We monitored respiratory patterns, transcutaneous PO2 (tcPO2) and transcutaneous PCO2 (tcPO2) in three infants with clefts and severe failure to thrive. Unexplained dysphagia, muscular weakness and cardiac enlargement were other prominent symptoms. During sleep, repeated obstructive apneas accompanied by significant hypoxemia (tcPO2 less than 6 kPa) were recorded in all infants. Relief of the respiratory obstructions by means of nasopharyngeal intubation led to rapid growth catch-up and disappearance of the cardiac and gastrointestinal symptoms. This improvement in clinical condition was paralleled by an increase in transcutaneous PO2. Palatal closure according to Veau-Wardill-Killner led to a marked decrease in the number of airway obstructions and a significant improvement in blood gas homeostasis. The clinical condition of the infants was equally improved. We suggest that a respiratory investigation should be performed in infants with clefts and poor growth in spite of adequate caloric intake. Early closure of the palate should be considered in infants with signs of a respiratory failure.
Vein segments from the posterior facial vein of the rabbit were surgically isolated and re-anastomosed, either by manual suture technique or by the use of a new mechanical anastomotic device, the UNILINK apparatus. The purpose of the study was to compare anastomotic patency and time required for an orthotopic vein grafting procedure, when the two techniques were used. In the grafts anastomosed with the UNILINK technique, both clinical and histological evaluation showed 100% patency, while 20% of the sutured grafts showed impaired flow as a result of occlusive thrombosis. When the mechanical device was used, the full procedure was completed within one third of the time, as compared to suture anastomoses.
Surgical advancement of the chin, and postoperative relapse, were studied during a three-year period in 17 patients. Changes were measured on lateral cephalograms obtained at certain intervals. Sagittal skeletal changes were recorded parallel to the Frankfort Horizontal plane. Soft tissue changes were recorded by advancement of soft tissue Pogonion along a line parallel to the mandibular base line and by the increase of the angle NFL/NCL. The average skeletal advancement was 8 mm with a relapse of 1 mm two months after surgery. No further changes were registered during a three-year observation period. The average soft tissue advancement was 7.5 mm from two months after surgery and no relapse was found after this time. The soft to hard tissue ratio of the changes was 0.94 which corresponds to results reported in the literature. There was no correlation between the average amount of advancement and the amount of relapse. The range of changes showed a wide variation, however.
Capsular contracture is the main problem following breast augmentation with silicone implants. Subjective assessment has been the predominant method for evaluating breast firmness hitherto, although several objective methods have been described. In this prospective study applanation tonometry was used on 76 women following augmentation mammaplasty. Breast firmness was measured five times during the first postoperative year. Approximation of the breast imprint area to an ellipse was shown to be accurate and to simplify the estimation of the applanation surface, which is proportional to breast compressibility. The results correlated well with the subjective assessments using the Breast Augmentation Classification (BAC). A classification based on applanation tonometry is presented.
Osseointegration, defined as direct bone-to-implant contact, has been suggested as an approach for improving the results of arthroplasties of the major joints. An experimental investigation in femoral-patellar joint of the rabbit was performed to evaluate whether osseointegration could be achieved in a one-stage surgical procedure. After three months, it was found that the screws used for anchorage of the prosthesis showed an average direct bone-to-implant contact of 60% in three selected consecutive threads on each side. The range was 40-90%. These figures correspond well with previously reported ones from bone anchored titanium fixtures. It was therefore concluded that osseointegration of dynamically loaded screws used for anchorage of a femoral-patellar joint prosthesis may be achieved in spite of the fact that no controlled healing period for the screws was observed.
A speech evaluation of 203 CLP patients operated on at the Department of Plastic Surgery, Rikshospitalet, Oslo, during the period 1969-75 has been performed. All patients had the posterior palate closed using a modified von Langenbeck technique at an average age of 24.4 months. The speech evaluation, based on 4 clinical tests, was done at the age of 6 years by experienced speech pathologists. The results were considered good concerning articulation and nasality in 86.2% and 80.5%, respectively. Among the 36 patients with moderate or severe nasality, 28 had a pharyngoplasty performed. The final speech results were considered good in 97.3% of the whole sample.
