Endoscopy for regional lipectomy.

With the advances in endoscopic surgery, reconstructive surgeons search for applications in the field of soft tissue contouring. The improvements in endoscopic surgery in other fields are based on surgery within well-contained spaces that allow insufflation. However, minimally invasive surgery in the soft tissue planes has been limited by the relative inability to control separation of the tissue planes to allow a working space for instrumentation. This animal model shows the ability to open up and elevate any soft tissue space by means of external traction elevation and exact separation of tissue layers to allow endoscopic surgery without the need for insufflation. With the use of endoscopic equipment, the removal of fat from any area of the body becomes a much more precise art because of visualization and illumination and the ability to gain immediate hemostasis while exact contouring through removal of layers of fat can be achieved.

Minimally invasive harvesting of rectus abdominis myofascial flap in the cadaver and porcine models.

The rectus abdominis muscle has been used in reconstructive surgery as a superiorly and an inferiorly based pedicle flap as well as free flap. Since flap necrosis is unusual, the primary morbidity of the harvesting is donor-site complications, including infections, seromas, poor cosmesis, and hernias. Minimally invasive surgery has been used in abdominal, thoracic, and urologic surgeries with favorable results. To date, flap harvesting and other soft-tissue surgeries have been considered inaccessible to minimally invasive surgery based on existing techniques. We demonstrate in the (5) cadaver and (5) porcine models the technique of endoscopic harvesting of a superiorly based vertical myofascial pedicle flap. Without insufflation, we create a soft-tissue space to operate within using external skin traction. We demonstrate that this flap harvesting can be performed without the obligatory large skin incision. Donor-site complications may be decreased with less tissue disruption. In our cadaver models, we have tried using the rectus without the anterior fascia based on its superior pedicle for breast reconstruction. For this purpose, we use the endoscissors with cautery to create a tunnel up on the chest wall. The muscle based on its superior pedicle could be rotated up on the chest wall subcutaneously, allowing primary closure of the anterior sheath using the endostapler. If the anterior sheath is sacrificed or cannot be closed primarily, mesh can be used to create a reinforcing layer stapled to the edges of fascia and midline. Endoscopic surgery offers an excellent alternative for soft-tissue reconstruction without compromising the results.

Endoscopy mastectomy and breast reconstruction: endoscopic breast surgery.

This article describes a new method of external traction elevation which is applied to the breast in order to perform an oncologically thorough glandular removal and axillary dissection followed by immediate autologous reconstruction while significantly reducing wound morbidity and greatly improving cosmesis.

Microsurgical revascularization of the ophthalmic artery.

We have developed and performed a microsurgical arterial anastomosis to revascularize the ophthalmic artery in patients with ischemic visual loss, resulting in improvement in visual function. A detailed description of the surgical procedure is discussed as well as the indications for surgery in these cases. An ischemic etiology of visual impairment was predicted by binocular fundus reflectometry, a noninvasive technique to indicate ocular perfusion abnormalities. Encouraging early results suggest that such a revascularization procedure may provide a therapeutic option for a particular group of patients with progressive ischemic visual loss.

The effect of tooth preparation design on the breaking strength of Dicor crowns: 2.

Six maxillary first premolar tooth preparation designs for all-ceramic restorations were tested for their effect on the strength of Dicor crowns. Ten crowns were fabricated for each preparation design, and the breaking strengths were measured. Three finish line designs (1.2-mm shoulder with sharp axiogingival line angle, 1.2-mm chamfer, and 0.8-mm chamfer) and two total occlusal convergence angles (5 degrees and 15 degrees) were tested. All preparations possessed 2.0 mm of occlusal reduction. The average breaking strengths of the 10 Dicor crowns were compared to those of 10 metal ceramic control restorations. The three groups of restorations fabricated for preparations with 5 degrees of occlusal convergence were significantly weaker than those made for preparations with 15 degrees of convergence. The metal ceramic restorations were significantly stronger (247.45 kg) than the strongest Dicor crowns (56.2 kg).

Comparative study of condylar settings of three semiadjustable articulators.

The reproducibility of arcon semiadjustable Whip Mix, Denar Mark II, and Hanau 158 articulators was tested using multiple protrusive and lateral edge-to-edge wax interarch registrations made with an interocclusal device. Photographic and cephalometric tracings verified an identical angulation between the axis-orbital craniofacial reference plane and the maxillary occlusal plane for the subject and both the Denar Mark II and Hanau 158 articulators. This angle was 2.5 degrees less in the Whip Mix instrument. Three operators made three settings for each of 12 protrusive and 24 lateral interarch registrations for each articulator. Results showed significant differences between instruments. Whip Mix consistently gave the highest.angulations and Hanau 158 the lowest. For protrusive records there was no significant difference between examiners, but for lateral records a significant difference in examiner registration was found. For both protrusive and nonworking registrations, interaction was seen between instrument and operator and between instrument and registration, and a significant difference was seen between records. This study supports previous studies showing that semiadjustable articulators using interarch records have a low level of reproducibility and are subject to variables of instrument, operator, and occlusal records.

The effect of tooth preparation design on the breaking strength of Dicor crowns: Part 1.

Six maxillary first premolar all-ceramic tooth preparation designs were tested for their effect on the strength of Dicor crowns. Ten crowns were fabricated for each preparation design, and their breaking strengths were measured. Three finish line designs (1.2-mm shoulder with sharp axiogingival line angle, 1.2-mm shoulder with rounded axiogingival line angle, and 0.8-mm chamfer) and two total occlusal convergence angles (10 degrees and 20 degrees) were tested. All preparations possessed 2.0 mm of occlusal reduction. The average breaking strengths of the 10 Dicor crowns were compared to that of 10 metal ceramic control restorations. The tooth preparation with a 1.2-mm shoulder finish line, sharp axiogingival line angle, and 10 degrees of total occlusal convergence produced the strongest Dicor crowns (88.6 kg). The weakest restorations were observed when a 0.8-mm chamfer finish line (66.8 kg) was used. The metal ceramic restorations were significantly stronger (247.45 kg) than the strongest Dicor crowns (88.6 kg).