Contribution of prosthetic therapy in the management of nasopharyngeal stenosis following uvulopalatopharyngoplasty.
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Adolescent↗
Biomedical subjects
D Serafin
Publications and source records attributed to D Serafin.
Establishment of normal ranges of laser Doppler blood flow in autologous tissue transplants.
Over a 3-year period, 136 patients were monitored following free autologous tissue transplantation using a laser Doppler flowmeter linked to a computerized data-acquisition system. This monitoring system has indicated perfusion compromise in free flaps more rapidly than clinical observation alone. Most important, this has resulted in an increase in salvage rate from 50.0 to 82.4 percent. In addition, our overall success rate has increased from 92.6 to 97.8 percent since introducing this monitor clinically. Computerization also has facilitated the collection of data, which has enabled us to establish expected values for postoperative blood flow in several types of donor tissues used for microvascular reconstruction. Finally, this computerized monitoring system has relieved personnel from basing decisions on subjective data.
Adult↗
Reconstruction of rat femoral veins with microvascular prostheses.
Synthetic conduits have not been suitable for microvascular reconstruction owing primarily to their high thrombogenicity. Vein replacements are the most vulnerable to thrombosis because of their low shear rates and low pressure. Experimental replacement of microvenous segments with prosthetic segments has shown little success. Recent technological advances in biomaterials and control of thrombogenesis provide the potential for success in the development of venous prostheses. The purpose of this study was to assess the use of nonbiodegradable composite polyurethane microvascular prostheses for reconstruction of rat femoral veins. Rat femoral venous defects of 10 mm were reconstructed with autogenous vein (n = 12), unprocessed plain polyurethane (n = 5), and nonbiodegradable composite polyurethane (n = 31). Patency was evaluated by direct observation and proximal venous milking tests. The patency rate of composite grafts was not significantly different from that of isotopic vein (p = 0.5, Fisher's exact test), and both had higher patency than unprocessed polyurethane (p less than 0.01). Composite grafts were examined sequentially using light and scanning electron microscopy. Grafts were fully endothelialized between the first and third months. The neointimal, neomedial, and neoadventitial layers could be seen more distinctly over time. New opportunities in reconstructive microsurgery may be opened by microvascular prostheses that are complaint and thromboresistant.
Animals↗
Acute difluoromethylornithine treatment increases skin flap survival in rats.
Difluoromethylornithine (DFMO) pretreatment for 7 days improved survival of rat abdominal skin flaps in previous studies. The purpose of this study was to determine if acute administration of DFMO enhances survival. Each rat had a 7 x 7-cm abdominal skin flap raised on a single epigastric neurovascular pedicle. Within 1 minute of pedicle ligation, the rats were given 0, 1, or 4 gm/kg of body weight of DFMO intraperitoneally. Putrescine was administered to additional rats alone or with DFMO. After 48 hours, the percentage of flap survival was estimated using fluorescein injection and planimetry to quantify the perfused and unperfused areas. Flap survival increased from 71 +/- 3% in controls to 83 +/- 2% and 92 +/- 3% in rats treated with 1 and 4 gm/kg of DFMO, respectively (p less than 0.005). Putrescine reversed the protective effect of DFMO, suggesting a specific polyamine-related mechanism. This study indicates that there may be both short- and long-term polyamine pools through which DFMO acts. In summary, DFMO may prove to be important in preventing cell death following acute ischemia.
Animals↗
Stimulation of DNA synthesis in human epidermis by UVB radiation and its inhibition by difluoromethylornithine.
The purpose of this study was to determine whether the rate of DNA synthesis in human skin could be increased by UVB radiation and to determine the potential for reversing the stimulatory effects of UVB radiation by alpha-difluoromethylornithine (DFMO). Split-thickness facial skin was grafted onto athymic CD-1 Nu/Nu mice on the anterolateral dorsal surface. Following graft healing for 6 weeks, grafts were treated with 0%, 2%, or 5% DFMO (a potent inhibitor of polyamine biosynthesis) and subsequently irradiated with 0.15 J/cm2 of UVB light. Two days after UVB exposure, [3H]thymidine was injected and the grafts were dissected and counted. Ultraviolet radiation significantly increased thymidine incorporation, indicating increased DNA synthesis. The stimulatory effects of UV radiation were significantly reduced by topical application of 5% DFMO. Thus administration of DFMO most likely decreased the polyamine level and decreased the rate of DNA synthesis, which may have caused a decreased rate of epidermal proliferation. Thus the topical application of DFMO may prove beneficial for UVB exposure and other hyperproliferative states where a decrease in the rate of cell turnover might be desirable.
Aged↗
Reduction mammaplasty utilizing an inferior pedicle nipple-areolar flap.
A technique utilizing the inferiorly based dermal pedicle nipple-areolar flap is described. The advantages of this technique are:(1) predictable breast shape based on preoperative markings; (2) direct visibility of all areas for ease of resection and hemostasis; (3) retention of normal nipple duct connections; (4) no impairment of subjective sensation; and (5) adequate blood supply. This technique has particular application in younger women, in whom nipple sensation is quite important. The interruption of the intercostal nerve branches is usually limited because of the thickness and width of the inferior pedicles. Utilizing our modifications of the technique originally described, this versatile flap can now be used routinely in reduction mammaplasties requiring the removal of either small amounts (200 gm) or quite large amounts (2,500 gm) of tissue with consistently satisfactory aesthetic results and excellent patient satisfaction.
