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At least 163 records · Page 9Linked to original sources

PubMed2004

[Value of autologous chondrocyte transplantation in experimental cartilage defects reconstruction. Part II: Microscopic analysis of reconstructed cartilage structural integrity and surface regularity].

UNLABELLED: Experimental and clinical tests proved that cultured, autologous chondrocytes retain their properties and have ability to reconstruct hyaline-like cartilage, which represents chemical composition and biomechanical characteristics similar to normal hyaline cartilage. The aim of this part of the study was microscopic evaluation of repair tissue structural integrity and surface regularity after autologous chondrocyte transplantation. MATERIAL AND METHODS: Repair of partial thickness cartilage defect (ICRS III(o) grade) on distal femur joint surface was evaluated (25 adolescent rabbits). Procedures were performed in two groups: I--autologous chondrocyte transplantation under periosteal flap, II--periosteal graft. Chondrocytes were isolated from the cartilage specimens by enzymatic digestion and cultured in vitro. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale. RESULTS: In group I, 4 weeks after the procedure surface of the reconstructed tissue was irregular. 8- and 12-week observation found the surface regular and plain, and repair tissue exhibited complete structural integrity. In group II, in all follow-up periods regenerate surface was irregular, there was many fissures and cracks in graft tissue, and in several cases--regenerate disintegration. CONCLUSION: Obtained results indicate, that hyaline-like cartilage reconstructed after autologous chondrocyte transplantation was characterized by regular, plain surface and complete structural integrity.

Animals↗

PubMed2005

[Different psychological impact of immediate breast reconstruction and delayed breast reconstruction].

OBJECTIVE: To investigate the optimal time to perform breast reconstruction after mastectomy for breast cancer. METHODS: From May, 2001 to March, 2004, 52 patients were performed immediate or delayed breast reconstruction after mastectomy. They were given questionnaires to assess for satisfaction, sexuality, anxiety, depression, body image and self-esteem. RESULTS: 97% of the IR group patients were very or moderately satisfied while only 75% of the DR group were so (P = 0.026). Only 6% of the IR group compared with 30% of the DR group felt an obvious impairment of their sexual attractiveness (P = 0.043). Anxiety (P = 0.014) and depression (P = 0.006) were less in the IR group than the DR group. Body image (P = 0.012) and self-esteem (P = 0.003) were superior in the IR group. CONCLUSIONS: If tumor characters and patient health permit, immediate breast reconstruction should be performed after mastectomy for breast cancer.

Adult↗

PubMedDate not supplied

[Secondary breast bilateral reconstruction with myocutaneous pedicled latissimus dorsi flap after primary bilateral skin sparing mastectomy reconstruction with consecutive severe capsular contraction].

We present a patient who was operated due to bilateral breast carcinoma with immediate bilateral breast reconstruction with silicone implants after skin sparing mastectomy in a neighbouring country to Croatia. One year following the operation a severe bilateral capsular contracture was manifested. Due to a large umbilical hernia and lower laparotomy scar it was not possible to reconstruct the breasts with any abdominal free or pedicled flap. We performed bilateral secondary breast reconstruction with latissimus dorsi myocutaneous flap and silicone implants in two stages with good postoperative result.

Adult↗

PubMed1983

Delayed vaginal reconstruction in the fibrotic pelvis following radiation or previous reconstruction.

Vaginal reconstruction was performed in 14 patients who had developed vaginal stenosis secondary to extensive pelvic fibrosis after pelvic radiation therapy (12 patients) or prior vaginal reconstruction (2 patients). Sixteen procedures were performed using a split-thickness skin graft. All patients had satisfactory vaginal restoration, and 12 patients reported good vaginal function. No fistula developed as a result of the operative procedure, but one patient later developed a rectovaginal fistula resulting from tumor recurrence. Successful vaginal reconstruction can be achieved even years after initial therapy in patients who develop an obliterated vagina from previous radiation or surgery.

Adult↗

PubMed1995

Soft tissue reconstructive choices for craniofacial reconstruction.