Perichondrium from rabbit auricular or rib cartilage was used as a free autogenous graft and transplanted either to the subcutaneous tissue of the back of the rabbit or to an experimental defect in the femur condyles. Outgrowth of new tissue, morphologically indistinguishable from cartilage, was observed after six weeks. Inorganic 35SO4, administered in vivo, was incorporated into the newly formed tissue. The labelled products were isolated, identified, and compared with those obtained from authentic cartilage of auricular, rib or joint surfaces. The products of newly formed cartilage were similar to those of authentic cartilage. The results support earlier morphological findings, indicating that perichondrium from rib cartilage has a better ability to regenerate than auricular perichondrium. The synovial environment seems to have a positive effect on the generation of cartilage.
Steel scalpel, electrocautery, CO2 laser used in a continuous wave mode (CW) and rapid superpulse mode (RSP), and contact Nd: YAG laser were tested on pig skin incisions. Speed of incision and histological changes near the wounds were examined. Light microscopical observations were made on postoperative day 0 using standard Van Gieson stain. Width of the scar on postoperative day 14 was also measured. Steel scalpel produced the least pathological changes in the skin, followed by RSP. Electrocautery did not differ significantly from the CO2 lasers in this respect on postoperative day 0. The damage was larger after contact Nd:YAG laser. The situation was essentially similar on postoperative day 14. The width of the scar was narrowest after steel scalpel and widest after contact Nd:YAG laser (p less than 0.01; Nd:YAG vs. other methods). Electrocautery and the two CO2 lasers produced equal scarring. However, electrocautery was significantly faster than any of the lasers (p less than 0.001).
An experimental animal model was used to study the effects of occlusion of skeletal muscle blood flow on spontaneous denervation activity (fibrillation potentials). The aim was to investigate whether recording of fibrillation potentials could provide a valuable electrophysiological technique for monitoring muscle tissue circulation during free flap surgery. In both the fast-twitch anterior tibial muscle and the slow-twitch soleus, the number of fibrillation potentials decreased rapidly (within 30 sec) after occlusion of the blood flow and after 5 min only few fibrillation potentials were present. In the fast-twitch muscle, the fibrillation potentials disappeared within 10 min in most animals, but sporadic potentials were seen for up to 18 min in one animal after the blood vessels were clamped. In the slow-twitch muscle, sporadic single fibrillation potentials were seen for a longer time than in the anterior tibial muscle and fibrillation potentials were often observed for more than 20 min after clamping of the blood vessels. However, the initial decrease in the number of fibrillation potentials was rapid in both muscles. This means, if the same is true in human muscle, that the method is sufficiently rapid to permit restoration of the circulation so that the muscle flap can be saved if the blood flow is occluded after a muscle transfer operation. Thus, recording of fibrillation potentials may provide a powerful and simple technique for monitoring free flap circulation.
In 30 patients posterior repositioning of the entire maxilla has been performed. No postoperative intermaxillary fixation (IMF) has been applied. The surgical procedure is described and data given on the distance of repositioning. Results of cephalometric analysis indicate good long-term stability after surgery. We concluded that omitting IMF not only enhances patient comfort, but has no deleterious effect on postoperative stability of the maxilla.
The main problem with silicone implants in augmentation mammaplasty and breast reconstruction is the development of capsular contracture. The universal method for evaluating the degree of firmness of the breast is the subjective palpation technique and the classification according to Baker. Many objective methods using calipers for measurements of compression, different devices for indentation and discs for applanation tonometry have been described, but none of these have been widely accepted. In this paper a new measuring instrument is presented based on the principle of a constant compression force between two caliper jaws applied to the breast. The inverse value of the compressibility of the breast is read on a scale on the device. This objective method correlates acceptably with the palpation technique according to the Breast Augmentation Classification (BAC) (12), which is a modification of Baker's classification (1978), except for the first follow-up.
A total of 63 cases of cutaneous malignant melanoma in children have been reported to the Danish Cancer Registry during the 40-year period from 1943-1982. In order to describe the true incidence of childhood melanoma in Denmark, a clinical and pathological evaluation was performed. Not surprisingly we found that childhood melanomas were gravely overdiagnosed in Denmark. Nine cases of childhood melanoma were identified in our material. Seven of these were aged 10 to 14 years. Two of the tumours had developed in congenital giant naevi. The crude incidence rate was estimated to be between 0.24 x 10(-6) and 0.32 x 10(-6). In Denmark this corresponds to one new case of childhood melanoma every 3 to 4 years.
A modified sagittal split technique has been evaluated in 42 dentate patients, in whom no postoperative intermaxillary fixation was used. Twenty-three patients had mandible set-back performed and 19 patients mandibular advancement. The method makes possible a safe split osteotomy under controlled conditions. The design of the osteotomy and screw osteosynthesis counteracts relapse. Omitting intermaxillary fixation facilitates postoperative handling of the patient and promotes rehabilitation.
