Comparison of Diathermy versus Scalpel Skin Incision in Oncological Surgeries

Introduction: Surgical incisions are usually made with scalpel. Usage of scalpel usually results in skin bleeding which obscuresthe operating field resulting in wastage of operating time. Although diathermy is increasingly used for underlying tissue dissection,cutting, and hemostasis, its use for making skin incisions is not gaining favor.Aim: The aim of our study was to compare the value outcome of diathermy incisions versus scalpel incisions in abdominalsurgeries.Materials and Methods: This prospective comparative study was conducted to compare the outcome of diathermy incisionsversus scalpel incisions in oncological surgeries. Total of 80 patients who divided into Group A (scalpel incision) for 39 patientsand Group B (diathermy incision) for 41 patients. Treatment protocol and follow-up protocol were followed and the results werestatistically analyzed and discussed.Results: Out of 80 patients, 39 patients had scalpel incision and 41 patients had diathermy incision. In the scalpel group outof 39 patients, 21 patients were male and 18 patients were female, the mean duration of incision time in the scalpel group is116 sec, the mean value of incisional blood loss in the scalpel group is 1.9/ml, the mean operating time in the scalpel group is36.42 min, and the mean value of post-operative pain in day 1 is 6.42, day 2 is 5.18, and day 3 is 3.66. In the diathermy groupout of 41 patients, 26 patients were male and 15 patients were female, the mean duration of incision time in the diathermy groupis 88.52 sec, the mean value of incisional blood loss in the diathermy group is 1.4/ml, the mean operating time in the diathermygroup is 38.75 min, and the mean value of post-operative pain in day 1 is 5.12, day 2 is 3.88, and day is 2.01.Conclusion: The findings of the present study show that diathermy seems to provide some benefit with respect to post-operativewound pain, less incision time, and less incisional blood loss and has obvious safety advantages to the surgical team comparedwith scalpel.

Scalpel versus diathermy skin incision: a randomised clinical trial

Background: Scalpel skin incision produces a clean, incised wound with minimal tissue destruction. Cutting diathermy also produces an incised wound that heals as well as the one that is created by cold scalpel but with an added advantage of achieving quick hemostasis and saving operative time. The main thing of the present study is to verify and compare the usefulness of diathermy skin incision vs. scalpel skin incision in general surgical patients.Methods: The study was conducted in Medical College and Hospital, in 60 patients randomly selected for diathermy and scalpel incision, between 14-65 years age group, between January 2011-June 2012. Post operative pain, seroma, hematoma, discharge were observed and results were analyzed and compared for the two groups using Mann-Whitney U Test.Results: Diathermy group, with incision related time of 6.20±0.97 sec/cm, was significantly quicker (p=0.003) than scalpel incision, with incision time of 6.76±0.84 sec/cm. Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups.Conclusions: We demonstrate that the diathermy provides efficient cutting of skin, with no superior wound-healing profile, comparable to that of the traditional scalpel blade.

Comparison Of Superficial Surgical Site Infections Following Use Of Diathermy And Scalpel For Making Skin Incisions In Open Inguinal Hernia Repair

The use of electrocautery for making skin incisions remains controversial. Its effect on the rate of Superficial Surgical Site Infection (SSSI) vis-à-vis scalpel use was compared in this study. Atotal of 100 patients undergoing open inguinal hernia repair were divided into two: 50 in Electrocautery group, 50 in Scalpel group. Patients were assessed for up to 30 days post-operatively by an assessor blinded to the method used for making skin incision. CDC/NHSN criterion for SSSI was adopted for wound assessment while grading was done using Southampton Wound Grading System. Both groups had comparable mean age (p-value=0.29) and BMI (p-value=0.39). The difference in the incidence of SSSI (5 in Electrocautery, 7 in Scalpel group) on statistical analysis was found to not be significant (p-value=0.53). We conclude that skin incision made with electrocautery is a safe alternative and a convenient method for performing surgeries.

