Advances in hemangioma evaluation and treatment.
Explore the source record for details and available documents.
Adrenal Cortex Hormones↗
Biomedical subjects
L C Argenta
Publications and source records attributed to L C Argenta.
Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine.
The use of subatmospheric pressure to promote wound healing has increased in popularity during the last several years. The original studies on granulation tissue formation used a 125-mmHg vacuum. The use of alternative sources of subatmospheric pressure has led to many questions regarding efficacy or risk. In this report a swine model is used to quantify and compare the effects of low vacuum suction (25 mmHg) and high vacuum suction (500 mmHg) produced by various vacuum pumps and wall suction systems with the standard 125-mmHg vacuum. Additionally, the effects of an unregulated air leak in the sealing system were examined. All four wound treatments were examined on each of 4 pigs. Wounds were treated until one of the wounds had granulated to a level flush with the surrounding tissue. Wounds treated with the standard 125-mmHg vacuum had filled with granulation tissue by day 8. At this time wounds treated with 25 mmHg had filled 21.2% with new granulation tissue, and wounds treated with 500 mmHg had filled 5.9% with new tissue. Wounds treated with 125 mmHg with a hole in the sealing drape had increased in size 197% because of the debridement of necrotic tissue. In conclusion, wounds treated with a 125-mmHg vacuum exhibited a significant (p < 0.0001) increase in the rate of granulation tissue formation compared with treatment at 25 mmHg or 500 mmHg. The presence of an unregulated air leak in the sealing drape results in significant progression (p < 0.0001) of the wound secondary to dehydration and progressive necrosis.
Animals↗
The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone.
Lower-extremity wounds with exposed tendon, bone, or orthopedic hardware present a difficult treatment challenge. In this series of patients, subatmospheric pressure therapy was applied to such lower-extremity wounds. Seventy-five patients with lower-extremity wounds, most of which were the result of trauma, were selected for this study. Dressings made of sterile open-cell foam with embedded fenestrated tubing were contoured to the wound size and placed into the wound. The site was covered with an adhesive plastic sheet. The sheet was placed beneath any external fixation devices, or the fixation device was enclosed within the sheet. The tubing was connected to the vacuum-assisted closure pump. Continuous subatmospheric suction pressure (125 mmHg) was applied to the wound site. The wounds were inspected and the dressings were changed every 48 hours.Vacuum-assisted closure therapy greatly reduced the amount of tissue edema, diminishing the circumference of the extremity and thus decreasing the surface area of the wound. Profuse granulation tissue formed rapidly, covering bone and hardware. The wounds were closed primarily and covered with split-thickness skin grafts, or a regional flap was rotated into the granulating bed to fill the defect. Successful coverage was obtained without complication in 71 of 75 patients. Wounds have been stable from 6 months up to 6 years.
Bandages↗
Use of specialized bone screws for intermaxillary fixation.
Fixation of the injured mandible to the maxilla is a proven method of stabilizing mandibular fractures and ensuring proper occlusion. The authors report their results with new specialized intraoral bone screws (IMF Screw System; Howmedica Leibinger, Inc., Carrollton, TX) that are designed for the purpose of achieving intermaxillary fixation (IMF). Nineteen patients were placed into rigid IMF using IMF screws alone. Indications were nondisplaced mandibular fractures; symphyseal, body, and angle fractures; midfacial fractures requiring temporary IMF; and edentulous patients with any of these fracture types and an adequate prosthesis. All procedures were performed with the patient under general anesthesia. The authors found that the operative time was markedly shorter than with standard IMF techniques, patient satisfaction was high, and there were no infections related to the screws. All 19 patients remained in stable, accurate occlusion and had adequate healing. One patient continues to have paraesthesias in the mental nerve distribution after screw removal. Although there is the potential for tooth and nerve injury when screws are placed improperly, the IMF Screw System seems to be a safe and reliable method of achieving secure mandibular fixation.
Bone Screws↗
Treatment of soft tissue defects in pediatric patients using the V.A.C. system.
