Reduction mammaplasty using the inferior pedicle technique.

A retrospective study of 350 reduction mammaplasties by the inferior pedicle technique performed over a 3-year period allows a critical evaluation of postoperative complications and patient satisfaction. The procedure can be done in a timely manner on an outpatient basis and is applicable to breasts of different shapes and sizes. The rate of postoperative complications (5%) was comparable with previous studies. Patient satisfaction was high (98%), with near-total relief of preoperative symptoms. Concern about the resultant scars was low (2%) when the incisions followed the natural contour of the breast.

What makes us strong: urban aboriginal perspectives on wellness and strength.

The limitations of a needs orientation for aboriginal mental health planning are evaluated in terms of the discrepancy between First Nations and western medical paradigms of health. We propose an alternative approach that focuses on how aboriginal people conceptualize wellness and describe their strengths. This provides a focus for initiatives that promote well-being by enhancing strengths rather than concentrating solely on deficits. We illustrate this approach by highlighting the indigenous knowledge of urban First Nations people in Vancouver's Downtown Eastside neighbourhood. We conclude that supporting existing strengths promotes wellness in holistic, culturally appropriate, and empowering ways.

The role of various antithrombotic agents in microvascular surgery.

The ultimate goal in microvascular surgery is to achieve improved patency rates while reducing complications of systemic antithrombotic agents. Using a described model of microarterial thrombosis, the antithrombotic effects of oral aspirin (ASA) were assessed in rats. ASA-treated animals (30 mg/kg orally) exhibited significantly prolonged mean bleeding times 1 h and 24 h after dosing when compared to controls (p < 0.01). Platelet aggregation profiles also displayed an inhibition of platelet aggregation in the ASA group relative to controls. In the thrombosis model, however, patency rates were significantly improved at 20 min, but all vessels were thrombosed at 24 h.

Effects of ketorolac tromethamine (Toradol) on a functional model of microvascular thrombosis.

Ketorolac tromethamine (Toradol), a potent nonsteroidal anti-inflammatory drug used for postoperative pain, also strongly inhibits platelet aggregation. The anti-thrombotic effects of intramuscular ketorolac were assessed with a described rat model of microarterial thrombosis. After a single dose of ketorolac mean bleeding times were significantly prolonged (p < 0.01) and platelet aggregation was markedly reduced. Patency rates at 20 min were significantly higher in ketorolac groups compared to controls (p < 0.005). However, all vessels were thrombosed at 24 h. Scanning electron microscopy demonstrated decreased platelet aggregation and decreased thrombus formation in ketorolac treated animals at 20 min. The prolonged bleeding time and reduction in platelet aggregation add support to concerns of bleeding complications reported in patients treated with ketorolac perioperatively. Thus, ketorolac should probably not be used for pain relief in patients in whom postoperative haematoma formation is a particular concern. In addition, in this model, ketorolac as a single agent was ineffective for long-term prevention of microarterial thrombosis.

The effects of ultraviolet irradiation on wound contraction in the hairless guinea pig.

Ultraviolet radiation has been shown to alter wound tensile strength and evoke a number of intracellular changes in fibroblasts. We examined the effects of relatively high doses of ultraviolet radiation on subsequent wound contraction of circular wounds in the hairless guinea pig model. Female hairless guinea pigs were divided into two experimental groups receiving 80 J/cm2 or 480 J/cm2 every other day for 16 weeks. Age-matched unirradiated animals were used as controls. After exposure, all animals had either a 4 mm punch biopsy (80 J/cm2) or a 2.4 cm diameter ((480 J/cm2) Groups 3 and 4) circular area excised from the dorsum. The extent of wound enlargement immediately following wounding of the irradiated animals was decreased as compared to the controls. The rate of wound contraction was significantly lower during early stages of wound contraction in each group of irradiated animals, and wound contraction was significantly slower overall in both groups of irradiated animals compared to controls.

An in vitro study on the effect of UVA radiation on human gingival fibroblasts.

