Three-dimensional radiofrequency tissue tightening: a proposed mechanism and applications for body contouring.

The use of radiofrequency energy to produce collagen matrix contraction is presented. Controlling the depth of energy delivery, the power applied, the target skin temperature, and the duration of application of energy at various soft tissue levels produces soft tissue contraction, which is measurable. This technology allows precise soft tissue modeling at multiple levels to enhance the result achieved over traditional suction-assisted lipectomy as well as other forms of energy such as ultrasonic and laser-generated lipolysis.

The free flap and plate in oromandibular reconstruction: long-term review and indications.

The purpose of this study was to define the role of reconstruction plates as bone replacement in oromandibular reconstruction. From 1987 through 1991, 71 consecutive oral cancer patients underwent composite resection and reconstruction and were entered into one of two studies. In the first study of 31 patients, 15 underwent oromandibular reconstruction using a radial forearm osteocutaneous flap, while the remainder (16) received a radial forearm fasciocutaneous flap together with a mandibular reconstruction plate. The second study involved 40 subsequent patients, all receiving the latter form of reconstruction. Twenty-one of the plates were stainless steel, and the remaining 19 were of the titanium hollow screw (THORP) type. We followed the patients prospectively. We defined success as a reconstruction that we did not have to remove. Additionally, since the patients had limited life expectancy, we developed the idea of days of life lost and incorporated it into our definition of a successful outcome. Vascularized autogenous bone proved to be more successful than metallic plates used alone in terms both of reconstruction survival and of minimizing days of life lost. The overall success rate of mandibular plate reconstruction was 78.9 percent, but analysis by defect type revealed a failure rate of 35 percent when the defects were anterior and only 5 percent when they were lateral. THORP plates demonstrated a trend towards more durability. We would now recommend plate reconstruction only in lateral defects in patients with a poor prognosis.

Fixation of the vascularized bone graft in mandibular reconstruction.

One hundred and forty vascularized bone grafts were used for mandibular reconstruction in 135 patients. Most followed surgical ablation of squamous carcinoma recurring (or persisting) after irradiation. This paper analyzes the fixation techniques and their effects on bony union. Of 140 vascularized bone grafts, 132 survived and were reviewed. Fifty were stabilized using rigid techniques and 82 by interosseous wires. Rigid fixation had a success rate of 94 percent, while nonrigid techniques resulted in bony union in 96.3 percent. The three failed cases of rigid fixation occurred when short mandibular compression plates were used in iliac crest grafts. We conclude that vascularized bone grafts exhibit a high degree of bony union and that fixation technique--rigid versus nonrigid--appears unimportant in this context. Compression plating is clearly bone-dependent. Nevertheless, use of the reconstruction plate simplifies mandibular reconstruction, and the extra hardware does not appear to increase infection or other soft-tissue complications.

The radial forearm flap: a biomechanical study of the osteotomized radius.

An experimental study was undertaken to determine the effect of an osteotomy on radial strength and to compare two techniques used clinically to perform these osteotomies. Forty preserved human cadaveric radii were randomized into osteotomized (20) and nonosteotomized (20) groups. Osteotomized bones were further randomized into beveled-corner (10) and squared-corner (10) groups. A 9-cm-long, one-third thickness segment of bone was removed, similar to the defect resulting from a radial osteocutaneous transfer. All bones were tested to breaking using a four-point bending apparatus. Osteotomized radii were significantly weakened, with breaking strengths only 24 percent of the control group. Although the beveled osteotomy group appeared stronger than the squared osteotomy group, this finding was not significant with the numbers tested. In view of the weakness of the osteotomized radius, we recommend excising no more than one-third of the radial diameter and postoperative immobilization of the forearm for 8 weeks. A beveled osteotomy prevents overcutting at the corners and allows better visualization of the depth of cut. With these measures, the incidence of fracture may be reduced.

Nonoperative treatment of trigger fingers and thumbs.

This article reports our experience with the management of 93 consecutive patients with 108 trigger digits initially treated by triamcinolone acetonide injections into the flexor tendon sheath. It appears that two distinct clinical types of trigger digits exist--nodular and diffuse. Ninety-three percent (63/68) success was obtained in the nodular type compared with 48% (10/33) in the diffuse type (p less than 0.05). We conclude that the patients with the nodular type should be offered a simple cortisone injection. Those patients seen initially with the diffuse type should probably be offered surgical decompression.

Normolipidemic xanthomata of the hand extensor tendons.

A 48-year-old man presented with soft tissue lumps over the metacarpophalangeal joints of the long and index fingers of his left hand due to tendon xanthomas. His personal history and laboratory investigations were negative for familial hyperlipidemia or other medical conditions. A simple debulking procedure produced a good cosmetic and functional result at 7 years' followup.