Twenty-seven consecutive pediatric patients presenting to the orthopaedic surgery or plastic surgery services were reviewed after completion of wound care with the Vacuum Assisted Closure (V.A.C.) system. Each patient presented with complex soft tissue wounds requiring coverage procedures. Patients with acute wounds and wounds present after nonsuccessful attempts at surgical closure (dehisced incisions and failed flaps) were treated. All soft tissue defects healed without extensive coverage procedures using the V.A.C. system. In the majority of patients, use of the V.A.C. system produced a profuse bed of granulation tissue over all exposed bone, tendon, joint, and/or hardware, which could be covered with split thickness skin graft. Other patients were treated successfully with delayed primary closure, local flap advancement (one patient underwent a pedicled cross-leg flap), or by secondary intention. Use of the V.A.C. device is valuable in increasing the rate of granulation tissue formation and healing of extensive soft tissue injuries in pediatric patients. This vacuum system aids in the debridement of necrotic tissue and local soluble inflammatory mediators that may inhibit the proliferation of granulation tissue. These improvements in the local wound environment seem to accelerate wound healing compared with traditional methods. Before the development of the V.A.C. system, a minimum of nine patients within this group would have required free tissue transfer to obtain adequate coverage. The V.A.C. device seems to permit earlier coverage with local tissue or split-thickness skin grafting techniques, thereby decreasing the need for extensive microvascular tissue transfers in pediatric patients.
Adolescent↗
Use of subatmospheric pressure to prevent doxorubicin extravasation ulcers in a swine model.
UNLABELLED: Application of subatmospheric pressure to sites injected with doxorubicin prevented ulcer formation in treated sites (0 ulcers/16 sites) compared to control wounds (10 ulcers/16 sites) in a pig model. BACKGROUND AND OBJECTIVES: Extravasation of doxorubicin hydrochloride (Adriamycin) frequently causes chronic ulcers, which usually progress and expose underlying structures such as tendons and bone. The exact mechanism of action that causes cell death and the chronic ulcers is unknown. METHODS: Eight sites were injected intradermally with doxorubicin on each of 4 pigs. Four sites on each animal served as untreated controls. The remaining four sites were exposed to 125 mm Hg subatmospheric pressure applied 1 h after injection. The sites were observed on a three times per week schedule. Sites that did not develop ulcers were re-injected up to a total of four injections. The animals were observed for 5 weeks. RESULTS: Ten of sixteen control sites developed ulcers. No subatmospheric pressure treated sites developed ulcers. The incidence of ulcer formation was significantly less for treated wounds compared to control wounds at P < 0.001 by Fisher's exact test. CONCLUSIONS: This physical modality appears to successfully prevent ulcer formation after doxorubicin injection.
Animals↗
Positron emission tomography studies confirm the need for early surgical intervention in patients with single-suture craniosynostosis.
Craniosynostosis, the premature fusion of one or more cranial sutures, may occur in isolation or in association with a syndromic constellation. Multiple-suture synostosis has consistently been associated with brain compression and increased intracranial pressure, and frequently decreased cognitive development. Single-suture craniosynostosis, however, has been thought by some to be an aesthetic problem with infrequent consequences on brain function and development. Some studies have disputed this concept and have argued a correlation between single-suture craniosynostosis and abnormalities in development. The purpose of this study was to determine, using an objective radiographic tool, positron emission tomography scans, if patients with single-suture craniosynostosis had any abnormalities in cerebral glucose metabolism that would indicate changes in local brain function. A total of 10 children with single-suture craniosynostosis, eight males and two females, ranging in age from 0.1 to 3.2 years, were enrolled in this prospective study approved by the Internal Review Board. Six of the children had sagittal synostosis, three had metopic synostosis, and one had coronal craniosynostosis. Each of the patients had preoperative positron emission tomography scans performed 1 to 5 weeks before cranial reconstructive surgery and postoperative scans at 6 to 12 weeks after surgery. Surgical treatment consisted of cranial vault remodeling in eight of the children and strip craniectomy with cranial expansion in two of the children. After surgery, the two scans were compared qualitatively and quantitatively by a single radiologist. The results demonstrated variable regional increases and decreases in local post-operative cerebral glucose metabolism. However, in the posterior occipital region, the area of visual development and visual spatial coordination, there was a consistent postoperative increase in all 10 patients. Maximum glucose metabolic rate was increased up to 30.2% with a mean of 9.9%, and average glucose metabolic rates demonstrated a maximum increase of up to 18.8%. The results of this study indicate cerebral glucose metabolism consistently increases in the posterior occipital cortex after surgical release of single-suture craniosynostosis. Future developmental studies are being performed to examine the functional consequences of these metabolic changes.
Age Factors↗
Uvular transposition: a new method of cleft palate repair.