The recent availability of a 99.9% UVA source has made possible studies that show that low energy wavelengths, previously considered innocuous, significantly affected wound healing in hairless guinea pigs. Decreased wound tensile strength and a slower rate of wound contraction in irradiated animals were among the changes noted. Because of their advocated role in the wound healing process, fibroblasts were chosen to study the effects of pure UVA exposure at a cellular level. 3H-thymidine uptake levels were measured in 8 groups of fibroblast cultures (12 samples/group). The cultures were exposed to varying concentrations of pure UVA. Previously incorporated 14C-thymidine levels were used to compensate for differences in cell numbers between samples. At a fluence of 3.65 x 10(-3) watts/cm2, a significant decrease in 3H-thymidine incorporation (compared to controls) was seen for all exposure periods and there was a dose-dependent decrease only in 3H-thymidine uptake for cells exposed to 1-4 min of UVA. Using post-exposure incubations of 2-16 h, a time-dependent recovery of 3H-thymidine uptake was also demonstrated, from 40% of control at 4 h, to 75% at 8 h, and 99% at 16 h. The near-complete recovery at 16 h was seen in exposures up to 2.73 joules/cm2 (12 min), whereas higher concentrations showed only partial recovery. These studies demonstrated the deleterious, though reversible, effects of UVA on fibroblasts and suggest a possible pathophysiologic process for UVA's effect on wound healing in this animal model.

The reversibility of UV-altered wound tensile strength in the hairless guinea pig following a 90-day recovery period.

Investigations in our laboratory showed that exposure to ultraviolet radiation significantly diminishes wound tensile strength in hairless guinea pigs. A recurring question is whether changes in wound tensile strength are reversible. The present project addresses whether wound tensile strength in irradiated and control animals differs following a 90-day healing period after irradiation and wounding. Group 1 animals (n = 10) served as nonirradiated controls. Group 2 animals (n = 10) were irradiated with a UVA/B source receiving a cumulative dose of 8,960 joules/cm2 over a 16-week period. Following completion of the irradiation schedule, a standard 6 cm midline incision was made on the dorsum of each animal and then allowed to heal for 90 days. At this time, wound tensile strength measurements were performed. The mean wound tensile strength value for the control group (4.62 +/- 0.16) was not significantly different compared to the irradiated animals (4.23 +/- 0.24). The alteration in wound tensile strength observed at 21 days in animals irradiated with a UVA/B light source is reversible after a 90-day recovery period.

Wound tensile strength in the hairless guinea pig following irradiation with pure ultraviolet-A light.

Ultraviolet light in the wavelength range of 315-400 nm (UVA) is known to penetrate the epidermis more readily than UVB and to result in significant dermal damage. Fibroblasts within the dermis are responsible for the production of collagen, which is the chief determinant of wound tensile strength during the third week of wound healing. The present study assesses the effects of UV radiation limited to the UVA wavelength on wound tensile strength in the hairless guinea pig. Twenty female hairless guinea pigs were randomly divided into two equal groups (n = 10). Group 1 animals served as controls. Group 2 animals were irradiated with 120 J/cm2 from a pure UVA fluorescent light source every other day for a period of 21.3 weeks (cumulative dose = 8960 J/cm2). Upon completion of the irradiation schedule, a standard 6 cm linear full-thickness surgical wound was created on the dorsum of all animals and allowed to heal for 21 days. The wounds were excised and wound tensile strength was assessed by determining breaking strength and dividing by the breaking-point surface area. Wound tensile strength was significantly lower (p less than 0.0017) in irradiated animals (0.99 +/- 0.12) than in controls (1.54 +/- 0.08). Therefore, UVA at this dose significantly decreased wound tensile strength in this model and raises further concern regarding exposure to this wavelength of ultraviolet radiation.

A dose-related curve of wound tensile strength following ultraviolet irradiation in the hairless guinea pig.

