Piece Of Fascia Research Articles

Evaluation of round window stimulation using the floating mass transducer by intracochlear sound pressure measurements in human temporal bones.

Round window (RW) stimulation with a floating mass transducer (FMT) can be studied experimentally and optimized to enhance auditory transduction. The FMT (MED-EL Vibrant Soundbridge) has been recently implanted in patients with refractory conductive or mixed hearing loss to stimulate the RW with varying degrees of success. The mechanics of RW stimulation with the FMT have not been studied in a systematic manner. In cadaveric human temporal bones, measurements of stapes velocity with laser vibrometry in response to FMT-RW stimulation were used to optimize FMT insertion. The effect of RW stimulation on hearing was estimated using simultaneous measurements of intracochlear pressures in both perilymphatic scalae with micro-optical pressure transducers. This enabled calculation of the differential pressure across the cochlear partition, which is directly tied to auditory transduction. The best coupling between the FMT and RW was achieved with a piece of fascia placed between the RW and the FMT, and by "bracing" the free end of the FMT against the hypotympanic wall with dental impression material. FMT-RW stimulation provided differential pressures comparable with sound-induced oval window stimulation greater than 1 kHz. However, less than 1 kHz, the FMT was less capable. Measurements of stapes velocity and intracochlear sound pressures in scala vestibuli and scala tympani enabled experimental evaluation of FMT stimulation of the RW. The efficacy of FMT-RW coupling was influenced significantly by technical and surgical factors, which can be optimized. This temporal bone preparation also lays the foundation for future studies to investigate multiple issues of relevance to both basic and clinical science such as RW stimulation in stapes fixation, nonaerated middle ears, and third-window lesions, and to answer basic questions regarding bone conduction.

Processing of fascia for vocal fold injection. A study in vitro and in paralyzed canine vocal folds.

To evaluate the simplest and safest method to mince fascia for autologous vocal fold injection, we performed an in vitro study applying porcine fascia and a prospective study using a canine model. Six different surfaces were tested in the laboratory for mincing fascia. The ease of handling of tissue on each surface was noted. Minced fascia was studied by microscope under polarized illumination, and the number and nature of foreign particles were recorded. After the safest method to mince fascia was established, 2 dogs were operated on. The recurrent nerve was sectioned, and a piece of fascia lata was harvested and cut with scissors on a steel surface. Fascia injection deep into the thyroarytenoid muscle was performed. The dogs were painlessly sacrificed 6 months later, and the larynges were removed for histomorphological study. On cutting, all polymer surfaces released small amounts of particles. These were not evident when we used glass or steel plates, but their hard surfaces were difficult to work on. Cutting a piece of fascia with scissors was found to be effective and safe in terms of microscopic foreign particles. The two dogs suffered no perioperative or late complications. Six months later, a well-preserved, vascularized, collagen-rich tissue was in its place without any evidence of acute or chronic inflammation. The histomorphological findings were identical to those of our previous study, with the exception that this time, no foreign particles from the mincing surface were present. An autologous fascia graft proves to be well preserved and well tolerated in the augmentation of a paralyzed vocal fold, and scissors are simple and effective in mincing it for injection.

PUBOVAGINAL SLING USING ALLOGRAFT FASCIA LATA VERSUS AUTOGRAFT FASCIA FOR ALL TYPES OF STRESS URINARY INCONTINENCE: 2-YEAR MINIMUM FOLLOWUP

