Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers.

BACKGROUND: Burns to the dorsum of the fingers and hands require debridement and immediate coverage by skin flap at the earliest opportunity. In such situations, the conventional abdominal wall flap is still commonly used as it is a convenient and safe technique, but the foremost problem with this flap is that it is thick and therefore cosmetically unacceptable; it is also functionally not very suitable as the bulkiness of the digits prevents full range of motion. We have developed a modified thin abdominal flap (glove flap) which attains good results. METHODS: Incisions are made in the skin of the abdominal wall only where the hand is to be inserted and where each of the finger tips will be pulled through. The flap is undermined just under the skin to the depth that preserves the subcutaneous vascular networks to create a thin flap. The interdigital area of the flaps should not be undermined so as to create a glove-type pocket. The hand is then inserted in this subcutaneous pocket. After insertion of the injured hand for 10 to 14 days, the flap is resected and attached to the hand. RESULTS: Seven hands of 5 patients were treated by this technique and all the flaps survived safely. The function of the hands and fingers, including range of motion (ROM) in each joint, was successfully salvaged. The reconstructed hands and fingers were aesthetically pleasing. CONCLUSIONS: Although the abdominal wall flap is not a new technique, our modifications to this flap make it possible to acquire functionally and aesthetically better results. Although many excellent techniques such as perforator flaps have been reported recently, we conclude that the abdominal wall flap is still a very useful technique because it can be performed easily, safely and within a short time.

Surgical correction of cauliflower ear.

We have classified the cauliflower ear into different types according to the zone and the degree of deformity. One major group is deformity without change in the outline of the ear, and this is divided into four subgroups according to the zone. All of these subgroups can be treated by shaving the deformed cartilage through suitable incision lines. For deformities accompanied by a skin deficit, a postauricular skin flap should be used. The other major group is deformity accompanied by a change in the outline of the ear, which is divided into two subgroups. If the ear is rigid, a conchal cartilage graft is used. If the structural integrity of the ear is poor, costal cartilage is used to provide rigidity.

New treatment of a visible linear scar in the scalp: multiple hair-bearing flap technique.

Scars on the scalp have no hair, and can be conspicuous even when narrow. Alopecia, especially in the whorl of hair at the back of the parietal region, is very difficult to camouflage. We present a new technique using multiple hair-bearing flaps harvested from near the area of alopecia, each flap including 10-15 hairs. We treated 24 patients who were suffering from alopecia, with scar sizes ranging from 2 cm to 17 cm in length and from 0.5 cm to 2 cm in width. Between three and 12 flaps per patient were used to complete the treatment. All wounds healed without complications, and satisfactory results were achieved in 20 patients. Hair loss from the flap was rare. The scar could be hidden by the hair immediately after the operation. In four patients, a visible scar remained or was created at the donor site. These patients required a secondary repair. The major advantages of this technique are that the dense hair bundles in the flap are studded here and there in the scar, the scar can be reduced and the residual scar can be hidden by the flap hair. This technique is most useful for the parietal and occipital areas, especially near the whorl of hair.

The use of water structure breakers, urea and guanidium chloride, new mobile phase modifiers in reversed-phase partition high-performance liquid chromatography.

Organic solvent-free mobile-phase systems in ion-pair reversed-phase partition high-performance liquid chromatography (IPRP-HPLC) are demonstrated; using urea at 3.0-7.0 molal (mol kg-1) as a modifier in a mobile phase on an octadecylsilanized silica column, four nitrophenolates and metal 4-(2-pyridilazo)resorcinol (PAR) chelates (in PAR chelates system an aqueous mobile phase with 15 wt% methanol was used) were separated rapidly within 6 min at no sacrifice to the separation efficiency. On the addition of urea in the mobile phase, reduced retention times of nitrophenolates and naphthalenesulfonates and also diminution of the height equivalent to a theoretical plate were observed. The addition of urea and guanidium chloride (GuCl) in the mobile phase gave rise to a decrease in the mobile phase volume; in turn, this meant an increased volume of the stationary phase. As the concentration of urea and GuCl in the mobile phase increased, the volume of the mobile phase in the column decreased within about 70% and 40% at 7.0 molal of urea and GuCl, respectively. A decrease in the mobile phase volume suggests an increase in the extent of solvation of the bonded hydrocarbon chain of the stationary phase. The possible explanations for the LC behavior with the urea and GuCl are turned into reduction of hydrophobic interaction in LC processes, solute partitioning and entangling of alkyl chain brushes, with the addition of urea. The water structure breakers, urea and GuCl, most likely affect the solvation states of both solute molecules and the hydrocarboneous stationary phase by changing the nature of the water solvent, which provides a new technique for fine tuning of the LC resolution of the analytes.