VISUAL AND ANATOMIC OUTCOME OF VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING FOR REFRACTORY DIABETIC MACULAR EDEMA / Шинэ санаа Шинэ нээлт

@#BACKGROUND: Loss of skin elasticity due to redundancy of the upper eyelid (dermatochalasis) and falling of the upper eyelid border to a lower position (blepharoptosis) are often the earliest signs of facial aging. Upper eyelid blepharoplasty is an effective procedure to establish a good eyelid position, and is the most common facial cosmetic procedure [1]. When performing upper eyelid blepharoplasty, eyelid symmetry is essential for a satisfactory surgical outcome. Even if not possible, every surgeon tries to achieve complete symmetry when performing aesthetic eyelid surgery [2]. Several previous studies by surgeons with > 10 years of experience reported how preoperative incision markings should be made to achieve satisfactory surgical outcomes and excellent surgical results for upper eyelid blepharoplasty [3-7]. However, none of these studies investigated naturally occurring asymmetry when applying a preoperative design for upper blepharoplasty incision markings. During the preoperative design step, we noticed certain asymmetric tendencies. We therefore characterised these differences to ensure a more effective preoperative design for upper blepharoplasty incision markings for both eyelids. METHODS: This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. We measured medial canthal excision angle (MCA), maximal lid excision height (MLH), maximal lid excision width (MLW), peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software. RESULTS: The mean MCA for the right side (30.68 ± 10.16°) was significantly different to that for the left side (35.39 ± 13.82°; p < 0.001). The mean MLH for the right side (1.17 ± 0.24 cm) was significantly different to that for the left side (1.24 ± 0.25 cm; p = 0.002). The mean MLW for the right side (0.72 ± 0.19 cm) was significantly different to that for the left side (0.77 ± 0.21 cm; p = 0.011). The mean peak point angle for the right side (15.67 ± 5.09°) was significantly different to that for the left side (18.11 ± 5.49°; p = 0.001). The mean peak point distance for the right side (2.41 ± 0.31°) was significantly different to that for the left side (2.22 ± 0.28 cm; p = 0.001). CONCLUSION: In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximised by including the asymmetries in the preoperative design.

ASYMMETRY OF PREOPERATIVE INCISION DESIGN MARKINGS FOR UPPER BLEPHAROPLASTY / Шинэ санаа Шинэ нээлт

@#BACKGROUND: Loss of skin elasticity due to redundancy of the upper eyelid (dermatochalasis) and falling of the upper eyelid border to a lower position (blepharoptosis) are often the earliest signs of facial aging. Upper eyelid blepharoplasty is an effective procedure to establish a good eyelid position, and is the most common facial cosmetic procedure [1]. When performing upper eyelid blepharoplasty, eyelid symmetry is essential for a satisfactory surgical outcome. Even if not possible, every surgeon tries to achieve complete symmetry when performing aesthetic eyelid surgery [2]. Several previous studies by surgeons with > 10 years of experience reported how preoperative incision markings should be made to achieve satisfactory surgical outcomes and excellent surgical results for upper eyelid blepharoplasty [3-7]. However, none of these studies investigated naturally occurring asymmetry when applying a preoperative design for upper blepharoplasty incision markings. During the preoperative design step, we noticed certain asymmetric tendencies. We therefore characterised these differences to ensure a more effective preoperative design for upper blepharoplasty incision markings for both eyelids. METHODS: This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. We measured medial canthal excision angle (MCA), maximal lid excision height (MLH), maximal lid excision width (MLW), peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software. RESULTS: The mean MCA for the right side (30.68 ± 10.16°) was significantly different to that for the left side (35.39 ± 13.82°; p < 0.001). The mean MLH for the right side (1.17 ± 0.24 cm) was significantly different to that for the left side (1.24 ± 0.25 cm; p = 0.002). The mean MLW for the right side (0.72 ± 0.19 cm) was significantly different to that for the left side (0.77 ± 0.21 cm; p = 0.011). The mean peak point angle for the right side (15.67 ± 5.09°) was significantly different to that for the left side (18.11 ± 5.49°; p = 0.001). The mean peak point distance for the right side (2.41 ± 0.31°) was significantly different to that for the left side (2.22 ± 0.28 cm; p = 0.001). CONCLUSION: In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximised by including the asymmetries in the preoperative design.

