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At least 145 records · Page 8Linked to original sources
PubMed2006

Intacs adjustment surgery for keratoconus.

PURPOSE: To describe the visual outcome of keratoconic eyes managed with Intacs (Addition Technology, Inc.) that required additional Intacs surgery (defined as any combination of removal, exchange, addition, or shifting of an Intacs segment). SETTING: Private refractive surgery center, Jerusalem, Israel. METHODS: This retrospective noncomparative interventional consecutive small case series studied all eyes of a cohort of 58 keratoconic eyes managed with Intacs that had additional Intacs surgery. The uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity, manifest refraction, videokeratography, and patient questionnaires on visual function were assessed. These outcome measures were compared before Intacs implantation, before Intacs adjustment, and 1 year after the final Intacs adjustment. Eyes having any intervention other than Intacs surgery were excluded. RESULTS: Of 58 keratoconic eyes managed with Intacs, 7 had additional Intacs surgery. After the initial Intacs surgery, 6 of these eyes had UCVA < or =20/100 and 1 had UCVA of 20/50. After the final Intacs adjustment, 3 eyes achieved UCVA > or =20/40, 5 achieved UCVA > or =20/70, and 2 remained <20/200. The indications for Intacs adjustments were increased astigmatism in 4 eyes, induced hyperopia (overcorrection) in 3, and undercorrection in 1. One eye had both surgically induced astigmatism and hyperopia. Induced astigmatism and hyperopia were most often managed by removing the superior segment. The undercorrected eye, having initially received a single inferior segment, was treated by implanting a superior segment. CONCLUSIONS: Approximately 10% of keratoconic eyes managed with Intacs may require Intacs adjustment surgery, which often has a good outcome.

Adult↗
PubMed2006

The use of prostheses in skeletally immature patients.

Prosthetic reconstruction in the skeletally immature patient is challenging because of the necessity to cope with expected disruption of limb growth after resection of one or more major growth plates and the high demands placed on implants by young patients. Although prosthetic reconstruction in children is fraught with many problems, it is usually possible to obtain a good functional limb at skeletal maturity. Extendable prostheses are readily acceptable to patients and their parents. The availability of noninvasive extendable prostheses is expected to lead to fewer complications, fewer surgical interventions, and even improved function. This article reviews the indication, evolution, and clinical and functional results of extendable endoprostheses, drawing from experience in the last 30 years of using such prostheses in children.

Adolescent↗
PubMed2006

Targeted reinnervation for improved prosthetic function.

Target motor reinnervation can produce additional myoelectric control signals for improved powered prosthesis control. This reinnervation allows simultaneous operation of multiple functions in an externally powered prosthesis with physiologically appropriate pathways, and it provides more intuitive control than is possible with conventional myoelectric prostheses. Target sensory reinnervation has the potential to provide the sensory feed-back to the amputee that feels like it is in the missing limb. This concept has great potential for improving the function of people with upper limb amputations, especially for high-level amputations, in which the disability is greatest. It is hoped that future research will develop the technique further and build synergistically with other exciting research areas.

Amputation, Surgical↗
PubMed2006

Pediatric prosthetics: an update.

The present and the future in pediatric prosthetics are bright as a result of ongoing development of new components, materials, and techniques. The focus of clinicians, therapists, and researchers should be to determine the best way of matching components, techniques, and socket designs to the dynamic needs of the child as he or she develops from infant to adult.

Amputation, Surgical↗
PubMed2006

Progressive upper limb prosthetics.

The field of upper extremity prosthetics is a constantly changing arena as researchers and prosthetists strive to bridge the gap between prosthetic reality and upper limb physiology. With the further development of implantable neurologic sensing devices and targeted muscle innervation (discussed elsewhere in this issue), the challenge of limited input to control vast outputs promises to become a historical footnote in the future annals of upper limb prosthetics. Soon multidextrous terminal devices, such as that found in the iLimb system(Touch EMAS, Inc., Edinburgh, UK), will be a clinical reality (Fig. 22). Successful prosthetic care depends on good communication and cooperation among the surgeon, the amputee, the rehabilitation team, and the scientists harnessing the power of technology to solve real-life challenges. If the progress to date is any indication, amputees of the future will find their dreams limited only by their imagination.

Amputation, Surgical↗
PubMed2005

Fabrication of a craniofacial implant surgical and treatment planning guide.

A procedure is described to fabricate a surgical guide to assist in the placement of craniofacial implants for prosthetic auricular rehabilitation. An impression is made of the defect, and a wax pattern of the missing ear is completed and evaluated on the patient. The definitive wax prosthesis is processed in acrylic resin. An occlusal maxillary splint is also fabricated. The occlusal splint and the acrylic resin ear are joined together using an extraoral acrylic resin bar. The resulting surgical guide provides proper orientation of the acrylic resin ear while remaining securely attached to the maxillary arch. This surgical guide can also be utilized for pretreatment radiographic examination.

Acrylic Resins↗
PubMed2006

Rotationplasty--a unique surgical procedure with a functional outcome.