Successive determinations of platinum(II) and selenium(IV) with 1,4-dibromo-2,3-diaminonaphthalene in aqueous micellar solutions.

Highly sensitive successive determinations for PtII and SeIV ions have been developed based upon reactions with 1,4-dibromo-2,3-diaminonaphthalene (Br2DAN), which forms a near-infrared (NIR) absorbing complex (epsilon = 1.2 x 10(5) l mol-1 cm-1 at 800 nm) and an emissive complex (ex. 386 nm, em. 604 nm) for PtII and SeIV ions, respectively, in acidic aqueous micellar solutions. In the presence of a cationic surfactant, cetyltrimethylammonium chloride, the detection limits for PtII and SeIV ions are 1.2 ng ml-1 (3 sigma) and 0.98 ng ml-1 (S/N = 3), respectively. Hydrobromic acid plays a key role to enhance the color development of the NIR-absorbing PtII complex. The influences of CuII and ZnII ions at the normal human serum levels are readily tolerated, and interference from FeIII ion at 35 mumol l-1 is circumvented by the addition of 50 mumol l-1 of polyaminocarboxylates, such as EDTA.

Entropy-controlled solvolytic dissociation kinetics of lanthanide(III) complexes with polyaminocarboxylates in aqueous solutions.

The factors involved in the formation of an inert complex in terms of solvolysis reaction have been studied for lanthanide(III)-acyclic polyaminocarboxylate complexes, as the basis for kinetically controlled selectivity used in analytical methodologies such as HPLC and HPCE. The rate constants for solvolysis and acid-assisted dissociation processes of the lanthanide complexes were determined in a batch system through metal- and ligand-exchange reactions. The reagents used were 8-amino-2-[(2-amino-5-methylphenoxy)methyl]-6-methoxyquinoline-N,N,N',N'-tetraacetic acid (Quin2) and O,O'-bis(2-aminophenyl)ethylene glycol-N,N,N',N'-tetraacetic acid (BAPTA) as octadentate ligands and trans-1,2-diaminocyclohexane-N,N,N',N'-tetraacetic acid (CyDTA) as a hexadentate ligand. It has been found that the rate constants for solvolysis vary from 5.7 x 10(-3) x s(-1) (La3+) to 1.7 x 10(-6) x s(-1) (Lu3+) depending on the ionic radii of Ln(III) ions for the Quin2 complexes, while no such monotonic dependence was observed for the BAPTA complexes. Among the parameters of activation, it is worth noting that there is a considerably large negative entropy of activation, of up to -250 J x mol(-1) x K(-1), and it is this which is responsible for the inertness of the Ln-polyaminocarboxylate complexes. Our data suggest that multiple ligation of the ligand in favor of the large coordination number of Ln(III) ions is of key importance for formation of the negative entropy of activation, in addition to the basicity of the ligand which also plays a significant role in the slow dissociation kinetics of the Ln(III) complexes.

Reconstruction of large nasal defects with a combination of local flaps based on the aesthetic subunit principle.