This prospective study was done to determine whether a new cleft palate repair utilizing uvular transposition improved speech outcome as measured objectively by a speech pathologist. In the uvular transposition procedure, the palate was lengthened with tissue from the uvula by a double-opposing Z-plasty; an intravelar veloplasty was performed, and two-thirds of the mass of the uvula was transposed to the nasal surface of the soft palate. This procedure facilitates velopharyngeal closure by significantly lengthening the palate, anatomically reconstructing the muscles of the palate, and decreasing the palatal excursion necessary to achieve closure. Sixty-two children with a cleft palate were treated with this procedure performed by the senior surgeon between the years of 1988 and 1995. These children were then enrolled in cleft lip and palate clinic at age 2 to 3 years and blindly evaluated yearly by a single speech pathologist who specialized in pediatric speech pathology. Postoperative clinical follow-up ranged from 36 to 112 months (mean, 56.8 months). Perceptual nasal emission was found to be normal in 59 of the 62 patients (95 percent). Nasometry was performed in all 62 of these patients, and the mean score was 15.7 percent, well within the accepted normal range of 25 or less at our institution. Only two of these children (3 percent) required a pharyngeal flap for velopharyngeal insufficiency. These findings suggest that the uvula transposition cleft palate repair may result in good normalization of speech with negligible rates of velopharyngeal insufficiency.
Articulation Disorders↗
Vacuum-assisted closure for the treatment of degloving injuries.
Degloving injuries of the hand and foot pose difficult reconstructive and rehabilitation challenges. After an excellent experience with split-thickness skin grafting with the vacuum-assisted closure device, we began studies with full-thickness skin grafts and traumatized skin. The device has been used with successful reapplication of full-thickness degloved skin in two patients. The first patient suffered degloving of the foot; the second patient, degloving of the hand.
Foot Injuries↗
Hallermann-Streiff syndrome: experience with 15 patients and review of the literature.
Hallermann-Streiff syndrome is rare, with approximately 150 case reports in the world literature. The syndrome consists of proportionate nanism; hypotrichosis; atrophy and extreme thinness of the skin, particularly over the facial area; an unusual "bird-like" face with mandibular hypoplasia; a prominent thin, pointed nose; congenital cataracts; and severe dental abnormalities. This appears to be a sporadic mutation, and the inheritance pattern is unknown. Clinical management must focus on the more life-threatening and developmental issues early on, and aesthetic deformities can be addressed after the adolescent growth period is complete. Surgical correction of cataracts should be undertaken early in life to preserve vision. Airway issues need to be addressed early. Other reconstructive procedures, including rhinoplasty, facial augmentation, and mandibular surgery, have been successful and can be performed later in life. We report on our clinical findings in 15 patients with this condition, our attempts at reconstruction, and complications we have encountered in treating this patient population. Five of our patients had produced normal chromosome studies, and none have had similarly affected siblings. Four have had normal, unaffected children. Most of our patients have undergone multiple reconstructive procedures and have done relatively well. Eleven of our patients, however, have encountered significant intermittent respiratory difficulty manifested as early feeding difficulty, recurrent upper respiratory tract infection, sleep apnea, and respiratory arrest. Three patients required tracheostomy because of respiratory difficulty, and one child died of postoperative respiratory compromise. The management of these complicated and difficult patients is discussed.
Adolescent↗
A controlled subatmospheric pressure dressing increases the rate of skin graft donor site reepithelialization.
The ability to increase the rate of skin graft donor site reepithelialization significantly in a cost-effective manner has important implications for the patient undergoing major reconstructive procedures. In this study the effect of externally applied reduced pressure (the V.A.C.) on the rate of healing of donor site wounds was initially investigated using a porcine model (N = 4), then repeated on humans (N = 10). Split-thickness skin grafts were harvested from the backs of pigs using standard technique. Half of the donor sites were treated with subatmospheric pressure (125 mmHg) and half were treated with an OpSite dressing. Biopsies taken every 48 hours demonstrated that sites exposed to reduced pressure healed at a much faster rate than sites treated with a standard occlusive dressing. Similarly, donor sites in humans reepithelialized faster in 7 of 10 patients, the rate was the same in 2 of 10 patients, and OpSite was faster in 1 of 10 patients. We believe this technology has the potential to be a relatively simple and cost-efficient method for increasing the rate of donor site healing.
Adult↗
Sinus pericranii.
Sinus pericranii is an anomalous extracranial vascular malformation that is in continuity with the intracranial dural venous sinuses. Five case reports, three congenital and two traumatic, are described. Clinical management, including evaluation, diagnosis, and treatment, is discussed. Awareness of this entity by plastic surgeons will allow for earlier diagnosis and appropriate surgical management, resulting in decreased risk of complications.
Adult↗
A new and reliable method of securing skin grafts to the difficult recipient bed.
Explore the source record for details and available documents.
Adolescent↗
Observations and thoughts on the changing constellation of cranial deformities.
Explore the source record for details and available documents.
Craniosynostoses↗
Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation.
