RESUMO
Closure of the radial forearm flap donor site has been achieved by triangulating the defect and using a full-thickness skin graft from the adjacent volar forearm. Coverage of the flexor carpi radialis tendon has been more robust, and the aesthetic results have been superior to split-thickness skin-graft coverage of the forearm flap donor site.
Assuntos
Antebraço/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/métodos , Bandagens , Dissecação , Sobrevivência de Enxerto , Humanos , Transplante de Pele/patologia , Retalhos Cirúrgicos/patologia , Técnicas de Sutura , Tendões/cirurgiaRESUMO
Infection is an occasional but serious complication of tissue expansion. Bacteria in many cases are found both inside and outside the expander. The mechanism of how they spread inside and out is not fully understood. In the current study, we have assessed both the expander membranes (n = 28) and the port (n = 42) in terms of leakage and transmission of Staphylococcus aureus in normal expansion (100 percent) and overexpansion (400 percent) in an in vitro model. Our results indicate that the membrane was impermeable to S. aureus, whereas the bacteria were able to migrate freely through the puncture sites in the ports.
Assuntos
Contaminação de Equipamentos , Staphylococcus aureus/crescimento & desenvolvimento , Dispositivos para Expansão de Tecidos , Expansão de Tecido , Permeabilidade da Membrana Celular , Movimento Celular , Ambiente ControladoRESUMO
Excellent patency rates are currently established in the use of autogenous veins as interposition vein grafts in microsurgical practice. Allografts may be a viable alternative source of vein grafts. Recent advances in cryobiology have enabled the controlled freezing of tissues with preservation of vital cellular elements. Although several reports have shown the successful use of cryopreserved large-vessel allografts, few have addressed cryopreservation of microvessels (1 to 2 mm in diameter). In this study, the authors have successfully cryopreserved femoral veins in a rat model and transplanted them as interposition vein grafts into arterial defects across major histocompatibility barriers (ACI to Lewis). Short-term patencies (21 days) were determined, and histologic and scanning electron microscopic analysis were performed. Patency of 100 percent was achieved in both fresh control veins and in cryopreserved veins at 21 days.
Assuntos
Criopreservação , Terapia de Imunossupressão , Microcirurgia , Veias/transplante , Animais , Veia Femoral/patologia , Veia Femoral/transplante , Ratos , Ratos Endogâmicos ACI , Ratos Endogâmicos Lew , Grau de Desobstrução Vascular , Veias/patologiaRESUMO
Endoscopic techniques have found increasing applications in general surgery. In this article, an attempt has been made to utilize endoscopy via a subcutaneous approach in an experimental pig model for dissection of fat, muscle, and fascia.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , Endoscopia/métodos , Tecido Adiposo/cirurgia , Animais , Modelos Animais de Doenças , Masculino , Músculos/cirurgia , Projetos Piloto , Instrumentos Cirúrgicos , SuínosRESUMO
The Cavitron ultrasonic surgical aspirator has been successfully used in general surgery and neurosurgery. We have explored its use in the dissection of small-diameter blood vessels and nerves (1-2 mm) in a rat model. Our results seem to indicate that this technique may be useful in isolating blood vessels surrounded by fatty tissue without damage to the vessel itself. In this study, however, high-frequency ultrasound did cause significant damage to peripheral nerves.
Assuntos
Microcirurgia/instrumentação , Músculo Liso Vascular/cirurgia , Nervos Periféricos/cirurgia , Instrumentos Cirúrgicos , Terapia por Ultrassom/instrumentação , Animais , Desenho de Equipamento , Músculo Liso Vascular/patologia , Nervos Periféricos/patologia , Ratos , Ratos EndogâmicosRESUMO
A dedicated microcomputer system has been developed to provide voice control over a wide variety of motorized devices. Employing a 8051 microprocessor with 16 kilobytes of ROM and 16 kilobytes of non-volatile RAM, the system potentially realizes an OEM cost of under $100. Other features include: a simplified user interface, a failsafe stop and voice programmable capabilities. This system has the potential to bring voice control into the marketplace in a wide variety of applications. Currently, the system has been adapted to surgical microscopes and is used in controlling several types of hospital beds.
Assuntos
Sistemas Computacionais/economia , Ciência de Laboratório Médico/tendências , Microcomputadores/economia , Interface Usuário-Computador , Voz , Algoritmos , Inteligência Artificial , Sistemas Computacionais/tendências , Custos e Análise de Custo , Humanos , Ciência de Laboratório Médico/instrumentação , Microcomputadores/tendências , Reprodutibilidade dos Testes , Design de Software , Estados Unidos , VocabulárioRESUMO
Vein grafts are used frequently in microvascular surgery, but an adequate supply of autogenous veins is not always available. The search for an ideal substitute for autogenous vein continues. We present a case of lower extremity reconstruction made difficult by lack of suitable autogenous vein for venous outflow from a rectus abdominus free flap. A 36 cm cryopreserved allograft saphenous vein was used on an emergency basis for this problem.
