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At least 1,603 records · Page 89Linked to original sources
PubMed2004

Plastic solutions for orthopaedic problems.

INTRODUCTION: Infection and exposure of the implant may occur in 1-12% of patients operated on for arthroplasty or osteosynthesis. Variables such as tissue viability, presence of infection, exposure of osteosynthesis material and patient-related factors contribute to the lack of general consensus regarding the management of these defects. MATERIALS AND METHODS: Between January 1999 and January 2001, six patients were treated for complex soft-tissue defects following various orthopaedic procedures at the Department of Plastic Surgery in the Slotervaartziekenhuis in Amsterdam, a rheuma-orthopaedic orientated hospital. All patients were initially treated by radical debridement and vacuum-assisted closure (VAC) system of the wound. After 1 week, this was followed by transplantation of a pedicled or free flap to cover the defect. We studied the medical history, initial orthopaedic procedure, wound treatment, transplanted flap and outcome of plastic surgery in this group. RESULTS: Plastic surgical intervention led to wound closure in all cases. In only one case was the osteosynthesis material removed because of osteomyelitis. CONCLUSIONS: We conclude that the earlier coverage with vital tissue is obtained, the lower the incidence of infection. Early consultation by a plastic surgeon will increase a positive outcome of treatment of complex tissue defects.

Adult↗
PubMed1998

The morphologic changes in lamellar bodies and intercorneocyte lipids after tape stripping and occlusion with a water vapor-impermeable membrane.

It has been reported that artificial restoration of barrier function by a water vapor-impermeable membrane after tape stripping induces barrier abrogation in hairless mice, impeding rather than enhancing barrier recovery. To address this issue, we examined the morphologic changes in the epidermis after tape stripping and occlusion with a water vapor-impermeable membrane in murine skin. Male hairless mice were used for all studies of barrier perturbation and occlusion. Barrier disruption was achieved by repeated application of cellophane tape. Immediately after tape stripping the animals were wrapped in a tightly fitting water vapor-impermeable membrane. Transepidermal water loss (TEWL) was measured 20 min after tape stripping and 14, 24, 36, 48 and 60 h after occlusion. For electron microscopy the samples were treated with osmium tetroxide (OsO4) or ruthenium tetroxide (RuO4). When tape-stripped animals were wrapped in a water vapor-impermeable membrane, thereby preventing water flux, barrier function did not recover normally. These results demonstrate that an artificial block to TEWL with an impermeable membrane did not enhance barrier recovery. By electron microscopy many transitional cells and lacunae of various sizes were seen within the intercellular spaces of the stratum corneum after occlusion following tape stripping. Occlusion also caused alterations in both lipid lamellar membrane structures in the stratum corneum interstices and the lamellar bodies in the cytosol of granulocytes and transitional cells. Secreted lamellar body contents also appeared to be abnormal in the stratum corneum-stratum granulosum junction.

Animals↗
PubMed2001

Functional and structural changes of the epidermal barrier induced by various types of insults in hairless mice.

Acute barrier disruption, regardless of the method of induction, depletes the stratum corneum intercellular lipids and this stimulates a series of lipid/ DNA synthesis activities which lead to barrier recovery. After barrier disruption by tape stripping, occlusion with a water vapor-impermeable membrane inhibits barrier repair. In this study, we investigated the changes in the murine epidermis after barrier perturbation by tape stripping and three different types of surfactants (Emalex NP-12, ENP-12; sodium dodecyl sulfate, SDS; benzalkonium chloride, BKC). To examine the effect of an artificial barrier, we covered the animals with a water vapor-impermeable membrane for 3 days following barrier disruption and then exposed them to the air for 2 days. The histological findings after occlusion or air exposure were similar. However, after air exposure for 2 days, the thickness of the epidermis including the stratum corneum and the stratum granulosum layers decreased to about half that of the epidermis after occlusion. Ultrastructural examination revealed obvious distortion of the lamellar bilayers within the stratum corneum interstices immediately after barrier disruption. After 3 days of occlusion, extensive disorganization was evident in the intercellular domain of the stratum corneum, whereas 2 days after removal of the occlusion, the normal basic unit structure of the lamellar bilayers had partially reappeared. Our findings provide evidence that the kinetic pattern of barrier repair and the morphological changes are similar after occlusion following barrier disruption regardless of the mechanism of disruption.

Animals↗
PubMed2002

The effect on arterial blood gases and heart rate of bilateral nasal packing.

In order to elucidate the blood gas and heart rate changes caused by bilateral nasal packing, 21 healthy subjects who had had septoplasty or septorhinoplasty were investigated with pre- and post-operative blood gas measurements and 24-h Holter monitoring. Nasal packing caused a significant decrease in O2 saturation (P < 0.05), a borderline decrease in PO2 (P = 0.09), insignificant changes in PCO2, pH and HCO3 (P > 0.05), a significant increase in minimum and mean heart rates (P < 0.05) and insignificant changes in maximum heart rates; however, further research is necessary to elucidate the direct cause-and-effect relationship. No serious arrhythmias were observed. Although these changes may be within normal levels for healthy subjects, they may have serious consequences for patients with cardiopulmonary diseases.