Cosmetic selection of skin incision for resection of choledochal cyst in young female patients

BACKGROUNDS/AIMS: Open surgery for choledochal cyst has a disadvantage of skin incision scar from operative wound, which can be a definite disadvantage especially in young female patients. This study focused on the cosmetic aspect of skin incision for resection of choledochal cyst in young female patients. METHODS: During a 2-year study period, 11 adult female patients aged less than 40 years underwent primary resection of choledochal cyst by a single surgeon. The cosmetic effect of two types of skin incision was evaluated. RESULTS: The patients underwent mini-laparotomy through either a right subcostal incision (n=8) or an upper midline incision (n=3). The mean length of skin incision was 10 cm for right subcostal incisions and 9 cm for upper midline incisions. It took approximately 1 hour to repair the operative wound meticulously in both groups. At the 6 month to 1 year follow-up, a slight bulge on the skin scar was observed in 3 (37.5%) patients of the right subcostal incision group and 1 (33.3%) patient of the upper midline incision group. CONCLUSIONS: The results of this preliminary study support the claim that cosmetic effect of the upper midline incision for CCD surgery appears to be non-inferior to that of the right subcostal incision if the incision is placed accurately and repaired very meticulously.

Z-lengthening of the Achilles Tendon with Transverse Skin Incision

BACKGROUND: The risk of various complications after Achilles tendon lengthening is mainly related to the length of surgical exposure and the lengthening method. A comprehensive technique to minimize the complications is required. METHODS: The treatment of Achilles tendon tightness in 57 patients (95 ankles) were performed by using a short transverse incision on a skin crease of the heel and by Z-lengthening of the tendon. In the severe cases, two or three transverse incisions were required for greater lengthening of the tendon, and a serial cast or Ilizarov apparatus was applied for the gradual correction. The results of these 95 ankles were compared to those of 18 ankles, which underwent percutaneous sliding lengthening, and to the 19 ankles, which received Z-lengthening with a medial longitudinal incision. RESULTS: The functional and cosmetic satisfaction was achieved among those who underwent the tendon lengthening with the new technique. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score improved from 56.1 to 81.8. The second operations to correct recurrence were performed in the two cerebral palsy patients. CONCLUSIONS: The new technique has a low rate of complications such as scarring, adhesion, total transection, excessive lengthening, and recurrence of shortening. The excellent cosmesis and the short operation time are the additional advantages.

The Efficacy of Carotid Tubercle as an Anatomical Landmark for Identification of Cervical Spinal Level in the Anterior Cervical Surgery: Comparison with Preoperative C-arm Fluoroscopy

BACKGROUND: In cervical anterior approach, transverse skin incision is preferred due to cosmetic reasons. Precise skin incision is required to reach the surgery segment while minimizing soft tissue injury. Skin incision site is frequently identified using C-arm fluoroscopy or the carotid tubercle. Accordingly, this study was conducted to investigate the efficacy of skin incision using the carotid tubercle as a marker. METHODS: This study was retrospectively conducted on 114 patients who underwent anterior cervical surgery by the same surgeon from April 2004 to June 2012. The rate of the appropriate insertion of K-wire, which was inserted into the disc after anterior approach, into the surgery segment was compared between 62 patients where skin incision site was identified using C-arm fluoroscopy before skin incision and 52 patients where skin incision site was identified using carotid tubercle palpitation before surgery. RESULTS: The needle was shown to have been inserted into the planned site in 106 patients out of the total 114 patients. The appropriate insertion of the needle was shown in 59 patients of group I (95.2%) and in 47 patients of group II (90.4%). Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of one-segment surgery was shown to be 89.7% in group I and 82.6% in group II. Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of two-segment surgery was shown to be 100% in group I, and 96.4% in group II due to one case of the failure at C3-4 and C5-6. The success rate of three- and four-segment surgeries was shown to be 100% in both groups. CONCLUSIONS: The identification of skin incision site via carotid tubercle palpation was useful for surgeries involving two or more segments. Furthermore, it could be useful for one-segment surgery if surgical site is identified using vertebral body or soft tissues such as longus collis rather than insertion into the disc.

The Effect of Desflurane with Remifentanil for Hemodynamic Responses to Skin Incision