Herein is described a technique that uses a combination of local flaps to reconstruct large defects involving the nasal dorsum and cheek. The flaps used are a transposition flap elevated from the area adjoining the defect and bilateral cheek advancement flaps. This technique leaves all suture wounds at borders of the aesthetic subunits that have been described previously. Color and texture matches were good and symmetrical. The transposition flap can be modified according to whether the defect includes the nasal tip. After raising the cheek advancement flap, it is also possible to use a dog-ear on the nasolabial region for any alar defects. Nine patients were treated using this procedure. The technique is very reliable (no complications such as congestion and skin necrosis in our series) and is easy to perform. One patient had palpebral ectropion after the operation and underwent secondary repair. In this series, defects measuring 45 x 30 mm in maximum diameter and including the nasal dorsum, nasal tip, ala, and cheek were treated.

Retroauricular flap: its clinical application and safety.

We report the application and safety of the retroauricular flap in 38 cases. The flap was used on the anterior auricular surface in 21 cases, in the peri-auricular region in five cases, in the region of the preauricular sideburn area in two cases, in the malar region in six cases, in the eyelid in three cases and in the intraorbital region in one case. When this flap was used in the auricular or periauricular region, the blood circulation was safe and the appearance was aesthetically good in flaps pedicled by the postauricular vessels or by the superficial temporal vessels. However, when the defect was more remote from the auricle, the blood circulation of the flaps pedicled by superficial temporal vessels, whether subcutaneous pedicle flaps or free flaps, was unstable. In some cases there was extensive or partial necrosis of the distal area of the flap. On the other hand, the free flaps pedicled by the postauricular vessels had satisfactory blood circulation, but the vessels were sometimes short, narrow and difficult to find, especially the veins. In these cases, we were obliged to use the superficial temporal vessels. A further problem is that some of the patients, especially younger women, were dissatisfied when the retroauricular flap was used in the malar region because of the reddish colour of the flap.

A new operative method of correcting cryptotia using large Z-plasty.

A large Z-plasty on the postauricular surface of the ear has been used for successful reconstruction of cryptotia. This technique provides extensive skin coverage of the posterior auricle without skin grafting. The technique is easy and simple. The natural hairline is not disturbed and the temporoauricular sulcus is emphasised. Almost all of the scar is hidden behind the auricle. It has been performed on 17 patients with no recurrence of the cryptotia. One patient had partial congestion in the cranial-flap tip, which improved within 1 week. There were no other complications.

Reconstruction of a subtotally amputated auricle: a case report.

A 42-year-old woman presented with a subtotal amputation of the left auricle except for the helical skin. The treatment was by primary suture with debridement of some margins, and the auricle healed well. The fact that the treatment was successful without microvascular anastomoses is important, considering the anatomical features of the auricular vascular networks.

A novel fluorescence reagent, 10-hydroxybenzo[h]quinoline-7-sulfonate, for selective determination of beryllium(II) ion at pg cm(-3) levels.

A facile method has been developed for the highly sensitive and selective determination of ultratrace Be(II) ion using a new fluorimetric reagent, 10-hydroxybenzo[h]quinoline-7-sulfonate (HBQS), under extremely alkaline conditions, at pH 12.0. This reagent is quite suitable for the very small ion, Be(II), to form a 6-membered chelate ring, compatible with a high fluorescence yield. The stoichiometry of the chelate is 1:1 for Be-HBQS at pH 12.0. The calibration graph gave a wide linear dynamic range, 2-100 nmol dm(-3) of Be(II) ion with the detection limit (3s blank) of 0.52 nmol dm(-3), or 4.7 pg cm(-3). The excellent sensitivity and toughness toward the matrix influence were demonstrated using the artificial sample solutions for air-dust. Coupled with the simple masking procedure using EDTA, the method enables one to determine Be(II) ion at nanomolar levels in the presence of metals at the natural abundance levels in air-dust samples, typically Al, Ca, Cu, Fe, Mg, Pb, and Zn at 130, 150, 1.0, 70, 33, 3.0, and 8.0 micromol dm(-3), respectively, in the final solution. The proposed method was successfully applied to the determination of Be in urban air.