Adult↗
Is there a reduction mammaplasty for "all seasons?".
No technique will serve the needs of all patients requiring a reduction mammaplasty and mastopexy. However, the modified, inferiorly-based dermal flap technique appears to us to offer the most advantages and the greatest latitude for a predictable breast reduction in most of these patients.
Adolescent↗
Late development of hematoma around a breast implant, necessitating removal.
We present a patient who bled into the pocket around a breast implant 2 1/2 years after an augmentation mammaplasty. She had received inflatible silicone prostheses, each containing 40 mg of triamcinolone acetonide. Our belief is that this large dosage of corticosteroid was responsible for the late erosion of the medium-sized artery, which caused the hemorrhage. Exploration and evacuation of the hematoma was followed by an uneventful postoperative course.
Adult↗
The nurse anesthetist, a changing role: past, present and future.
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Humans↗
Microsurgical composite tissue transplantation.
Since 1974, 69 patients with extensive defects have undergone reconstruction by microsurgical composite tissue transplantation. Using this method, donor composite tissue is isolated on its blood supply, removed to a distant recipient site, and the continuity of blood flow re-established by microvascular anastomoses. In this series, 56 patients (81%) were completely successful. There have been eight (12%) failures, primarily in the extremities. There have been five (7%) partial successes, (i.e., a microvascular flap in which a portion was lost requiring a secondary procedure such as a split thickness graft). In those patients with a severely injured lower extremity, the failure rate was the greatest. Most of these were arterial (six of seven). These failures occurred early in the series and were thought to be related to a severely damaged recipient vasculature. This problem has been circumvented by an autogenous interpositional vein graft, permitting more mobility of flap placement. In the upper extremity, all but one case were successful. Early motion was permitted, preventing joint capsular contractures and loss of function. Twenty-three cases in the head and neck region were successful (one partial success). This included two composite rib grafts to the mandible. Prolonged delays in reconstruction following extirpation of a malignancy were avoided. A rapid return to society following complete reconstruction was ensured. Nine patients presented for reconstruction of the breast and thorax following radical mastectomy. All were successfully reconstructed with this new technique except one patient. Its many advantages include immediate reconstruction without delayed procedures and no secondary deformity of the donor site. Healthy, well vascularized tissue can now be transferred to a previously irradiated area with no tissue loss. This new method offers many advantages to older methods of reconstruction. Length of hospital stay and immobilization are reduced. The total number of operative procedures required in achieving the desired result is also less, thus decreasing the cost of hospital care.
Arm↗
Transfer of free flaps to provide well-vascularized, thick cover for breast reconstructions after radical mastectomy.
The use of a free flap to bring in well-vascularized cover for a breast reconstruction (following radical mastectomy) is presented. Eleven of 12 such transfers were successful. (One free groin glap failed, and that reconstruction was abandoned.) Patients for breast reconstruction who have a marked deficiency of healthy, well-vascularized skin and subcutaneous tissue in the area are suitable candidates for this operative procedure. When a free groin flap is transferred, the donor defect is minimal.
Axilla↗
Microsurgical composite tissue transplantation: a new method of immediate reconstruction of extensive defects.
Of thirty-five cases of microsurgical composite tissue transplantation, twenty-five (71 per cent) were completely successful, four (11 per cent), were partially successful, and six (17 per cent) failed. If a microvascular flap should fail, older but more lengthy methods of reconstruction may be employed with a reasonable chance for success. The advantages of the donor groin flap are discussed. Operative technic and management are outlined.
Angiography↗
A rib-containing free flap to reconstruct mandibular defects.
A composite free flap based on intercostal vessels may be used to reconstruct in one stage defects around the mandible in which skin, soft tissue and bone are missing. A delay procedure is recommended one week prior to transfer.
Humans↗
The vascularization of free flaps: a clinical and experimental correlation.
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Animals↗
Comparison of free flaps with pedicled flaps for coverage of defects of the leg or foot.
The use of free flaps to repair defects of the leg or foot is a viable alternative to cross-leg flaps because (1) the total time of immobilization and hospitalization is less, (2) the total number of general anesthetics is less, and (3) the morbidity and cost are less. Increased experience will enhance the survival statistics for free flaps, making their use the method of choice for the reconstruction of defects in the distal part of the lower extremity.
Adolescent↗
Fourteen free groin flap transfers.
We present 14 free flap transfers, 9 of which were completely successful (74 percent), two of which were partial successes (14 percent), and 3 of which were failures (22 percent). All the 5 cases involving free flaps to the head and neck region were successful. In the 9 cases involving free flap transfer to an extremity, 4 were completely successful (44 percent), two were partially successful (22 percent), and 3 were failures (34 percent). Many factors determine the success or failure of free flap transfer, but two that seem most significant are (1) the technical expertise and experience of the surgeon, and (2) the quality of the vasculaturein the recipient bed.
History, 20th Century↗
Successful treatment of acute vascular insufficiency in a hand by intra-arterial fibrinolysin, heparin, and reserpine. Case report.
A patient is presented who presumably had multiple drugs injected intra-arterially in the right hand. Clinical signs and angiographic evidence of severe vascular insufficiency were well demonstrated. Therapy with fibrinolysin, reserpine, and heparin was followed by a return of normal circulation.
Acute Disease↗