal fistula or obstruction.

Animals↗
PubMed1999

Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: lessons learned from the North American subfascial endoscopic perforator surgery registry. The North American Study Group.

PURPOSE: The safety, feasibility, and early efficacy of subfascial endoscopic perforator surgery (SEPS) for the treatment of chronic venous insufficiency were established in a preliminary report. The long-term clinical outcome and the late complications after SEPS are as yet undetermined. METHODS: The North American Subfascial Endoscopic Perforator Surgery registry collected information on 148 SEPS procedures that were performed in 17 centers in the United States and Canada between August 1, 1993, and February 15, 1996. The data analysis in this study focused on mid-term outcome in 146 patients. RESULTS: One hundred forty-six patients (79 men and 67 women; mean age, 56 years; range, 27 to 87 years) underwent SEPS. One hundred and one patients (69%) had active ulcers (class 6), and 21 (14%) had healed ulcers (class 5). One hundred and three patients (71%) underwent concomitant venous procedures (stripping, 70; high ligation, 17; varicosity avulsion alone, 16). There were no deaths or pulmonary embolisms. One deep venous thrombosis occurred at 2 months. The follow-up periods averaged 24 months (range, 1 to 53 months). Cumulative ulcer healing at 1 year was 88% (median time to healing, 54 days). Concomitant ablation of superficial reflux and lack of deep venous obstruction predicted ulcer healing (P <.05). Clinical score improved from 8.93 to 3.98 at the last follow-up (P <. 0001). Cumulative ulcer recurrence at 1 year was 16% and at 2 years was 28% (standard error, < 10%). Post-thrombotic limbs had a higher 2-year cumulative recurrence rate (46%) than did those limbs with primary valvular incompetence (20%; P <.05). Twenty-eight of the 122 patients (23%) who had class 5 or class 6 ulcers before surgery had an active ulcer at the last follow-up examination. CONCLUSIONS: The interruption of perforators with ablation of superficial reflux is effective in decreasing the symptoms of chronic venous insufficiency and rapidly healing ulcers. Recurrence or new ulcer development, however, is still significant, particularly in post-thrombotic limbs. The reevaluation of the indications for SEPS is warranted because operations in patients without previous deep vein thrombosis are successful but operations in those patients with deep vein thrombosis are less successful. Operations on patients with deep vein occlusion have poor outcomes.

Adult↗
PubMed2001

Successful breast reconstruction with a perforator to deep inferior epigastric perforator flap.

The authors report their experience with deep inferior epigastric perforator (DIEP) flap breast reconstruction in which an unusual recipient site was used. Successful anastomosis between a suitable perforating vessel from the internal mammary axis and the deep inferior epigastric bundle was performed, and the advantages of this alternative recipient site (perforator to the DIEP flap) are examined.

Anastomosis, Surgical↗
PubMed1990

[Corneal wound healing after perforating and non-perforating excimer laser keratectomy. An experimental study].

For clinical use of the excimer laser more detailed knowledge of corneal wound healing is necessary. With an ArF excimer laser (193 nm, 750 mJ/cm2, 20 Hz) and a special slit mask system perforating and non-perforating keratectomies were performed in a series of 55 rabbits with a follow-up from one hour to six months post-op. After enucleation the corneas were immediately processed for light microscopy, scanning and transmission electron microscopy and vital staining of the endothelium (trypan blue/alizarin red S). In perforating cuts the endothelial reaction consists of polymegathism, migration, formation of multi-nucleated giant cells, metaplasia-like proliferation and ultimately stable reformation of the cell pattern (1h to 42d). Epithelium fills the anterior wound gap within three days with subsequent regression of the plug. Fibroblastic activity in the adjacent stroma leads to cellular immigration, production of new collageneous lamellae and complete reorganization of the wound cleft (1d to 6m). Nonperforating excisions showed similar healing tendency of stroma and epithelium, but no severe endothelial damage could be detected. Compared with former studies using knife incisions our results do not reveal significant difference regarding epithelial and stromal wound healing events. The encouraging healing tendency of the endothelium--similar to regeneration after ultrasound and Nd:YAG-laser damage--also confirms the applicability of excimer lasers in corneal surgery.

Animals↗
PubMed1997

Esophageal perforation and caustic injury: management of perforated esophageal cancer.

Perforation of esophageal cancer is an unusual complication that most often results from instrumentation. The management of this condition must be individualized on the basis of the patient's condition and the stage of the cancer. For patients who are otherwise well and have localized disease, a standard resection is performed. Stent placement and esophageal exclusion are sometimes used for patients in good condition but in whom resection is not feasible. Supportive care alone is reserved for patients who have end-stage disease or are otherwise not candidates for aggressive therapy. Although the overall mortality rate is 50%, the risk for patients who undergo resection is less than 10%. This risk is similar to that found in patients undergoing elective resection and supports the concept that aggressive therapy should be pursued in highly selected patients with perforated esophageal cancers.

Esophageal Neoplasms↗
PubMed1989

[Incidence of recurrence following surgery of perforating and non-perforating complications in Crohn disease].

From 1980-1987 131 patients were operated for Crohn's disease. Among these 73 patients had perforated (PC) free perforation, abscess, fistula, and 47 had nonperforating complications (NC). Ileums, bleeding, stenosis reoperations (58 pts, 44%) were seen more often in the PC-group (57%) compared to 31% in the NC-group. Furthermore there was a high concordance in the indication for the initial and subsequent operations.

Adult↗
PubMed1988

[Perforations of the small intestine and intestinal parasitic diseases. Apropos of a case of peritonitis caused by the perforation of the small intestine combined with Taenia saginata infection].

A case is reported of peritonitis from perforation of the small intestine found on operation to be due to Taenia saginata. A review of the relevant literature of the last 20 years failed to find many similar cases, parasites, particularly Taenia being an exceptional direct cause of perforation. In the case reported, however, a direct cause/effect relation is highly probable.

Adult↗