Generation of localized modes in an electrical lattice using subharmonic driving.

We show experimentally and numerically that an intrinsic localized mode (ILM) can be stably produced (and experimentally observed) via subharmonic, spatially homogeneous driving in the context of a nonlinear electrical lattice. The precise nonlinear spatial response of the system has been seen to depend on the relative location in frequency between the driver frequency, ω(d), and the bottom of the linear dispersion curve, ω(0). If ω(d)/2 lies just below ω(0), then a single ILM can be generated in a 32-node lattice, whereas, when ω(d)/2 lies within the dispersion band, a spatially extended waveform resembling a train of ILMs results. To our knowledge, and despite its apparently broad relevance, such an experimental observation of subharmonically driven ILMs has not been previously reported.

Augmentation mammoplasty: personal evolution of the concepts looking for an ideal technique.

The purpose of this paper is to report our personal experience in the field of augmentation mammoplasty. This experience is based on over 15 years in practice and working with more than 400 cases using different types of prostheses (single-lumen gel-filled, single-lumen saline-filled, double-lumen, smooth or texturized surfaces), different routes (submammary, periareolar, transaxillary), and different locations of the implant (complete submuscular, subglandular, subpectoral). Our present preference is for a partial submuscular (subpectoral) augmentation mammoplasty through an inferior periareolar route. The results of 91 consecutive patients operated on with this technique from January, 1990 to December, 1994, during the blow-up of the controversy on silicone, are reported.

Anatomical study on the temporal fascial layers and their relationships with the facial nerve.

The recent application of endoscopic techniques in facial rejuvenation has stimulated a new interest in the anatomy of this region. In endoscopic face lift, as in open techniques, one of the main steps is the conjunction of dissections of the upper and midface without damage to the frontal branch of the facial nerve. This article provides an accurate account of the organization of the temporal fascial layers and their relationship with the facial nerve. The authors' dissections confirm that the frontal branch, despite the variations in branching patterns, has an anatomical relationship with the surrounding fasciae that can be deemed constant and predictable: The frontal branch lies in the deep layer of the fatty tissue interposed between the suprazygomatic extension of the superficial musculoaponeurotic system (SMAS) and the superficial leaflet of the temporal aponeurosis. The arrangement of the temporal fasciae on the zygomatic arch is also discussed.

[New evolution of the technique in trasaxillary augmentation mammaplasty: subpectoral-subglandular implant]. / Nuova evoluzione dell tecnica di mastoplastica additiva per via ascellare: impianto in sede sottopettorale-sottoghiandolare.

Transaxillary subpectoral augmentation mammaplasty combines the advantages of an axillary located scar with those of a submuscular pocket. However, according to the classical technique, the caudal extension of the pectoral fascia prevents the prosthesis from filling completely the inferior breast pole, thus creating a double submammary fold and/or an excessive fullness of the superior quadrants. In order to overcome this limit Barnett (1990) proposed to disrupt the caudal extension of the pectoral fascia along with its insertions to the submammary fold, thus allowing the implant to lie in a submuscular plane superiorly and in a subglandular/subcutaneous one inferiorly. In this paper the authors present their clinical experience with this new surgical technique.

Surgical anatomy in endoscopic facial rejuvenation.

Endoscopic facial rejuvenation is a new technique which allows to greatly reduce the scar morbidity especially in the forehead region. Other advantages are its safety and accuracy due to the excellent magnification provided by the endoscope which enhances the visualization of muscles, nerves and vessels and shows clear surgical planes. Anyway, a sound knowledge of the distribution of the fascial system at the temporo-zygomatic region and of the relationships between the temporal fasciae, the interposed fat pads and the frontal branch are fundamental both in the prevention of nerve injury and in the successful result of the endoscopic procedure. In this paper an accurate account of the anatomical structures and their relationships encountered during a subperiosteal endoscopic facial procedure by dissecting 20 facial halves has been provided.

Anatomical reconstruction versus camouflage of the inferior two thirds of the nasal septum.