A dose-related curve of wound tensile strength was derived following exposure to three doses of predominantly UVA (Ultraviolet A) radiation (98.3% between 315 nm and 400 nm, 1.7% less than 315 nm). Forty female hairless guinea pigs were divided into four equal groups: Group 1 (controls); Group 2 (40 J[Joules]/cm2/day); Group 3 (80 J/cm2); and Group 4 (160 J/cm2). Preoperatively, the experimental groups were irradiated on alternate days for 16 weeks. Serial dorsal punch biopsies (4 mm) were taken prior to the initial exposure and subsequently at 2, 4, 8, 12, and 16 weeks and examined histologically and microscopically. Then, standard 6 cm midline dorsal surgical wounds were made and allowed to heal for 21 days. Wounds were excised and wound tensile strength was assessed. Significant decreases (p less than .05) were noted in wound tensile strength of Groups 2, 3, and 4 compared to the controls, with the decrease being directly related to the dose received. Dermal changes were noted in all irradiated groups as early as four weeks after initial UVA/B exposure. Electron microscopy revealed elastosis and disruption of collagen fibers. Prolonged exposure to radiation, predominantly in the UVA range, appears to impede wound healing in a dose-related fashion and elicits elastosis and collagen disruption.

Comparison of single-dose antithrombotic agents in the prevention of microvascular thrombosis.

A model of thrombosis was used to evaluate the efficacy of single-dose heparin, hemodilution, and 40,000 milliwatts dextran in the prevention of microvascular thrombosis. Forty Lewis rats (275 gm body weight) were divided into four groups (n = 10): hemodilution (6 ml NS), single-dose heparin (1 mu/gm), 40,000 mw dextran (0.3 gm/100 gm), and control (0.275 ml NS). After exposure of the superficial femoral arteries, a model of arterial crush with arteriotomy followed by an intimal abrasion was used. The animals randomly received one of the four solutions above. Experimental results included patency rates of 90% at 20 minutes and 10% at 24 hours in the hemodilution group, 100% at 20 minutes, and 70% at 24 hours in the single-dose heparin group, and 100% at both 20 minutes and 24 hours in the dextran group. A 100% thrombosis rate was observed in the control group at 20 minutes and 24 hours. Single-dose heparin and dextran significantly improved patency in comparison to both the control and hemodilution groups at 24 hours (p less than 0.01). Scanning electron microscopy of the vessels revealed thrombus deposition consistent with these findings. These results indicate that single-dose heparin and single-dose dextran reduce thrombosis in this model of microvascular injury.

The effects of ultraviolet radiation on wound healing.

The effects of prior ultraviolet light exposure on wound tensile strength and skin histology were evaluated in the hairless guinea pig model. Hairless guinea pigs (strain IAF/HA-HO) were irradiated with either UVA (80 J/cm2) or UVB (0.46 J/cm2) every other day for 16 weeks. Following cessation of treatment, a standard dorsal wound was made in each animal, allowed to heal, and mechanically tested to failure at 21 days. Serial 4 mm punch biopsies were obtained prior to the initial exposure and at 2, 4, 8, 12 and 16 weeks. Histological examination with haematoxylin and eosin, trichrome and elastin stains was performed. In comparison to the unexposed control group, wound tensile strength was significantly less in the UVA- and UVB-irradiated animals. Histological examination revealed a marked endothelial swelling and eosinophilic infiltration in the irradiated groups. These results indicate that repeated exposure to even moderate doses of non-ionising radiation alters normal skin structure and adversely affects subsequent wound tensile strength in this model.

Assessment of the lymphocyte response to silicone.

The biocompatibility of silicone is once again the focus of increased interest. Long considered inert, silicone has now been reported to be responsible for macrophage inhibition in rats and to possibly cause adjuvant disease in humans, and the related compound silica has elicited an antibody response in mice. The present study evaluates lymphocytic response to silicone as expressed by the demonstration of immunologic memory, or changes in specific lymphocyte subpopulations. Thirty-six female Lewis rats (250 gm body weight) were used as test animals. Group 1 (n = 12) was injected subcutaneously with 2.5 ml Freund's Complete Adjuvant (FCA) alone. Group 2 (n = 12) was injected with 2.5 ml FCA sonicated with silicone gel. Group 3 (n = 6) was injected with 2.5 ml FCA, and at 4 weeks, gel-filled silicone implants were placed subcutaneously. Group 4 (n = 6) was injected with 2.5 ml FCA sonicated with silicone gel, and gel-filled silicone implants were placed at 4 weeks. An additional group of six rats (group 5) served as control for the experimental animals, and a group of four rats (group 6) served as naive control. Groups 1 and 2 were sacrificed at 4 weeks, and splenic lymphocytes were obtained for lymphocyte transformation assays performed against silicone. Assays also were run with the addition of the known mitogens Con A, PHA, LPS, and pokeweed. Cytofluorographic analysis of pan-T, T-helper, T-suppressor, and B-cell populations was performed. Groups 3, 4, 5, and 6 were harvested at 8 months, and splenic lymphocytes were subjected to lymphocyte transformation assay.(ABSTRACT TRUNCATED AT 250 WORDS)