Separation selectivity of anionic metal complexes of N,N'-bis(hydroxybenzyl)ethylenediamine-N,N'-diacetic acid in ion and ion electrokinetic chromatography.

The complexes of Fe(III), Co(III), Mn(III), Al(III), Cu(II), Ni(II), Cd(II) and Zn(II) with N,N'-bis(hydroxybenzyl)ethylenediamine-N,N'-diacetic acid (HBED) were separated by ion exchange in different modes: ion chromatography (IC) and ion electrokinetic chromatography (IEKC). In column IC these complexes were separated on an IonPac AS4a anion-exchange column (Dionex, USA). Parameters of the background electrolyte that were examined in IEKC mode include polymer, competing ion concentration and pH. The use of poly(diallyldimethylammonium chloride) (PDADMACl) as a modifier in IEKC provides separation selectivity only slightly different from that observed in IC on the IonPac AS4a column. Optimal separation conditions were found to be: 0.1 mM HBED, 50 mM PDADMAOH, 10 mM Na2 B4 O7, pH adjusted to 10 with acetic acid. The use of an aromatic ligand allowed a 10-fold decrease in detection limits of metal ions in comparison with previously studied EDTA. A separation efficiency up to 400,000 theoretical plates was demonstrated for IEKC.

A capillary electrophoretic reactor with an electroosmosis control method for measurement of dissociation kinetics of metal complexes

The solvolytic dissociation rate constants of 1:2 complexes of Al3+ and Ga3+ with an azo dye ligand, 2,2'-dihydroxyazobenzene-5,5'-disulfonate (DHABS, H2L2-), have been evaluated with a capillary electrophoretic reactor (CER) system. This CER system is based on the fact that metal complexes encounter an overwhelming force to dissociate when apart from the ligand by CE resolution. Treatment of a capillary with a slightly acidic buffer solution, e.g., pH 5, reduces the double-layer potential (zeta) of the inner silica wall. Owing to slow relaxation of the deprotonation equilibria of superficial silanol groups known as the pH hysteresis, this zeta potential can be actually retained during the electrophoresis of the metal complexes in question with a neutral buffer at pH 7.0. This method enables one to manipulate migration times, namely, residence times in a capillary tube, from 5 to 90 min, depending on the prescribed conditioning pH, without changing any other operation conditions such as buffer composition and electric field strength. The excellent performance of the CER is exemplified by the accurate estimation of the dissociation degree of the complexes. The dissociation degree-time profiles for the complexes are quantitatively described using both internal and external standards; the very inert complex of [Co(III)L2]5- for the peak signal standardization and methyl orange for the injection volume correction. The solvolytic dissociation rate constants of the 1:2 complexes of Al3+ and Ga3+ ions with DHABS [AlL2]5- and [GaL2]5- into the 1:1 ones have been determined as (4.9+/-1.0) x 10(-4) and (3.7+/-0.3) x 10(-3) s(-1) at 303 K, respectively.

Potential of ethylenediaminedi(o-hydroxyphenylacetic acid) and N,N'-bis(hydroxybenzyl)ethylenediamine-N,N'-diacetic acid for the determination of metal ions by capillary electrophoresis.

Two aromatic polyaminocarboxylate ligands, ethylenediaminedi(o-hydroxyphenylacetic acid) (EDDHA) and N,N'-bis(hydroxybenzyl)ethylenediamine-N,N'-diacetic acid (HBED), were applied for the separation of transition and heavy metal ions by the ion-exchange variant of electrokinetic chromatography. EDDHA structure contains two chiral carbon centers. It makes it impossible to use the commercially available ligand. All the studied metal ions showed two peaks, which correspond to meso and rac forms of the ligand. The separation of metal-HBED chelates was performed using poly(diallyldimethylammonium) polycations in mixed acetate-hydroxide form. Simultaneous separation of nine single- and nine double-charged HBED chelates, including In(III), Ga(III), Co(II)-(III) and Mn(II)-(III) pairs demonstrated the efficiency of 40,000-400,000 theoretical plates. The separation of Co(III), Fe(III) complexes with different arrangements of donor groups and oxidation of Co(II), Mn(H), Fe(II) ions in reaction with HBED have been discussed.