The extensive blood supply to the scalp enables the use of local flaps based mainly on the superficial temporal artery: these include skin, temporoparietal fascia, subgaleal fascia, and temporal fascia. Also, the temporalis muscle provides flaps based upon the temporal branches of the internal maxillary artery. On top of the skull, scalp flaps, galeal flaps, and pericranial flaps can be used as random flaps or as axial flaps based on the problems or anatomic reasons that would preclude microvascular reconstruction. The pectoralis, latissimus, splenius capitis, and trapezius muscle flaps can dependably reach the base of the skull. The increasing reliability and versatility of microvascular reconstruction render their use standard for craniofacial reconstruction.

Adult↗

PubMed1993

[Forum: reconstruction of the traumatic thumb. Reconstruction of the thumb by osteocutaneous flaps of the forearm].

The authors present different techniques of thumb reconstruction using osteocutaneous retrograde island forearm flaps. They describe an original thumb reconstruction technique by using the anterior interosseous osteocutaneous retrograde island flap and present two clinical cases. The advantages and disadvantages as well as the indications of this kind of thumb reconstruction procedure are discussed.

Adult↗

PubMed1993

[Forum: reconstruction of the traumatic thumb. Reconstruction of the thumb in a child by double transfer. Apropos of a clinical case].

The authors present a case of atypical thumb reconstruction in children, using a combined vascularized joint transfer and a free partial big toe transfer. They describe a burned hand with first metacarpal amputation and transproximal phalanx amputation of the index. According to the "bank finger" principle the metacarpophalangeal joint was transferred on the top of the first metacarpal, vascularized by the two collateral pedicles. The second metacarpal shaft was removed to create the first web and kept for bone grafting. A "wrap-around" flap (Morrison) with an intercalated bone graft completed this reconstruction. A first web orthesis was used to prevent retraction. Result at six months was functionally and cosmetically good, but the normal growth of the reconstructed thumb must be demonstrated by the future. Finally, the other procedures are considered.

Amputation, Traumatic↗

PubMed1993

[Forum: reconstruction of the traumatic thumb. The thumb in hand mutilations. Indications for reconstructive surgery].

The indications for reconstruction of the thumb in traumatic mutilations of the hand are presented in relation to the various conventional and microsurgical techniques. Several clinical situations are distinguished according to the severity of the hand mutilation and the number of severed fingers. Paucidigital amputations (one or two fingers including the thumb) should be treated by pollicisation or other techniques (Matev, osteoplastic reconstruction, second toe or "custom-made" transfers) depending on whether or not the other fingers need to be preserved. Pluridigital amputations (the thumb and two or three long fingers) require transfer of the 2nd toe or "custom-made" transfers avoiding a further reduction of the digital capital of the hand. Amputations of the five fingers create oblique, transverse or convex sections which, when they are proximal, require elongation of one, two or three digits depending on whether surgery is designed to restore a bipod or tripod pinch grip. Lastly, complex mutilations require a combination of digital reconstruction and palmo-commissural skin repair by neurovascular free flaps from the foot. Nonsurgical management should also be discussed in every case.

Amputation, Traumatic↗

PubMed1997

Anterior cruciate ligament reconstruction. Bone-patella tendon-bone versus semitendinosus anatomic reconstruction.

In this article, the long term (2-10 years; mean, 4.8 years) followup results of two reconstructive procedures for the anterior cruciate ligament are compared. The bone-patella tendon-bone (with interference fit fixation) was performed on 69 knees, and the semitendinosus anatomic reconstruction was performed on 68 knees, in a population of 76 men and 52 women (age range, 15-60 years; average, 31 years). The patients in the two groups showed no difference in subjective results or activity level and no significant difference to manual testing. The semitendinosus procedure group had a slightly higher KT manual maximum failure rate than the patella tendon group (17% versus 11%). Arthrometric stability did not show deterioration, but patient satisfaction decreased in those patients who had meniscectomies. Both procedures showed satisfactory results during the long term followup. However, if the secondary restraints are compromised, the stiffer bone-patella tendon-bone construct is preferred for reconstruction of the chronic anterior cruciate ligament deficient knee.

Adolescent↗

PubMed1997

Three-dimensional reconstruction from reduced sets of very noisy images acquired following a single-axis tilt schema: application of a new three-dimensional reconstruction algorithm and objective comparison with weighted backprojection.

