Textured surface silicone breast implants: histology in the human.

Previous studies on the interaction of textured silicone breast implants has analyzed tissue expanders or used animal models. To date, the data on long-term results of the textured silicone breast implants have not examined permanent implants or in vivo effects in the human. A prospective study was designed to examine the interaction of textured silicone breast implants in a human over several years. A single surgeon, standard surgical technique, and single-type implant design were included. The results revealed 78% had silicone particles in the tissue immediately adjacent to the implant interface. No distant migration, metaplasia, or adverse effects were noted. Our results indicate that silicone fragmentation is common but appears to be confined to the local environment.

The postoperative use of wound adhesives. Gum mastic versus benzoin, USP.

Our results, combined with the work of previous authors, show that gum mastic not only offers superior adhesive qualities compared with benzoin, USP but also has a lower incidence of postoperative contact dermatitis and subsequent skin discoloration. In light of the widespread use of surgical adhesives, this study is important in documenting the low incidence of complications and the advantages of gum mastic compared with benzoin, USP.

Further refinements on the triangular flap closure of the cleft lip.

Refinements in the triangular flap closure of the unilateral cleft lip are presented. Randall's mathematical interpretation of the Tennison repair has been extended by using a series of arcs to determine the crucial points which form the triangular flap. Using this easily taught method, an isosceles triangular flap can be plotted which will interdigitate into the noncleft side of the lip. Two symmetrical vertical distances on either side of the cleft are thus formed. This allows for a standardized repair which may be more readily taught than the rotation-advancement technique. In addition, flaps are created which are turned medically toward the cleft and are used to accentuate the philtral pout, close the nostril floor, and reinforce the lip repair, allowing closure of even extremely wide clefts in one stage. These refinements in using the triangular flap closure for the repair of the unilateral cleft lip are diagrammatically presented. We believe that these refinements enhance the results of this closure.

A review of scalp split-thickness skin grafts and potential complications.

A review of 113 patients who underwent 178 scalp split-thickness skin graft procedures is presented. Although our study confirms some of the work of previous authors, we found that the scalp donor site has potential complications which should be considered. These complications are minor in the adult population. In the pediatric population, however, excessive blood loss due to the relatively large surface area of the scalp limits the use of the scalp as a preferred donor site.

Reconstruction with vascularized composite tissue in patients with excessive injury following surgery and irradiation.

The biological effects of a single high dose of radiation are examined. Both cellular injury and repair are reviewed during early, intermediate, and late phases. Anticipated composite tissue morbidity is detailed for therapeutic radiation doses administered to the head and neck, breast and thorax, and perineum. Patients who demonstrated excessive time-dose fractionation values were irradiated with lower x-ray energies. Those in whom there was an overlap of treatment fields presented a serious challenge to the reconstructive surgeon. Judicious selection of well-vascularized composite tissue outside the portals of irradiation, preferably with a long vascular pedicle, facilitated reconstruction. When possible, both donor and recipient vasculature should be outside the irradiated area to ensure uninterrupted blood flow to the transferred or transplanted tissue.

Atypical mycobacterial cervical lymphadenitis--treatment with surgery and antibiotics.

Five patients, ages 2 to 5 years, were successfully treated for cervical lymphadenitis caused by the avium intercellulari complex of atypical bacteria. Preoperative treatment with standard antituberculosis therapy had been unsuccessful. Extensive surgery requiring a conservative radical neck dissection was sometimes required. Three patients had such extensive and progressive disease that immediate excision was impossible. These patients received a course of Amikacin with considerable improvement, permitting adequate excision and reconstruction. A fourth patient who received Amikacin did not respond, although sufficient excision was possible. This preliminary data indicates that a combined treatment of Amikacin and surgery in extensive cases may be useful in the treatment of cervical lymphadenitis due to atypical mycobacteria.

Transcutaneous PO2 monitoring for assessing viability and predicting survival of skin flaps: experimental and clinical correlations.

Rectangular skin flaps based on the right superficial epigastric vessels were designed on the groins of 36 rats. Preoperative control, intraoperative, and postoperative readings of oxygen tension (PO2) were made at proximal, central, and distal sites on the flaps with a transcutaneous PO2 (tcPO2) monitor under various conditions of oxygen inspiration. The results of this experimental work indicated that the tcPO2 monitor was useful in continuously and rapidly measuring changes in oxygen concentration in skin flaps in a noninvasive fashion. The monitoring demonstrated that the response time of the flaps to changes in the concentration of inspired oxygen was rapid (less than 15 seconds). The monitoring also was valuable in assessing viability of the flaps, in predicting flap survival, and in detecting any systemic factors influencing oxygen transport, such as pneumonia. As a result of the experimental series, tcPO2 monitoring was used clinically to evaluate 18 flaps in 16 patients. As in the experimental series, the clinical measurements were significant and reproducible. They demonstrated that the tcPO2 monitor provides safe, reliable monitoring of peripheral oxygenation in the microcirculation that is rapid, continuous, and totally noninvasive. It is concluded that simultaneous tcPO2 measurements at control and flap sites provides a continuous record of the status of a flap that can improve the postoperative management of the surgical patient.