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At least 163 records · Page 9Linked to original sources
PubMed2000

Graft survival and effectiveness of dermal substitution in burns and reconstructive surgery in a one-stage grafting model.

Survival of the autograft and objective parameters for scar elasticity were evaluated after dermal substitution for acute burns and reconstructive surgery. The dermal substitute, which was based on bovine type I collagen and elastin-hydrolysate, was evaluated by intraindividual comparison in a clinical trial. The substitute was applied in a one-step procedure in combination with a split-thickness autograft. This treatment was compared with the conventional treatment, the split-thickness antograft. After 1 week, the percentage of autograft survival was assessed. The Cutometer SEM 474 was used to obtain objective measurements of skin elasticity parameters 3 to 4 months postoperatively. Forty-two pairs of wounds (31 patients, age 32.9 +/- 19.3 years; burned surface area, 19.8 +/- 14.5 percent) were treated because of acute burns. Reconstructive surgery was performed on 44 pairs of wounds (31 patients, age 33.9 +/- 17.5 years). Autograft survival was not altered by the substitute for reconstructive wounds, although a slight but significant reduction (p = 0.015) was established in the burn category for substituted compared with nonsubstituted wounds. However, the necessity for regrafting was not increased by substitution. Cutometer measurements of reconstructive wounds with a dermal substitute demonstrated a significant increase of pliability (50 percent, p < 0.001), elasticity (defined as immediate extension, 33 percent, p = 0.04), maximal extension (33 percent, p = 0.002), and immediate retraction (31 percent, p = 0.01), as compared with nonsubstituted wounds. After burn surgery, no improvement was found for the different elasticity parameters. Dermal substitution in a one-stage grafting model seems feasible with respect to graft survival. Skin elasticity was considerably improved by the collagen/elastin dermal substitute after reconstructive surgery.

Adult↗
PubMed2001

Breast reconstruction with free-tissue transfer.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the rationale for the use of free tissue transfer for breast reconstruction. 2. Understand the indications, advantages, and disadvantages of this method of reconstruction. The authors discuss the indications, advantages, and disadvantages of free-tissue transfer for breast reconstruction. The most common free flaps used today are individually discussed. Details about indications, contraindications, pertinent anatomy, pedicle characteristics, flap pliability, perfusion characteristics, advantages, and disadvantages for each of these flaps are presented. Details pertaining to the more common recipient vessels are presented. Future considerations are also briefly discussed.

Adult↗
PubMed2002

Three-dimensional reconstruction of the oral cavity using the free anterolateral thigh flap.

Oral cavity reconstruction after removal of locally advanced tumors is particularly difficult because anatomical restoration must accurately reproduce the original structure and enable effective and fast rehabilitation of mastication, swallowing, and phonation. The authors report their 2-year experience with 17 patients surgically treated for oral cavity cancer with reconstruction performed with the free anterolateral thigh flap. Thanks to its thinness and pliability, this flap has proven to be perfectly adaptable to the structural peculiarities of the resected areas and has enabled the authors to considerably reduce the cosmetic and functional complications in the donor area observed with other flaps (such as the radial forearm flap). Flap grafting has always been complete and regular, and no intraoperative and postoperative complications have been observed. Swallowing recovery has always been satisfactory. On the basis of the authors' results, their current approach to oral cavity reconstruction is based on the use of flaps that enable anatomical restoration of the resected areas and reduce morbidity of the donor site. They believe that the anterolateral thigh flap can offer all of these opportunities, and the surgery can be simultaneously performed by two surgical teams.

Adult↗
PubMed2002

The prepuce free flap in 10 patients: modifications in flap design and surgical technique.