Allografts have been substituted for autografts as a pubovaginal sling to decrease postoperative morbidity, although to our knowledge their long-term durability is unknown. Since 1997, we have offered allograft fascia lata as an alternative to autograft fascia in women undergoing the pubovaginal sling procedure. We describe our continued experience with those with a minimum 2-year followup. We retrospectively reviewed the records of 134 consecutive women with all types of stress urinary incontinence but without neurovesical voiding dysfunction or a significant degree of pelvic prolapse who underwent pubovaginal sling (allografts in 63 and autografts in 71) performed by a single surgeon. Rectus abdominis or fascia lata autograft and freeze-dried, gamma irradiated allograft slings were placed using identical techniques and a 2 x 12 cm. piece of fascia. Outcome analysis included a chart review, third party telephone interview and selective videourodynamics. Surgical outcome was categorized by daily pad use as cured-0, improved-1 or failed-greater than 1 pad. Of 140 women who received a pubovaginal sling 134 were still evaluable. Preoperative parameters were similar in each group. Mean followup plus or minus standard deviation was less in the allograft group (29 +/- 3 versus 44 +/- 7 months, p < 0.05). There was no statistical difference in the overall stress and urge incontinence cure rate in the allograft and autograft groups (45 of 63 cases and 55 of 71, p = 0.42), nor was there a difference in the total number with recurrent stress urinary incontinence (8 and 7, respectively, p = 0.58). In 24% and 16% of cases postoperative incontinence was due to urge incontinence in the allograft and autograft groups, respectively. Using allografts instead of autografts resulted in a significantly decreased postoperative pain and disability (p < 0.05). Using allograft fascia lata as an alternative to autologous fascia for a pubovaginal sling significantly decreases postoperative pain and disability without compromising efficacy at 2 years. Therefore, we believe that allograft fascia should remain a suitable alternative to autografts for pubovaginal slings.

PUBOVAGINAL SLING USING ALLOGRAFT FASCIA LATA VERSUS AUTOGRAFT FASCIA FOR ALL TYPES OF STRESS URINARY INCONTINENCE:

Allografts have been substituted for autografts as a pubovaginal sling to decrease postoperative morbidity, although to our knowledge their long-term durability is unknown. Since 1997, we have offered allograft fascia lata as an alternative to autograft fascia in women undergoing the pubovaginal sling procedure. We describe our continued experience with those with a minimum 2-year followup. We retrospectively reviewed the records of 134 consecutive women with all types of stress urinary incontinence but without neurovesical voiding dysfunction or a significant degree of pelvic prolapse who underwent pubovaginal sling (allografts in 63 and autografts in 71) performed by a single surgeon. Rectus abdominis or fascia lata autograft and freeze-dried, gamma irradiated allograft slings were placed using identical techniques and a 2 x 12 cm. piece of fascia. Outcome analysis included a chart review, third party telephone interview and selective videourodynamics. Surgical outcome was categorized by daily pad use as cured-0, improved-1 or failed-greater than 1 pad. Of 140 women who received a pubovaginal sling 134 were still evaluable. Preoperative parameters were similar in each group. Mean followup plus or minus standard deviation was less in the allograft group (29 +/- 3 versus 44 +/- 7 months, p < 0.05). There was no statistical difference in the overall stress and urge incontinence cure rate in the allograft and autograft groups (45 of 63 cases and 55 of 71, p = 0.42), nor was there a difference in the total number with recurrent stress urinary incontinence (8 and 7, respectively, p = 0.58). In 24% and 16% of cases postoperative incontinence was due to urge incontinence in the allograft and autograft groups, respectively. Using allografts instead of autografts resulted in a significantly decreased postoperative pain and disability (p < 0.05). Using allograft fascia lata as an alternative to autologous fascia for a pubovaginal sling significantly decreases postoperative pain and disability without compromising efficacy at 2 years. Therefore, we believe that allograft fascia should remain a suitable alternative to autografts for pubovaginal slings.

Histology of injected autologous fascia in the paralyzed canine vocal fold.

