Showing papers in "Plastic and Reconstructive Surgery in 1983"
TL;DR: The third edition of this two-volume set provides coverage of hand surgery with new chapters on wrist and elbow arthroscopy, principles and techniques of AO fixation, microneural reconstruction and management of complex open injuries.
Abstract: This two-volume set provides coverage of hand surgery. The third edition contains new chapters on wrist and elbow arthroscopy, principles and techniques of AO fixation, microneural reconstruction and management of complex open injuries. A section on microsurgery has been completely revised.
1,595Â citations
TL;DR: Clinical impressions that cranial donor sites are preferable for craniofacial recipient areas when clinically feasible are substantiated and confirm the increased resorption of endochondral bone grafts when compared with membranous grafts.
Abstract: Based on observations in the human suggesting improved membranous bone graft take, an experimental study was undertaken in 15 rabbits and 7 monkeys to evaluate the differences in take between membranous and endochondral bone grafts. Using vital stains, serial cephalograms, direct measurements, and point-counting techniques, the grafts were compared. In both types of experimental animals, membranous bone maintained its volume to a significantly greater extent than endochondral bone when autografted in the craniofacial region. The loss of volume with endochondral grafts was at the end of the experiment more than three times that of membranous grafts in the rabbit (65 percent endochondral loss versus 19.5 percent membranous loss) and more than four times volume loss in the monkey (17.2 percent membranous volume loss versus 88 percent endochondral loss). The uptake of vital stains (tetracycline and alizarin) was greater with membranous bone, and point counting demonstrated more living membranous bone (40.5 percent membranous versus 28.1 percent endochondral) at the end of the experiment. These studies confirm the increased resorption of endochondral bone grafts when compared with membranous grafts and substantiate clinical impressions that cranial donor sites are preferable for craniofacial recipient areas when clinically feasible.
598Â citations
TL;DR: The concept of modifying the body contour with liposuction by developing numerous subcutaneous "tunnels" with subsequent homogeneous contractions of the overlying skin will add a new dimension to the plastic surgeon's armamentarium as mentioned in this paper.
Abstract: The concept of modifying the body contour with liposuction by developing numerous subcutaneous "tunnels" with subsequent homogeneous contractions of the overlying skin will add a new dimension to the plastic surgeon's armamentarium. Successful correction of these deformities can be obtained without a large amount of surgical undermining and skin resection and with minimal scar formation (Figs. 4 through 11).
556Â citations
TL;DR: It is demonstrated that autogenous vein grafts can serve as a conduit for nerve regeneration in rodents by demonstrating restoration of conduction through the vein-grafted sciatic nerves with muscle reinnervation.
Abstract: This study was performed to determine whether vein grafts might serve as a conduit for nerve regeneration. A 1 cm segment of sciatic nerve was removed bilaterally in 12 Sprague-Dawley rats. On one side the gap was not repaired, and on the other side a segment of femoral vein was used to bridge the nerve gap. Nerve conduction studies and necropsies were performed at intervals. Reconstitution of nerve trunk continuity and healing of plantar ulcers occurred only in the vein-grafted side. Histologic examination revealed orderly growth of nerve fibers within the lumen of the vein grafts as early as 1 month after repair. Most regenerating nerve fibers passed through the proximal junction in an orderly pattern and reached the distal stumps within 2 months after repair. Results of nerve conduction study at 4 months after operation demonstrated restoration of conduction through the vein-grafted sciatic nerves with muscle reinnervation. Nearly normal muscle fibers in the gastrocnemius on the repaired side were confirmed at necropsy. This study demonstrated that autogenous vein grafts can serve as a conduit for nerve regeneration in rodents.
276Â citations
TL;DR: Results of this work demonstrate that in addition to providing increased surface area with controlled expansion, flaps raised in expanded skin have a significantly augmented surviving length.
Abstract: Controlled clinical tissue expansion, a new technique of providing donor tissue, results in an increase in surface area of expanded skin. The aim of the present study was to determine the effect of controlled tissue expansion on the surviving lengths of random-pattern skin flaps elevated in expanded tissue. In five pigs the surviving lengths of flaps raised in skin expanded for 5 weeks using a 250-cc rectangular Radovan-type tissue expander were compared with the survival lengths of flaps elevated in tissue in which a similar prosthesis was not expanded, bipedicle flaps delayed for 5 weeks, and control acutely raised random-pattern flaps. The expanded flaps had a mean increase in surviving length of 117 percent over control flaps, which was statistically significant. The delay flaps had an increase in survival of 73 percent over control flaps, which was also statistically significant. There was no significant difference in survival between expanded flaps and delayed flaps. Morphologic studies using radiographic techniques on one pig demonstrated increased vascularity with tissue expansion. The results of this work demonstrate that in addition to providing increased surface area with controlled expansion, flaps raised in expanded skin have a significantly augmented surviving length. The mechanism for this increased vascularity with expansion is not known at this time, but it may be due to physical forces associated with expansion acting as a stimulus for angiogenesis.