The prepuce free flap was used in 10 oral and oropharyngeal reconstructions. During the course of this study, various modifications took place. Residual penile skin necrosis and skin island necrosis early in the series led to modification of flap design. This solved the donor-site problem by placing the skin island more proximally, to consist of the outer layer of the prepuce and an equidimensional area of penile skin proximal to the prepuce. Identification of the vascular pedicle was greatly facilitated by changing to retrograde dissection, making skin incision in the mons veneris superfluous. Incongruence between donor and recipient artery, together with microsurgical arrogance, resulted in (resolvable) inflow problems in four patients. One flap was lost. After modification, marginal necrosis still occurred in one flap, most likely because of an episode of venous congestion. Although much care was taken to not harvest more skin than in a regular circumcision, penile skin shortage, especially during erection, appeared to be the major long-term shortcoming of this flap. Flap thinness and pliability, both expected strongholds of the flap, were evident during flap inset, but less apparent during follow-up because of postoperative radiotherapy in the majority of the cases. The best indications for this flap include defects in the tonsillar area extending into the soft palate, tongue, lateral oropharynx, retromolar trigonum, gums, and vallecula.

Aged↗
PubMed2002

Anterolateral thigh flap for postmastectomy breast reconstruction.

Most postmastectomy defects are reconstructed by use of lower abdominal-wall tissue either as a pedicled or free flap. However, there are some contraindications for using lower abdominal flaps in breast reconstruction, such as inadequate soft-tissue volume, previous abdominoplasty, lower paramedian or multiple abdominal scars, and plans for future pregnancy. In such situations, a gluteal flap has often been the second choice. However, the quality of the adipose tissue of gluteal flaps is inferior to that of lower abdominal flaps, the pedicle is short, and a two-team approach is not possible because creation of the gluteal flap requires that the patient's position be changed during the operation. In 2000, five cases of breast reconstructions were performed with anterolateral thigh flaps in the authors' institution. Two of them were secondary and three were immediate unilateral breast reconstructions. The mean weight of the specimen removed was 350 g in the three patients who underwent immediate reconstruction, and the mean weight of the entire anterolateral thigh flap was 410 g. Skin islands ranged in size from 4 x 8 cm to 7 x 22 cm, with the underlying fat pad ranging in size from 10 x 12 cm to 14 x 22 cm. The mean pedicle length was 11 cm (range, 7 to 15 cm). All flaps were completely successful, except for one that involved some fat necrosis. The quality of the skin and underlying fat and the pliability of the anterolateral thigh flap are much superior to those of gluteal flaps and are similar to those of lower abdominal flaps. In thin patients, more subcutaneous fat can be harvested by extending the flap under the skin. Use of a thigh flap allows a two-team approach with the patient in a supine position, and no change of patient position is required during the operation. However, the position of the scar may not be acceptable to some patients. Therefore, when an abdominal flap is unavailable or contraindicated, the creation of an anterolateral thigh flap for primary and secondary breast reconstruction is an alternative to the use of lower abdominal and gluteal tissues.

Adult↗
PubMed2003

The increasing use of enteral flaps in reconstruction for the upper aerodigestive tract.

The enteric flaps commonly used in free tissue head and neck reconstruction include the gastro-omental flap, the omental flap, and the free jejunal flap. These flaps have demonstrated excellent reconstructive results for defects of the oral cavity, oropharynx, hypopharynx, cervical esophagus, and contouring defects of the head and neck. Their main advantages include tissue pliability, tubed shape, ease of contouring, and the ability to secrete mucus. Recent studies report outcome measurements for flap loss, fistula rates, postoperative swallowing, speech, and cosmesis. Now that experience has been gained to the point of routine use of these flaps, randomized trials are needed to determine the functional advantages of the enteric flaps compared with other reconstructive options.

Humans↗
PubMedDate not supplied

Effects of enhanced patient education on compliance with silicone gel sheeting and burn scar outcome: a randomized prospective study.