BACKGROUND: Desflurane can induce sympathetic nervous activity and increase mean arterial blood pressure and heart rate, especially when used above the concentration of MAC-BAR. Opioids can reduce this response during general anesthesia. We compared the effect of the use of 1 ng/ml remifentanil and 50% N2O with 1 MAC desflurane for cardiovascular responses to skin incision with the effects of the use of sevoflurane. METHODS: We recruited 47 patients with ages between 20 and 60 years, and ASA physical status 1, who were scheduled for appendectomy surgery under general anesthesia. The patients were divided into two groups. Anesthesia was induced with remifentanil (target-controlled effect-site concentration of 2 ng/ml), 2 mg/kg propofol and 0.7 mg/kg rocuronium. After tracheal intubation, anesthesia was maintained as follows. Group D (desflurane) was administered an end-tidal concentration of 4.0% desflurane with remifentanil (target-controlled effect-site concentration of 1 ng/ml) and 50% N2O. Group S (sevoflurane) was administered an endtidal concentration of 1.1% sevoflurane with remifentanil (targetcontrolled effect-site concentration of 1 ng/ml) and 50% N2O. The mean arterial blood pressure and heart rate were measured at baseline, after tracheal intubation, every minute for 3 minutes before skin incision, and for 5 minutes after skin incision. RESULTS: There was no difference in the changes of mean arterial blood pressure and heart rate between the patients in the two groups before and after skin incision. CONCLUSIONS: As with sevoflurane, the addition of 1 ng/ml remifentanil to 1 MAC desflurane and 50% N2O can effectively blunt the cardiovascular responses to skin incision.

Surgical repair of recurrent cervical cancer at a skin incision site with using a Gore-Tex(R) Patch: A case report / 대한산부인과학회지

Recurrence of cervical cancer at a skin incision site is uncommon. We met a patient who received an incomplete operation for cervical cancer and she was transferred to our hospital. When she underwent the first operation she was misdiagnosed as having a benign uterine mass and she received an abdominal total hysterectomy. But the postoperative pathologic finding was cervical cancer. Therefore she was then referred for postoperative cisplatin-5FU concurrent chemo-radiotherapy. Five months after the concurrent chemo-radiotherapy, one solitary metastatic mass was found in the abdominal scar. We performed wide excision. The fascia defect at the excision site was so wide we could not perform the primary closure. Therefore, we used a polytetrafluoroethylene (Gore-Tex(R)) patch as a fascia substitute and we reconstructed the abdominal wall with a fasciocutaneous flap. Then she received cisplatin concurrent chemo-radiation therapy.

Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Insertion Using the Fluoroscopy and Minimal Skin Incision

PURPOSE: Continuous ambulatory peritoneal dialysis (CAPD) is an important method of performing renal replacement therapy in patients with chronic renal failure. A significant number of complications and catheter failures in CAPD are due to mechanical pro-blems and peritonitis. We describe our experience with CAPD with using fluoroscopy and a minimal incision technique to reduce complications. METHODS: We reviewed 57 CAPD patients at Dong-A University Medical Center from June 2004 to March 2005. All the procedures were standardized and performed by a single surgeon with using a flexible guide wire under aseptic fluoroscopic control through a minimal incision. Antibiotic treatment was done for three days after the surgery. RESULTS: The patients consisted of 30 males and 27 females. The common reasons for CAPD insertion were diabetic nephropathy (25 patients) and hypertension (9 patients). The mean operation time was 52.2+/-15.8 minutes. All the initial procedures were carried out under local anesthesia. Four of the patients needed their catheter repositioned during their postoperative course, which was done under local anesthesia in three cases and under spinal anesthesia in one case. Catheter malfunction occurred in 4 patients, and peritonitis developed in 8 patients (for wound related peritonitis in 1 patient and for catheter related peritonitis in 7 patients). CONCLUSION: Making a minimum incision and catheter insertion under fluoroscopic control for CAPD is a safe and highly effective method to reduce the incidence of catheter related complications. Furthermore, strict patient education is crucial for optimum catheter care, which is closely associated with development of peritonitis in CAPD patients.

Short term results of Minimally Invasive TKA

PURPOSE: To compare the radiologic and clinical results of patients who had primary total knee arthroplasty(TKA) with 3 different arthrotomy technique: quadriceps-sparing approach(group Ia), minimal incisional approach(group Ib), conventional parapatellar approach(group II). MATERIAL AND METHODS: We assessed 114 patients(142 knees) treated between December 2003 and March 2005(minimal follow-up was one year). Group Ia, Ib and II consisted of 24 patients(32 knees), 23 patients(30 knees) and 67 patients(80 knees). The evaluation included radiologic alignment, skin incision, tourniquet time, blood loss, ambulatory ability and knee score of Hospital for special surgery(HSS). RESULTS: Group Ia and Ib had the results that indicate increased range of motion, shorter length of hospital stay, less skin incision and more tourniquet time. There were no differences between the groups in radiologic alignment, blood loss, and HSS score. CONCLUSION: Although total knee arthroplasty using a minimal incision may provide some early advantages, minimal incision can impede a surgeon's visual field and may influence component alignment. Therefore, these minimal incision approaches should be performed in limited patients with strict indication.