274Â citations
TL;DR: Thank you very much for reading anthropometry of the head and face in medicine, and maybe you have knowledge that, people have search hundreds of times for their favorite novels, but end up in harmful downloads.
Abstract: Thank you very much for reading anthropometry of the head and face in medicine. Maybe you have knowledge that, people have search hundreds times for their favorite novels like this anthropometry of the head and face in medicine, but end up in harmful downloads. Rather than reading a good book with a cup of coffee in the afternoon, instead they juggled with some malicious virus inside their computer.
272Â citations
TL;DR: A versatile flap based on the deep inferior epigastric artery is presented and its application for local and free-flap transfer is discussed and presented in two clinical cases.
Abstract: A versatile flap based on the deep inferior epigastric artery is presented. Its application for local and free-flap transfer is discussed and presented in two clinical cases. The possible inclusion of bone as an osteocutaneous flap is outlined. The flap can be raised with ease and speed, and the donor site is repaired as a linear scar. Since the latissimus dorsi flap with its pedicle based in the axilla has become the workhorse for the upper torso, this extended flap may become its distal counterpart with its pedicle based on the groin.
247Â citations
TL;DR: This paper introduces an aggressive reconstructive approach in which radical scar excision is followed by immediate coverage of a newly sculpted cartilage framework with a temporoparietal fascial flap and skin graft.
Abstract: Secondary ear reconstructions due to either previous surgical failures or severe traumatic injuries present a significant reconstructive challenge. In this paper we introduce an aggressive reconstructive approach in which radical scar excision is followed by immediate coverage of a newly sculpted cartilage framework with a temporoparietal fascial flap and skin graft. This approach evolved through experience with 40 patients who required secondary reconstructions due to either previous surgeries or trauma.
237Â citations
TL;DR: It was demonstrated that skin flaps fail because of arterial insufficiency, and it was shown that arteriovenous shunting is not a major cause of skin flap necrosis.
Abstract: An experimental study was undertaken in pigs to clarify the pathophysiologic events occurring in a failing skin flap. It was demonstrated that skin flaps fail because of arterial insufficiency. Arteriovenous shunting is not a major cause of skin flap necrosis.
210Â citations
TL;DR: The author's experience with 10 gluteus maximus myodermal free flap breast reconstructions is reviewed and the superior gluteal free flap can achieve a reliable, permanent, and aesthetic reconstruction of the breast without silicone implants.
Abstract: The author's experience with 10 gluteus maximus myodermal free flap breast reconstructions is reviewed against the current methods of reconstruction using silicone implants, latissimus dorsi flaps, regional skin flaps, and rectus abdominis myodermal flaps. The superior gluteal free flap can achieve a reliable, permanent, and aesthetic reconstruction of the breast without silicone implants. The softness, projection, natural appearance, and patient satisfaction are excellent compared with other methods. It is particularly useful in patients who object to the use of artificial implants, are not suitable for regional flaps, or have disappointing results from previous reconstructions. Technical modifications of the flap design and selection of the recipient vessels are important.
183Â citations
TL;DR: Two new cutaneous free-flap donor areas are described on the medial and lateral sides of the thigh and it is predicted that these flaps will become important donor sites for reconstructive problems requiring resurfacing of cutaneous defects in various anatomic areas.
Abstract: Two new cutaneous free-flap donor areas are described on the medial and lateral sides of the thigh. The medial thigh flap is supplied by an unnamed artery from the superficial femoral artery and is drained by the accompanying venae comitantes. Its nerve supply is from the medial femoral cutaneous nerve. The lateral thigh flap has its vascular pedicle from the third perforating artery of the profunda femoral artery and its accompanying vein. The lateral femoral cutaneous nerve provides sensation over the area. These flaps provide a large surface area of both skin and subcutaneous tissue without the usual bulk of subcutaneous fat and muscle. Their desirable features include long vascular pedicles with large vessel diameters and potential of being neurovascular flaps with specific sensory nerve supply and predictable anatomy. The principal disadvantage is that the donor site may leave a slight contour defect with primary closure or require grafting when a large flap is taken. We predict that these flaps will become important donor sites for reconstructive problems requiring resurfacing of cutaneous defects in various anatomic areas.