A series of basic animal studies using a new subatmospheric pressure technique (The V.A.C.) to expedite wound healing are presented. The technique entails placing an open-cell foam into the wound, sealing the site with an adhesive drape, and applying subatmospheric pressure (125 mmHg below ambient) that is transmitted to the wound in a controlled manner. Utilizing a pig model, four studies were undertaken to determine the effect of subatmospheric pressure on laser Doppler-measured blood flow in the wound and adjacent tissue (N = 5), rate of granulation tissue formation (N = 10), clearance of bacteria from infected wounds (N = 5), and measurement of nutrient flow by random-pattern flap survival (N = 5). Blood flow levels increased fourfold when 125 mmHg subatmospheric pressure was applied. Significantly increased rates of granulation tissue formation (p < or = 0.05) occurred with both continuous (63.3 +/- 26.1%) and intermittent (103% +/- 35.3%) application. Tissue bacterial counts significantly decreased (p < or = 0.05) after 4 days of application. Random-pattern flap survival significantly increased (p < or = 0.05) by 21% compared to controls. We determined that the application of controlled subatmospheric pressure creates an environment that promotes would healing.
Animals↗
Vacuum-assisted closure: a new method for wound control and treatment: clinical experience.
Despite numerous advances, chronic and other difficult-to-manage wounds continue to be a treatment challenge. Presented is a new subatmospheric pressure technique: vacuum-assisted closure (The V.A.C.). The V.A.C. technique entails placing an open-cell foam dressing into the wound cavity and applying a controlled subatmospheric pressure (125 mmHg below ambient pressure). Three hundred wounds were treated: 175 chronic wounds, 94 subacute wounds, and 31 acute wounds. Two hundred ninety-six wounds responded favorably to subatmospheric pressure treatment, with an increased rate of granulation tissue formation. Wounds were treated until completely closed, were covered with a split-thickness skin graft, or a flap was rotated into the health, granulating would bed. The technique removes chronic edema, leading to increased localized blood flow, and the applied forces result in the enhanced formation of granulation tissue. Vacuum-assisted closure is an extremely efficacious modality for treating chronic and difficult wounds.
Atmospheric Pressure↗
Nonsurgical modalities to enhance healing and care of soft tissue wounds.
The rapidly aging population and patients with multiple concomitant pathologies present an increasing population of patients with nonhealing and problem wounds causing an unwelcome challenge for all health care providers. Many of these patients are not surgical candidates, or surgical procedures have failed to close their wounds. These wounds are particularly worrisome when an orthopaedic component is included, since bone and hardware must be covered as quickly as possible to prevent infection and even worse complications. We present a brief overview of several nonsurgical modalities that may be used to heal soft tissue wounds completely or to prepare the wound so a smaller surgical intervention may be done with greater chance for success. We include exogenous application of growth factors, cultured keratinocyte grafts, electrical stimulation, hyperbaric oxygen, and a vacuum-assisted closure system (V.A.C.).
Electric Stimulation Therapy↗
An increase in infant cranial deformity with supine sleeping position.
Abnormalities of the occipital cranial suture in infancy can cause significant posterior cranial asymmetry, malposition of the ears, distortion of the cranial base, deformation of the forehead, and facial asymmetry. Over the past 2 years, we have noted a dramatic increase in the incidence of deformation of the occipital skull in our tertiary referral center. Our patient referral base has not changed appreciably over the past 5 years and patients have been referred from the same primary practitioner base. The timing of this increase correlates closely with the acceptance in our area of recommended changes in sleeping position to supine or side positioning for infants because of the fear of sudden infant death syndrome (SIDS). A total of 51 infants with occipital cranial deformity, with a mean age of 5.5 months at presentation, have been evaluated and treated by a single craniofacial surgeon in the 16-month period from September 1993 to December 1994. Older infants were treated with continuous positioning by the parent keeping the infant off the involved side. Younger infants and those with poor head control were treated with a soft-shell helmet. Mean timing of initial diagnosis and start of treatment was 5.5 months. Mean duration of helmet for positional treatment was 3.8 months. To date, only 3 of 51 patients have required surgical intervention, and other patients demonstrated spontaneous improvement of all measured parameters. Follow up has ranged from 8 to 24 months. We believe that most occipital plagiocephaly deformities are deformations rather than true cranio-synostoses. Despite varying amounts of suture abnormality evidenced on computed tomographic scans, most deformities can be corrected without surgery. In cases where progression of the cranial deformity occurs, despite conservative therapy, surgical intervention should be undertaken at approximately 1 year of age. The almost universal acceptance in the State of North Carolina of positioning neonates on their backs to avoid SIDS, may well increase the incidence of these deformities in the future.
Cranial Sutures↗