1/24. Treatment of depressed scars with a dissecting cannula and an autologous fat graft.Contemporary options for the improvement of depressed scars include scar revision with an elliptical excision, z-plasty, w-plasty, and geometric broken-line closure. dermabrasion and laser treatment has been used to obtain a uniform skin surface. When scars are hypertrophic, intralesional steroids and silicone pressure therapy may be useful. Occasionally, scars may be adherent to the underlying fascia. The resulting depression along the length of the scar worsens the aesthetic deformity. Fat injection is an established method for treating depressions and contour deformities. We report encouraging results with the use of this fat injection technique into a pocket made with a sharp cannula in treating 30 patients with postsurgical scars that were depressed and adherent to the underlying fascia. This technique is a useful addition to the surgeon's resources when treating scars.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/24. "Endoview" project of intrapartum endoscopy.INTRODUCTION: The change in obstetrical practices over the last decade in favor of trials of labor in patients with uterine scars has resulted in increased incidences of uterine ruptures. Although neither repeat cesarean delivery nor a trial of labor is risk free, evidence from a large multicenter study shows vaginal birth after the cesarean (VBAC) is associated with shorter hospital stays, fewer postpartum blood transfusions, and a decreased incidence of postpartum maternal fever. The uterine rupture remains the most serious complication associated with VBAC. Factors associated with uterine rupture include excessive exposure to oxytocin, dysfunctional labor, and a history of more than 1 cesarean delivery.2 Because uterine rupture may be a life-threatening event, intrapartum surveillance and the ability to perform an emergency surgery are both necessary when trial of labor is allowed. Until now, no early symptoms pathognomonic to uterine rupture had been described. We share our experiences with the novel approach to the problem - an intrapartum endoscopy. MATERIALS AND methods: Endoscopic examination was accomplished by using the intraoperational fiberscope (Olympus and Endoview system (Costa Mesa, CA, USA). A gas-sterilized 25-cm long fiberscope is introduced into the amniotic cavity through the cervical canal after rupture of the membranes. The distance between the fiberscope and the object varies from 3 to 50 mm. The fiberscope has a separate channel for the fluid infusion (normal saline) throughout the procedure; the surgeon looks through the eyepiece directly and exhibits control over the flexible scope. The duration of endoscopy is less than 15 minutes. The inserting of the endoscopic device is very similar to that of insertion of an intrauterine pressure catheter. The IRB Committees of both participating institutions approved the study protocol. Twenty-eight patients with an unknown or poorly documented site of the uterine scar were included in the study. An ultrasound examination had been performed on all patients prior to endoscopy to assess fetal wellbeing and placental location. The ages of the patients ranged from 21 to 38 years. Eighteen women had 1 previous cesarean delivery, and 10 had 2. The performance of intrapartum endoscopy did not interfere with fetal monitoring; 21 fetuses were monitored externally, 7 internally. Indications for previous cesarean deliveries were as follows: fetal distress in 11 cases, failure to progress in labor in 8, placenta previa in 2, and unknown in 7. Twenty-one patients delivered vaginally; 7 had had repeat cesarean deliveries. All neonates were born in satisfactory condition. The Apgar scores at 1 minute varied from 7 to 9 and at 5 minutes from 8 to 10. The integrity of the uterine wall was assessed by manual postpartum uterine exploration in each case of vaginal delivery and by visualization and palpation of the scar site in each abdominal delivery. RESULTS: The lower uterine segment and contractile portion of the anterior uterine wall were visualized successfully in all patients. In 25 patients, the presumed scar site looked totally indistinguishable from the rest of the lower uterine segment and anterior uterine wall. Two scars were identified as vertical in 2 patients who were delivered by a repeat abdominal operation. A vertical scar appears as a groove running in a cephalad-caudad direction from the lower uterine segment into the contractile portion of the anterior uterine wall. The usefulness of the intrapartum endoscopy is best demonstrated by the following case reports (2 of 28 study cases).- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/24. Change of weight-bearing pattern before and after plantar reconstruction with free anterolateral thigh flap.We reconstructed a large-sized defect at the weight-bearing plantar region by a free anterolateral thigh flap successfully. This is the first case report of using the anterolateral thigh flap for reconstruction of the plantar foot. Based on the preoperative and postoperative pedogram examinations, the pressure distribution on the weight-bearing area reconstructed by the transferred flap was obviously improved and demonstrated a nearly normal pattern. No previous report has compared the weight-bearing pattern before and after large plantar reconstruction with a free flap. The anterolateral thigh free flap, which provides adequate bulk and contour of the foot, and which withstands weight pressure and shearing force and has the ability to provide recovery of sensation, is considered a good alternative in covering a large weight-bearing plantar defect.