TL;DR: This method replaces an inexact concept in the surgeon's imagination with a three-dimensional image of the craniofacial skeleton that is useful in defining aberrant anatomy, planning surgical procedures, and evaluating the results of such operations.
Abstract: A new method for reconstruction of a three-dimensional surface from a sequence of high-resolution axial CT scans has been developed. This algorithm is realized as a set of computer programs that can operate on commercially available CT scanners or evaluation consoles. The program is both efficient and easy to implement. No operator intervention is required. The images produced simulate photographs of the skull. Frontal, lateral, oblique, bird's eye, worm's eye, and rear views are generated. As with photographs and conventional radiographs, each of these projections uniquely displays specific anatomic details. This method of osseous surface reconstruction is now routinely applied to all patients evaluated for major craniofacial reconstruction at our institution. The images are useful in defining aberrant anatomy, planning surgical procedures, and evaluating the results of such operations. This method replaces an inexact concept in the surgeon's imagination with a three-dimensional image of the craniofacial skeleton.
TL;DR: By following guidelines, the platysma flap has been successfully used for facial reconstruction in 7 of 8 consecutive patients and may be beneficial to include the external jugular and/or the communicating veins in the flap.
Abstract: Meticulous anatomic dissection of the vasculature of the superficial anterolateral neck indicates that the platysma and overlying skin are supplied by direct cutaneous arteries measuring 0.5 mm in diameter. The small arteries are branches of the postauricular and occipital arteries in the upper lateral neck, the facial and submental arteries in the upper medial neck, the superior thyroid artery in the middle of the neck, the subclavian artery in the lower medial neck, and the transverse or superficial cervical arteries in the lateral aspect of the neck. These vessels traverse the undersurface of the platysma muscle to provide blood flow to the overlying skin. As opposed to this direct cutaneous system, the myocutaneous blood supply perforating through the sternocleidomastoid is scant. The platysma skin flap will survive if the blood supply from at least one region is preserved. In addition, it may be beneficial to include the external jugular and/or the communicating veins in the flap. By following these guidelines, the platysma flap has been successfully used for facial reconstruction in 7 of 8 consecutive patients.
TL;DR: The ability to transfer the flap as a free transfer widens the scope of the flap to reconstruct both heel and forefoot defects where local instep tissue or vascularity are inadequate for local reconstruction.
Abstract: The instep flap needs neither muscle nor a transposition base for survival or innervation. It can be transposed as an island fasciocutaneous flap either on the medial or lateral plantar neurovascular bundles or both, and it can be transferred also as a free flap from the opposite foot. Four cases demonstrating the use of the flap as an island and free flap are presented with follow-up ranging from 1 to 2 years. The absence of muscle in the flap provides greater stability of the heel reconstruction and results in a lesser secondary defect. Sensation in the flaps is diminished but adequate for long-term function, but hyperkeratotic reaction remains an unpredictable problem. The ability to transfer the flap as a free transfer widens the scope of the flap to reconstruct both heel and forefoot defects where local instep tissue or vascularity are inadequate for local reconstruction. The secondary defect, particularly when no muscle is included in the flap, has been minimal.
TL;DR: A new classification of malformations of the face and cranium is proposed, based on embryologic studies and observations concerning a great number of patients seen by the authors.
Abstract: A new classification of malformations of the face and cranium is proposed, based on embryologic studies and observations concerning a great number of patients seen by the authors. First of all, one should distinguish between cerebral craniofacial (with brain and/or eyes involved) and craniofacial malformations. Craniofacial malformations may be characterized by dysostosis and by synostosis. Malformations with dysostosis may be produced by transformation as well as differentiation defects. Synostosis is always caused by a differentiation defect. A new nomenclature is introduced.
TL;DR: This technique (honeycombed suction lipectomy) appears more reliable than suction curettage that employs sharp dissection, which is truly sculpting of the soft tissues.
Abstract: We have used the honeycombed suction lipectomy (wet and/or dry) in over 700 patients. It represents a major advancement in the treatment of the localized adiposities of the body. Its advantages are eliminating the need for long, unsightly scars and reducing operating time and morbidity. Selection of appropriate patients is of paramount importance for reliable results because this technique is truly sculpting of the soft tissues. Results improve also with the proper training and experience of the surgeon. The indications and complications have been discussed. This technique (honeycombed suction lipectomy) appears more reliable than suction curettage that employs sharp dissection.
TL;DR: Vascularized bone transfer appears to be the preferred surgical technique whenever possible for vascularized frontal bone transfer in immature rabbits.