To evaluate the histology of minced and injected autologous fascia graft in the augmentation of unilateral vocal fold paralysis. Prospective study using a canine model. Nine dogs were operated. At first, a piece of fascia was harvested from fascia lata and minced into tiny chips with a scalpel. Cutting off a section of the recurrent nerve paralyzed the right vocal fold. The minced fascia-paste (0.1 mL) was injected using a pressure syringe into the paralyzed thyroarytenoid muscle under direct laryngoscopy. Two animals were killed at 3 days, one at 10 days, three at 6 months, and three at 12 months postinjection. Each dog underwent laryngectomy and serial coronal sections of paraffin blocks from the posterior part of the vocal folds were made. The dogs experienced no complications perioperatively or during follow-up. Under microscopy, muscle of the paralyzed vocal fold was atrophied in comparison to the contralateral control. There was an acute inflammatory reaction induced by the graft. This did not exist in the specimens taken at 6 and 12 months. No extensive edema, areas of necrosis, or formation of granulomas was seen at any time. Maturation of the graft was characterized by active collagen remodeling up to 12 months. At that time the graft consisted of firm, condensed fibrous tissue. Scar formation around the graft was moderate, and the subepithelial layer of the vocal fold remained undisturbed. Each graft consisted of singular foreign bodies from the polyamide mincing plate. We cannot exclude that their presence would have had an impact on the final architecture of the graft. In a canine vocal fold, the free fascia graft is well tolerated and after 12 months a well-organized, collagen rich tissue is seen on histological sections. The findings are in accordance with clinical studies applying free fascia grafts.

あぶみ骨手術が著効を示したあぶみ骨脱臼症例

We report a patient with traumatic perilymphatic fistula caused by an earpick. Exploratory tympanotomy was performed via endoaural incision. The patient was found to have a dislocated stapes in the vestibule. The stapes was removed, and no perilymphatic leakage from the oval window was seen. Jugular pressure was also performed with no lymphatic leakage. We then injected physiological salt solution at 37°C into the oval window. Lastly, stapes surgery was perfomed and a piece of fascia was placed over the perforation in the tympanic membrane using fibrin glue. The patient's operation was performed 3 days after trauma and improvement of vertigo and hearing (sensory and air-bone gap) was obtained after surgery.

New use for the temporalis superficialis fascia in the facial contour: lip sculpture.

Since 1989, the author has been using autologous grafts of the temporalis superficialis fascia, with a total of 303 areas grafted. The grafts are readily acquired; they do not present any problem to the donor area and they eliminate peribucal wrinkles in particular, contribute to the filling in and increase of the turgidity of the lips by hardening them, and produce the projection of the cutaneous vermillion line. The fascia are interposed between the skin and the muscles by dominating the action in the skin and having an exceptional integration of a definitive character with no absorption. We visualize the placement of the pieces of fascia with the assistance of a Reverdin needle, as there are no incisions, but rather just small holes. Its use is also applied to the fading of the naso-labial furrow and the glabellar wrinkles. The same material is used in correcting rhinoplasty sequelae and the increase of volume in the congenital or acquired sunken-in face. The contribution with the definitive use of grafted fascia offers refinement in the filling in the facial contour at the centripetal sunken-in areas of the face, as an ancillary procedure in the musculo-cutaneous facelift stretching.

Spontaneous rupture and thrombotic effects in a swine model of untreated abdominal aortic aneurysms

Background: In our previous canine model of abdominal aortic aneurysm, although aneurysm growth was observed, the aneurysms did not rupture. This prompted us to develop a swine model, which has the advantage of fibrinolytic and coagulation systems similar to those found in humans. Methods: We simulated aneurysms by connecting fascia pouches to the aorta. In nine pigs, two pieces of fascia (5 x 8 cm each) were sutured to the posterior surface of the aorta. After the lateral edges of the aorta were sutured together, the aorta was clamped below the renal arteries and at the aortic bifurcation. We then resected a piece of aorta within the pouch, clamped the pouch below the open roof, and unclamped the aorta. When the entire pouch had been sutured, the last clamp was removed and blood flowed into the "aneurysm." The total aortic cross clamp time was between 4 and 25 minutes. Results: "Aneurysm" size ranged from 3.0 x 2.5 cm to 7.5 x 4.0 cm (length x width). Aneury sm rupture occurred in seven pigs between 4 and 43 days after initial surgery; however, rupture never occurred at a suture site. Aneurysm size at rupture was two to four times greater than that of the original pouch. We found thrombus in all of the aneurysms examined more than 2 days after surgery. Histology revealed aneurysm walls that were thicker than the fascia. Although fascia segments could be identified because of their characteristic trilayer of thick collagen fibers, most of the aneurysm wall contained thin collagen fibers. These observations are consistent with new collagen production. Conclusion: We constructed a swine model of abdominal aortic aneurysm that possessed the features of growth and rupture necessary to simulate human aneurysms. Our method will allow techniques designed to isolate aneurysms from the circulation to be tested in a model with a fibrinolytic system similar to that of humans.

