Corset platysmaplasty.
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Dermatologic Surgical Procedures↗
Biomedical subjects
B Hirshowitz
Publications and source records attributed to B Hirshowitz.
The securing of a polyethylene tube prior to intravascular dye injection in anatomic microcirculation research: the three-tie technique.
A simple and reliable method for securing the cannulated polyethylene tube to the blood vessel wall prior to intravascular dye injection is described. The three-tie technique has been used in many vascular anatomic studies without any leakage of the injection fluid taking place around the tube.
Blood Vessels↗
The management of exposed cardiac pacemaker pulse generator and electrode using restricted local surgical interventions; subcapsular relocation and vertical-to-horizontal bow transposition techniques.
This paper describes an approach to the treatment of exposed pacemaker generator and electrode. Local infection is controlled by the administration of systemic antibiotics and topical antibacterial solutions. Because the generator and lead are enveloped by an inert synthetic coating, it is possible to eradicate an infection without their removal if it is due to a weak opportunist pathogen fully sensitive to antibiotics. Thereafter, subcapsular relocation of the exposed generator or vertical-to-horizontal transposition of the exteriorised lead is carried out. These surgical interventions are designed to overcome the vertical force which tends to cause the extrusion of the pacing hardware.
Aged↗
Pulmonary complications in burn patients resuscitated with a low-volume colloid solution.
The occurrence of the adult respiratory distress syndrome (ARDS) and pneumonia was assessed in 482 patients with severe burns, but without evidence of inhalation injury. The patients were resuscitated during the burn shock period with a low-volume formula consisting mainly of plasma. The incidence of ARDS was 2.5 per cent for the entire burn population, and 9.4 per cent for 65 patients with burns covering more than 50 per cent of the body surface area. The general incidence of pneumonia was 4.4 per cent but was 12.5 per cent for the 65 patients with the extensive burns. These incidences were compared with other studies, and a pathophysiological explanation has been offered to explain differences in the frequency of pulmonary complications. The present review indicates that resuscitation with a low-volume formula consisting mainly of colloids can act as prophylaxis for reducing the incidence of ARDS and pneumonia.
Adolescent↗
Effect of decidua angiogenic factors on experimental dermis allografts.
Meshed human dermis allografts containing human uterine angiogenic factor were implanted over full thickness surgical skin wounds in rats. Enhanced angiogenesis of the wound bed, three times more than that observed in control grafts, was found in experimental grafts at 3 days postimplantation. This was accompanied by a greater amount of granulation tissue formation, enhanced granulation tissue penetration into the dermal grafts and accelerated incorporation of the grafts. Angiogenesis of the wound bed regressed to control levels at 7 days postimplantation. The growth and penetration of the granulation tissue and the accelerated incorporation of the dermis grafts, however, continued ahead in the experimental grafts while necrosis appeared in the control grafts. The relevance of these results for acceleration of wound healing and improvement of the wound bed for subsequent application of cultured epidermal grafts is discussed. This method may be extended to the treatment of ulcers and burns.
Angiogenesis Inducing Agents↗
Burn resuscitation with a low-volume plasma regimen--analysis of mortality.
The results of a mortality analysis from the Burn Center in Rambam Medical Center, Haifa, Israel, over a 5-year period are presented. The management of severe burns during the 'shock' period included a low-volume resuscitation formula consisting mainly of plasma and a small volume of crystalloid solution. The efficacy of burn management was assessed by probit analysis of the mortality data. We derived the percentage of body surface area burned associated with a 50 per cent probability of death (LA50) for four different age groups. The LA50 values obtained were compared to those obtained from other series; they compared favourably, demonstrating that resuscitation with low volumes consisting mainly of colloids may reduce complications associated with fluid overloading and therefore improve the LA50.
Adolescent↗
[Is Solcoderm suitable for treating malignant skin tumors?].
Solcoderm, a liquid preparation developed in the USSR, is recommended for topical treatment of benign and malignant skin tumors. We present 5 out of 25 patients treated in our department over the past 2 years who had been treated with Solcoderm for malignant skin tumors. The preparation appeared to have affected only the superficial layers of the tumor and had not penetrated in depth. Cellular remnants tended to spread far beyond the confines of the original tumor and seemed to become much more aggressive. To be effective, the technique of applying the drug would have to be much more complicated than originally specified. Both the functional and esthetic results are much worse than expected.
Acetates↗
Free-fat injections for the correction of hemifacial atrophy.
Three adult patients with long-standing hemifacial atrophy were treated with repeated free-fat injections at 4- to 8-week intervals. The longest follow-up study to date is 18 months, and following the expected postoperative resorption, no further loss of bulk of injected fat has been observed. On palpation, the feel of the fat is normal, and facial expression is also good. The relative ease of this procedure, which does not entail any scarring, appears to justify more widespread use of free-fat injections to restore facial soft-tissue depressions.
Adipose Tissue↗
Free composite serratus anterior muscle--rib flap for reconstruction of severely damaged foot.
A 23-year-old man who underwent below-knee amputation of one leg and sustained extensive soft-tissue damage with a bony defect of the other foot presented an unusual reconstructive problem. By means of microsurgical techniques a free serratus anterior-rib flap was transferred to restore function of the foot. A four-year follow-up showed good rehabilitation.
