Cutaneous Incision Research Articles

CARL LANGENBUCH AND THE LAZARUS HOSPITAL: EVENTS AND CIRCUMSTANCES SURROUNDING THE FIRST CHOLECYSTECTOMY

Carl Langenbuch performed the first cholecystectomy at the Lazarus Hospital in Berlin in July 1882. This operation followed scientific experiment, careful thought, cadaver dissections and careful patient selection. Langenbuch's career was linked with the Lazarus Hospital in Berlin, to which he was appointed as Director at the age of 27. The hospital was then 4 years old and in a poor area of Berlin, and they grew in reputation together. Going through repeated troubled times, this hospital has withstood financial disaster, three wars, an occupation and the ambitions of administrators and developers. Treatment for cholecystitis before Langenbuch was stone extraction from spontaneous cutaneous biliary fistula or skin incision of near-pointing empyema. Cholecystostomy was carried out by Bobbs (1867), by Sims (1878), and championed by Kocher (1878) and Tait (1879). Langenbuch carried out a cholecystectomy in 1882 and subsequently recommended choledochotomy, duodenotomy and sphincterotomy in the management of stones in the bile ducts. He carried out one of the earlier major right liver resections in 1888. Also, he was famous for his sciatic nerve stretching for tabes dorsalis, management of gunshot wounds and his dissertations at the German Surgical Society before becoming renowned for cholecystectomy. The surgical world owes Langenbuch proper acknowledgement for his contribution to hepatobiliary surgery.

Juxtaciliary approach for multiplex chalazion surgery

A new approach for the operation of simplex or multiplex chalazion is presented, consisting of making a horizontal cutaneous incision parallel and very close to the ciliary edge. The incision should be deep, leaving intact the roots of the lashes and the Riolano muscle on the posterior side. Then the orbicularis muscle should be detached from the anterior surface of the tarsus. Using this approach there is little blood and it permits good exposure of the chalazion. When the treatment of choice has been carried out, the skin is replaced and the cutaneous wound sutured. The resulting scar is practically invisible.

Extended thoracoscopy: a biopsy method to be used in case of pleural adhesions

Extended thoracoscopy (ET) allows several large biopsies to be taken in patients with thick adhesions of the pleura when normal thoracoscopy is impossible. Twenty patients with undiagnosed pleural effusion or thickening and two with associated pulmonary tumour close to the chest wall underwent ET because closed adhesions prevented the induction of an artificial pneumothorax. Under local anaesthesia and neuroleptanalgesia, at the site of suspected lesions on computed tomographic (CT) scan, a cutaneous incision of 3-4 cm is made on the appropriate intercostal space. After dissection with blunt scissors, the operator introduces his finger to create a space in the pleural cavity. The thoracoscope is inserted to inspect the pleura and to take several biopsies for histopathological examination. A chest tube is inserted for a few minutes after checking airtightness and haemostasis. The procedure is well-tolerated. In three cases no pleural biopsy could be taken; in three patients a false negative diagnosis was observed. A correct diagnosis was obtained in 16 out of 19 patients (84%). If performed by a pulmonologist experienced with thoracoscopy ET is a rapid, safe and efficient method to obtain biopsies in cases where normal thoracoscopy after induction of a pneumothorax is not possible. It considerably reduces the need for open thoracotomy.

Small-Incision Techniques in Ophthalmic Plastic Surgery

A stepped surgical incision, in which an initial small cutaneous incision is followed by progressively longer incisions in the subcutaneous tissues, limits postoperative scar formation in the skin. Placement of incisions parallel to relaxed skin-tension lines further reduces the size of the scar. We describe how these principles may be applied to ophthalmic plastic surgical procedures to improve cosmesis. Autogenous fascia lata can be harvested with scissors through a 15-mm incision parallel to relaxed skin-tension lines, placed over the middle of the iliotibial tract. Lacrimal bypass operations can be performed well and with good cosmesis through a 12 to 15-mm skin wound if the above principles are followed.

Open Rhinoplasty Without Skin-Columella Incision

For the last 4 years, the author has been using the open lower cartilaginous vault rhinoplasty, making an external cutaneous incision on the columella. After observing the improved results in patients with nasal tip, lateral crura, and medial crura difficulties, the author widely recommends the use of this procedure in selected patients. In addition to multiple advantages which have been reported useful in open-tip rhinoplasty in the past, the author has contributed two additional advantages: that it avoids scarring columella skin and that it can be extended to cope with defects of the entire lower cartilaginous vault. Disadvantages are some residual edema in some patients over a 6-months period and prolongation of operating time.