In this work we propose a reconstruction algorithm (ART with blobs) that has not been previously used in electron Tomography and we compare it with the standard method in the field (weighted back projection, WBP). We assume that only a limited set of very noisy images, collected around a single axis tilt, is available; which is a typical situation in Electron Tomography. In general, the reconstruction problem is underdetermined (due to the limited number of projections) and the data are inconsistent (due to the high level of noise). The evaluation of the results is performed in a rigorous way by a task-oriented approach which makes use of numerical observers. ART with blobs outperforms WBP for a number of key tasks. Results are presented both for simplified line integral data and for realistic simulations of macromolecular structures embedded in amorphous ice.

Algorithms↗

PubMed1992

Computer-assisted 3D-reconstruction and statistics of the limbic system. 1. Computer-assisted 3D-reconstruction of the hippocampal formation, the fornix, and the mamillary bodies.

The hippocampal formation of eight perfusion-fixed human brains was examined using new methods according to stereotactic and morphometric principles (macrovibratome and computer-aided 3D reconstruction). The reconstructions form part of a neuroanatomical reference system (NeuRef). This reference system allows for 3D visualisation of the brain and its components on a computer graphic workstation, as well as for the presentation of the union set based on a neuroanatomical structure taken from this sample of brains. This retrievable knowledge of neurofunctional systems is important for the preoperative planning of neurosurgeons and the adjustment of radiotherapy.

Adult↗

PubMed1997

Total anorectal reconstruction with a double dynamic graciloplasty after abdominoperineal reconstruction for low rectal cancer.

PURPOSE: Total anorectal reconstruction with a double dynamic graciloplasty was performed after abdominoperineal reconstruction (APR) for low rectal cancer. In four patients an additional pouch was constructed to improve neorectal motility and capacity. The aim of this study was to evaluate the results in the first 20 patients and to report on the preliminary results of patients with an additional pouch. METHODS: Twenty patients with a mean age of 52 (range, 25-71) years and a rectal tumor at a mean of 3 (range, 0-5) cm from the anal verge were treated. In 14 patients the Miles resection, colon pull-through, and construction of a neosphincter were performed in one session. Six patients had the double graciloplasty at an average of 4.1 (range, 1.1-8.8) years after APR. In four patients a pouch was constructed with an isolated segment of distal ileum. RESULTS: After a mean follow-up of 24 (range, 1-60) months after APR, none of the patients developed local recurrence, whereas four patients developed distant metastasis. Fifteen of 20 patients were available for evaluation, and 5 patients were still in training. Of these 15 patients, 8 patients were continent (53 percent), 2 patients were incontinent, and in 5 patients the perineal stoma was converted to an abdominal stoma. Failures were attributable to necrosis of the colon stump (n = 2) and incontinence (n = 3). At 26 weeks mean resting pressure was 44 (standard deviation (SD), 28) mmHg, and mean pressure during stimulation was 90 (SD, 46) mmHg at a mean of 3.5 (SD, 1.2) volts at 52 weeks. Mean defecation frequency was three times per day (range, 1-5). Of the eight patients who were continent, six used daily enemas. Mean time to postpone defecation was 11 (range, 0-30) minutes. CONCLUSION: In experienced hands, the double dynamic graciloplasty is an oncologically safe procedure that can have an acceptable functional outcome in a well-selected group of patients. However, to improve the outcome, further modifications will be necessary. So far, the addition of a pouch has not resulted in improved outcome.

Adenocarcinoma↗

PubMed2001

Clinical and radiographic results of ACL reconstruction: a 5- to 7-year follow-up study of outside-in versus inside-out reconstruction techniques.

