Experience In Reconstructive Surgery Research Articles

Recognition of potential morbidity after use of the radial artery as a conduit for coronary artery revascularization

The use of the radial artery as an alternative vascular conduit for coronary bypass surgery has become increasingly popular. The plastic surgery experience with radial forearm flaps has shown that sacrifice of the radial artery is not always a benign maneuver. The potential morbidity after using this conduit donor site in terms of hand dysfunction or wound healing problems can be significant, and frequently must ultimately be addressed as part of the role of the reconstructive surgeon. Case examples of skin necrosis, subsequent forearm wound infection and hypertrophic scarring after radial artery harvest are presented to introduce this as a real concern and to allow a review of the entire spectrum of potential problems in this regard. Any selection process where the radial artery may be chosen as the coronary revascularization conduit must anticipate these known donor site complications.

Extension to the sacrum of previous adolescent scoliosis fusions in adult life.

Numerous reports have indicated an increased risk for the development of precocious degenerative changes leading to pain in patients who had fusions done in adolescence for scoliosis, which extended into the lower lumbar spine. The anatomic situation may lead to instability, or spinal stenosis or both. This paper represents the evolving experience in reconstructive surgery for patients in whom a fusion was to be extended to the sacrum. Reconstructive surgery will require, if necessary, decompression posteriorly for spinal stenosis if present. Stabilization is acquired through an anterior and posterior approach with anterior and posterior instrumentation. The evolution of treatment modalities since 1976 shows a decreased pseudarthrosis rate from an initial 83% to 3% at present.

Initial plastic surgery experience with the first telemedicine links for the British Forces

In January 1998, the first telemedicine link for the British Defence Medical Services was established between the British military hospital in Sipovo, Bosnia and the Royal Hospital Haslar, the main triservice hospital in the UK. Further links were established later in the year. These simple links use a high-resolution digital camera, the Olympus C1400L and the C1400XL, to capture still images. These are then transmitted without loss of definition as electronic mail attachments to obtain specialist opinions in plastic surgery as well as in radiology, dermatology, orthopaedics, urology, ophthalmology, general medicine, maxillofacial surgery and pathology. Its use is illustrated by representative case reports from the first 11 referrals from Sipovo and elsewhere to the Plastic Surgery Department at Haslar. This system is suitable for use within both a military and a civilian context, anywhere in the world. It can readily be adapted for use by general practitioners and hospital doctors to facilitate referrals to plastic surgery departments.

Summary Roles of the head and neck surgeon on the surgery of the anterior skull base and inf ratemporal fossa

Roles of the head and neck (H & N) surgeon on the surgery of the anterior skull base and infratemporal fossa seem to be very important because they have knowledge of the anatomy of the skull base and face and have techniques and experience of the oncological surgery. However, the domain of H & N surgeons in this field is limited in some institutes due to lack of experience and techniques of neurological and plastic surgery. In order to establish the domain of H & N surgery in the field of the skull base surgery, it is important for H & N Surgeons to collaborate to the skull base surgery actively and learn the techniques of other fields. This results in the development of the skull base surgery.

Analysis of 136 Cases of Reconstructed Penis Using Various Methods

Our experience in reconstructive surgery of the penis in 136 cases is reported. The postoperative complication rate was 13.24 percent. Five methods were used: the radial forearm free flap, the superficial inferior epigastric artery flap, the superficial circumflex iliac artery flap, the anterolateral thigh flap, and the combined cutaneous flap. The choice of the method had to be made depending on the patient's condition and prediction of the operative results. The penis not only should have a good appearance with normal size but also should have good sensation and function. The keys to success of this operation are considered to be correct preoperative planning, careful manipulation, and excellent anastomoses.

Congenital stenosis involving a long segment of the trachea: Further experience in reconstructive surgery

Since we introduced the surgical technique for the repair of congenital stenosis involving the entire trachea with a successfully treated patient in 1982, four more patients have undergone a tracheoplasty employing the same technique for congenital stenosis involving a long segment of trachea. This article describes the refinement of surgical technique, the management of patients during and after operation, and the long-term outcome.

Experience in Reconstructive Surgery of Craniomaxillofacial Deformities: With Osteomesh, Eleven Years Experience

ABSTRACTThe best possible implantable biomaterial for bony contour abnormalities is autogenous bone grafts. However, some conditions may be present that require use of alloplastic materials. Such alloplastic material must be inert and there should be no reaction in the body to it. The composite graft described in this chapter is a combination of the two different materials described. To have a better take, the bone graft used is ground with a craniotome, and then mixed with blood. This produces an inductive matrix that promotes osteoneogenesis. The alloplastic material is a tray or a template where the bone is placed “in”, “on”, or “under” the implant to allow for complete solidification and better healing. The material used is polyetherurethane-impregnated terephthalate (Dacon) also referred to as osteomesh (R) (Xomed Corporation, Jacksonville, Florida). In a few instances the osteomesh was removed and we noted complete solidification of the bone (resembling skull in the case of the skull defect). For over eleven years, since the success in the experimental animal [1], this composite graft was used in clinical situations with good success [2] in over 100 patients. These patients treated were selected and a strict set of indications and contraindications were instituted and implemented, prior to the applications of this treatment in the individual patient.

