Complete bilateral cleft lip.
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Cleft Lip↗
Biomedical subjects
Y Har-Shai
Publications and source records attributed to Y Har-Shai.
The viability of revascularized calvarial bone graft in a pig model.
This study compared the vascularity and resorption of calvarial bone flaps based on an undisturbed pedicle and on a previously (4 weeks) detached pedicle of the superficial fascia (galea) and periosteum and free calvarial bone grafts. Nine adult pigs were used, in three of which a silicone rubber compound was injected intravascularly immediately after the transfer confirmed the vascularity of both pedicled bone flaps. In six pigs, volume changes were assessed intraoperatively by a water displacement method and also 12 weeks postoperatively. Both pedicled bone flaps preserved their original volume, whereas free skull grafts showed approximately 50% of volume loss (p less than 0.001). Decalcified hematoxylin and eosin sections of the specimens obtained 12 weeks postoperatively showed a normal calvarial appearance in both pedicled bone flaps and extensive fibrous tissue infiltration into free grafts. It is suggested that a previous detachment of galea and periosteum does not interfere with the use of vascularized calvarial bone graft, which may provide a more predictable result than a free bone graft.
Animals↗
Comparison of inorganic bovine bone mineral particles with porous hydroxyapatite granules and cranial bone dust in the reconstruction of full-thickness skull defect.
Twenty adult rabbits were used to evaluate the biocompatibility and osteoconductivity of Bio-Oss, an inorganic bovine bone mineral, in the reconstruction of full-thickness skull defects. Skull defects were treated with either autogenous bone dust, porous hydroxyapatite granules, Bio-Oss particles, or were left untreated as controls. Histological examination of decalcified sections showed incorporation of Bio-Oss into the host tissue without a significant inflammatory reaction. Measurement of the profile area occupied by the bone revealed that Bio-Oss, hydroxyapatite, and the control had the same amount of bone ingrowth, whereas autogenous bone dust produced a greater amount of bone (p < 0.01). We conclude that Bio-Oss, like porous hydroxyapatite, has sufficient osteoconductive properties and can also be used as a bone substitute material.
Animals↗
Muscle microcirculatory impairment following acute compartment syndrome in the dog.
Visualization of the intramuscular microcirculation during and after compartmental syndrome was studied by microangiograms and histologic cross sections. A marked reduction in the circulation of the endomysial capillary network was found during compartment tamponade, whereas the perimysium arteriolar system was patent. Revascularization took place by formation of distorted blood vessels accompanied by intramuscular hematomas in muscles 7 and 14 days after the compartment insult. The cross sections show massive fibroblastic activity around blood vessels that caused concealed intramuscular pressure-ischemic contracture resulting in the foci of myofibrillar necrosis seen within normal muscle tissue. The muscle located in the tamponaded compartment profusely bleeds when it is touched, even though its viability is in doubt. The explanation for this clinical observation might be the abnormal intramuscular revascularization that was found in this work.
Acute Disease↗
The vascular anatomy of the galeal flap in the interparietal and midline regions.
The potential extension of the galeal flap in the interparietal area was studied on 17 fresh human cadaver heads by intravascular dye injection technique. It was demonstrated that an ipsilateral superficial temporal artery that supplies the galeal flap does not cross the midline or anastomose with the contralateral superficial temporal artery but ensures the survival of a flap extended up to 1 cm proximal to the sagittal suture line. The width of the temporoparietal flap can be extended up to 15 cm, depending on the vascular pattern of the superficial temporal artery. When required, the lateral extension may provide the required soft-tissue bulk despite the reduced flap length.
Aged↗
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↗
Hypertonic mannitol ameliorates intracompartmental tamponade in model compartment syndrome in the dog.
Acute compartment syndrome (ACS) is a devastating complication of rhabdomyolysis caused by muscle tamponade secondary to increased intracompartmental pressure (Pi). ACS requires emergency surgical decompression when Pi greater than 30 mmHg (normal less than 4.0 mmHg) and clinical signs exist. The present study was undertaken to examine whether mannitol which has been used extensively for prevention of acute renal failure in rhabdomyiolysis may also improve muscular hemodynamics in ACS. ACS was produced in dogs by injecting dog plasma into the anterolateral compartment of the hind limb. The Pi was directly monitored. Control dogs received saline, whereas experimental dogs received intravenously 20% mannitol (0.15 ml/min/kg) over a period of 1 h. The initial Pi was set arbitrarily at 100 mm Hg. Following the establishment of ACS, the spontaneous mean decrease in Pi in the control group was 40% of initial value over 60 min (n = 5) versus a decrease of 65%/60 min in the experimental (mannitol) group (n = 7, p less than 0.01). The net mean decompressive effect of mannitol treatments was approximately 28 mm Hg (mean control Pi minus mean experimental Pi at time 60 min). Extrapolated to man with ACS, such a decrease in Pi induced by mannitol theoretically could relieve compartmental tamponade noninvasively.
Angiography↗
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↗
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↗
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 volume limitation of the galeal temporalis flap in facial augmentation.
Galeal temporalis flaps based on the superficial temporal vessels have been used for facial augmentation and can be extended to the contralateral side beyond the midline in order to achieve maximum volume. In five patients, the volumes of extended galeal flaps were measured intraoperatively using a water displacement method. The calculated volume varied between 28 and 38 cm3. Experience with this flap showed satisfactory results with no complications; therefore, it is concluded that the extended galeal temporalis flap may be a first choice in the correction of facial soft tissue deficits less than 40 cm3. Clinical cases are presented.
Adult↗
A well developed alveolabial sulcus of the intermaxilla in a complete bilateral cleft lip and palate.
An uncommon well developed alveolabial sulcus in a baby born with a complete bilateral cleft lip and palate is presented. The possible embryonic explanation for this extremely rare finding is discussed.
Cleft Lip↗
Phosphorus burns: a practical approach to local treatment.
Most phosphorus burns are of limited extent. First aid consists of vigorous irrigation with water or saline followed by application of soaked dressings. At the Rambam Medical Center Burn Unit, washing of the wounds with 1% copper sulfate and 5% sodium bicarbonate solutions occurs before removal of phosphorus particles. In selected patients, prompt excision of the injured tissue and skin grafting are recommended. Fluid replacement and close monitoring of ECG, serum calcium, phosphorus, and electrolytes are recommended for all patients with such burns.
Bicarbonates↗