Abstract: Composite flaps containing vascularized frontal bone were transferred on muscle pedicles in immature rabbits. Vascular continuity was maintained on one side and interrupted on the other. Bone weights at 16 weeks following transfer were compared with those of unoperated controls. The conventional bone graft demonstrated significant reduction in osseous mass. The vascularized bone maintained its mass compared with unoperated controls. Vascularized bone transfer appears to be the preferred surgical technique whenever possible.
TL;DR: Over a period of 6 years, 54 toe-to-hand transfers were performed, 24 for thumb and 30 for finger reconstruction, and forty-nine toes (90.7 percent) survived.
Abstract: Over a period of 6 years, 54 toe-to-hand transfers were performed, 24 for thumb and 30 for finger reconstruction. Refinements in evaluation, preparation, and surgical technique are detailed. Forty-nine toes (90.7 percent) survived. Exploration was required for circulatory compromise following 13 transfers (34.2 percent), to good effect in 9 (69.2 percent). Secondary surgery was performed in 26 cases, consisting of tendolysis, osteotomy, and deepening of the first web space. Review was undertaken at an average of 1 year and 9 months after transfer. Power grip averaged 28.5 percent of the normal hand and pinch strength 26.6 percent, great toe transfer giving 35.7 percent and second toe transfer to thumb giving 15.6 percent strength compared with normal. Static two-point discrimination of less than 10 mm was present in 37.5 percent of those studied under 2 years after surgery and in 75 percent of those studied more than 2 years later. The choice of procedure for thumb reconstruction is discussed in detail, as are supplementary skin cover, vascular considerations, and the high exploration rate.
TL;DR: C cancellous bone is the material of choice for bone grafting alveolar clefts in the 7- to 11-year age group and will be inadequate to provide sufficient bone formation and should be supplemented by a bone graft remains to be established.
Abstract: A method is described for harvesting cancellous bone from the diploic space. In our opinion, this is the material of choice for bone grafting alveolar clefts in the 7- to 11-year age group. The procedure could be performed at an earlier age if the maxillary segments are under orthopedic control and in proper alignment. Success of the procedure depends on proper orthodontic preparation of the maxillary segments and careful, complete closure of the soft tissues across the anterior palatal cleft, the nasal lining defect, and the anterior alveolus. Results have been encouraging in terms of bone formation, and tooth migration into the bone graft can be expected if there has been no damage to the dental sac. Closure of the alveolar defect at the time of the primary lip closure would preclude the eventual need for a bone graft, but it cannot be accomplished without early, precise alignment of the maxillary segments if extensive periosteal denudation is to be avoided. The age beyond which periosteal closure alone will be inadequate to provide sufficient bone formation and should be supplemented by a bone graft remains to be established.
TL;DR: Because congenital nevocellular nevi can be distinguished clinically and histologically from acquired nevi, and because of their apparent increased potential for malignant degeneration, it is felt that treatment by tangential excision or dermabrasion require further study.
Abstract: Because congenital nevocellular nevi can be distinguished clinically and histologically from acquired nevi, and because of their apparent increased potential for malignant degeneration, we favor complete one-stage excision of these nevi, regardless of the size of the lesion or the age of the patient, at the earliest opportunity, whenever such surgery is feasible and practical. If there is a question about the clinical diagnosis, a cutaneous punch biopsy can help determine the true nature of the lesion. Significantly, Walton et al. and Rhodes and coworkers found discrepancies in the literature concerning the level of nevus cells in neonates. They concluded that until these differences are reconciled, nevus cells in the deep reticular dermal collagen may be a sufficient, but not a necessary criterion for the diagnosis of congenital melanocytic nevus. We currently favor complete one-stage excision of congenital nevocellular nevi and feel that treatment by tangential excision or dermabrasion require further study. Finally, we present this paper as "advice" not only to the three authors who, in a recent issue of the British Journal of Plastic Surgery, requested it, but also to all clinicians. Hopefully, with time and further study, better criteria will be determined and a more definitive approach to this problem will be established.
TL;DR: Contraction of an excisional wound can be described by a decaying exponential with a non-zero asymptote between days 6 and 39 after wounding.
Abstract: Contraction of an excisional wound can be described by a decaying exponential with a non-zero asymptote between days 6 and 39 after wounding. Regardless of size or shape, the contraction-rate constant is invariant within age- and species-matched animals. Differently shaped wounds of the same size contract at the same rate during the exponential period. Shape exerts its effect prior to the onset of contraction by defining the size of the wound entering the exponential period. Perimeter is the factor by which shape determines size.
TL;DR: Twenty-seven consecutive fasciocutaneous flaps comprising skin, fat, and deep fascia have been successfully used to close a variety of defects on the lower leg and trunk.