Surgical excision of a congenital lateral fistula of the upper lip: An intra-oral approach

A new technique for removal of a congenital lateral upper lip fistula is described, using an intra-oral approach. Previous reports of removal of such a congenital malformation have used an extra-oral approach. The technique described allows for excellent visualization of the fistula without cutaneous lip incision. Using this approach, good aesthetic results and complete removal of the fistula and associated mucous glands can be obtained.

The use of a single fronto-zygomatic osteosynthesis plate and a sinus balloon in the repair of fractures of the lateral middle third of the face

In certain orbito-zygomatic fractures, a fronto-zygomatic screwed plate and a sinus balloon permit, at the expense of a single eyebrow incision, the repositioning of the cheekbone and the alignment of the other fracture sites; the other fractures sites consolidate and remodel themselves spontaneously due to the action of the adjacent soft tissues. The plate is malleable so that correct reduction can occur during the course of surgical repair; the plate should align the cheekbone perfectly. Neglect of the stability offered by reduction after exposure of the bone fragments may seem exaggerated, in simple cases; the orbital approach is without risk and limited. This argument - which also depends on the experience of the surgeon - does not apply in the case with a comminution of the orbital rim; closed fracture site reduction and distant osteosynthesis offer an alternative to the classical repair which requires a wide cutaneous incision and significant periosteal stripping with the subsequent risk of eyelid distortion.

Influence of Boar Seminal Plasma on the Distribution of Spermatozoa in the Genital Tract of Gilts

The main purpose of the present study was to investigate whether boar seminal plasma affects the transport of spermatozoa in the genital tract of oestrous pigs or not, with special reference to the sperm transport into the oviducts. Altogether 17 gilts were used in three experiments. Experiment I. In nine gilts one uterine horn was injected surgically with 1010 spermatozoa suspended in seminal plasma and the other uterine horn with 1010 spermatozoa suspended in TESNaK-glucose buffer solution. The sperm deposition was performed under general anaesthesia. The gilts were slaughtered 1–2 or 4–6 h after insemination. The genital tract was removed and the numbers of spermatozoa determined in oviducts and in uterine horns. Experiment II. The insemination doses were prepared exactly as in Experiment I. Approx. 24 h before insemination Polyvinylchloride cannulas were inserted into the uterine lumen of the horns, drawn via the midventral incision at linea alba subcutaneously to cutaneous incisions ventral to the vulva opening. One cannula was placed in each uterine horn. At standing heat the insemination doses were slowly injected through the cannulas. The gilts were slaughtered 1 h after insemination and the numbers of spermatozoa within the genital tract were counted. Experiment III. In three gilts under general anaesthesia the uterine horns were ligated 10 cm from the uterotubal junction. The semen doses (containing 2 × 109 spermatozoa), prepared as in Experiment I, were deposited into the uterine horns anterior to the ligatures through a cannula. The gilts were slaughtered 1 h after insemination, and the numbers of spermatozoa within the oviducts and ligated part of the uterine horns were counted. In all three experiments more spermatozoa were, on average, recovered in the oviducts connected to uterine horns inseminated with spermatozoa suspended in seminal plasma. In Experiments I and II this was the case for 10 of 14 gilts and in Experiment III for all the three gilts. It is therefore suggested that boar seminal plasma pro¬motes sperm transport into the oviduct of oestrous pigs. The back¬ground mechanism for this is discussed.

The use of a rapid new technique in the demonstration of cutaneous catecholamines

The demonstration of cutaneous monocamines was first made possible by the histoflourescent technique of Falck et al., J. Histochem. Cytochem., 10, 348, 1962, a very difficult and time consuming technique, available to only a few investigators. The present technique, using glyoxylic acid condensation requires no special equipment or expertise, and takes only 20 min from animal to microscope. Using this technique, it has been demonstrated that standard random skin flaps in the rat and pig are generally devoid of catecholamines in their entirety within 4 days of elevation, and catecholamine depletion also occurs by 4 days within 5 mm of any cutaneous incision. Catecholamine depletion, implying sympathectomy, could not be produced in the groin-based abdominal flap of the rat by section of the nerve in the caudal superficial epigastric pedicle, but could be produced by section of the filamentous fibers present between the abdominal wall and the skin.

Postlaryngectomy vocal rehabilitation.

