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At least 145 records · Page 8Linked to original sources
PubMed1980

Wall reinforcement with highly porous Dacron mesh in aortic surgery.

Wall reinforcement with highly porous synthetic Dacron mesh was devised and evaluated in various aortic operations. Excellent attachment of the mesh to the aortic wall, good preservation of pliability of the aorta, and efficient pressure resistance with minimal scar tissue formation were the usual findings. This type fo wall reinforcement was employed in 60 patients for the following indications: 1) prevention of suture line complications; 2) wall reinforcement of aortic aneurysm without resection; 3) reinforcement of adventitia or autogenous vein following thromboendarterectomy. It is concluded that reinforcement with highly porous synthetic Dacron mesh should be superior to reinforcement with conventional prosthetic Dacron graft.

Aorta↗
PubMed2002

Cultured skin substitutes reduce donor skin harvesting for closure of excised, full-thickness burns.

OBJECTIVE: Comparison of cultured skin substitutes (CSS) and split-thickness skin autograft (AG) was performed to assess whether donor-site harvesting can be reduced quantitatively and whether functional and cosmetic outcome is similar qualitatively in the treatment of patients with massive cutaneous burns. SUMMARY BACKGROUND DATA: Cultured skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been shown to close full-thickness skin wounds in preclinical and clinical studies with acceptable functional and cosmetic results. METHODS: Qualitative outcome was compared between CSS and AG in 45 patients on an ordinal scale (0, worst; 10, best) with primary analyses at postoperative day 28 and after about 1 year for erythema, pigmentation, pliability, raised scar, epithelial blistering, and surface texture. In the latest 12 of the 45 patients, tracings were performed of donor skin biopsies and wounds treated with CSS at postoperative days 14 and 28 to calculate percentage engraftment, the ratio of closed wound:donor skin areas, and the percentage of total body surface area closed with CSS. RESULTS: Measures of qualitative outcome of CSS or AG were not different statistically at 1 year after grafting. Engraftment at postoperative day 14 exceeded 75% in the 12 patients evaluated. The ratio of closed wound:donor skin areas for CSS at postoperative day 28 was significantly greater than for conventional 4:1 meshed autografts. The percentage of total body surface area closed with CSS at postoperative day 28 was significantly less than with AG. CONCLUSIONS: The requirement for harvesting of donor skin for CSS was less than for conventional skin autografts. These results suggest that acute-phase recovery of patients with extensive burns is facilitated and that complications are reduced by the use of CSS together with conventional skin grafting.

Burns↗
PubMed1993

Intrinsic connections between representation zones in the cat motor cortex.

The functional organization of intrinsic connections in the cat motor cortex was examined by combining intracortical microstimulation with neuroanatomical tracers. After single injections of a dye into a cortical site from which wrist flexion was evoked, clusters of retrogradely labeled somata and of anterogradely labeled axon terminals were found throughout the forelimb representation zones. These intrinsic connections rarely involved representation zones of the hindlimb or the face musculature. These data indicate that extensive intracortical connections mediate reciprocal synaptic interactions among groups of cells involved in the execution of different movement segments. These clustered, horizontal connections may be used for coordinating the activity of different cortical representations for the execution of complex movements, and may also be involved in the pliability of motor representation maps.

Animals↗
PubMed1995

The vascularized temporoparietal fascial flap for correction of the deep superior sulcus.

The deep superior sulcus is one of the more difficult problems to correct in the enophthalmic or anophthalmic orbit. Multiple procedures as well as materials have been proposed in recent years to address the cosmetic deformity. These methods have used a number of alloplastic and autogenous materials. Ideal correction of a soft tissue deformity uses well-vascularized autogenous tissue. This paper introduces the use of the temporoparietal fascial flap for correction of the deep superior sulcus. The advantages of this flap over other materials lies in its pliability, vascularity, thinness, ease of mobilization, and minimal subsequent donor site morbidity or deformity.

