Long-term effects of extraluminal dilatation with a rigid circle on arteriovenous anastomotic line in venous grafts transposed into arterial defects.

Postanastomotic narrowing resulting from subintimal hyperplasia is a well-known phenomenon. In the current study the authors compared a metallic circle and conventional suture technique in anastomoses performed in two ends of external jugular vein grafts interposed in carotid arteries of rabbits. They recorded the patency rates, fluid flow rates, and histological effects of the circle on the anastomotic line and compared them with conventional suture anastomoses. In 16 rabbits (experimental group) a standard suture was used in both ends of the jugular vein graft transposed to the carotid arteries on one side. On the other side, circle anastomoses were performed on both ends of the vein graft. In an additional 8 rabbits (control group), the anterior jugular veins and carotid arteries were dissected on both sides and left. During postoperative week 12, in 8 rabbits of the experimental group, the flow rates of carotid arteries were measured in vitro, and intraluminal silicone casts were prepared. In the remaining 8 experimental rabbits, carotid angiographies were performed and anastomotic segments were harvested for histological examination. Flow rates were also measured in the control group, and artery and vein segments were harvested. The patency rates of the vein grafts with metallic circle anastomoses were 100%, whereas conventional suture patency was 75% at week 12. Flow rates were significantly higher in the metallic circle-anastomosed vein grafts (74 ml per minute vs. 123 ml per minute, mean values; p < 0.05). Histological examination revealed reduced intimal thickness in the metallic circle anastomoses compared with conventional suture anastomoses. Dilatation of the arteriovenous end-to-end anastomotic line by a rigid circle prevents anastomotic narrowing in the long term.

Tangentially split gluteus maximus myocutaneous island flap based on perforator arteries for the reconstruction of pressure sores.

From 1995 to 1997, the authors used tangentially split gluteus maximus myocutaneous island flaps based on the musculocutaneous perforator arteries for the reconstruction of pressure sores located in the trochanteric, sacral, and ischial regions of 30 ambulatory and paraplegic patients. The postoperative follow-up period was 18 months. Postoperative electromyograms were performed on the ambulatory patients to compare the function of the gluteus maximus muscles on each side. There were one major and two minor postoperative complications. There was no total flap loss. The major advantage of this technique is the preservation of most of the gluteus maximus for stair climbing and single-limb support in the ambulatory patient. The tangentially split gluteus maximus myocutaneous island flap is recommended as the procedure of choice for closure of sacral, ischial, and trochanteric ulcers in both the ambulatory and nonambulatory patient.

Reconstruction of mandible with fibula free flap.

The fibula can be used as a donor for a free flap for mandible reconstruction. It has the advantages of low donor site morbidity, consistent shape, ample length, and distant location to enable a two-team approach, allowing multiple osteotomies because of its periosteal circulation. It can be raised with a skin island for composite tissue reconstruction. Eight segmental mandibular defects (average 11.62 cm) were reconstructed following resection for tumour. Six defects consisted of bone alone and the other two had only a small amount of associated intraoral soft-tissue loss. Two patients underwent primary reconstruction. We performed two or three osteotomies on each graft and used miniplates and wires for bone fixation. The flaps survived in all patients. All osteotomy sites healed primarily. The aesthetic result of reconstruction was satisfactory.

Septo-orbitoperiostoplasty for the treatment of palpebral bags: a 10-year experience.

The orbital region is sensitive to the undesirable effects of any surgical intervention, because of its anatomical location and the importance of the eyelids in facial sign language. The procedures performed for correction of baggy eyelids may have remarkable undesired results. In recent years, we have made a special effort to analyze the causes, to minimize these undesirable effects, and to be able to offer patients more natural and safer results. We have designed a new technique called septo-orbitoperiostoplasty for the treatment of baggy eyelids, based on preservation of orbital fat and correction of the supportive layer. This technique consists of placing the orbital fat back into the orbital cavity and its retention by suturing the lax septum to the periosteum of the orbital rim. Neither an incision on the orbital septum nor an excision of the orbital fat is performed. It can be performed for both upper and lower eyelids. This paper describes the surgical procedure and shows the results obtained from 74 patients who had been treated with this technique over a 10-year period. All patients were followed up for an average of 5 years.

