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[The use of latex expanders for the formation of a conjunctival space in anophthalmos].

Methods for conjunctival cavity plasty in anophthalmia and their advantages and drawbacks are discussed. The known methods do not always bring about satisfactory results (ensure a stable position of the prosthesis in the cavity). A method for conjunctival cavity formation with latex expanders is proposed. Original designs of expanders for the conjunctival cavity were used. The method is interesting and promising for conjunctival cavity plasty in anophthalmia when the cavity is shrunk.

Anesthesia, General↗
PubMed2000

Results of the superior oblique tendon elongation procedure for severe Brown's syndrome.

PURPOSE: To evaluate the outcomes of the silicone tendon expander for the treatment of Brown's syndrome. METHODS: This paper consists of 2 parts: a chart review of patients who have under gone the silicone tendon elongation procedure for Brown's syndrome and a survey of the surgical experience of the members of the American Association of Pediatric Ophthalmology and Strabismus. Charts of 15 consecutive Brown's syndrome patients who underwent the superior oblique tendon expander were reviewed by the author from 1987 to 1997. An additional patient referred to the author for management of complications of the silicone tendon expander procedure after surgery elsewhere for Brown's syndrome is reported. The second aspect of the study is a fax survey sent to all 450 members of the American Association of Pediatric Ophthalmology and Strabismus listed in the 1997-1998 directory. Pediatric ophthalmologists were asked to answer questions regarding their experience using the silicone tendon expander for Brown's syndrome. RESULTS: Of 15 patients operated on by the author, preoperative limitation of elevation in adduction measured -4 in 14 patients and -3 in 1 patient preoperatively. Postoperatively, 14 of the 15 patients showed improved motility, with essentially normal versions in 10 patients (no more than +/- 1 oblique dysfunction); 3 patients were undercorrected (2 mild and 1 severely); and 2 had a consecutive superior oblique paresis (1 mild and 1 requiring an inferior oblique weakening procedure). The 1 patient with a severe undercorrection that did not improve after the silicone tendon elongation procedure showed continued restriction by intraoperative forced ductions after superior oblique tenotomy. Superior oblique tendon was not the cause of Brown's syndrome in this patient. The average final result graded on a scale of 1 to 10 (10 being best) was 8.3. Thirteen of 15 patients (87%) achieved a final result score of 7 or better with a single surgery, and an additional patient was corrected with a second surgery providing an overall success rate of 93%. Ten of the 15 patients had at least 11 months' follow-up, and 6 of the 10 patients showed a delayed improvement over a 4- to 6-month period. Five patients had more than 5 years of follow-up, and 4 (80%) had an excellent long-term outcome (final result, 9 to 10) with a single operations; all 5 had a good final outcome (final result, 7 to 10, mean 9.2) with 1 patient requiring a second surgery. There were no long-term complications, including no extrusions, no restriction of ocular rotations, and no infections. The patient who underwent the procedure elsewhere demonstrated limited movement of the eye to adduction elevation, and there was underaction of the ipsilateral superior oblique muscle. A reoperation performed by the author revealed positive forced ductions up and nasal ward. There were scars and adhesions in the area of the silicone implant, including scar to superior nasal sclera and superior rectus muscle. The silicone implant was removed and scar excised until forced ductions improved. This resulted in improved motility. Thirty-nine AAPOS members reported on 140 patients who had undergone the silicone tendon elongation procedure for Brown's syndrome. Judged by the surgeon on a scale of 1 to 10 (10 being best), 26 surgeons rated 91 patients (65%) as good with a score of 8 to 10, and 14 surgeons rated 18 patients (13%) poor with scores of 1 to 3. Complications were recorded for 9 patients and included scarring and restriction with removal of silicone implant in 4 and spontaneous extrusion in 5. Three of the 5 spontaneous extrusions came from the same surgeon, and in another case a surgeon used a 10 mm length of silicone. CONCLUSIONS: A novel procedure, the silicone tendon expander, is an effective option for correcting Brown's syndrome caused by a stiff or inelastic superior oblique tendon; long-term outcomes are excellent. Proper technique with maintenance of the tendon capsule is critical to the successful outcome of the procedure.

Eye Movements↗
PubMed2000

Tissue expander: histological and histochemical study 6 months after transplant--our experience.

Implanting an expander in the subcutaneous layer causes gradual expansion and provides additional tissue for reconstruction of tissular defects. The force applied remodels the connective tissue and modifies dermis contractibility in additional tissue. Other authors confirm that parameters such as mitosis and hyaluronan influence the system in the tissue regeneration processes. We studied histochemical and morphological variations of tissue expanders before and 6 months after transplant. Our histochemical data do not show any changes in dermis glycosaminoglycans of the expanded and transplant-expanded skin when compared to controls. Morphological data demonstrate reorganization of connective fibers and disappearance of the papillar layer. The latter is not yet formed in the expanded skin 6 months after transplant. This suggests that a long time is required for biological reconstruction of epidermal-dermal interactions after transplant.

Adolescent↗
PubMed2001

Revision total knee arthroplasty: planning, management, controversies, and surgical approaches.

Revision total knee arthroplasty can be a technically challenging procedure fraught with potential complications. In many cases, obtaining adequate exposure is difficult, and failure to do so can directly cause technical errors and complications. Patient-specific systemic comorbidities and anatomic details can further complicate the procedure. Careful preoperative evaluation can help to facilitate optimal results. Furthermore, specific surgical techniques help to improve the surgical exposure and can minimize complications such as wound healing problems, component malposition, and extensor mechanism disruption. All surgeons undertaking these procedures require a thorough understanding of these principles.