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/24. Delayed visual deterioration after pituitary surgery--a review introducing the concept of vascular compression of the optic pathways.BACKGROUND: Delayed visual deterioration after pituitary surgery has been attributed to secondary empty sella syndrome and downward herniation of the optic nerves and chiasm, but the pathophysiological basis of this condition is still a matter of debate. review: According to the literature, prior radiation therapy, previous visual impairment and transcranial surgery constitute risk factors for delayed visual deterioration. radiation-induced vascular changes and/or strangulation of the optic nerves or chiasm are thought to compromise local blood flow. Downward herniation of the optic pathways was present in the majority of cases, but did not correlate with visual symptoms and signs, while dense scarring of the chiasm was a reproducable finding in all surgically explored cases. Indentations in the upper margin of the optic nerves or chiasm caused by the A1 segments of the anterior cerebral arteries have been reported repeatedly. As perichiasmal scarring constitutes the most consistent finding, the intimate relationship between artery and nerve with consecutive pulsatile pressure may constitute a causative factor in delayed visual dysfunction after pituitary surgery. The authors therefore introduce the concept of vascular compression, which is illustrated with a personal case of a successful decompression procedure with teflon interposition between the A1 segment and the non-herniated optic nerve to treat visual loss eight months following removal of a hemorrhagic pituitary adenoma. CONCLUSIONS: Clinicians should be aware that surgical exploration via a transcranial approach is indicated in cases of progressive visual loss late after pituitary surgery, no matter whether downward displacement of the optic pathways is present on imaging studies or not. Special attention should be paid intra-operatively to the dissection of the intimate relationship between the anterior cerebral arteries and the optic nerves and chiasm.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/24. Histologic study of healing after ab interno laser sclerostomy.We examined the histologic characteristics of healing after ab interno laser sclerostomy in a human eye. A KTP 532 green laser coupled to a 300-microns quartz fiberoptic probe was used to create an ab interno sclerostomy in a terminally ill patient with pigmentary glaucoma. The intraocular pressure increased five days postoperatively and did not respond to medical treatment. The patient died six weeks postoperatively of metastatic lung cancer. Histopathologic analysis showed a patent 150-microns scleral lumen from the anterior chamber to the episclera, surrounded by a 300-microns zone of acellular thermal damage. There was no healing of the lumen. The subconjunctival end of the lumen was capped with a thick episcleral scar, which caused the failure of the operation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/24. An anesthetic technique to fabricate a pressure mask for controlling scar formation from facial burns.An anesthetic technique, involving nasotracheal intubation, after mask induction with halothane, nitrous oxide, and oxygen, is described for use during fabrication of a contoured facial pressure mask. Rationale and benefits are discussed, and particular emphasis is placed on the potential problems of the commonly used ketamine-based technique.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
7/24. Effectiveness of silastic sheet coverage in the treatment of scar keloid (hypertrophic scar)Several methods for the treatment of scar keloids have been reported. In this article, use of a 1-mm-thick silastic sheet placed over the scar keloid for 8-12 hours daily is reported. This procedure produced better results than the so-called pressure method.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/24. A semi-rigid transparent face mask in the treatment of postburn hypertrophic scars.Scars, following burns to the face or subsequent skin grafts, can become hypertrophic. The concept of pressure in their treatment is not new. Elastic garments have been popularised and used successfully. However, they have certain limitations. To date, very little reference has been made in the literature to the use of masks. The use of a semi-rigid face mask in the treatment of hypertrophic scars is described. These masks are comfortable to wear, well tolerated and very effective. case reports are presented and the technique of manufacture detailed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/24. Non-pressure treatment of hypertrophic scars.A silicone gel (Dow Corning X7-9119) has been successfully used in the management of hypertrophic scars. The gel softens and reduces scars in a shorter time period than pressure therapy. Relevant properties of the material and its mode of action have been investigated. The mode of action is unknown, but it is not due to pressure, temperature, oxygen tension or occlusion.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
10/24. The fluid silicone prosthesis.Injected fluid silicone serves as a soft prosthetic device and is an effective alternative to surgery in the management of corns and calluses. The material can relieve pain in weightbearing scars, reduce the incidence of recurring neuropathic ulcers, and protect skin at points of bony pressure. Augmenting subcutaneous tissue reduces both the vertical forces that cause direct pressure and the shear stresses imposed on plantar skin during horizontal acceleration or deceleration. The only significant side effect has been fluid migration, which is asymptomatic upon weightbearing and is seen only rarely when small amounts are implanted. Histologic examination of long-term biopsy and necropsy specimens has revealed no adverse tissue response. The safety and efficacy of injectable silicone as a soft-tissue implant in the foot have not been confirmed by the food and Drug Administration, and pending completion of authorized investigation, the material is not available. Successfully completed studies, federal approval, and proper use could provide relief for millions of people who suffer from these common foot disorders.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
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