A new approach for the treatment of recurrent large abdominal hernias: the overlap flap.

In this article we report a new technique for the treatment of recurrent large abdominal hernias and skin laxity: the overlap flap. This technique combines abdominoplasty with hernia repair. Obese patients with recurrent large abdominal hernias and skin laxity could benefit from this operation. This operation could not be performed in patients with a wide absence of the abdominal wall. A total of six patients were treated with this technique in our clinic. Follow-up of the patients has ranged from 1 to 4 years. Cosmetic results were excellent in all patients. No recurrence of the hernias has been observed in any of the patients. Two flaps are prepared; the lower one is deepithelialized, and it is used as an autogenous mesh in place of a prosthetic material to reinforce the abdominal wall, and the upper flap is prepared and overlapped on this lower one.

A new technique for distal hypospadias repair: advancement of a distally deepithelialized urethrocutaneous flap.

We report on a new modification technique and the latest results of a procedure for treating cases of distal hypospadias with minimal or no chordee called advancement of a distally deepithelialized urethrocutaneous flap. This procedure incorporates correction of chordee, mobilization of the urethrocutaneous flap, and advancement of the flap through a tunnel until it reaches the tip of the glans. A total of 30 children underwent treatment using this procedure in our clinic. Follow-up of the patients ranged from 2 months to 3 years. Cosmetic results were excellent in all the patients. Fistula formation has been observed in only one patient, possibly due to a surgical accident. This technique may only be applied in distal hypospadias patients with minimal or no chordee in whom the meatus is localized to the coronal level or 0.5 cm proximal to it. Patients with a short urethra or in whom the meatus is distally localized but with severe chordee are not candidates for this technique. In general, this technique is not applicable in patients with ventral penile curvature. We would like to emphasize that this repair technique allows for simple and safe dissection of the distal urethra composed of only mucosa without corpus spongiosum around it. This kind of distal urethra can be advanced easily to the tip of the glans penis with the help of the dermal component.

Tissue expansion-assisted prefabrication of the forehead flap for nasal reconstruction.

A new technique for nasal reconstruction is described. This method--expansion-assisted flap prefabrication--is essentially a simultaneous application of pretransfer grafting and tissue-expansion procedures for creating custom-made forehead flaps to meet varying requirements of nasal reconstruction. We have applied this new technique on seven patients, with full-thickness nasal defects during a 3-year period. Results from these patients are presented with a review of different use of flap prefabrication principles in nasal reconstruction.

Growth potential of autogenous cartilage grafts in expanded skin: an experimental study in rabbits.

The effect of tissue expansion on the growth potential of autogenous cartilage grafts was studied in 10-day-old New Zealand white rabbits. The rabbits were divided into two groups: In Group 1 (n = 12) after 2 weeks of tissue expansion by using a 10-ml tissue expander, a cranially based 4 x 4-cm dorsal skin flap was raised and a 1 x 1-cm autogenous cartilage graft from the midportion of the left ear was transplanted beneath the flap in each rabbit. In Group 2 (n = 12) elevation of dorsal skin flaps and transplantation of the grafts were performed in the same way but without a previous tissue expansion. The grafts were removed at 30 and 60 days after transplantation in both groups, for histological examination and measurement of the dimensional changes to determine the growth rate. In both groups, histological examination revealed characteristic findings for cartilage growth, however, Group 1 (expansion) demonstrated a statistically significant increase in the growth of cartilage grafts when compared with Group 2 (control) (p = 0.0001). The results of this study indicate, from the standpoint of acceptance and growth potential of autogenous cartilage framework, that there is no drawback to using this tissue expansion technique for reconstruction of the ear in childhood.

Eminectomy for the treatment of chronic subluxation and recurrent dislocation of the temporomandibular joint and a new method of patient evaluation.

We have performed this technique bilaterally on 39 patients with chronic subluxation and 13 patients with recurrent dislocation since 1985 and have had good results with patient satisfaction. These patients had significantly higher articular eminences than normal control individuals. Also, we have used echography as a new application of an old technique, to evaluate the patients objectively in the preoperative and postoperative periods.