Adult↗
An attempt to harness the viscoelastic properties of skin in face lift operations--a preliminary report.
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Dermatologic Surgical Procedures↗
External longitudinal splitting of the biceps brachii muscle for coverage of repaired brachial vessels: an anatomical study and clinical application.
The external longitudinal splitting of the biceps brachii muscle offers a convenient and safe method for covering exposed vessels in the medial aspect of the arm in cases with loss of soft tissue. This anatomical study reveals rather variable and inconsistent patterns of blood supply to the biceps brachii muscle. The common denominator among the patterns is the fact that the nutrient vessels to the muscle originate in its posterior deep surface and course thereafter in a fan shape upward to the surface of the anterior aspect of the muscle. This microcirculatory pattern permits the external longitudinal splitting of the biceps brachii muscle along the whole anteromedial aspect of the short-headed belly without compromising its blood supply and function. An illustrative case is described.
Adult↗
The hypospadias silicone loop: a method to treat strictures of the distal reconstructed urethra.
The silicone loop was used to ensure patency of the distal urethra reconstructed by a tubularized full-thickness skin graft in patients with proximal or penoscrotal hypospadias. By this method we avoid repeated dilations of the urethra and the attendant anesthesia and discomfort to the patient.
Equipment Design↗
An attempt to harness the viscoelastic properties of skin in face lift operations--a preliminary report.
In 16 women who underwent face lift operations, we performed intraoperative stretching of the undermined facial and neck skin using either a silicone bag for expansion or skin traction sutures. The object of this endeavor was to attempt to harness the viscoelastic properties of the skin to maximize the amount of skin excision and so improve the overall long-term operative results. We believe we were successful with both techniques. It is not clear at this juncture whether the long-term results of this one-stage procedure will approximate those of the two-stage procedure, which were consistently satisfactory.
Aged↗
Treatment of hemangiomas by sclerosing agents: an experimental and clinical study.
Twenty-one patients with hemangiomas on the face and lip who were treated with injections of sclerosing agents are discussed. The mode of action of these drugs was also studied experimentally on rats, which were injected through the pampiniform plexus of the spermatic cord. In the clinical study all patients showed satisfactory resolution of the hemangiomas with commensurate improvement in their appearance. The experimental study provides an explanation for the replacement of blood vessels by young connective tissue.
Adolescent↗
Testicular autotransplantation after traumatic castration.
Severe genitoperineal trauma with total avulsion of testicles in a 7-year-old boy resulted from a road accident. Soft tissues were reconstructed by local flaps and skin grafts. The only testicle that was found was reimplanted in his biceps muscle in an attempt to restore endocrine function. A human chorionic gonadotropin test showed no response, indicating that the transplanted tissue did not survive.
Arm↗
External longitudinal splitting of the tibialis anterior muscle for coverage of compound fractures of the middle third of the tibia.
In this modern era, compound fractures of the middle third of the tibia are relatively common. With the advent of external fixation, these fractures can be more rapidly and effectively dealt with, and attention can be directed to immediate coverage of the exposed bone. External longitudinal splitting of the anterior tibialis muscle offers a convenient and safe method for converting the open fracture to a closed one. The uniqueness of the tibialis anterior muscle is two-fold. It is circumpennate, and it has an internal axial tendon corresponding to almost its total length. Both these features impart to it considerable strength, and the muscle splitting herewith described does not appear to impair its function. Five treated limbs, each with loss of soft tissues overlying compound mid-third tibial fractures, are presented. Rapid healing and virtual absence of bone infection was observed in all cases.
Adult↗
Early enteral nutrition for mass burn injury: the revised egg-rich diet.
An aggressive enteral nutritional approach has been employed to support our severely burned patients. The diet is based on a daily intake of 5 eggs/10 kg of body weight, incorporated into milkshakes. Twelve patients with severe burns (age, 24 +/- 4 years; burns, 54 +/- 12 per cent of total body surface area (TBSA] were studied. Enteral feeding was initiated on the day of injury and gradually reached the full formula within 3-7 days. Feeding was carried out either orally or through a nasogastric drip or a combination of both, depending on the patient's condition. Each bottle of milkshake contained 2318 kJ, 29 g protein, 51 g carbohydrate and 28.6 g fat in 250 ml. Each millilitre of the diet contained 9.32 kJ. The protein provided 21 per cent of the total calorie intake, while the fat and carbohydrate provided 42 per cent and 37 per cent respectively. The mean daily intake consisted of protein (5 +/- 1.5 g/kg), carbohydrate (8 +/- 0.75 g/kg) and fat (5 +/- 1 g/kg), providing a daily administration of 378-420 kJ/kg. Plasma lipids remained within normal limits during the 40 days of the diet, while serum protein levels rose to normal levels within the first 3 weeks.
Adult↗
Sodium poisoning: a lethal case of a burned child.
An unusual case of lethal salt poisoning of a burned child is presented. Excessive hypernatraemia and hyperosmolality resulted in an irreversible cascade of events which lead to death despite vigorous attempts to rescue the victim.
Administration, Topical↗