Long-term results of dermal grafting for the repair of nasal septal perforations.

The closure of nasal septal perforations is a significant surgical challenge with a high failure rate. Dermis placed between mucoperichondrial advancement flaps may be an alternative. The usefulness of dermal grafting for the repair of nasal septal perforations was initially investigated in an animal model. Four pigs had 1.5 x 2.5 cm perforations surgically created and closed with either temporalis fascia or dermis placed under a local mucoperichondrial flap. The dermal graft group had an average closure of 80% with histologically normal mucosal surfaces. The temporalis fascia group had no closure. Fourteen patients with chronic nasal septal perforations from iatrogenic causes, trauma, and drug abuse were repaired with dermal grafting. Nine patients had complete closure, 3 patients had partial closures, and 1 patient's graft dislodged on the first postoperative day. Dermal grafts placed between mucoperichondrial flaps are a viable alternative for the closure of nasal septal perforations.

The role of outfracture in correcting post-rhinoplasty nasal obstruction.

Post-rhinoplasty nasal osbtruction is often related to narrowing in the region of the nasal valve. Correction of this obstruction can include inferior turbinectomy, septoplasty spreader grafts and nasal valvuloplasty. The authors have seen cases of severe valve stenosis related to infracture after osteotomy which did not respond to any of the aforementioned procedures. These patients were treated with revision osteotomy with outfracture. We discuss patient selection and surgical technique for revision osteotomy with outfracture as well as a cadaver dissection demonstrating the effects of infracture and outfracture on valve area. The clinical results, based on patient satisfaction and pre- and postoperative photographs, are presented. Revision osteotomy with outfracture should be included in the surgeon's armamentarium for the treatment of post-rhinoplasty nasal obstruction.

Retropharyngeal abscess: clinical review.

Retropharyngeal abscess, once a relatively common entity in children, is uncommon today. From 1981 to 1991, we treated 20 cases. Abscesses secondary to upper respiratory infection in children were seen only in three (15%) cases. Trauma and foreign bodies were the most common etiologic factors in the adult subgroup. Streptococcus viridans and Klebsiella pneumoniae were the most common pathogens. The use of contrast-enhanced computed tomography has had a significant impact on the diagnostic work-up. The choice of initial antibiotic therapy is discussed. There were no deaths in this series.

Persistent severe asthma in an adult from transient dog exposure: a brief communication.

While atopy is commonly found without signs of asthma, it has been proposed that in some settings, allergen exposure itself can lead to the development of the asthmatic diathesis. To date, this theory has been primarily supported by cases of occupational asthma, where prolonged symptoms have persisted following termination of exposure to the suspect allergen. This model is complicated by associated medicolegal implications, as well as by the generally long-term nature of the exposure, raising questions about the concurrent natural history of a given patient's illness. We report a case of non-occupational dog dander-induced asthma. Exposure was on an intermittent basis over a 15-month period, with the patient exhibiting a classic late phase response. Following discontinuation of exposure to dog dander, he continued to have symptoms, considerably in excess of his findings prior to dog dander exposure.

Human microvessel endothelial cell isolation and vascular graft sodding in the operating room.

We have evaluated multiple factors inherent to an operating room-compatible endothelial cell procurement and sodding procedure. Microvessel endothelial cell isolations have been performed on fat tissue obtained from over 140 patients with a 100% success rate. Liposuction-derived fat was optimal with respect to cell yield, and isolation time. The devices and equipment used were acceptable to the operating room and the complete cell procurement procedure was successful even in the hands of personnel with minimal training. Fat digestion was achieved using crude clostridial collagenase, with an average cell yield of 1 x 10(6) microvessel endothelial cells/gm of fat. Evaluation of this procedure with canine fat using an operating room acceptable procedure resulted in a 100% procurement success rate requiring 1.5 hours (+/- .5 hrs) for completion of the fat isolation, and cell isolation procedure. Microvessel EC could subsequently be used in graft seeding or sodding techniques to establish endothelial cell monolayers on vascular grafts. Our results indicate that one person with minimal cell isolation background can reproducibly isolate large quantities of sterile autologous endothelial cells in the operating room for immediate use in endothelial cell seeding/sodding procedures.