The purpose of this study was to determine whether enhanced patient education increases compliance with silicone gel sheeting (SGS) on hypertrophic (HT) scars and to determine whether this results in any improvement in scar outcome. Outpatients with a HT burn scar were randomized to either a conventional education group (CEG), which received routine instruction on the use of SGS or to an enhanced education Group (EEG), which also received routine instruction, along with a detailed 5-page handout and a 26-minute videotape. The CEG (n = 12, 67% male, age 38 +/- 10 years) and the EEG (n = 13, 77% male, age 47 +/- 10 years) were followed monthly for 6 months. Subjects in the EEG wore SGS for 21.8 +/- 3.0 hr/day compared with only 10.1 +/- 7.5 hr/day of use in the CEG (P <.001). Scars in the EEG had significantly better Vancouver Scar Scale ratings for pigmentation (P =.02), height (P =.03), and pliability (P =.02) by 6 months. Patients in the EEG had significantly better subjective ratings for the parameters of scar itch (P =.01), color (P =.02), hardness (P =.01), and elevation (P =.01). Finally, scars in the EEG had significantly better ratings for border height (P =.002) and thickness (P =.01) at 6 months based on evaluation of digital photographs. Detailed multimedia patient education improves compliance with SGS and results in a better scar outcome.

Adult↗
PubMed2004

Free-style free flaps.

Free-tissue transfer has become the accepted standard for reconstruction of complex defects. With the growth of this field, anatomic studies and clinical work have added many flaps to the armamentarium of the microvascular surgeon. Further advancements and experience with techniques of perforator flap surgery have allowed for the harvest of flaps in a free-style manner, where a flap is harvested based only on the preoperative knowledge of Doppler signals present in a specific region. Between June of 2002 and September of 2003, 13 free-style free flaps were harvested from the region of the thigh. All patients presented with an oral or pharyngeal cancer and underwent resection and immediate reconstruction of these flaps. All flaps were cutaneous and were harvested in a suprafascial plane. The average size of the flaps was 108 cm2 (range, 36 to 187 cm2), and the average length of the vascular pedicle was 10 cm (range, 9 to 12 cm). All flaps were successful in achieving wound coverage and functional outcomes without any vascular compromise necessitating re-exploration. Free-style free flaps have become a clinical reality. The concepts and techniques used to harvest a free-style free flap will aid in dealing with anatomic variations that are encountered during conventional flap harvest. Future trends in flap selection will focus mainly on choosing tissue with appropriate texture, thickness, and pliability to match requirements at the recipient site while minimizing donor-site morbidity.

Adult↗
PubMed2005

Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale.

BACKGROUND: Although scar evaluation tools are necessary for an evidence-based approach to scar management, there is as yet no generally accepted tool. The Patient and Observer Scar Assessment Scale was developed recently and found to be a useful subjective evaluation tool for burn scars. The authors tested the Patient and Observer Scar Assessment Scale on linear scars, the largest category of surgical scars. METHODS: One hundred linear surgical scars were assessed by three independent observers using the observer scale to evaluate vascularity, pigmentation, thickness, relief, pliability, and surface area. The patients evaluated their scars simultaneously and 2 weeks later using the patient scale for the following parameters: pain, itching, color, stiffness, thickness, and relief. RESULTS: The internal consistency of the observer and patient scales was good (Cronbach's alpha = 0.86 and 0.90, respectively). The reliability of the observer scale was good for the total score (r = 0.96, p < 0.001) and separate items (r > 0.86, p < 0.001) for three observers. Even a single observer evaluated scars reliably with respect to the total score (r = 0.88, p < 0.001) and the items vascularity, pigmentation, thickness, and surface area (r > 0.70, p < 0.001). The patient's intraobserver reliability was good for the total score (r = 0.94, p < 0.001) and separate items (r > 0.89, p < 0.001). The coefficient of variation of the total score was 10.4 percent for the observer scale and 15.8 percent for the patient scale, indicating good agreement. CONCLUSIONS: The Patient and Observer Scar Assessment Scale is an appropriate subjective tool for the evaluation of linear scars.

Adolescent↗
PubMed2005

A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound.