A functional model of microvascular thrombosis.

A new model of microvascular thrombosis is presented, with the evaluation of single-dose heparin in the prevention of microvascular thrombosis. The technique, which involves arterial crushing and an arteriotomy with intimal abrasion, was performed on the superficial femoral artery of the rat. The model was applied to a series of 30 consecutive rat superficial femoral arteries. A 100 percent thrombosis rate was seen immediately and at 24 hours in 10 nonheparinized animals. An operator control group of 10 vessels without intimal abrasion had a patency rate of 100 percent immediately and at 24 hours. Ten vessels following single-dose heparin and intimal abrasion were all patent initially, with 7 remaining patent at 24 hours. Reproducibility of the model was documented by a second operator with similar results. Utilizing this model, single-dose heparin was effective in maintaining vessel patency.

The effects of prior exposure to silicone on capsule formation, histology, and pressure.

Investigations into the effects of prior silicone exposure on subsequent capsule formation around silicone implants assume particular relevance in light of the exponential increase in the medical application of polymers such as silicone. The inert nature of silicone has been in question with regard to its effects on the immune system, specifically whether or not it may act as a hapten or antigen. The present study analyzes the effects of prior silicone exposure on subsequent capsule formation, histological consistency, and pressures when an animal is reexposed to a silicone implant. Twelve female Lewis rats (body weight 250 g) were randomly divided into two groups. Group 1 (n = 6) rats were subcutaneously injected with 2.5 ml of Freund's Complete Adjuvant, Group 2 (n = 6) rats were injected with an equal volume of adjuvant sonicated with silicone gel. At 4 weeks a gel-filled silicone implant was placed subcutaneously in each animal. Capsule pressures were obtained at 4 months and the capsules from 3 rats from Group 2 were excised and examined microscopically. Pressures were measured again at 8 months and all remaining capsules were excised and examined. No statistically significant differences were noted when comparing two profiles over time between silicone-exposed and nonexposed animals in regard to capsule thickness or capsule pressure. However, capsule pressures were significantly lower at 8 months than at 4 months in both groups (p less than 0.034). In this model, significant reductions in capsule pressure were noted in both groups over time, but prior exposure to silicone did not appear to alter capsule histology, thickness, or pressure.

The fate of free autogenous fascial grafts in the rabbit.

Fascial grafts were taken from 34 New Zealand rabbits and implanted above and below the cranial periosteum in the same animal. They were placed as four-layered folded grafts and as single-layered grafts. When harvested from 6 to 14 months after transplantation, the multi-layered grafts and the single-layered grafts on bone had maintained their bulk but consisted histologically of only a retained collagen matrix with no viable cellular structure. The one-layered grafts on periosteum, however, retained their cellular make-up with normal vascularity and normal cellular structure when harvested at approximately the same intervals.

Protocol for replantation and revascularization of digits and limbs.

This report was designed to aid the primary care physician who is confronted with traumatic amputations, and to suggest treatment and triage guidelines. Giant strides have been made in the past 25 years in the area of microsurgery. It is now possible to salvage a digit or limb that in earlier times would have been lost. The most important steps begin at out lying hospitals at which the patient is first evaluated. This exciting new area of surgery requires education and standardization of treatment to afford the patient the best care possible.

Cellular schwannoma of the hand.

A rare case of cellular schwannoma of the hand is reported. The tumor was seen initially in a 90-year-old white man following a 60-year benign clinical course. This interesting neoplasm is commonly misdiagnosed as a malignant tumor.