This study compared the clinical outcome of anterior cruciate ligament (ACL) reconstruction between the inside-out and the outside-in techniques and assessed radiographically whether surgical technique affects the position and direction of the bone tunnels. A patellar tendon ACL reconstruction was performed in 141 patients with inside-out (group I, n = 78) and outside-in technique (group II, n = 63). Clinical results were evaluated using the International Knee Documentation Committee (IKDC) form; radiographic study was performed in anteroposterior, lateral, and notch views. Overall results in group I were normal in 23% of cases, nearly normal in 55%, and abnormal in 22%; in group II there were normal results in 19% of cases, nearly normal in 57%, abnormal in 19%, and severely abnormal in 5%. Radiographic examination identified important differences between the two groups. The main differences between the two surgical techniques were related to the positioning of the femoral tunnel. With the inside-out technique the femoral tunnel was significantly more vertical, both in the frontal and the sagittal planes. Moreover, the femoral tunnel was higher when drilled from the inside, but the difference between the two techniques was not statistically significant. The differences found between the two techniques regarding the tibial tunnel were not significant, although in the inside-out group the tibial tunnel seemed slightly more lateral, vertical, and posterior. Moreover, we observed a greater risk of bone-screw divergence on the femur in the inside-out group. This divergence was greatest in the sagittal plane. However, we observed no effect of this bone-screw divergence on the stability of the knee at follow-up.

Adolescent↗

PubMed2000

Reconstruction after total pharyngolaryngoesophagectomy. Comparison of elongated stomach roll with microvascular anastomosis with gastric pull up reconstruction or something like that.

BACKGROUND: We have performed total pharyngolaryngoesophagectomy in case of double cancer, head-neck and thoracic esophageal cancer, or cervical esophageal cancer that extended down to the level of aortic arch. The procedure is very challenging. METHODS: From April 1984 to May 1998, 14 patients underwent the procedures for double cancer of head-neck and thoracic esophagus (n=10), hypopharyngeal or cervical esophageal cancer (n=3), and synchronous esophageal cancer (n=1). The grafts used were whole stomach (n=6), elongated stomach roll (n=5), and stomach roll with free jejunum (n=3). The routes of reconstruction were posterior mediastinum (n=10), antesternal (n=3), and retrosternal (n=1). RESULTS: Elongated stomach roll with microvascular anastomoses was long enough for reconstruction and the blood supply of the graft was sufficient. There was no fatal complication in this procedure. Oral feeding was achieved in 13 (93%) patients. CONCLUSIONS: The elongated stomach roll with microvascular anastomosis is efficient and the placement of the conduit in the posterior mediastinum is recommended to allow a better alimentary comfort in total pharyngolaryngoesophagectomy.

Adult↗

PubMed1999

Anterior cruciate ligament reconstruction and physiological joint laxity: earliest changes in joint stability and stiffness after reconstruction.

Physiological joint laxity is an important element of normal knee joint function, providing smooth joint movement. However, the objective evaluation of post-operative results after knee ligament surgery is usually based primarily on stability and range of motion, and joint laxity has been ignored. In this study, we measured the joint stiffness of 82 knees undergoing anterior cruciate ligament (ACL) reconstruction with the Leeds-Keio artificial ligament, before the operation, immediately after the operation, and finally when the full range of motion was achieved postoperatively; changes in joint laxity after the ACL reconstruction were investigated. Before the operation, joint laxity was greater than that of the normal side (P < 0.01), but immediately after the operation it diminished compared not only with that observed preoperatively, but also with that of the normal side. When the full range of motion was achieved, joint laxity was lower than that observed immediately after the operation (P < 0.01), but still remained higher than that of the normal side (P < 0.01). In other words, stability was achieved, but joint laxity was diminished through the operation. In this series, a stiffer artificial ligament than the natural ACL was used, and maximum tension was applied during the operation, aiming at better stability, but this may cause diminution of joint laxity.

Adolescent↗

PubMed2002

[Is there new knowledge on embryology and functional anatomy of human mimetic muscles and the upper lip? A contribution to point selection, skin incision and muscle reconstruction in primary lip-nose reconstruction of uni- and bilateral lip-jaw-palatal clefts].

