Annals of plastic surgery
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Annals of plastic surgery · Oct 1996
Case ReportsUse of a monitor muscle flap in buried free forearm flap transfer.
The free forearm flap is a reliable and versatile tool in head and neck reconstruction. However, the patency of the microvascular anastomosis is difficult to monitor when the flap is buried in the reconstruction of the esophagus or orbital floor. We used a portion of forearm muscle on a branch of the radial artery and vein as a monitor flap. ⋯ Monitor muscle flaps are raised easily during elevation of the forearm flap. This technique was used successfully in 5 patients. This monitoring method provides a simple and reliable assessment of viability when direct monitoring of the forearm flap is not possible.
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Annals of plastic surgery · Sep 1996
Endothelin-1 kinetics in plasma, urine, and blister fluid in burn patients.
Endothelin-1, a peptide isolated from vascular endothelial cells, facilitates the constriction of vascular smooth muscle and various pharmacological actions including vasodilation, the proliferation of smooth muscle cells and fibroblasts, and the stimulation of arachidonic acid metabolism. In this study, plasma, urine, and blister fluid endothelin-1 concentrations were determined in burn patients and changes in vasoactive substances derived from endothelial cells secondary to burns were investigated. Plasma endothelin-1 concentrations in burn patients were significantly lower than those in healthy individuals at rest. ⋯ The amounts of endothelin-1 excreted in urine by burn patients over 24 hours also were higher than those in healthy individuals. The finding of high concentrations of endothelin-1 in blister fluids suggests that endothelin-1 is produced at wound regions in burn victims. Clinically, it appears that endothelin-1 is involved in circulation at the wound surface or in the healing of burns.
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Annals of plastic surgery · Aug 1996
Case ReportsFemur lengthening with a vascularized tibia bone flap.
A vascularized tibial bone flap based on a single nutrient vessel has been previously proposed for use in long-bone reconstruction. While the routine use of the tibia for donor bone tissue is precluded by its essential weight-bearing function, in select cases it provides a useful alternative to standard donor bone sources. Cadaver dissection was performed to confirm the endosteal and periosteal vascular anatomy of the tibia. ⋯ Expanded use of tibial vascularized allografts in long-bone reconstruction may be made possible following future development of effective and safe immunosuppressive therapy. Transfer based on the posterior tibial pedicle, which includes the endosteal nutrient vessel as well as the periosteal supply via the tibialis posterior muscle, maximizes bone perfusion. The pedicle is of sufficient length to be used for positioning the tibia in the thigh or for free transfer to distant sites.
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Annals of plastic surgery · Jun 1996
Case ReportsAggressive use of free flaps in children for burn scar contractures and other soft-tissue deficits.
Free flap reconstruction in children is often undertaken with trepidation due to a variety of perceived technical difficulties and variable reports of success. The present report examines the efficacy of free tissue transfer in children, with particular attention given to the use of fasciocutaneous flaps in burn reconstruction. Over a 12-year period, 38 free flaps were done on 30 patients with an average age of 10 years (range, 16 months-17 years). ⋯ During follow-up (range, 1-103 months), 39% of patients underwent a minor secondary revision of the flap reconstruction. This series demonstrates the efficacy of free tissue transfer in children in providing the majority of these patients with a successful, one-stage reconstruction with morbidity similar to that reported for adult patients. Moreover, the use of fasciocutaneous free flaps for pediatric burn reconstruction is shown to provide a durable and aesthetically superior treatment of these difficult problems.
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Annals of plastic surgery · May 1996
Case ReportsCushing's syndrome in postburn children following intralesional triamcinolone injection.
Intralesional triamcinolone acetonide has been used extensively for the treatment of hypertrophic and keloid scars. Complications are few, usually being local skin color changes, prominent vascular markings, or subcutaneous atrophy. Cushing's syndrome following intralesional administration of triamcinolone acetate has only been described twice, both in adult patients. ⋯ Consultation with endocrinologists revealed no concurrent disease process. It appears that these two pediatric patients may have had a form of hypersensitivity to triamcinolone acetonide, as Cushing's syndrome was not the result of an overdose. In conclusion, intralesional triamcinolone acetonide should be used with an increased degree of caution in the pediatric population.