From an anatomical standpoint, the support of the inferior two thirds of the nose is ensured by the cartilaginous septum. Usually, the reconstruction of total loss of the quadrangular cartilage is performed with some success by means of camouflage procedures such as L-shaped struts or cantilever grafts. In this article we report on four patients who presented with severe collapse of the inferior two thirds of the nose. Although the cartilage was completely gone, the septal linings were intact on both sides. An anatomical reconstruction of the quadrangular cartilaginous septum was performed, harvesting a cartilaginous rib graft, carving it to reproduce the septal plate, and suturing it to the nasal spine. The short- and long-term follow-up showed satisfactory aesthetic and functional results, with good height of the nasal profile, adequate tip projection, and patency of the airways. No evidence of similar reports on this particular technique has been found in the literature.

Superior orbital fissure syndrome complicating zygomatic fractures. Pathogenesis and report of a case. Case report.

Superior orbital fissure syndrome complicates zygomatic fractures either when the nerves that cross the fissure are damaged by bone fragments, or when the increased pressure in the orbit at the time of the injury compresses the nerves against the rim of the fissure. Oedema and bleeding may also have the same effect. We present a patient who was treated conservatively, and the ophthalmological problem subsided, although not completely, within a year.

Fascio-fascial suspension technique in medial thigh lifts.

Redundant thigh tissue can be corrected by the thigh lift. However, this is a seldomly used procedure because of postoperative problems such as inferiorly displaced and wide scars, vulvar distortion, and early recurrence of ptosis. In order to limit these complications, we developed a deep anchoring technique based on the overlap of the adductor longus and gracilis fasciae. A group of 18 patients underwent a medial thigh lift using this technique and were followed for at least 12 months after surgery. The fascio-fascial suspension gives strong vertical support with minimal tension on the skin, thereby reducing the complications traditionally associated with this procedure.

Port-wine stains: long-term histologic changes induced by argon and CO2 laser treatment.

A good success rate has been achieved using argon and CO2 laser in the treatment of port-wine stains. So far however only a few studies have been published concerning the long term histologic changes in the irradiated skin. In the present study we report our findings from skin biopsies in patients treated for port-wine stains with argon and CO2 lasers. The results show that in spite of the high level of selectivity of optical absorption of argon emission by hemoglobin, after 3-9 months there is histologic evidence of connective proliferation and reactive fibrosis of the necrotic dermis comparable with that resulting from CO2 emission.

The versatility of pectoralis major muscle and musculocutaneous flaps in the reconstruction of the oral cavity and of the anterior chest wall.

Musculocutaneous flaps, allowing one stage reconstructions and reducing the stay in hospital and rehabilitation period, have revolutionised modern plastic surgery. Muscle flaps are a good alternative to provide adequate coverage of tissue losses but with limited scarring. The authors report their 5 year clinical experience in the reconstruction of oral cavity and chest wall defects using the pectoralis major as muscle or musculocutaneous flap. The preliminary data of an angiographic study, confirming the segmentation of the pectoralis major muscle into two subunits, each provided with its own vascular supply (mainly the clavicular and the sternocostal segment), are also presented. The short and long-term results confirm the excellent viability and versatility of the pectoralis major musculocutaneous and muscle flap. In particular the complications rate is so low that this procedure can be considered safe and reliable.

Anatomical basis for a safe and easier approach to composite rhytidectomy.

The authors present the anatomical findings that have made an easier approach to composite rhytidectomy possible. The lower lateral border of the orbicularis oculi muscle (OOM) overlies the zygomaticus major muscle (ZMM), the upper third of which tightly adheres to the malar bone. The OOM is innervated throughout over its circumference by a plexus of small facial nerve branches. From its deeper surface, the ZMM is innervated by two to four branches in its upper third and middle third. These branches are jeopardized in an extended sub-SMAS dissection as this tends to go deep into the ZMM. The malar fat pad is superficial to the SMAS layer that invests the zygomaticus and levator labii muscles and, with age, tends to slide downward, medially deepening the nasolabial folds. An extended dissection beyond the OOM tends to remain superficial to the upper part of the ZMM, zygomaticus minor, and levator muscle complex. We have found that extending the suborbicularis dissection inferiorly and laterally offers three major advantages: (1) The correct deep subcutaneous plane just above the ZMM, zygomaticus minor muscle, and levator complex can be found easily, leaving all of the fat attached to the skin. The only structures at risk are some minor motor branches to the OOM that can be divided without any morbidity because of the extensive plexiform innervation.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone lengthening in malformed upper limbs: a four year experience.