Tissue culture of surgically prepared temporalis fascia.

Temporalis fascia which is used to graft the tympanic membrane has been shown to be viable in tissue culture by a previous pilot study. This present study reports the effect on the viability of the fascia by scraping loose connective tissue from it and allowing it to dry. Pieces of fascia from 30 patients were each divided in 4 and prepared to give explants, fresh, fresh and scraped, dried, and dried and scraped. The fascia grew from 17 patients when cultured fresh, 5 when fresh and scraped, 1 when dried, and none when dried and scraped. These results are significantly different and show that the fascia is devitilized when prepared by the normal method for use in tympanoplasty.

Malignant tracheoesophageal fistula secondary to Hodgkin's disease: Successful surgical treatment with free fascia-muscle graft and left colon bypass

A case of malignant tracheoesophageal fistula due to Hodgkin's disease at the mediastinum and mid-third of the esophagus is reported. The fistula developed after x-ray therapy (2,000 rads) to the medistinum. In another hospital, she had undergone two unsuccessful attempts to close the fistula surgically with muscle flap grafts, following tracheostomy and feeding gastrostomy. The third operation, performed successfully 2 months later at The Roosevelt Hospital, included division of the esophagus above the fistula with cervical esophagostomy. A free muscle graft was used to close the fistula in the trachea. One month later, subcutaneous antiperistaltic left colon bypass was performed in one stage to connect the cervical esophagus with the lower stomach. At the same time, distal closure of esophagus at the cardia, pyloroplasty, and splenectomy were done. These operations allowed that time, recurrence of the fistula necessitated a fourth operative repair. This time, a 2 inch square piece of fascia and its underlying muscle from the gluteus medius were used to reinforce the closure. The fistula remains closed to date.

Enlarging the ear canal in intact canal wall tympanoplasty.

AbstractIn chronic otitis media, the external meatus and ear canal are often small and tortuous. Gill reported that a third of_250_ears with. congenital atresia had chronic otitis media, often unsuspected. Bellucci has emphasized the role of the Eustachian tube in determining the extent of chronic otitis media, so it follows that the small and tortuous ear canal are part of the congenital defects in this disease.Farrior and Caparosa have previously mentioned enlarging the ear canal in intact canal wall tympanoplasty.The usual post‐aural incision is made and the soft tissue of the canal dissected forward off the bone. A first vertical incision is made through the canal wall skin near the annulus, a second through the concha, and the two are connected by a longitudinal incision. The flaps are shifted apart to enlarge the canal, and an elipse of conchal cartilage is excised. The intact tympanoplasty is completed in the usual fashion, and the defect in the drum and canal is closed with a large tongue‐shaped piece of fascia which is brought out over the concha through the second incision. The canal is packed with strips of silk and cotton balls for two weeks.The result is a meatal opening and canal with a trumpet shape and adequate size.

Transperiovenous nephrectomy and nephropexy

The author finds that for fixation of the kidney the most reliable methods are those where the kidney is suspended by the fibrous capsule to the rib with a piece of fascia or aponeurosis of the external oblique abdominal muscle. The normal incision for such nephropexy is an oblique, extraperitoneal incision.