Vocal rehabilitation is one of the most important aspects of the therapy offered to the laryngectomee. A one-stage operation for vocal rehabilitation, following total laryngectomy can aid this process. A mucous membrane communication between the hypopharynx and an anterior cervical cutaneous trephine incision is constructed during laryngectomy repair. The operation following laryngectomy involves the construction of a skin tube between the tracheostoma and pharyngostoma. A silicone tracheal tube is used for a short period following this reconstruction to facilitate the initiation of phonation. Experience with this procedure in 31 consecutive laryngectomies is discussed.

Surgical suture-canine tissue interaction for six common suture types.

AbstractMaximum extraction stress and integrated extraction work were measured for sutures implanted for 3, 7, and 14 day periods. Six common non‐absorbable sutures, representative of braided and monofilamentary forms, were implanted subdermally and were used for cutaneous incision closure with purebred pointer dogs. The data show: (1) Braided sutures, polyester/Teflon, silk‐type B, and silk–silicone interacted with peripheral tissue to a significantly greater degree than the monofilamentary types, nylon, polypropylene, and polyethylene; (2) polyester–Teflon braided suture interacted to a lesser degree than the other braided sutures; (3) the relatively intense interaction of plain silk and silicone‐treated silk appears to reflect the combined effects of mechanical aspects of braiding and of biochemical response; and (4) all braided sutures swelled over the implantation periods with as much as a 70% increase in diameter after 14 days for silk.

Studies in the healing of cutaneous wounds. I. The healing of incisions through the skin of pigs.

THE FUNDAMENTAL importance of repair, in general, and of fibrogenesis, in particular, in a wide variety of pathological processes is generally conceded. While analysis of repair of cutaneous injuries is intrinsically interesting and of practical importance, study of the healing of such wounds has been and will no doubt continue to be widely used as a model of repair processes in general. Yet despite the notable increase in the literature on wound healing during the last decade, certain basic problems concerning repair in general, first noted during the 19th century, still remain unresolved. It is maintained here, that failure to resolve certain of these theoretical and practical problems is in large measure due to the fact that 19th century descriptions of the healing of cutaneous wounds seem to persist unquestioned in the literature. Even the temporal order of events in healing cutaneous incisions is presently stated by many authorities to

Effect of increased tissue traction upon tensile strength of cutaneous incisions in rats.

SummaryThe tensile strength of simple skin incisions and those healing under increased tension was measured after 14 days of healing. The incisions which healed under increased tissue tension attained a significantly greater tensile strength as measured with an Instron tensiometer. This effect was used to explain previously observed differences in the rate of gain of tensile strength of transverse and longitudinal incisions.

Mitotic Rates of Rat Epidermis

Adult epidermal tissues are renewing cell populations. Mitosis continuously provides new cells replacing those that became keratinized and ultimately shed. It seems plausible to assume that in the epidermis of growing individuals mitosis supplies cells both for cell addition (growth) and renewal. During growth, more cells are presumably retained in the tissue than become lost through desquamation. It is feasible by cutaneous incision to temporarily revert adult epidermis into a growing cell population. Presumably also during healing, cell production exceeds cell loss. What is the magnitude of cell production for renewal of adult epidermis, for simultaneous cell addition and renewal during growth, as well as during epidermal regeneration? To elucidate these problems, the mitotic rates of three epidermal cell populations (ear, plantar, and abdominal epidermis) were determined in the growing, adult, and senile rat. Further, the adult ear and back skin epidermis was converted by cutaneous incision into regenerating cell populations, and the mitotic rates were determined during healing at intervals from six hours to nine days.

The effect of pentobarbital (Nembutal, Mebumal NFN) on corticotrophin release in the rat.

ABSTRACT The effects of high doses of pentobarbital sodium (Nembutal sodium, Mebumalnatrium NFN) on endogenous corticotrophin release were investigated. Under the stage of anaesthesia endogenous corticotrophin release was almost totally blocked, whereas under the stage of awakening from anaesthesia the secretion of corticotrophin exceeded the »resting level«. In normal, non-anaesthetized rats, subcutaneous or intraperitoneal injections did not per se affect circulating free plasma steroid levels. In pentobarbital-anaesthetized rats neither subcutaneous, intraperitoneal, nor intravenous injections influenced the plasma steroid levels. Minor surgical procedures, e. g. cutaneous incisions or cutting the tail tip of the rats did not immediately affect endogenous corticotrophin secretion under pentobarbital anaesthesia. The findings and their application for the simplification of corticotrophin assays and their limitations are discussed.