Adult↗
PubMed2000

[Ehancement of tissue expansion in guinea pig by local delivery of chemical agents using a new type expander].

OBJECTIVE: To search for the new method to increase the rate of tissue expansion. METHODS: A new type of double-lumen expander was buried in the back of guinea pig. Through the expander chemical agents (papaverine) were delivered. RESULTS: The new expander could effectively deliver chemical agents. In comparison with the control group, the blood flow, survival length and the length to width ratio of the expanded flap in the experimental group increased statistically. The immediate retraction ratio of the flap decreased significantly. The epidermis was thicker while the dermis was not significant different from the control. The panniculus carnosus was significant thinner in the expanded group than the unexpanded group. The deep connective tissue was statistically thinner in the group using the new type expander. CONCLUSION: The new type of expansion method could accelerate tissue expansion rate and improve the quality of expanded skin and flap.

Animals↗
PubMed2000

[Analyzing study of complications of tissue expansion related to the injectable system].

OBJECTIVE: To analyze the complications of tissue expansion related to its injectable system. METHODS: One hundred and ninety six patients were followed up and analyzed for the complications of the tissue expansion concerned to its injectable system. The management of these complications was also reviewed. RESULTS: There were five kinds of the complications(with the occurrence of 32%) related to the injectable system in this group patients. The highest frequency of the complications occurred in the implantation stage. Further management was also documented well. CONCLUSION: The complications of tissue expansion related to the injectable system occurred commonly and should be paid more attention on them.

Adolescent↗
PubMed2002

[Effect of the endoexpander pressure of continuous and constant pressure expansion on the drug permeability].

OBJECTIVE: To investigate the effect of the endoexpander pressure of continuous and constant pressure expansion on the drug permeability. METHODS: The expanders were divided into two groups, the normal expansion and the continuous and constant pressure expansion (4.6 kPa). Each expander was filled with 0.2% Metronidazole, then the expanders were immersed wholly in normal saline and sealed totally. At several intervals over 72 hours, the surrounding saline was sampled and the drug concentration of the sample was measured respectively. RESULTS: Both groups were permeable to the Metronidazole and the concentration outside the expander would reach the effective concentration in 48 hours. The drug concentration of the continuous and constant pressure expansion was higher than that of the normal one and there was significant difference between the two groups (P < 0.01). CONCLUSION: The endoexpander pressure in continuous and constant pressure expansion can enhance the drug permeability. In view of this, in the course of continuous and constant pressure expansion, 0.2% Metronidazole can be used to prevent and control the infection.

Humans↗
PubMed2001

[Clinical study of a new expander with an agent delivery system and the effect of a chemical agent on tissue expansion].

OBJECTIVE: To search for a method to enhance tissue expansion. METHOD: A new type of expander with an agent delivery system was used to expand soft tissue in 15 patients. During expansion Papaverine was delivered through the delivery system into the tissue around the expanders. RESULTS: It took 26 days to expand to the anticipated volume in the new expansion method group (NEM) and 51 days in the general expansion method group (GEM) (P < 0.01). Before operation the NEM group was over-expanded by 92.4% while the GEM group was over-expanded by 27.12%. At full expansion the blood flow of the expanded area of the two groups was 1.27 (NEM) and 0.64 (GEM). The immediate skin retraction of the two groups was 20.17% (NEM) and 38.26% (GEM). CONCLUSION: The new expansion method can accelerate expansion speed and improve the quality of expanded skin and flap.

Drug Delivery Systems↗
PubMed2002

[Cancer update on breast reconstruction].

Breast reconstruction is evolving towards immediate reconstruction (IBR). Adjuvant radiotherapy remains an esthetical contraindication to classical techniques due to complication rate (capsular contracture, flap necrosis and contracture). Tissue expansion combined with radiotherapy must be evaluated. IBR quality of life raises the issue of its evaluation. IBR current limits seem to be psychological. The quality of preoperative information will determine IBR real life experience.

Breast Neoplasms↗
PubMed2002

Contracted anophthalmic socket repair.

PURPOSE: The aim of this paper is to describe a simple method for severely contracted anophthalmic socket repair in which a silicone sphere is used as an expander for widening and deepening severely contracted conjunctival sacs. PATIENTS AND METHOD: This method was used in five patients. Each patient had undergone previous operations but they could not wear artificial eyes and there was no hope of performing any other type of surgical procedure successfully. In our surgical method, the severely contracted conjunctiva is cut deeply at the desired level of the upper and lower eyelid fornix. A certain amount of scar tissue is excised and a silicone sphere is placed under the eyelids. The eyelid margins are sutured to each other with a double-running nylon suture. After four months, the eyelid fissure is opened and a special round-shaped artificial eye is inserted. The original silicone sphere is used as an expander in the evenings during the next two or three months. RESULTS: This procedure was used successfully in four of the five cases. In one case the silicone sphere was lost and cicatrization reoccurred. The longest follow-up time is now five years, the shortest, one year. CONCLUSION: Using a silicone sphere as an expander can be an alternative surgical method for contracted anophthalmic socket repair. The main advantage of this method is its simplicity. In order to use this procedure, good cooperation between doctor and patient is essential.

Adult↗