Abstract: Twenty-seven consecutive fasciocutaneous flaps comprising skin, fat, and deep fascia have been successfully used to close a variety of defects on the lower leg and trunk. The advantages of these flaps are enumerated, and the blood supply of the deep fascia and its relationship to the tissues deep and superficial to it are described.
TL;DR: It is found that a rhinoplasty does not adversely affect the nasal airflow, and those patients who had procedures to improve their nasal airflow did indeed obtain it, and data were statistically significant.
Abstract: The Effects of Nasal Surgery on Airflow Eugene Courtiss;Robert Goldwyn; Plastic and Reconstructive Surgery
TL;DR: A technique for eyebrow lift is presented which employs the eyebrow arch used by makeup artists to add subjectively to the operation and prevent the aesthetically displeasing result of a too highly arched brow.
Abstract: A technique for eyebrow lift is presented which employs the eyebrow arch used by makeup artists to add subjectively to the operation and prevent the aesthetically displeasing result of a too highly arched brow. The marking technique to achieve the proper life is outlined. A concomitant blepharoplasty technique and its indications are presented.
TL;DR: This procedure attempts to eliminate the cause of the deformity of the levator labii superioris and will thoroughly eliminate the regeneration of muscle, and thus a permanent correction is achieved.
Abstract: Myectomy and partial resection of the levator labii superioris promises a far better and direct approach to the problem of upper gum exposure during smiling. This procedure attempts to eliminate the cause of the deformity. The resected muscles are of the striated muscle group and are composed of single muscle fibers running the entire length of the trunk. Adequate resection of these muscles will thoroughly eliminate the regeneration of muscle, and thus a permanent correction is achieved. The resulting smile is very attractive and pleasing to both patient and surgeon.
TL;DR: An innervated cross-finger flap for treatment of severe fingertip injuries is described, and a group of patients with similar injuries treated with standard cross- finger flaps exhibited slower sensory return that progressed to a lower level.
Abstract: An innervated cross-finger flap for treatment of severe fingertip injuries is described. With this method, the dorsal skin over the middle phalanx, together with its sensory nerve, is transferred as a compound skin-nerve flap. A neurorrhaphy is performed between this nerve and the cut end of the digital nerve at the injury site. Seven of eight patients (88 percent) treated with this method (mean follow-up time 14.4 months) achieved measurable two-point discrimination. The average for those who did was 4.8 mm. A group of patients with similar injuries treated with standard cross-finger flaps exhibited slower sensory return that progressed to a lower level. In this group (mean follow-up time 16.3 months), three of six (50 percent) achieved measurable two-point discrimination with a mean value of 9 mm.
TL;DR: The latissimus dorsi myocutaneous flap can be employed successfully in head and neck reconstruction when the size or nature of the defect precludes the use of local or regional flaps.
Abstract: The latissimus dorsi myocutaneous flap can be employed successfully in head and neck reconstruction when the size or nature of the defect precludes the use of local or regional flaps. Generous amounts of hairless skin and muscle may be transferred in one operative procedure while producing an acceptable donor defect. Certain measures may be taken to enhance dependability of the flap and minimize complications, and these are discussed. The Doppler flowmeter is helpful in ascertaining patency of the main-flap vessels preoperatively as well as in identifying specific cutaneous perforators for accurate placement of the island. Locating the paddle two-thirds of the way down the muscle ensures adequate blood supply and sufficient pedicle length for most defects between the thoracic outlet and the roof of the orbits.
TL;DR: In this paper, the authors performed chromosome analysis of 240 spermatozoa from 18 normal men using in vitro fertilization of zona-free golden hamster eggs and found that the frequency of chromosome abnormalities in this population was 9.2% (22/240).
Abstract: Chromosomal analysis of 240 spermatozoa from 18 normal men was performed using in vitro fertilization of zona-free golden hamster eggs. The frequency of chromosome abnormalities in this population was 9.2% (22/240). Of the abnormal complements, 18 were aneuploid (13 hyperploid and five hypoploid) and four had a chromosome break. The sex ratio of Y-bearing to X-bearing sperm was .68. The frequency and type of sperm chromosome abnormalities is compared with those seen in spontaneous abortions.
TL;DR: A method of breast mound reconstruction without an implant whereby a large latissimus dorsi flap alone is employed and a method of calculation of the minimal breast flap volume is described.
Abstract: A method of breast mound reconstruction without an implant is described whereby a large latissimus dorsi flap alone is employed. A method of calculation of the minimal breast flap volume is also described. Examples of three representative cases are shown.