Adult↗
PubMed1977

Physiology of aging: metabolic changes during the climacteric and menopausal periods.

Endocrine regulation is altered with age. Changes in hormone secretory rates, patterns of secretion, and responses to physiologic and pharmacologic stimuli have been demonstrated. Target tissue sensitivity to hormones appears to be age related and to involve hormone receptor mechanisms, enzymatic responses, and carrier proteins. The aging process reflects changes in cellular structure and metabolism that decrease the function and efficiency of tissues. Structural changes occur with age and are characterized by a loss of elastic tissue, accumulation of highly crosslinked collagen, reduction in ground substance, and an increase in a cellular fluorescent pigment called lipofuscin. These changes decrease the pliability of tissues and alter membrane permeability. Modifications in protein synthesis and enzymatic systems may predispose the aged to autoimmune and neoplastic disease. Endocrine diseases are common in the aged and often may be atypical in their presentation. Cancer is common in the elderly and may be associated with endocrine manifestations because the tumor is producing hormones. Physicians must be aware of these syndromes so that a correct diagnosis can be established, treatment instituted, and the quality of life improved. Laboratory test results in the aged must be carefully interpreted because most aged patients are taking medications that interfere with endocrine tests and also the normal range for the elderly has not been clearly established. Abnormal laboratory diagnostic tests are common in the aged and do not always imply endocrine disease. No hormone can reverse the natural process of aging; however, hormones do regulate all metabolic functions and the neuroendocrine system plays a key role in all phases of growth, maturation, and aging.

Adrenal Gland Diseases↗
PubMedDate not supplied

Rating the burn scar.

A reliable, objective, and universal method of assessing burn scars does not exist in today's burn literature. Such a method is necessary to provide a descriptive terminology for the comparison of burn scars and the results of treatment. The method should be applicable to patients both within an institution and between burn centers. A burn scar assessment has been devised based on physical parameters. These relate to the healing and maturation of wounds, cosmetic appearance, and the function of the healed skin. Pigmentation, vascularity, pliability, and scar height are assessed independently, with increasing score being assigned to the greater pathologic condition. Normal skin has a score of 0. Seventy-three patients were assessed by three separate occupational therapists and the findings subjected to statistical analysis for interrater reliability. For each parameter a Cohen's kappa statistic of approximately 0.5 +/- 0.1 indicates a statistically significant agreement between observers. These values were found to improve with time. This appears to be a useful tool for the assessment of burn scars, allowing objective comparison of the same scar by different observers.

Adolescent↗
PubMedDate not supplied

Photographic measurement of volar forearm skin movement with wrist extension: the influence of elbow position.

An important function of skin is to allow joint range of motion to occur. An assumed clinical relationship exists between joint movement and skin pliability. The purpose of this research was to document skin movement of the forearm and wrist with photography, to quantify the amount of skin movement during wrist extension, and to investigate the influence of elbow positions on forearm skin movement. Twenty volunteers had markings placed on the skin of the volar forearm. Each subject performed the motion of wrist extension in two elbow test positions of flexion and extension. Photographs were taken of the skin markings at the beginning and end of wrist extension. A significant difference was found in the amount of forearm skin movement that occurred when the elbow was extended and flexed (p < 0.001). These results substantiate the use of multijoint range of motion during burn rehabilitation.

Adult↗
PubMedDate not supplied

A prospective study of burn scar maturation in pediatrics: does age matter?

A prospective study was performed to determine whether patterns of burn scar maturation varied among different pediatric age groups. Patients were divided into three groups according to age at the time of burn injury: birth to 3 years, 4 to 11 years, and 12 to 18 years. Scarring of sheet grafts on an extremity was assessed throughout the maturation process in three areas: vascularity, pliability, and height. A 1-inch square was selected on the graft edge adjacent to unburned skin. Two experienced therapists independently evaluated the test area and averaged their scores. There were no significant differences in rate of scar maturation between age groups. Burn scar maturation of sheet skin grafts in the pediatric patient with burns demonstrated a rapid peak of scarring (1 to 2 months) and scar maturation (9 to 13 months).

