Prospective randomized trial of open versus percutaneous surgery for trigger digits.

Various methods for the treatment of trigger digits exist. This study was designed to compare the results of an open surgical technique with those of a percutaneous surgical technique for the treatment of trigger digits. Ninety-six patients with 100 trigger digits were randomized to either open (n = 46) or percutaneous (n = 54) surgical release of the first annular pulley. Operation time, duration of postoperative pain, recovery of motor function, and surgical complications were assessed. Trigger digits were successfully treated in 98% of the cases using the open surgical technique and in 100% of the cases using the percutaneous technique. Mean operation time was significantly longer using the open technique. Mean duration of postoperative pain and time to recovery of motor function were significantly shorter for patients treated with the percutaneous method. No serious complications were observed in either group. We conclude that percutaneous correction of trigger digits is a quicker procedure, is less painful, and shows significantly better results in rehabilitation than open surgery.

Accuracy of ultrasonography and magnetic resonance imaging in detecting failure of breast implants filled with silicone gel.

We prospectively studied the accuracy of magnetic resonance imaging (MRI) and ultrasonography (US) for preoperative detection of rupture in 35 single-lumen implants filled with silicone gel in 18 patients. The positive predictive value of US for rupture of an implant was 70% and the negative predictive value 64%. Sensitivity and specificity were 44% and 87%, respectively. Accuracy, defined as the total true positive and true negative values divided by the total number of implants studied was 66%. The positive predictive value of MRI was 100% and the negative predictive value 90%. The corresponding sensitivity and specificity were 88% and 100% and the accuracy 94%. MRI offers significantly better diagnostic sensitivity (p = 0.02) and accuracy (p = 0.004), and should be regarded as the "gold standard" in the evaluation of rupture of breast implants filled with silicone gel. When MRI is not readily available, US is an acceptable alternative.

Augmentation mammaplasty: the story before the silicone bag prosthesis.

Czerny from Heidelberg is generally accepted to have performed the first augmentation mammaplasty in 1895. Since then, a variety of nonsilicone materials have been injected or implanted to augment or to reconstruct the hypoplastic female breast, including autologous tissues, intramammary- or submammary-injected alloplastic materials, and preformed alloplastic materials other than silicone. For various reasons outlined in this review, none was fully acceptable. The introduction of the medical-grade silicone bag prosthesis in the early 1960s improved the results of mammary augmentation dramatically and reduced the incidence of fibrous contracture and implant extrusion. Other methods of breast augmentation became obsolete.

Imaging signs and radiologists' jargon of ruptured breast implants.

Silicone gel leakage problems are central to the furor over the complications alleged to be caused by breast implants. Because clinical examination may not reveal confirmatory signs of gel bleed or rupture, radiologists are often requested by plastic surgeons to evaluate the integrity of the implant's envelope. The findings of the various imaging investigations are reported in terms such as "teardrop," "linguini," and "snowstorm." To interpret the radiologist's report correctly, the plastic surgeon should be familiar with these terms and the findings they represent. In this article, we present an explanation of the radiologists' vocabulary in these matters, as well as an indication as to the significance of the various signs.

Life span of silicone gel-filled mammary prostheses.

The discussion on possible side effects of implanted silicone has resulted in a growing number of patients inquiring whether or not their mammary prostheses are intact and when failure of the prostheses is to be expected. Between November 1988 and May 1995, 182 patients had their silicone mammary prostheses replaced, repositioned, or removed one to three times. Capsular contraction, dislocation, pain paresthesia, and/or suspected rupture were common indications for surgery. To try and be able to provide an indication as to the correlation of implant age and integrity, we recorded the status of all 426 prostheses observed during secondary surgery. In this selected group of patients, approximately 50 percent of the mammary prostheses with an implant age of 7 to 10 years showed gel bleed or rupture. Applying the survival Kaplan-Meier curve, 50 percent of implants may be expected to bleed or be ruptured at the age of 15 years. Rupture was observed more frequently than gel bleed. It seems that there is no chronologic relation between gel bleed and rupture.

Migration of silicone through the fibrous capsules of mammary prostheses.

The usual reaction of the human body to implantation of a silicone prosthesis is formation of a fibrous capsule. Local reactions to silicone outside this fibrous capsule and distant migration of silicone particles have been described. So far, transcapsular migration of silicone particles from the mammary implant through the fibrous capsule of mammary prostheses has not been studied. In this prospective study 71 capsules found in 40 patients were histologically studied. The chi-squared test was applied to evaluate a possible correlation between silicone migration on the one hand and implant age and integrity of the prostheses on the other. The degree of silicone migration was discerned in four stages. Stage 1 represents no silicone particles in the capsule, stage 2 represents migration up to less than half of the capsule thickness, stage 3 shows migration confined to the outer half of the capsule thickness, and stage 4 means transcapsular silicone migration. In only 4 of 71 capsules no migration into or through the capsule was observed. The degree of silicone migration was significantly less in patients in whom the capsule was calcified and was significantly more in patients in whom implantation exceeded 12 years. There was no significant correlation between the status of the prosthesis (intact, bleeding, or ruptured) and the degree of silicone migration.

Silicone breast implant bleed and rupture: clinical diagnosis and predictive value of mammography and ultrasound.

Silicone breast implants have been used since 1962. Reliable methods to detect rupture and silicone gel bleed are needed, even more so because of increasing concern about the possible hazards of silicone. In cases in which clinical examination is not conclusive, additional radiodiagnostic evaluation may be useful in diagnosing intracapsular and extracapsular rupture of mammary prostheses. In the series presented, combined ultrasound and mammography shows a sensitivity for prosthesis rupture of 64% and a specificity of 81%. Silicone gel bleed cannot be detected by means of clinical examination or by combined mammography and ultrasound.

Improvement in blood flow and diameter of the postanastomotic rat tail artery by topical application of lidocaine in varying concentrations.

Prolonged spasm in small vessels is a major problem after microsurgical procedures. Topical agents applied to resolve these spasms have been the subject of many experimental studies. In this model we studied the effectiveness of various concentrations of lidocaine in resolving microvascular spasms induced by anastomosing the ventral rat tail artery.

Resolution of experimental microvascular vasoconstriction in rats by topical application of lidocaine hydrochloride in varying concentrations.

Various lidocaine hydrocholoride concentrations were used to measure the degree of resolution of ergotamine-induced vasospasm of the rat tail artery. Also further studies are indicated; 12% lidocaine seems to be as effective as 20% lidocaine. The widely used 2% lidocaine had little effect on the experimentally induced vasospasm.