ROTATIONPLASTY is a surgical procedure that may be appropriate for children with severe congenital femoral deficiency or children with malignant tumors of the femur or proximal tibia. OSTEOTOMIES AND RESECTION of the femur and tibia are performed, allowing the patient's foot to be rotated 180 degrees and reattached while preserving the nerves, muscles, and blood supply. THE POSTERIOR-FACING FOOT functions as the patient's knee joint in a specially fitted prosthesis. Although the outcome is visually unusual, for some children, regaining function and physical capabilities outweighs cosmetic concerns. The surgical procedure is technically challenging and requires a multidisciplinary approach.

Artificial Limbs↗
PubMed2000

Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops.

Part of the complexity of mitral valve chordal replacement with expanded polytetrafluoroethylene (ePTFE) sutures is determining the correct replacement chordal length and knotting the ePTFE suture without sliding the knot. We describe a technique of measuring the required chordal length and making a "premeasured" Gore-Tex chordal loop that abolishes problems of inadvertently altering chordal length during fixation. This improves the reproducibility of chordal replacement surgery, and can be used both via conventional and minimally invasive approaches.

Chordae Tendineae↗
PubMed2002

Simplified technique for determining the length of artificial chordae in mitral valve repair.

Artificial chordal replacement using polytetrafluoroethylene sutures has become an established component in the technique for mitral valve replacement with good long-term results. Although various techniques have been described to determine the length of the artificial chordae, this has remained somewhat problematic. A neo-chordae that is too short will, in effect, result in a restricted leaflet movement. A neo-chordae that is too long will be ineffective in controlling leaflet prolapse.

Chordae Tendineae↗
PubMed1999

Fabrication and use of a surgical template for placing implants to retain an auricular prosthesis.

A procedure is described for the fabrication of a 3-dimensional surgical template to guide the placement of implants to retain an auricular prosthesis. This procedure requires a diagnostic wax pattern that is checked while on the patient to ensure it is positioned correctly and is also the correct size. The wax pattern is processed into a clear, methyl methacrylate resin, 3-dimensional surgical template. The most effective type of surgical template for planning implant placement is a 3-dimensional acrylic template that closely resembles the final prosthesis. This template will direct the implant placement where the retentive elements are most easily concealed, under the thickest areas of the prosthesis, which are the antihelix and antitragus. This location allows the best esthetic and functional results. An additional advantage of this technique is that it allows the retrieval of the diagnostic wax pattern of the auricle so that it can be used to fabricate the definitive prosthesis.

Ear, External↗
PubMed1998

Porous polyethylene orbital implant in patients with retinoblastoma.

OBJECTIVE: The purpose of the study was to assess integration of porous polyethylene allografts in 37 anophthalmic sockets of retinoblastoma enucleations. DESIGN: A clinical review. PARTICIPANTS: Thirty-four patients (19 female, 15 male) whose age when diagnosed with retinoblastoma ranged from 1 to 72 months participated. Sixteen patients had unilateral retinoblastoma and 18 had bilateral retinoblastoma. INTERVENTION: Enucleation (3 bilateral, 31 unilateral) with implantation of a porous polyethylene (PP) sphere (16-20 mm in diameter) was performed. Of the 37 spheres, 34 were primary implants and 3 were secondary implants. In the eight patients with postimplantation exposure, the PP implant had to be removed. MAIN OUTCOME MEASURES: Data on eight sockets with exposed PP implant were measured. RESULTS: There were no implant extrusions, but conjunctival dehiscence-exposure occurred in eight patients (21.6%). In 3 of 37 sockets, the volume replacement was not good, and in 5 cases, fornices were too shallow to accommodate a well-fitting prosthesis. In all but one socket, the overall cosmesis was graded subjectively from acceptable (grade 2) to excellent (grade 3). CONCLUSIONS: Although the PP implant is a useful and a less-expensive alternative to hydroxyapatite in the porous matrix implant category, if conjunctival exposure takes place, the implant presents a serious management problem because of its nonresponsiveness to medical and surgical treatments.

Biocompatible Materials↗
PubMed1999

Benefits of stereolithography in orbital reconstruction.

OBJECTIVE: To describe the benefits of the stereolithography (SLA) modeling system in the evaluation and surgical planning of selected bony orbital pathology. DESIGN: Two case reports. PARTICIPANTS: One patient presented with a displaced left orbital roof fracture into his orbit causing globe compression and binocular vertical diplopia. A second patient underwent removal of his right orbital floor, medial wall, and inferior portion of his lateral wall during excision of a cylindrical cell papilloma of the paranasal sinuses. Postoperatively, he suffered from globe ptosis and binocular oblique diplopia. INTERVENTION: Stereolithographic models of the patients' orbits were obtained from computed tomography data to better assess the bony orbital pathology. In the second patient, the model was used as a template to create a temporary custom fit prosthesis to repair the defect of his orbital walls. RESULTS: The SLA models were useful in evaluating the dimensions of the bony defects and in preoperative surgical planning. Intraoperatively, the SLA models facilitated orbital surgical rehabilitation. Postoperatively, both patients noted resolution of their diplopia after reconstruction of more normal bony anatomy. CONCLUSIONS: In selected cases, SLA offers highly accurate models of the bony orbit for preoperative evaluation, surgical planning, and teaching and can act as a template for custom prosthesis manufacturing. This technology increases the orbital surgeon's options in managing complex orbital pathology.