BACKGROUND: Hypertrophic scarring caused by sternotomy is prevalent among Asians. The effectiveness of silicone gel in scar prevention may influence the decision of surgeons and patients regarding its routine use during the postoperative period. METHODS: The authors conducted a randomized, placebo-controlled, double-blind, prospective clinical trial. The susceptibility to scar development varied among patients; therefore, sternal wounds were divided into the upper half and the lower half. Two types of coded gel prepared by an independent pharmacist were used on either half. Thus, selection and assessment biases and confounders were eliminated. RESULTS: One hundred wounds in 50 patients were randomized into two arms, 50 control and 50 silicone gels. The median age was 61 years and there were 34 men and 16 women. Ethnic distribution was 28 Malays, 18 Chinese, and four Indians. No side effect caused by the silicone gel was noted. Ninety-eight percent of patients had moderate to good compliance. The incidence of sternotomy scar was 94 percent. At the third month postoperatively, the silicone gel wounds were scored lower when compared with the control wounds. The differences were statistically significant in all parameters, including pigmentation (p = 0.02), vascularity (p = 0.001), pliability (p = 0.001), height (p = 0.001), pain (p = 0.001), and itchiness (p = 0.02). CONCLUSIONS: The effect of silicone gel in prevention of hypertrophic scar development in sternotomy wounds is promising. There are no side effects and patients' compliance is satisfactory. This study may popularize the use of silicone gel in all types of surgery to minimize the formation of hypertrophic scars in the early postoperative period.

Adult↗
PubMed2006

A cadaver study in preparation for facial allograft transplantation in humans: part I. What are alternative sources for total facial defect coverage?

BACKGROUND: Reconstruction of facial defects in burn, trauma, and head-neck cancer patients is challenging. The lack of autogenous tissue availability and the need to match facial texture and color are major concerns. METHODS: Anatomical dissections were performed to search for alternative sources for facial-scalp reconstructions in five cadavers. The composite facial-scalp flaps, radial forearm, anterolateral thigh, bipedicled deep inferior epigastric perforator, and bipedicled scapular-parascapular flaps were harvested. The total surface areas of the facial defects and alternative traditional flaps were measured. RESULTS: The mean surface area for combined facial-scalp flaps and facial flaps without scalp was 1192 +/- 38.2 cm and 675 +/- 22.3 cm, respectively. When compared with the total surface area of the facial-scalp flap, it was found that the radial forearm flap covered 13 +/- 2.58 percent, the anterolateral thigh flap 19 +/- 3.72 percent, the bipedicled deep inferior epigastric perforator flap 35 +/- 1.56 percent, and the bipedicled scapular-parascapular flap 48 +/- 4.64 percent of the defect, respectively. When measurements were taken for coverage of the facial defect without scalp, it was found that the radial forearm flap covered 24 +/- 4.0 percent, the anterolateral thigh flap 34 +/- 6.50 percent, the bipedicled deep inferior epigastric perforator flap 62 +/- 3.03 percent, and the bipedicled scapular-parascapular flap 84 +/- 8.30 percent of the defect, respectively. CONCLUSIONS: The authors' cadaver dissection confirmed that none of the conventional cutaneous autogenous flaps are able to cover total facial defects. Currently, the best option for reconstruction of the full facial defect is the autogenous bipedicled scapular-parascapular flap because of its large size and texture. However, perfect match of facial skin texture, pliability, and color can only be achieved by transplantation of the facial skin allograft from the human donor.

Aged↗
PubMed2003

The flashlamp-pumped pulsed dye laser (585 nm) treatment of hypertrophic scars in Asians.