Calcitonin gene-related peptide (CGRP), a recently discovered neuropeptide, is a potent vasodilator and increases blood flow in many vascular beds. The effect of CGRP treatment was investigated in critical pig pedicle and island flaps. Prior to pharmacological treatment the peroperative circulation border was estimated with fluorescein. Intradermal or intraarterial flap treatment with CGRP was given. Control flaps were untreated or injected with saline. Increased or decreased survival was calculated as the difference between the peroperative fluorescein penetration border and the survival border one week after surgery. CGRP treatment significantly increased the survival of both random pedicle and island flaps. CGRP doses as low as 3 ml x 10(-14) M (equal to 0.03 fmoles) increased the survival of random pedicle flaps. In 4 untreated pigs the deep circumflex iliac arteries were excised and artery ring preparations were studied in vitro. A dose-dependent relaxation of artery rings was noted between 10(-9) M and 10(-7) M CGRP.
Capsaicin causes release and long-term depletion of neuropeptides from sensory neurons. Recently, critical rat pedicle flaps pretreated with capsaicin have shown decreased survival. In the present study, the effect of systemic capsaicin pretreatment on the no-reflow phenomenon was investigated in the rat. Effective depletion of neuropeptides was confirmed with functional tests and immunohistochemistry. Groin island flaps were exposed to 4, 6, 8, 10 or 12 hours of warm ischemia, and flap survival was judged one week postoperatively. In contrast to previously reported negative effects on pedicle flap survival after pretreatment with capsaicin, the present study showed no difference in flap survival between capsaicin-pretreated rats and controls. It is concluded that depletion of neuropeptides from sensory neurons does not have negative effects on the tissue's ability to withstand prolonged complete ischemia. As this contrasts with the findings in critical pedicle flaps, the influence of sensory neuropeptides and the necrosis mechanisms are likely to be different in these two types of ischemic conditions.
Twenty-two island skin flaps based on the deep circumflex iliac vessels were elevated in pigs. A comparative study of Laser Doppler flowmetry (LDF) and electromagnetic flowmetry (EMF) was undertaken. Flow values were compared during selective arterial and venous occlusion, nerve stimulation and intra-arterial noradrenaline or papaverine injection. The effectiveness of flap temperatures and blood gas data in monitoring vascular occlusions was also investigated. Similar and simultaneous responses in LDF and EMF values were noted during the different experimental manipulations, but for single simultaneous LDF/EMF observations from different animals the correlation coefficients were poor. The accuracy of EMF measurements in monitoring total flap inflow was confirmed by a high correlation with total venous outflow values. Major vascular occlusions also resulted in significant changes in the flap temperatures, and in the flap blood gases.
With increased use of tissue-expanders the incidence of exposed implants is expected to rise. Eight cases with salvage of an exposed implant are presented. At repair great care was taken to prevent tension on the suture lines either by reducing the volume of the implant or by using a skin flap. Seven patients healed without further complications. In one patient the implant had to be removed due to reexposure. We find that salvage of implants should be tried in suitable cases. If this procedure is not successful a traditional surgical procedure with removal of the implant only has to be delayed for a short time.
Collagenase was injected into the ears of rabbits and the cheek-pouches of hamsters. The acute and long-term microvascular effects were studied by vital microscopy and microangiography. The enzyme was injected at three different concentrations: 120 units/ml, 600 units/ml and 3,000 units/ml. The medium (600 units/ml) and high (3,000 units/ml) concentrations induced effects on the microcirculation such as blood flow impairment and microbleedings. The magnitude of these effects was related to the concentration of the enzyme. Generally, these microvascular effects were of low magnitude as compared with other substances tested using the same experimental models.
A combination of rupture of the ulnar collateral ligament in the first metacarpophalangeal joint and a concomitant spiroid fracture of the proximal phalanx in the thumb is described. Suture of the ligament was performed ten weeks posttraumatically, and a good result was achieved.
The incidence of local recurrence and cumulative survival rate were compared for two groups of patients with stage I malignant melanoma of the lower leg. Group 1 included 119 patients treated from 1964 to 1978 with a wide local excision extending to the ankle. Group 2 included 58 patients treated from 1978 to 1981 with a 5 cm incision margin in all directions. Lesions within both groups were comparable based on measurements of tumor thickness. However, level of invasion indicated significantly more advanced lesions in the first group. Risk of local recurrence was related to thickness and ulceration. There were no statistically significant differences in frequency of local recurrences or cumulative survival rates between the two groups.