Accidents, Traffic↗
PubMed1998

Transcatheter occlusion of atrial septal defects: an initial experience with the Amplatzer septal occluder.

OBJECTIVE: To discuss the initial experience with the use of a new double disc occluding device, the Amplatzer septal occluder in transcatheter occlusion of secundum atrial septal defects (ASD). METHODS: Transvenous sizing of secundum ASD was performed in five children under general anaesthesia using transoesophageal echocardiographic and fluoroscopic guidance. An Amplatzer septal occluder equal to or minimally larger than the stretched diameter of the ASD was used for transcatheter occlusion of the defect in three suitable patients. Pulmonary balloon valvuloplasty with a 18 mm x 3 cm Mansfield balloon catheter was carried out in one patient with associated pulmonary valvar stenosis in the same procedure setting. RESULTS: Stretched diameters of the defects in the three patients ranged from 14 to 17 mm. Devices of sizes 14, 17 and 17 were deployed through 7F and 8F sheaths, respectively. The upper and lower rims of interatrial septum were more than 8 mm in all patients. All patients had successful occlusion with complete obliteration of the atrial left to right shunting. Simultaneous pulmonary balloon valvuloplasty for the valvar stenosis reduced pressure gradient from 53 mmHg to 22 mmHg across the valve prior to septal occlusion in one patient. No intraprocedural or short-term complication was encountered. CONCLUSIONS: The design of the Amplatzer septal occluder permits ease in loading, delivery, deployment and stable seating of the device. This initial experience shows that Amplatzer device occlusion is feasible, relatively safe and effective and appears to be a viable alternative to surgical closure of secundum atrial septal defects in properly selected patients.

Cardiac Catheterization↗
PubMed2002

Closed-field titanium magnets for the retention of complex craniofacial prostheses.

Where reconstruction with autogenous tissue is contraindicated in craniofacial reconstruction, or declined by the patient, a prosthesis may be used. Originally made from latex, cellulose or acrylic resins, prostheses are now largely made of silicone. These prostheses were traditionally retained using adhesives, natural undercuts at retention sites or spectacles. However, these methods were unsatisfactory because of frequent loss of retention, skin reactions to adhesives or unnatural movements of the prosthesis. Osseointegration became a popular method of prosthesis retention, initially using a bar-and-clip device. The use of a bar attached to the implant has certain shortcomings, however, including rigidity of the prosthesis and the difficulty in maintaining hygiene at the implant site. We present our experience with the use of magnets to hold the prosthesis in place, which allows ease of use, improved hygiene and a more natural mobility of the prosthesis.

Adolescent↗
PubMed1999

Digital prostheses for single finger amputations.

After amputation digital prostheses are infrequently used. With modern methods of fabrication both cosmetic and functional use are now possible. We have assessed the use of single digit prostheses in a district general hospital setting.

Adult↗
PubMed2002

[Rectusbanding by polypropylene-mesh--a new method for incisional hernia repair].

We report on a new method of incisional hernia repair applicable to any size. With exception of an area 1 cm medial of the m. rectus abdominis where the strip penetrates the anterior wall of the rectus sheath for a better fixation, the muscle ist looped in a loose way with a 2 cm wide band of polypropylene (Prolene(R)) on both sides at a distance of 2 cm depending on the size of the hernial opening. Different models of strips were used in 27 % of the cases adapted to anatomical particularities of the hernial opening. Anterior and posterior wall of the rectus sheath are closed by a continuous panacryl suture which covers the strip. Because of the wide subcutaneous excavation extending to the lateral margin of the rectus sheath an extensive drainage by Redon-Drainages as well as compression bandages are important therapeutical procedures until formation of seromas has finished. For perioperative antibiotic prophylaxis we used Cefuroxime (3 x 1,5 i. v.). From 07/1999 until 10/2001 75 patients underwent an operation in our department. The direct postoperative complications observed were: Seroma formation up to 300 ml after discharge in 5 patients (6,6 %) and wound infections in 2 patients (2,8 %). In none of the cases the mesh had to be removed. In a follow-up period of 6 to 24 months we found 2 recurrences in 60 patients (3,3 %). These were related to technical failures of the beginning. 64.9 % of the patients were free of complaints after 6 months and almost 96 % after one year. Only 3 patients (4 %) had to take analgetic drugs occasionally. With regard to the mobility of the abdominal wall we found no measurable limitation. The method of Rectusbanding is easy to learn for every surgeon and with little material the mesh-strip can be fixed safely. It can be cut to individual sizes and shapes adapted to the fascial proportions of the hernial opening.

Adult↗