Hypertrophic scars are common and cause functional and psychologic morbidity. Various treatment modalities have been advocated in the past, but the flashlamp-pumped pulsed-dye laser-585 nm (PDL) has been shown to be effective in the treatment of a variety of traumatic and surgical scars. This study was performed to determine the effectiveness of the PDL treatment of hypertrophic scars in Asians and to elucidate possible side effects and complications. Thirteen Asian patients with 19 hypertrophic scars that had no response to conservative therapies, such as pressure therapy, intralesional corticosteroid injection, or silastic gel sheeting for more than 6 months, were treated with the PDL. Three months after the last laser treatment, improvement in the appearance, reduction in scar height, and erythema as a result of the PDL treatment were evaluated and compared with baseline values. Compared with the baseline appearance, hypertrophic scars treated with the PDL showed a satisfactory clinical improvement of 84% (16 of 19), a significant percentage of scar flattening of 58.9 +/- 22.1%, and of erythema elimination of 75.7 +/- 19.9% at month 3 after the last laser treatment. The PDL treatment of hypertrophic scars can effectively improve scar pliability and texture and decrease erythema and associated symptoms. In addition, multiple treatment sessions are suggested for achieving greater response, but lower fluences are recommended for prevention of side effects in Asians with a higher melanin content of the skin.

Adult↗
PubMed2006

Norepinephrine modulates the inflammatory and proliferative phases of wound healing.

BACKGROUND: Injury results in the massive release of norepinephrine (NE) into the peripheral circulation. Recent investigations have demonstrated functional adrenoreceptors on the cellular mediators of cutaneous wound healing and NE-induced phenotypic alterations in immune cells have been demonstrated in vitro. Despite this, there is little description of how NE might alter the phases of wound healing in vivo. The purpose of this study was to compare cutaneous wound healing in norepinephrine-intact and norepinephrine-depleted mice. METHODS: Norepinephrine-depleted (NED) mice were generated by chemical axotomy with 6-hydroxydopamine and compared with norepinephrine-intact (NEI) animals (n = 6-12 per group, per time point). Using an excisional wound model, neutrophil recruitment was measured by myeloperoxidase assay. Macrophage recruitment and angiogenesis were measured by immunohistochemistry and re-epithelialization was determined histologically. The development of incisional wound disruption strength was determined over time. Finally, macrophage scavenger function was assessed by an in vitro latex bead phagocytosis assay. RESULTS: Wounds from NEI mice demonstrated greater neutrophil infiltration than NED wounds (24, 72 hours; p < 0.05). Wound macrophage recruitment was initially higher in NEI animals (24 hours, p < 0.05), but was eventually surpassed by that of NED animals (120 hours, p < 0.05). Angiogenesis was decreased while re-epithelialization was accelerated in NEI animals (p < 0.05). Wound disruption strength and macrophage scavenger function were unaltered between NED and NEI mice. CONCLUSIONS: Norepinephrine modulates the inflammatory and proliferative phases of wound healing in a temporally defined, cell-specific manner. By increasing recruitment of innate immune cells and expediting wound closure, norepinephrine appears to play a protective role in defense against infection.

Animals↗
PubMed2007

Soft tissue and cellular preservation in vertebrate skeletal elements from the Cretaceous to the present.

Soft tissues and cell-like microstructures derived from skeletal elements of a well-preserved Tyrannosaurus rex (MOR 1125) were represented by four components in fragments of demineralized cortical and/or medullary bone: flexible and fibrous bone matrix; transparent, hollow and pliable blood vessels; intravascular material, including in some cases, structures morphologically reminiscent of vertebrate red blood cells; and osteocytes with intracellular contents and flexible filipodia. The present study attempts to trace the occurrence of these four components in bone from specimens spanning multiple geological time periods and varied depositional environments. At least three of the four components persist in some skeletal elements of specimens dating to the Campanian. Fibrous bone matrix is more altered over time in morphology and less likely to persist than vessels and/or osteocytes. Vessels vary greatly in preservation, even within the same specimen, with some regions retaining pliability and other regions almost crystalline. Osteocytes also vary, with some retaining long filipodia and transparency, while others present with short and stubby filipodia and deeply pigmented nuclei, or are pigmented throughout with no nucleus visible. Alternative hypotheses are considered to explain the origin/source of observed materials. Finally, a two-part mechanism, involving first cross-linking of molecular components and subsequent mineralization, is proposed to explain the surprising presence of still-soft elements in fossil bone. These results suggest that present models of fossilization processes may be incomplete and that soft tissue elements may be more commonly preserved, even in older specimens, than previously thought. Additionally, in many cases, osteocytes with defined nuclei are preserved, and may represent an important source for informative molecular data.