Treatment of Carcinoma of the Thyroid

Most thyroid surgery in North America is completed via a cervical incision, which leaves a permanent scar. Approaches without cutaneous incisions offer aesthetic advantages. This series represents the largest series of transoral vestibular approaches to the central neck in North America, and the first published reports of robotic transoral vestibular thyroidectomy for thyroid carcinoma.Data was prospectively collected for patients that underwent transoral vestibular approach thyroidectomy and/or parathyroidectomy between April 2016 and February 2017.Fifteen patients underwent the procedure for removal of the thyroid (n = 12), parathyroid (n = 2) or both thyroid and parathyroid glands (n = 1). The first case was converted to an open procedure. Fourteen were completed through these remote access incisions, including patients with a body mass index as high as 44. There were no permanent complications. The postoperative median Dermatology Life Quality Index score was 3, which indicates a small effect on quality of life.The transoral vestibular approach to the central neck is a promising technique for patients who desire to optimize aesthetics.

Sutura intradérmica na cirurgia dos pequenos animais

After short considerations about the methods of closing wounds of the skin, the authors make a study about the subcuticular suture. Revising the bibliography which they were able to consult upon the subject they quote various methods subcuticular suture conceived by the authors. Immediately after they study the zig-zag subcuticular suture and describe the technique, the material, the method and the removing of the suture. They presente table with 241 operations performed on enimals, 206 being on dogs and 35 on cats, using systematically the indicated suture to the closing up of the cutaneous incisions. Based on discriminating observations carried out during three years of practice, they conclude by pointing out the advantages resulting of its use.

Observations on the use of sodium amytal and nembutal

As the result of personal experience I would draw the following conclusions:- 1. If given slowly, sodium amytal and nembutal, even in large doses and in bad (but not very bad) surgical risks, are quite safe, especially if ephedrine is used as a prophylactic. 2. In operations such as amputation of the breast, excision of glands in the neck, herniotomy, and in most minor surgical procedures, no supplementary inhalation anaesthesia need be required, provided that the area of the cutaneous incision has been injected with a local analgesic; once the skin incision has been made, the patient will, as a rule, remain quiescent for the duration of the operation. 3. The quantity of ether necessary as a supplemental anaesthetic is in most cases considerably less in amount than would otherwise have been required. As a result, pulmonary complications are rarely to be seen. Chest complications following on operations on the upper abdomen are by no means always due to the anaesthetic; they are more usually to be attributed to basal lung collapse caused by the operative manipulations. 4. I have not found either sodium amytal or nembutal to be a suitable anaesthetic for thyroidectomy, unless supplemented with nitrous oxide-oxygen or open ether.

INVESTIGATIONS ON THE OXYGEN CONTENT OF CUTANEOUS BLOOD (SO CALLED CAPILLARY BLOOD)

1. A procedure is devised whereby cutaneous blood (so called capillary blood) from a finger-tip can be obtained for gas analyses without coming in contact with the air. 2. Determination was made of the oxygen content of the arterial, cutaneous, and venous blood respectively from a normal resting individual, the arterial and cutaneous blood showing the same oxygen content (97.5 and 96.6 per cent of the total oxygen-combining power of the blood). Venous blood drawn simultaneously was 75 per cent saturated. 3. Using the fact that there is a maximum value for the oxygen-combining power of the blood, we have shown, without doing arterial puncture, that under different conditions (normal and pathological individuals, resting and after exercise) the cutaneous blood and the arterial blood are almost identical as far as the oxygen content is concerned. 4. We think that we are justified in extending the identity, found between the oxygen content of the arterial and cutaneous blood, to other substances in the blood, for instance sugar, salt, uric acid, etc., and also to the reaction of the blood. 5. We are unable to say whether this identity between cutaneous and arterial blood is always true; for example, in a patient with increased venous pressure. 6. In all the experiments we have discarded the first drop of blood, which in some instances was darker than the rest, and always used at least 2 cc. of cutaneous blood. Whether the same results would be obtained with a very small amount of blood, for instance 0.2 to 0.4 cc., we do not know. 7. The experiments show that unless the perfusion of the skin has been extremely great during the experiment, samples of blood obtained from an incision in the skin (of the finger) cannot represent the true capillary blood. The neutral expression cutaneous blood seems therefore for the present preferable to the term capillary blood for samples of blood obtained by cutaneous incisions.