Nasal reconstruction based on aesthetic subunits in Orientals.

Reconstruction based on the aesthetic subunit principle has yielded good aesthetic outcomes in patients with moderate to severe nasal defects caused by trauma or tumor resection. However, the topographic subunits previously proposed are often unsuitable for Orientals. Compared with the nose in white patients, the nose in Orientals is low, lacks nasal muscle, and has a flat glabella; the structural features of the underlying cartilage and bone are not distinctly reflected in outward appearance. The authors devised aesthetic subunits suitable for Orientals, and they used these units to reconstruct various parts of the nose. The major difference between these units and those presented previously is the lack of soft triangles and the addition of the glabella as an independent unit. The authors divided the nose into the following five topographic units: the glabella, the nasal dorsum, the nasal tip, and the two alae. The border of the nasal dorsum unit was extended to above the maxillonasal suture. The basic reconstruction techniques use a V-Y advancement flap from the forehead to reconstruct the glabella, an island flap from the forehead to reconstruct the nasal dorsum and nasal tip, a nasolabial flap to reconstruct an ala, and a malar flap to reconstruct the cheek. A combination of flaps was used when the defect involved more than one unit. This concept was used for nasal reconstruction in 24 patients. In one patient undergoing reconstruction of the nasal dorsum and in one undergoing reconstruction of the nasal tip, the texture of the forearm flap did not match well, which resulted in a slightly unsatisfactory aesthetic outcome. In one patient in whom the glabella, nasal dorsum, and part of the cheek were reconstructed simultaneously, a web was formed at the medial ocular angle, and a secondary operation was subsequently performed using Z-plasty. In one patient undergoing reconstruction with a forehead flap, defatting was required to reduce the bulk of the subcutaneous flap pedicle at the glabella. However, suture lines were placed in the most inconspicuous sites in all patients, and the use of a trapdoor contraction emphasized the three-dimensional appearance of the nose. The use of these aesthetic subunits for reconstruction offers several advantages, particularly in Oriental patients. Because the nasal dorsum is reconstructed together with the side walls, tenting of the nasal dorsum is avoided, which prevents a flat appearance of the nose. A forehead flap is useful in the repair of complex defects. Defects of the alae should be separately reconstructed with a nasolabial flap to enhance the effect of the trapdoor contraction and to highlight the three-dimensional appearance of the nose. Candidates for reconstruction should be selected on the basis of nasal structure. The results suggest that these units can also be used in some white patients.

Management of the hairline using a local flap in total reconstruction for microtia.

In cases of microtia with a low hairline, the manner in which hair is removed from the reconstructed auricle must be taken into consideration. This is one of the most common but difficult problems with reconstruction for microtia. The authors describe a new technique that uses a simple regional flap to resolve this problem. The hair-bearing skin in the estimated auricular region and its covering are removed using a local flap from the hairless mastoid region. This is done in the first stage of auricular reconstruction, the costal cartilage grafting is done in the second stage, and elevation of the auricle is done in the last stage. In 38 auricles of 36 patients who were treated from 1993 to 1995, eight auricles of eight patients were treated with this technique. In all cases, the hairless flap healed well, without vascular stasis or skin necrosis. In addition, no complications from using this technique occurred in the later stages of auricular reconstruction. With this technique, the skin of the flap provides a good texture and color match to the auricle. In addition, the skin of the flap has good elasticity for the cutaneous pocket for cartilage grafting. The harvested area of the flap can be hidden behind the reconstructed auricle. The authors initially wondered whether the marginal scar of the transposed flap's position in the auricle would be conspicuous. However, all of the scar became inconspicuous because it was positioned in the scaphoid fossa.

Aesthetic reconstruction for large upper lip defects in men.