Adolescent↗
PubMed2005

Use of sterile adhesive film and polypropylene mesh in the construction of a temporary silo in the treatment of omphalocele.

When a primary closure is not feasible, a synthetic material must be used in patients with congenital abdominal wall defects. Sterile adhesive film (drape) is reinforced with polypropylene mesh, and then it is used as a prosthesis for constructing a temporary silo. The drape surface is applied to the herniated viscera, which provides a smooth surface that does not adhere to the bowel loops. The adhesive film (drape) is a sterile, impermeable, transparent, and flexible material, which is readily available in all operating rooms. When combined with polypropylene mesh, an effective prosthesis can be created for the staged surgical treatment of congenital abdominal defects such as omphalocele and gastroschisis.

Biocompatible Materials↗
PubMed2002

Temporary closure of the abdominal wall (laparostomy).

The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favorable in the treatment of numerous surgical conditions, e.g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is temporarily closed, and a laparostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome. Regarding the technique and material used for the temporary closure, no prospective randomized data exists, but mesh materials are commonly used. They provide drainage of infectious material, permit visual control of the underlying viscera, facilitate access to the abdominal wall, preserve the fascial margin, enable healing by secondary intention, and allow mobilization of the patient. In the case of decreasing intra-abdominal pressure, meshes can be trimmed to centralize the rectus muscle and to facilitate definitive closure. Non-absorbable meshes have been frequently reported to cause enteric fistulae and persistent infection necessitating mesh explantation. While these infectious complications appear to occur less frequently with the use of absorbable materials, these meshes will finally lead to an incisional hernia, requiring repair with non-absorbable mesh after a period of 6-12 months. Nevertheless, in the complex situation requiring a temporary abdominal wall closure, use of absorbable mesh material is common and represents the state of the art.

Abdominal Cavity↗
PubMed2002

In-vitro analysis for microbial barrier properties of 2-octyl cyanoacrylate-derived wound treatment films.

BACKGROUND: In recent years, 2-octyl cyanoacrylate monomer has been formulated for various wound care products that have been approved by the Food and Drug Administration (FDA). PURPOSE: To evaluate the in vitro effectiveness of 2-octyl cyanoacrylate formulation-based films as barriers to various pathogens, including bacteria, fungi, and yeast. METHODS: The barrier properties of the cyanoacrylate films prepared by the following two methods were tested: (1) prepolymerized film and (2) in situ polymerized film. The upper surface of films was inoculated such that the microorganisms would have to penetrate the film to colonize the media beneath. Nine different organisms were used. Plates were observed for growth at two, four, and seven days after inoculation. RESULTS: No growth was observed in any test, with the exception of prepolymerized film challenged with Pseudomonas aeruginosa. The pattern of growth observed suggests that the bacteria colonized the medium by traveling around and not through the film. CONCLUSIONS: 2-Octyl cyanoacrylate-based films are excellent microbial barriers.

Bacteria↗
PubMed1988

Congenital idiopathic microcoria.

Five infants had congenital unilateral microcoria. The red reflex was absent and vision was severely reduced in all five eyes preoperatively. A pupil was created surgically in three of the eyes, resulting in a variable improvement in vision. The underlying lens was clear in all three children. The origin of the pupillary anomaly is unknown, but probably is related to remnants of the fetal pupillary membrane. Early surgical treatment and vigorous occlusion therapy can result in useful vision.

Child, Preschool↗
PubMed1975

The "parachute" stent.

A method of stabilizing intraoral skin grafts from outside the mouth is described. It provides excellent immobilization ot the graft and superior oral hygiene as compared with conventional intraoral stents.

Humans↗
PubMed1975

Improving the efficiency of wound drainage catheters.

We have modified the most commonly utilized wound drainage system to further reduce the incidence of postoperative accumulation of fluid under the skin flaps. This modification allows more efficient removal of debris, loose tissue fragments, and clots from the wound catheters and insures a constant negative pressure in the system. These maneuvers lengthen the usefulness and improve the efficiency of the catheters and have reduced the incidence of fluid accumulation.

Catheterization↗
PubMedDate not supplied

Beneficial effects of silicone cream on grafted skin.

The clinical effects of silicone cream were compared to vaseline on 27 patients with split (14 cases) and full thickness (13) skin grafts. Silicone cream occlusive treatment resulted in significantly less pigmentation and hardness in 21 out of 27 cases (78%), less marginal scar hypertrophy and redness in 10 and 7 cases respectively (37 and 26%), and in an even narrower marginal scar in 6 cases (22%). In nine cases of the split skin graft, fewer wrinkles resulted in the silicone cream treated lesion.

Adolescent↗