Assuntos
Criopreservação , Perna (Membro)/cirurgia , Veia Safena/transplante , Retalhos Cirúrgicos/métodos , Idoso , Humanos , Masculino , Preservação de Órgãos , Cicatrização , Ferimentos por Arma de Fogo/cirurgiaRESUMO
The case of a patient with multiple proliferating trichilemmal tumors and trichilemmal cysts of the scalp and back is discussed. The multicentric presentation of this tumor is unusual and, to our knowledge, has not been described previously. The appearance of trichilemmal cysts in association with multiple proliferating trichilemmal tumors suggests a common histogenesis of these two neoplasms. The typical presenting features, histologic description, and recommended treatment for these tumors are reviewed.
Assuntos
Dorso , Cisto Epidérmico/patologia , Couro Cabeludo , Feminino , Humanos , Pessoa de Meia-Idade , Dermatopatias/patologiaRESUMO
Recent advances in microvascular techniques have significantly enhanced the success rate of these procedures. Microvascular free tissue transfers at present have a 85-90% success rate. This, however, still leaves a 10-15% failure rate due primarily to thrombosis of the blood vessels at the anastomotic site. Previous work in the field has shown that anticoagulants such as heparin can reduce the rate of thrombosis. However, heparin can also cause on-site bleeding. Hirudin, a potent thrombin inhibitor of 65 amino acids, is available through recombinant technology. Our current experimental work utilized 75 male Sprague-Dawley rats for assessing the efficacy of hirudinized saline versus saline alone and heparinized saline as an irrigant in a microsurgery model of anastomosis. After exposing the right femoral artery in a standard fashion, the artery was clamped and a standard transverse division of the vessel was made. The vessel ends were irrigated with one of the three solutions then anastomosed. Vessels were observed for patency over a 3-day period. Initial results showed comparable performance of hirudinized saline and heparized saline, both of which were better than saline, for preventing thrombosis. From these initial data, and the reduced bleeding risk associated with hirudin, this agent appears to be a useful anticoagulant in microsurgery.
Assuntos
Anastomose Cirúrgica/efeitos adversos , Terapia com Hirudina , Microcirurgia/efeitos adversos , Trombose/prevenção & controle , Animais , Artéria Femoral/cirurgia , Fibrinolíticos/uso terapêutico , Masculino , Ratos , Ratos Endogâmicos , Proteínas Recombinantes/uso terapêutico , Irrigação Terapêutica , Trombose/etiologiaRESUMO
A case in which multiple cryopreserved allograft saphenous veins were used as vein grafts for a difficult mandible reconstruction with a free tissue transfer is reviewed. Use of allograft veins was recently reported for lower limb vascular reconstruction but not for free tissue transfers. Such grafts may represent a viable alternative to the use of autologous vein grafts and have the potential to decrease operating time and avoid necessary scars.
Assuntos
Criopreservação , Retalhos Cirúrgicos/métodos , Veias/transplante , Adulto , Feminino , Humanos , Infecções/cirurgia , Mandíbula/cirurgia , Prótese Mandibular/efeitos adversos , Reoperação , Transplante HomólogoRESUMO
At present, there is no accurate, reliable method of experimentally measuring capsular contracture. This study had four goals: (1) to define the parameters of capsular contracture employing principles of biomechanics of soft tissues, (2) to develop laboratory techniques to measure the parameters, (3) to design an implant that mechanically impedes the process of encapsulation, and, (4) to test this implant against a conventional one. We have developed a breast implant (the Pittsburgh implant) with an altered surface topography. Its silicone shell is punctuated by projections 1 mm in height and 1 mm in diameter. Two techniques were devised to measure contracture. The first involved measuring the force deformation along a coronal axis. The second involved measuring hydrostatic pressures within the implant resulting from the injection of known quantities of saline. Measurements were performed in vivo on 36 animals. By both force and pressure measurements, the Pittsburgh implant showed less capsular contracture (p = 0.12 and 0.012, respectively). Histology revealed that the prototype surface alters the linear arrangement of myofibroblasts and redirects the laminar collagen into a waveform pattern. We conclude from this experimental study that an altered surface topography may serve as a means of rendering a capsule less mechanically effective. We feel that the proposed methods can be used in the laboratory to characterize the extent of capsular contracture.