BACKGROUND: The great variety of primary cheiloplastic procedures in CLP patients shows that there is disagreement regarding the embryological development of this part of the face, the point selection, skin incision philosophy, and the macroscopic and microscopic functional anatomy of the human muscles of facial expression. We suppose from findings in Asian and African populations that the real embryological development of the upper lip differs from current textbook descriptions. Our own anatomical and embryological investigations serve as a basis for a critical discussion of different techniques of muscle reconstruction, point selection, and skin incision and for a description of an embryologically, functionally, and anatomically oriented operation technique for different entities of CLP. METHODS: The findings of this study result from investigations of the embryonal and early fetal development from the 26th to the 112th i.u. day in REM pictures of the Anatomical Institute of the University of Göttingen (n = 8) and serial histological investigations of the Carnegie and Hooker-Humphrey Collections at the Armed Forces Institute of Pathology, Washington, D.C. (n = 40). Furthermore, we carried out microsurgical dissections of the muscles of facial expression, the osseous and cartilaginous parts of the nose, and the midfacial sutures in two adult heads without congenital disorders and one newborn head with a primary unilateral complete cleft of the lip and alveolus. RESULTS AND DISCUSSION: The formation of the lower third of the upper lip is the result of contact of the maxillary bulges in the midline below the prolabium. According to this finding, the point selections and skin incisions have to be modified in the midline region in different types of uni- and bilateral CLP. Our technique of primary dissection, reorientation, and suturing of the muscles of facial expression is presented. The muscle reconstruction has to be performed independently from the skin preparation.

Cleft Lip↗

PubMed1980

Accurate three-dimensional reconstruction of neuronal distributions in brain: reconstruction of the rat nucleus locus coeruleus.

A technique is described which permits construction of accurate, quantified 3-dimensional maps of the distribution of neuronal cell groups in brain. The cartesian coordinates of landmarks and individual neurons are obtained from serial histological sections utilizing a computer-linked digitizing microscope. The digitized images of these sections are displayed on a computer graphics picture system where they are aligned so that spatial relationships within the nucleus are essentially identical to those of the intact brain. This is accomplished using information about landmarks obtained from photomicrotomy. As a consequence of the alignment procedure, each neuron is assigned a 3-dimensional coordinate representing its position in the reconstituted nucleus, and the reconstruction is oriented in a stereotaxic coordinate system. Nuclei from different brains can then be registered to one another, assigned coordinates relative to this standard coordinate space, and be compared statistically. Differences between nuclei in the spatial distribution of neurons in toto, or in the distribution of anatomically or physiologically defined subpopulations of neurons, can then be visualized with greater accuracy and in more detail than that permitted by traditional techniques. In addition, such comparisons can easily be quantified and statistically evaluated using, for example, analysis-of-variance techniques. For illustrative purposes, the technique is applied to the rat nucleus locus coeruleus as reconstructed from serial Nissl-stained sections.

Animals↗

PubMed2006

A retrospective study of the midterm outcome of two-bundle anterior cruciate ligament reconstruction using quadrupled semitendinosus tendon in comparison with one-bundle reconstruction.

PURPOSE: The objective of the study was to retrospectively compare the outcome of the first series of a 2-bundle anterior cruciate ligament reconstruction technique using quadrupled semitendinosus tendon with that of a 1-bundle reconstruction technique from 1992 through 1996. TYPE OF STUDY: Case-control study. METHODS: The 1-bundle group consisted of 56 patients with a follow-up period of 24 months or more (average, 46.5 months). The 2-bundle group consisted of 79 patients with a follow-up period of 24 months or more (average, 40.8 months). Manual knee laxity tests, anterior stability with KT-1000 (manual maximum), and knee extension and flexion strength by Cybex were evaluated using an average and standard deviation, and data were categorized according to the International Knee Documentation Committee (IKDC) classification. The Lysholm scale and the subjective recovery scale were also evaluated. RESULTS: A statistically greater number of patients in the 1-bundle group were positive (+ or ++) based on the Lachman test (34% in the 1-bundle group and 13% in the 2-bundle group). The average KT-1000 anterior laxity of 2.7 +/- 2.3 mm in the 1-bundle group was statistically greater than the 1.9 +/- 1.9 mm in the 2-bundle group, with a statistical power between 70% and 80%. The total Lysholm knee scale score was 93 points in both groups, and the subjective recovery score was equivalent, 82% in the 1-bundle group and 86% in the 2-bundle group, respectively. CONCLUSIONS: There was no statistical difference based on the IKDC, Lysholm, and subjective analysis. However, there was a statistical difference in the Lachman test, anterior drawer test, and KT-1000 measurements. LEVEL OF EVIDENCE: Level III.

Adolescent↗