Adolescent↗
PubMedDate not supplied

Acellular allodermis in burns surgery: 1-year results of a pilot trial.

We grafted 10 sites on 6 children with limited (< 25%) areas of body surface available for donor harvest with an acellular allogenic dermis and a thin autograft. Matched control sites were grafted with autograft alone. Study site autografts (0.0074 +/- 0.0007 in, median 0.006 in, range 0.006 to 0.012 in) were thinner than control site autografts (0.0102 +/- 0.0008 in, median 0.012 in, range 0.006 to 0.013 in), with a P value of .015. Endopoints were initial engraftment (in percent) as judged by a blinded experienced observer and Vancouver scar scores. The 6 children (3 girls and 3 boys) had an average age of 5.2 +/- 0.9 years (range 2.8 to 10 years) and an average burn size of 68.7% +/- 6.7% total body surface area (range 47% to 85% total body surface area). The 10 study and control sites were treated with 10 separate procedures; 9 of the procedures were reconstructive and 1 was performed for the excision of an acute burn. Successful initial epithelialization was noted at 7 days postburn for 83% +/- 3.4% (range 60% to 95%) at the cryopreserved acellular human dermis sites and 83.3% +/- 4.3% (range 60% to 98%) at the control sites (not significant, P = .96). At a mean follow-up interval of 43.7 +/- 3.6 weeks (median 52, range 26 to 52 weeks), the differences between the study and control sites in the total mean (pigmentation, vascularity, pliability, and height) of the patients' Vancouver scar scores were not different.

Burns↗
PubMedDate not supplied

Scar assessment: current problems and future solutions.

Current problems in the assessment of scars are discussed. The concept of subjective and objective aspects of scar assessment is introduced. The patient's own view of the scar (the subjective component) can currently be assessed and may be very influential in determining the patient's quality of life, irrespective of the actual physical characteristics of the scar. The objective aspects of the scar, including size, shape, texture, and pliability, are currently difficult to measure. Although the Vancouver Scar Scale has been used as the standard for objective measurements, there are problems with both the validity and reliability of this instrument. Various imaging techniques may permit more reliable and accurate methods for measuring the quantitative aspects of scars.

Burns↗
PubMedDate not supplied

Evaluation of nondistended pyriform sinus without respiratory maneuvers.

Detection of a nondistended pyriform sinus on cross-sectional imaging studies represents a diagnostic dilemma. The finding may be an inconstant physiologic phenomenon without clinical significance, or it may be due to tissue thickening and lack of pliability related to neoplasia or inflammation. Rescanning during respiratory maneuvers may clarify the anatomy, but full patient cooperation is needed. We demonstrate a method (turning the patient's head away from the side of the nondistended sinus) that induces distention of the pyriform sinus but does not require active patient participation.

Adult↗
PubMed1981

The right iliac fossa squelch sign: a marker of the irritable bowel syndrome.

The right iliac fossa squelch sign, not previously associated with the irritable bowel syndrome, is found in over one-third of patients at diagnosis. It is found in one-quarter of patients who have not improved at follow-up, but is virtually absent in those who have improved. It is also found in patients with active regional enteritis. Fluid feces passing through bowel of decreased pliability may be the factor which allows elicitation of the sign.

Adolescent↗
PubMed1996

Transplantation of cryopreserved cultured epidermal allografts.