Full sternotomy through minimal incision for cardiac surgery: A report of 38 cases / 中国微创外科杂志

Objective To summarize the clinical experience of 38 cases of cardiac surgery with full sternotomy through minimal skin incision.Methods A total of 38 cases of selective cardiac surgery were performed from June 2004 to December 2005.The operation was conducted under full sternotomy through a skin mini-incision.Results The operation was successfully completed in all the 38 cases.The total operation time was 175~359 min(mean,84 min),the drainage volume was 110~760 ml(median,380 ml),and the postoperatine hospital stay,7~32 d(mean,10 d).Postoperative short-term complications included 1 case of arrhythmia and 2 cases of pyrexia,all of which were cured.No thoracotomy for hemostasis was required.The incision healed by first intention without infection or separation.Follow-up examinations for 3~18 months(mean,9 months) in 38 cases showed significat improrement of symptoms.The left ventricular ejection fraction after operation was 0.45~0.73(mean,0.62).Conclusions Full sternotomy through minimal skin incision for cardiac surgery is safe and micro-traumatic.This procedure provides advantages of simplicity of performance,no need of special surgical instruments,and good cosmetic outcomes.

Predictive significance of spectral entropy in body movement due to skin incision during isoflurane anaesthesia / 解放军医学杂志

0.05),while the entropy index showed significant differences between the two groups(P

Middle Cerebral Artery Aneurysm Operation through Minicraniotomy (Minimized Pterional Approach): Technical Note

Since Yasargil's report, most neurosurgeons operate on middle cerebral artery(MCA) aneurysms through frontotemporal(pterional) bone flap under large skin incision which could result avoidable complications of facial nerve damage, temporal muscle atropy, paresthesia along incision scar and cosmetic bony defect. After careful review of detailed facial nerve anatomy, the author has developed a less invasive approach involving 8cm mini skin incision starting from 1.5cm above zygomatic arch, 1.5cm inside the anterior temporal hair line to upward 4-5cm and then curving forward 3cm length around 2cm above supraorbital ridge. Then, about 2.5cm mini-bone flap centered on pterion is made. After reflection of round dural flap, dissection of sylvian fissure was proceeded from just lateral end of limen insula, where middle cerebral artery(MCA) bifurcation or M2 segment was deeply located. The author has operated on consecutive 18 cases of MCA aneurysms using this minicraniotomy from 1996 to 1998 which provided sufficient working area enough not only for surgeon's free hand motion including multiple temporary clippings at one field but also inspection for other anterior circulation and posterior circulation systems. Hunt-Hess Grade for these patients were 17 cases of Grade II and 1 case of Grade I. Mean age of patients was 52.9 years old. There were 15 males and 3 females. Excellent postoperative neurological conditions were achieved without any morbidity or mortality. This approach is especially recommendable for patients with good neurological status for being less invasive and more convenient method.

Circumumbilical Incision Versus Right Transverse Hypochondrial Incision for a Ramstedt's Pyloromyotomy

BACKGROUND: Despite good surgical results from right transverse hypochondrial incisions for Ramstedt's pyloromyotomies, children remain concerned by the presence of an obvious and permanent scar. The aim of this study is to compare the results of two approaches. METHODS: Forty-eight infants underwent a Ramstedt pyloromyotomy for infantile hypertrophic pyloric stenosis. To facilitate the delivery of the pyloric mass, 22 patients were operated on via a standard right transverse hypochondrial incision and 26 patients via a circumumbilical incision with or without lateral wound extension. These two group were compared retrospectively. RESULTS: The groups did not differ significantly with respect to the length of the hospital stay or the perioperative complications. The circumumbilical incision with lateral wound extension allowed easy access to the pyloric mass without conversion of incisions due to inadequate exposure. All circumumbilical incisions healed well, resulting in an apparently unscarred abdomen. The final good cosmetic result of the circumumbilical incision satisfied all parents. CONCLUSIONS: We propose the circumumbilical incision as an alternative to be used in the operative approach to the pylorus in the treatment of infantile hypertrophic pyloric stenosis.