Bone lengthening by corticotomy, gradual distraction and stabilization with an external frame has proved to be effective in the repair of osseous defects in lower extremities. More recently this technique has been introduced also in the treatment of post-traumatic deformities and malformations of the upper limbs. From 1989 to 1992 we treated 38 patients (46 upper limbs) with bone lengthening of which 12 (16 upper limbs) affected by post-traumatic deformities and 26 (30 upper limbs) by malformations. We present herein our four year experience with malformed cases only. The results suggest that bone lengthening is a simple and reliable procedure to obtain good function, to correct angular deviations and, also, to give a better esthetic appearance. Satisfying results, low complication rates and simple execution recommend its use in the treatment of many congenital malformations of the upper limbs, usually in association with traditional techniques. However, we are now strongly selecting the indications in order to improve our future results. We stress in particular that the treatment of some malformations, as ulnar or radial club hands, could be radically modified by introduction of bone lengthening.

The surgical anatomy of the subcutaneous fascial system of the scalp.

The surgical anatomy of the fascial layers and vascularization of the scalp was studied by means of 11 bilateral cadaver dissections. This article is organized as follows: first, a description of the layers and fasciae of the scalp and their relationships with the main vascular structures, and then a description of the histological structure of the subgaleal fascia (composed of multiple connective vascularized sheets that glide over one another) and of its blood supply. In our dissections, we found the constant topographic distribution of the major perforant vessels to the subgaleal tissues as follows: in the temporal region, perforant vessels from the superficial temporal artery near and 10 to 14 cm above the zygomatic arch, where the superficial temporal artery leaves the surface of the galea to enter the superficial subcutaneous tissue, and in the fronto-parieto-occipital region, many small perforant vessels evenly entering the subgaleal plane every 5 to 10 mm. These findings could lead to greater use of fascial or composite flaps from the scalp region.

Repair of a recurrent urethrovaginal fistula with an island bulbocavernous musculocutaneous flap.

This paper describes a case of recurrent postpartum urethrovaginal fistula. The extent of the vaginal tissue loss and the perilesional scarring made direct closure of the defect not practicable. After suturing of the urethra, the anterior vaginal wall was reconstructed with an island bulbocavernous musculocutaneous flap raised from the left labium majus. Seven months after surgery, the flap healed well, and cystography showed a regular voiding without periurethral suffusions. Healing of thedonor site also was aesthetically satisfactory.

Bulbocavernous myocutaneous flap: a new technique in repair of recurrent urethrovaginal fistula.

This paper describes the case of a recurrent post-partum urethrovaginal fistula. The extent of the vaginal tissues loss and the perilesional scarring made the direct closure of the defect non practicable. After suturing the urethra, the anterior vaginal wall was reconstructed with an island bulbocavernous musculocutaneous flap raised from the left labium majus. Nineteen months after surgery the flap healed well without peri urethral suffusion.

[Carotid endarterectomy with placement of a PUR (polyurethane) patch]. / La TEA carotidea con posizionamento di patch in PUR.

In this study, 40 patients who underwent surgery for cerebro-vascular insufficiency were considered. Carotid endarterectomy was the procedure of choice in all of the patients; the arteriotomy was always closed using a PUR patch, a new material that, for its chemical and physical characteristics seems to be a good alternative to PTFE. All of the patients underwent surgery under loco-regional anesthesia, allowing a perioperative monitoring of the neurological status through the patient's active collaboration. During the postoperative period, non local or systemic pathology related to the use of the patch has been observed. During the short and half term follow-up, the patients underwent echo-Doppler of the supra-aortic trunks that didn't show either false aneurysms or thrombosis on the patch surface.