OBJECTIVE: To optimize cryopreservation methods for cultured epidermal allografts (CEAs) for transplantation onto wounds. DESIGN: Conditions were determined to optimize the cryopreservation of CEAs. Cryopreserved CEAs were then grafted onto 16 donor sites in a double blind randomized trial. MATERIALS AND METHODS: CEAs were grown in culture. Viability of cryopreserved CEAs was determined by: 1) trypan blue dye exclusion; 2) histology; 3) flow cytometry; and 4) acid lipase activity. Cryopreserved CEAs were grafted onto 16 donor sites. Wound healing assessments included 1) visual assessment of healing; 2) histologic assessment of re-epithelialization and differentiation; and 3) visual scar assessment. MEASUREMENTS AND MAIN RESULTS: CEAs were cryopreserved using a controlled rate freezer with an experimentally determined setting of -7 degrees C for the CEA freezing point. Such freezing conditions resulted in retention of approximately 92% of the original viability, no loss in basal keratinocytes as determined by flow cytometry, and no change in acid lipase activity. CEAs cryopreserved according to this method were grafted onto 16 donor sites in a double blind randomized trial. All donor sites underwent complete healing. Histologic examination of biopsies taken from the center of the wound beds showed that CEA-treated wounds significantly accelerated the rate of re-epithelialization (7.8 +/- 0.6 days vs. 9.2 +/- 0.9 days for CEA- and control-treated wounds, respectively; p = 0.039) and epithelial differentiation (p = 0.023) compared with control sites. Longterm results showed that CEA-treated wounds were comparable to control sites with regard to: 1) pigmentation; 2) scar height; 3) scar pliability; 4) vascularity; and 5) pain. Wounds treated with cryopreserved CEAs remained durable and not prone to blistering after healing. CONCLUSIONS: CEAs can be successfully cryopreserved for long-term storage. Upon retrieval from storage, CEAs may be used to treat partial thickness wounds.

Adult↗
PubMed1998

A newly developed shunt system for carotid surgery: T-shaped silicone shunt tubes and clamping devices: technical note.

BACKGROUND: Although the use of a shunt during carotid endarterectomy has been controversial, a convenient shunt system is still required. METHODS: We have devised an intraluminal shunt system, T-shaped silicone shunt tubes, and clamping devices for carotid surgery. The tube has enough pliability and length to be used in a looped or U-shaped mode and constructs a T-shape with a side arm available for monitoring blood pressure in the shunt system. Clamping devices, such as modified Sugita ring clips and encircle type bulldog clamps, make it possible to hold the tube by a simple maneuver and to minimize the intimal damage. RESULTS: This shunt system has been used in 170 carotid endarterectomies and other 10 carotid surgical operations, and the mortality and morbidity rates were 0% and 2.4%, respectively. CONCLUSION: This shunt system can be safely and easily used for cervical carotid surgery.

Brain Ischemia↗
PubMed1983

Clinical experience with polydioxanone monofilament absorbable sutures in plastic surgery.

Various sizes of undyed monofilament polydioxanone surgical suture were assessed in 52 surgical patients who underwent plastic surgery. With a single exception, follow-up observations were carried out for at least 40 days. Clinical results were judged satisfactory in 13 patients and excellent in 39 patients. The suture was found significantly better than gut in terms of pliability, ease of passage through tissue, ease of tying, strength, fray resistance, and overall handling properties. The undyed suture material tested in this study was rated as having inferior visibility when compared with surgical gut. This new suture material, the first synthetic absorbable available as a monofilament, would appear to be particularly useful in situations requiring extended wound support, in potentially infected wounds in which a monofilament suture would have lessened tendency to harbor pathogenic bacteria, and in cases where ease of passage through tissue, smooth tie-down, and precise knot placement are important.

Absorption↗
PubMed1983

The platysma musculocutaneous flap: experience with 24 cases.