Animals↗
PubMed2004

Loss of keratin 10 leads to mitogen-activated protein kinase (MAPK) activation, increased keratinocyte turnover, and decreased tumor formation in mice.

Keratin 10 (K10) is the major protein in the upper epidermis where it maintains keratinocyte integrity. Others have reported that K10 may act as a tumor suppressor upon ectopic expression in mice. Although K10(-/-) mice show significant epidermal hyperproliferation, accompanied by an activation of the mitogen-activated protein kinase (MAPK) pathway, they formed no spontaneous tumors. Here, we report that K10(-/-) mice treated with 7,12-dimethylbenz[a]anthracene (DMBA)/12-O-tetradecanoylphorbol-13-acetate (TPA) developed far less papillomas than wild-type mice. BrdU(5-bromo-2'-deoxyuridine)-labeling revealed a strongly accelerated keratinocyte turnover in K10(-/-) epidermis suggesting an increased elimination of initiated keratinocytes at early stages of developing tumors. This is further supported by the absence of label-retaining cells 18 d after the pulse whereas in wild-type mice label-retaining cells were still present. The concomitant increase in K6, K16, and K17 in K10 null epidermis and the increased motility of keratinocytes is in agreement with the pliability versus resilience hypothesis, stating that K10 and K1 render cells more stable and static. The K10(-/-) knockout represent the first mouse model showing that loss of a keratin, a cytoskeletal protein, reduces tumor formation. This is probably caused by an accelerated turnover of keratinocytes, possibly mediated by activation of MAPK pathways.

Animals↗
PubMed2004

A role for the androgen receptor in collagen content of the skin.

Collagen, the major macromolecular component of skin, is responsible for maintaining the structural integrity of the tissue as well as for providing important functional characteristics, such as pliability and thickness. We have been studying the structure and regulation of collagen in mouse mutations affecting the skin. In the course of these studies, we found that there are significant differences in collagen content between the skin of wild-type male and female mice, which become evident at puberty. Furthermore, male mice with an X-linked mutation in the androgen receptor gene (formerly called testicular feminization and abbreviated as Ar(Tfm)) showed decreased levels of collagen, indicating that the androgen receptor pathway contributes to the observed differences. These findings demonstrate that there are striking differences in the collagen content of skin between male and female mice, and provide a biochemical explanation for these differences.

Androgen-Insensitivity Syndrome↗
PubMed1975

Temperature dependence of water content of stratum corneum.

The water content of human stratum corneum has been measured gravimetrically in vitro in relation to relative humidity (RH) and temperature. Water content increased with increasing RH. Stratum corneum water content increased 50% when the temperature was raised from 20 to 35 degrees C at RH below 60%. Temperature dependence decreased with increasing RH until there was essentially no temperature dependence at 90% RH. The conclusion is that temperature changes could significantly affect water content in vivo and pliability of skin at RH below 60%.

Elasticity↗
PubMed1990

Characteristic appearances of colonic lipomas on barium enema: a guide to conservative management.

The double contrast barium enema appearances of seven colonic lipomas are reviewed. These lesions have submucosal features: intact mucosa, sharp margination and obtuse angles between the lesion and the adjacent colonic wall, as well as features characteristic of lipomas: pliability and shape change, broad pedicles and spherical appearances en face. They can be differentiated from the more significant colonic adenomas and then CT scanned to establish a histological diagnosis. The need for colonoscopic or surgical excision of these predominantly asymptomatic lesions occurring in elderly patients can be considerably reduced.

Aged↗