Contraction rates of meshed, nonexpanded split-thickness skin grafts versus split-thickness sheet grafts.

Contraction rates of wounds covered by meshed, nonexpanded split-thickness skin grafts were compared with split-thickness sheet-grafted wounds in a porcine model. No significant difference was found in wound contraction. When compared with previous studies, this study shows that differences in contraction previously observed were not a result of meshing and suggests that expansion may be the cause of the difference previously observed.

Long-term ineffectiveness of suspension material and musculofascial suspensions: a rabbit model.

The literature describes various methods of platysma and SMAS modification to enhance rhytidoplasty. This paper evaluates suspension materials: autogenous fascia and dermis, Gore- Tex, and a nylon suture to elevate the panniculus carnosus in a rabbit model using 15 animals. In the second part of this paper, 16 rabbits were used to evaluate imbrication and advancement techniques of the latissimus dorsi muscle. The ineffectiveness of permanently moving a viable, innervated muscle under tension is discussed.

Cleft lip repair using intramuscular hydroxyzine sedation and local anesthesia.

Intramuscular hydroxyzine was used alone for sedation in 18 cleft lip repairs with patients under 6 weeks of age. After injection of local anesthesia, the infants were quiet throughout the procedure. Blood pressure, pulse, respiration, and temperatures were normal throughout and the oxygen saturation remained above 94% in all cases. There were no complications noted with this series of patients and no patient required conversion to general anesthesia. Intramuscular hydroxyzine combined with local anesthesia and nerve block has been found to be a safe and effective method for cleft lip repairs in selected neonates under 6 weeks of age.

Complications of laser therapy in the gynecological patient: a review of four patients.

Complications of gynecological laser treatment for perineal disease have been seen with increasing frequency. This may be the result of more women undergoing therapy with this method. Four women presenting with unstable perineal scarring are discussed.

Toxicity of cleaning agents for removal of grease from wounds.

Industrial injuries are often open wounds contaminated with grease. Commercial compounds used for removing grease from intact skin are composed of petroleum distillates. These products are occasionally used to remove grease from open wounds. Using an animal model, this study examines the use of commercial compounds in open wounds in comparison with mild detergent and water. A clear correlation is established between their use and adverse tissue reaction. The use of soap and water as opposed to petroleum-based compounds is recommended for removal of grease from a wound.

The diagnosis of ruptured breast implants.

This study is a retrospective review of 18 patients treated by the authors and 14 reported patients with ruptured breast implants. A history of trauma was absent in 11 patients; 17 patients had closed capsulotomies. The physical findings of ruptured implants were nodules, decreased breast size, asymmetry, tenderness, and a softer texture. Mammograms were 90 percent accurate when silicone had migrated. In seven of eight false-negative mammograms, silicone was contained within the fibrous capsule. Mammography signs of rupture are summarized. The diagnosis of ruptured implants should be facilitated by recognition of the clinical presentations and radiographic signs.

Treatment of peripheral ischemia secondary to lidocaine containing epinephrine.

Accidental injection of local anesthetics containing epinephrine into a digit can cause distal tissue necrosis. Norepinephrine infiltration in subcutaneous tissue also causes tissue necrosis. Phentolamine has been used to prevent necrosis from norepinephrine. Because both epinephrine and norepinephrine are alpha- and beta-adrenergic stimulators, the rat foot model was developed to study the possible use of phentolamine or labetalol in protection against tissue necrosis after injection of epinephrine in the extremity. Phentolamine was found to be useful in preventing tissue necrosis after the injection of local anesthetic containing epinephrine in the skin of the rat foot. Labetalol was found to be less effective in preventing tissue necrosis. Phentolamine may be useful in preventing tissue necrosis after the inadvertent injection of epinephrine containing local anesthetics in the digit.

Complications of reduction mammaplasty: comparison of nipple-areolar graft and pedicle.

A retrospective study of breast reductions in 268 patients by two plastic surgeons was performed. Particular attention was paid to those patients treated by inferior pedicle techniques; these patients were compared with those treated by free nipple grafts. According to our findings, patients with skin loss were heavier and had longer suprasternal notch-to-nipple distances. Patients who had free nipple grafts were older and heavier and had larger specimen weights and longer suprasternal notch-to-nipple distances. Fifty-four of the original 268 patients were included in a substudy of larger breasts, defined as those with a specimen weight of over 700 g. Nineteen patients underwent free nipple grafts, and 35 underwent inferior pedicle techniques. None of the 19 patients having free nipple grafts developed complications, whereas 6 of the 35 undergoing inferior pedicle techniques sustained significant complications. We conclude that free nipple grafts should be considered over inferior pedicles in heavier patients with breast ptosis.

Reconstruction of mammary hypoplasma associated with chest wall deformities.

Three young women who had significant unilateral hypoplasia of the breast, accentuated by marked rib deformities and hypoplasia of the pectoralis muscle, were treated by two-staged reconstructions. A custom-made chest wall implant and a breast prosthesis were used. In the absence of cardiorespiratory compromise, these are simpler operations than rib osteoplasties and the cosmetic result is better.