Although many techniques use hair-bearing flaps to repair large upper lip defects in men, few preserve orbicularis sphincter function. Available techniques can also result in an unnatural appearance, because the entire upper lip is covered by a dense region of hair. We have developed a new technique and successfully repaired a large defect in the upper lip of three men. This technique uses flaps pedicled by angular vessels and includes the orbicularis oris muscle. A good outcome can be obtained both functionally and cosmetically when used in men with defects involving more than one-half of the upper lip.

Separation selectivity of some ethylenediaminetetraacetic acid and cyclohexane-1,2-diaminetetraacetic acid complexes in column and ion electrokinetic chromatography.

The complexes of Mn2+, Cd2+, Fe3+, Pb2+, Ni2+, Co2+, Zn2+ and Cu2+ with EDTA and cyclohexane-1,2-diaminetetraacetic acid (CDTA) were separated and detected in column and ion electrokinetic chromatography with suppressed conductivity and direct UV detection, respectively. In column ion chromatography (IC) these complexes were separated on an IonPac AS4A anion-exchange column (Dionex, USA). Parameters of carrier electrolyte, which were examined in the ion electrokinetic chromatography (IEKC) mode, include polymer and sulfate concentrations. In IEKC separation selectivity of complexes with poly(diallyldimethylammonium) cation as modifier is similar as for an IonPac AS4A column both for EDTA and CDTA chelates. It was shown that the ion-exchange capacity of the electrokinetic system is more than 100-times lower than the capacity of the IC column for the same peak resolution. In comparison with column main advantages of electrokinetic version are high separation efficiency (220,000-390,000 theoretical plates) and the absence of the analyte interaction with the sorbent matrix.

[Intraoperative electrophysiological monitoring for functional preservation of the cauda equina during lumbosacral surgery].

Adequate electrophysiological techniques to monitor function of the cauda equina have been proposed for surgery in patients with lumbosacral lipoma or myeloschisis. Motor fibers were identified by electrical stimulation in the operating field with bipolar rectangular impulses of 200 mu sec duration at 2 Hz under 5 mA and compound muscle action potentials (CMAPs) recorded from the leg and anal muscles. By recording CMAPs from the tibialis anterior, the biceps femoris, the gastrocnemius, and the external anal sphincter muscles, all of the roots from the fourth lumbar to the fourth sacral segment were continuously monitored. To spare recording channels, recordings were obtained from the right versus the left side. In our institute, 5 patients have undergone lumbosacral surgery while using this monitoring system, and the results indicated that there was no postoperative neurological exacerbation in any of the cases. According to a combination of the CMAPs produced by stimulation, the segment of the stimulated motor root could be identified electrophysiologically. Monitoring of somatosensory evoked potentials was not performed because this would have required too much time and would have prolonged surgery. However, some sensory fibers, which appeared to be posterior roots of the cauda equina on intraoperative inspection, could be identified indirectly with CMAPs recording because of current spreading from the stimulation to motor fibers.

Reconstruction of a three-dimensional structure using cartilage regenerated from the perichondrium of rabbits.

Human tissues such as those found in the ear, nose, eyelid, lip, and larynx have complicated and delicate three-dimensional structures, which are difficult to reconstruct and restore to normal function following damage by tumor, congenital disease, or trauma. We devised a new reconstructive technique for the lost tissues by using cartilage regenerated from the perichondrium. In 12 ears of 12 rabbits, the layer between the perichondrium and the cartilage was stripped off. The exposed cartilage was punched out in large amounts to resemble a flexible, honeycomb-like structure. Then, we sandwiched the rabbit ears with two thermoplastic plates, which maintained a structure of the anterior surface of the human ear for 8 weeks. Structural change was studied in all cases, and some parts of the remodeled tissue were studied pathologically. Out of 12 ears, 8 had a rigid structure with a shape like a human ear using regenerated cartilage from the perichondrium of rabbits, 2 were infected, and 2 had a decubitus ulcer on the conchal surface as a result of compression from the plate. This study suggests that the use of the cartilage regenerated from the perichondrium may lead to a successful treatment also in humans for a variety of three-dimensional structures that have been damaged.