The platysma musculocutaneous flap has been used in 24 patients for reconstruction in the head and neck area. In 22 patients, the superior vascular pedicle, the submental branch of the facial artery, was used, and in two other patients, the inferior pedicle, the superficial branch of the transverse cervical artery, was used. Twelve patients had reconstruction of the intraoral lining with a skin paddle on the platysma. The buccal mucosa and mandibular alveolar ridge are particularly well suited to this flap. Six patients had restoration of external skin, four had provision of both skin and lining with the same flap, and two had coverage of vulnerable structures with muscle alone. Forty-two percent of patients experienced a minor complication. Only four patients, however, required further surgery, and all 24 patients ultimately had satisfactory results. Of seven patients experiencing loss of a portion of the skin paddle, six had intraoral reconstruction. Meticulous dissection and attention to anatomic detail is necessary in raising the flap. Because of its thinness and pliability, we feel that the platysma musculocutaneous flap is an important addition to the techniques of head and neck reconstruction.

Adult↗
PubMed1994

Improving the latissimus dorsi myocutaneous flap with tissue expansion.

Although the latissimus dorsi myocutaneous flap is a safe and reliable technique for breast reconstruction, its versatility is limited when large cutaneous units are needed to resurface a heavily irradiated or scarred breast and chest wall. The thick back skin, in particular, may be unsuitable for reconstruction opposite either a hyperplastic or moderate sized but ptotic breast. Also, the likely need for a prosthesis can result in encapsulation and firmness. Expanding the latissimus flap has been suggested as a means of improving its aesthetic and reconstructive results. Indications for choosing an expanded flap in 10 patients included: (1) a need for autogenous tissue reconstruction of irradiated breast and chest wall tissues; (2) cutaneous coverage requirements that exceeded the availability of donor site skin; (3) the presence of a hyperplastic or ptotic contralateral breast that the patient preferred to match rather than alter; and (4) unavailability of an alternative flap such as a TRAM and unsuitability of an implant or expander without a flap. Results of this study in 10 patients requiring breast and chest wall reconstruction demonstrate that flap dimensions increased by approximately a factor of 1.5 after expansion. The latissimus flap was pre-expanded on the back before transfer in two patients when skin and soft tissues were inadequate, or was expanded post-transfer in eight patients for both immediate and delayed breast reconstruction. Eight patients underwent a total of two operations, including two who had nipple areolar reconstruction. Earlier in the series, two other patients had nipple areolar reconstruction performed as a third procedure. Mean follow-up was 15.1 months. Complications consisted of partial dehiscence of the donor site wound in one patient after transfer of an expanded flap measuring 16 x 28 cm; three patients developed symptomatic seromas requiring drainage. All patients had soft, nonpalpable implants and no distortion of the flap's shape. The application of tissue expansion techniques yields latissimus flaps that are notable for their capacious dimensions, thinned tissues, and improved pliability. Advantages include an avoidance of reduction or mastopexy procedures in patients with large, ptotic breasts and uncomplicated wound healing in those with a history of prior irradiation. Not all latissimus flaps need to be expanded, but some can be significantly improved when specific indications are present. Most importantly, expanded latissimus flaps appear to resist the early formation of periprosthetic encapsulation.

Adult↗
PubMed1998

The prepuce free flap: dissection feasibility study and clinical application of a super-thin new flap.

The aim of this study was to develop a free flap of the male prepuce. First, a dissection feasibility study was performed in eight male cadavers. Dissection proved feasible, and the mean surface area of the prepuce, when folded out, was 46.7 cm2. The mean pedicle length was 15 cm, with a mean diameter of the inferior external pudendal artery at its origin of 1.2 mm and a mean diameter of the inferior external pudendal vein at its origin of 1.9 mm. Next, a viability study was performed by isolating a prepuce free flap during male-to-female sex reassignment procedures. The flap as well as the residual skin of the penis shaft remained well perfused. Thereafter, the new prepuce free flap was successfully applied for the reconstruction of defects of the floor of the mouth, tongue, and oropharynx in two patients. The thinness and pliability of the flap, its large surface area, the long vascular pedicle, and the limited donor-site morbidity are the major advantages of this new flap. The possibility to raise the flap simultaneously with the tumor resection is an additional advantage. The small caliber of the flap artery seems to be the only drawback.

Aged↗