Further Experience in Reconstructive Surgery for Cloacal Anomalies

Further Experience in Reconstructive Surgery for Cloacal Anomalies

Further experience in reconstructive surgery for cloacal anomalies

This paper describes 13 more cases of urogenital sinus malformation with an anorectal anomaly, usually rectal atresia with rectovaginal fistula. It is vital to define the anatomy precisely in these cases to guide the operative approach best suited for repair. Neonatal loop colostomy is needed in most. Intermittent catheterization of the bladder and/or urine-filled vagina via the urogenital sinus can allow temporizing until the child is old enough for a definitive reconstruction. Various urinary diversions are best avoided if possible, except possibly a simple temporary suprapubic cystostomy. It is best to complete the reconstructive operation, in a single procedure which is often long and complex. Preliminary AP pullthrough of the colon without repair of the genitourinary aspect of the problem can lead to urinary tract stasis and serious obstructive uropathy. A satisfactory functional and anatomic solution is possible in most of these girls.

General Plastic Surgical Principles

The general surgeon can use the experience and skills of plastic surgery wisely for the benefit of his patient, but technique cannot supersede principles. Flexible and imaginative surgical care is based on sound principles, hard work, and mental discipline.

Repair and Reconstruction in the Orbital Region.

Recently, there have been a number of new or revised texts dealing with ophthalmic plastic surgery. The newest and one of the best is<i>Repair and Reconstruction in the Orbital Region</i>by John Clark Mustardé. The author has had training and broad experience in both ophthalmic and plastic surgery. This is a complete, well written, clearly illustrated compilation of accepted techniques augmented and frequently modified by the author's considerable experience in this field. The bibliography is scant by design but pertinent and, for the most part, up to date. Of particular interest are the sections dealing with grafts and flaps (especially the forehead flap), socket reconstruction and surgery of the lacrimal system. Many ophthalmic plastic surgeons writing today decry the use of the halving procedure to prevent notching in lid repair. The author subscribes to this view maintaining there is no need to sacrifice normal tissue when repairing lid defects.

Experience in Reconstructive Surgery with Patients Having Respiratory Paralysis

On the basis of this series it is felt that patients with severe respiratory paralysis can be given the benefits of reconstructive surgery without greater risk than is now thought suitable. It is our opinion that the techniques used in this surgery may be used in the treatment of other diseases, such as paralysis resulting from cervical-spine injury. Probably most important in our work has been the use of these techniques in procedures which result in considerable chest splinting and depressed respiration. We are impressed with the easier course of the patient following such procedures as thoracic-spine fusion when a respirator is used postoperatively, even if this equipment is not absolutely essential for the maintenance of life. Much to our surprise, the patients with the lower vital capacities have, as a whole, tolerated the procedures better than the patients with the higher vital capacities for whom respiratory equipment was not felt to be necessary. It is our opinion that the advisability of using mechanical respiratory aids in operations upon patients with decreased breathing function will come to be generally recognized, just as we now recognize the need to provide blood replacement during surgery rather than waiting until shock has occurred. The respirator which originally saved the patient's life now permits this patient to be operated upon.

Bone drilling in resistant chronic ulcers: A new principle

The unusually satisfactory results enumerated in detail in this communication are of particular gratification and interest to me in that they illustrate the dependability of the principles of both physiology and biology when applied to surgical procedure. The plan of the above treatment was arrived at by me from extensive experience in reconstructive surgery where at the operating table over a period of thirty-five years, I have repeatedly proved that the essential requirement of all reconstructive work is to make way for the provision of an adequate blood supply. I have often made the statement that new bone formation is no more likely to occur than a masonry wall without brick and mortar with which to build it, no matter how skillful the mason may be. It was my theoretical deduction that if we could bring an adequate blood supply from the center of the bone, through the cortex, directly to the base of the ulcer, by every physiological and biological principle the ulcer should promptly heal. This has been proved as definitely as it has been proved that when an adequate blood supply is brought to a bone graft, it will survive and thrive.

PROSTHETIC AIDS IN RECONSTRUCTIVE SURGERY ABOUT THE HEAD: PRESENTATION OF A NEW METHOD

Remarkable strides have been made in the field of plastic and cosmetic surgery in the last fifteen or twenty years. The defects brought about by modern warfare provided a large experience in reconstructive surgery. Congenital defects, and those caused by syphilis, tuberculosis and carcinoma, necessitated the development of a technic for their correction. During and since the World War, reconstructive surgery has grown to become a well known specialty, and remarkable results have been shown in rather hopeless looking cases. Plastic repair of traumatic deformities about the face was originally employed in this special field, but of late years the tendency has been to drift to the more lucrative and less laborious cosmetic field. However, I wish to consider only those cases of the true reconstructive type, namely, those in which there is a total or subtotal loss of parts. Gillies,¹one of the inventive geniuses in

Plastic Surgery of the Nose.

This book is based on the author's six years' experience in plastic surgery. About half of the text is devoted to cosmetic correction of nasal deformities. Since plastic surgery is really not a new branch of surgery, but dates from the time of Celsus and Tagliocozzi, we do not look for anything triumphantly new. Naturally, since the development of this field in the war, we may expect a great improvement in the way of modifications and technic, but the fundamental principles remain the same. The author makes a plea for professionalism instead of amateurism in the field of plastic surgery, and this point is well taken; for it should be stressed that work in this field should be in the hands of those who have made a special study of it. One must take exception to the author's feeling that the patient is continuously under observation by others and his