Minimal Skin Incision with Full Sternotomy for Congenital Heart Surgery / 대한흉부외과학회지

BACKGROUND: Although there have been few reports about minimal skin incision for the repair of congenital heart lesions, minimizing an unsightly scar is a particularly important factor in growing children. We have adopted a technique that permits standard full sternotomy, conventional open chest cardiopulmonary bypass, aortic cross-clamping, left atrial vent, and antegrade cardioplegia with minimal surgical scar. MATERIAL AND METHOD: With minimal skin incision and full sternotomy, 40 patients with congenital heart disease underwent open heart surgery from April 1997 through September 1997. Defects repaired included 30 ventricular septal defects, 4 atrial septal defects, and 1 sinus Valsalva aneurysm in 35 children(M:F=17: 18), and 3 Atrial septal defects, 1 ventricular septal defect, and 1 partial atrioventricular septal defect in 5 adults(M:F=1:4). Midline skin incision was performed from the second intercostal space to 1 or 2 cm above the xiphoid process. For full sternotomy, we used the ordinary sternal saw in sternal body, and a special saw in manubrium under the skin flap. During sternal retraction, surgical field was obtained by using two retractors in a crossed direction. RESULT: The proportion of the skin incision length to the sternal length was 63.1+/-3.9%(5.2~11cm, mean 7.3cm) in children, and 55.0+/-3.5%(10~13.5cm, mean 12cm) in adults. In every case, the aortic and venous cannulations could be done through the sternal incision without additional femoral cannulation. There was no hospital death, wound infection, skin necrosis, hematoma formation, or bleeding complication. CONCLUSION: We conclude that minimal skin incision with full sternotomy can be a safe and effective alternative method for the repair of congenital heart diseases in children and adults.

Double Skin Incision in Breast Operation

Now, in nearly all operations, bleeding is controlled by electric cautery (Bovie). Bovie discovered that a high-frequency alternating current could be used to incise tissue or coagulate blood to obtain hemostasis. The technique was popularized by other operations. In this procedure, a mild thermal injury occurs away from the plane of cautery, and blood vessels thrombose. Although this cautery is very useful for easily controlling the bleeding and for shortening the operation time, an electric hypertropic scar and a poor cosmetic skin incision margin remain; for young women, an operative scar assumes particular cosmetic importance. This study was made to improve the hypertropic scar and the poor cosmetic skin incision margin.

Incisão submamária para esternotomia mediana / Submammary incision for median sternotomy

Objetivo - Avaliar as indicaçöes, complicaçöes e os resultados estéticos e funcionais da incisäo submamária para esternotomia mediana em jovens e crianças do sexo feminino. Métodos - Duzentos e oitenta pacientes do sexo feminino com idades entre 2 meses e 42 anos (média = 5 anos, desvio padräo = 9 anos) foram submetidas a intervençöes cardíacas com o emprego de incisäo submamária para esternotomia mediana nos hospitais Sírio-Libanês e Matarazzo, de janeiro 1981 a outubro de 1991. Resultados - A exposiçäo foi adequada e, todos os pacientes, sem dificuldades técnicas ou complicaçöes maiores e os resultados estéticos e funcionais excelentes. Conclusäo - Os resultados justificam o emprego rotineiro da incisäo submamária para esternotomia mediana em pacientes do sexo feminino

Purpose - To evaluate the indications, complications, cosmetic and functional results with submammary skin incision for a median sternotomy in femules. Methods - Two hundred and eighty female patients have undergone submammary skin incision for a median sternotomy between 1981 to 1991 ages rangedirom 2 months to 42 years (m = 5 ± 9 years). Results - Adequate exposure of the heart was achived in every case, there were no technical problems, no major complications and the cosmetic and functional results are excellent. Conclusion - Complications associated with this incision are insignificant and the cosmetic and functional results are excellent justified routinely this approach for young women

DETECTION OF PLATELET MEMBRANE GLYCOPROTEIN WITH PAP-IMMUNOHISTOCHEMICAL TECHNIQUE / 中国法医学杂志

The platelets in the human mixed thrombus,hyaline thrombus antemortemand postmrtem skin incision wounds were detected by the PAP-immunohisto-chemical technique using monoclonal antibodies against the human platelet mem-brane glycoprotein(GPIb,GPIIIa).The positive reaction were observed inthe mixed thrombus,hyaline thrombus and in all the antrmortem skin incisionwounds,but not in the postmortem skin wounds.The significance of theapplication of this technique in the forensic medicine practice was discussed.