Faculty Bibliography

This study investigated axonal regeneration in a denervated nerve graft sutured end-to-side with a main peripheral nerve trunk. To demonstrate morphologic changes, the peroneal nerve was severed in a rat and coapted end-to-side to the posterior tibial nerve. The integrity of the epineurial and perineurial sheath was altered in four different groups. Histologic evaluation 30 days after operation showed axonal regeneration in the nerve graft in all groups. Morphometric analysis of cross sections of the grafted nerve elucidated the importance of severance of the perineurium in end-to-side neurorrhaphy

A bilateral extended scapular (scapular-parascapular) free flap was used in five patients with severe facial burn sequelae for complete resurfacing of the face with the exception of the nose, which was reconstructed in a separate operative procedure. All the flaps survived. Four were utilized for complete face resurfacing and one for neck and partial face resurfacing. The results were classified subjectively according to both patient and surgeon opinion. Good to fair results were obtained. The authors believe that this method might be further explored to obtain better results in these difficult cases

Sixteen patients (mean age, 1.9 years) underwent split-thickness calvarial bone grafting using a full-thickness craniotomy, high-speed drill, and osteotomes for bone harvesting. The minimal calvarial bone thickness for a successful graft was found to be 7 mm. All patients were diagnostically studied preoperatively with computed tomographic scans and skull films. The mean follow-up was 2.9 years (range, 0.75-7.9 years). All patients had successful graft take. There were no infections or mortalities. Continued graft growth was seen in all patients. There was one dural tear during harvesting with no cerebrospinal fluid leak or postoperative sequelae. This analysis indicates that split-thickness calvarial grafts can be safely and adequately performed in children as young as 13 months of age

The purpose of this study was to evaluate the application of bioabsorbable fixation devices in reconstructive craniofacial procedures in the pediatric population. We reviewed 22 cases in which bioabsorbable plates and screws were used in craniofacial surgery for reconstruction. The procedures were performed in a 7-month period. The patients ranged in age from 5 to 228 months at the time of surgery (mean, 76.7 months). The postoperative clinical follow-up ranged from 2 to 16 weeks. The fixation devices were evaluated with regards to satisfactory fixation at the time of procedure. The postoperative follow-up evaluated clinical wound healing, signs of infection or local inflammation, and visibility or palpability of plates through the skin. All patients except one showed satisfactory wound healing with no sign of infection or local inflammation. The plates provided satisfactory fixation and were not visible through the skin. Two patients had plates that were palpable at the 4-month follow-up period. One patient with repair of a blow-out fracture of the orbit with resorbable mesh had redness and swelling over the wound site 2 weeks postoperatively with resolution 4 weeks postoperatively. Our early experience suggests reabsorbable fixation is an attractive option in pediatric plastic and craniofacial surgery. With further experience, this technology may represent the standard of care in reconstruction of the infant calvarium

SPECIFIC AIM. To evaluate the take of skin grafts on conventionally prepared beds and on beds prepared by a carbon dioxide laser, with and without abrasion of the bed. SIGNIFICANCE. Graft take is dependent on hemostasis, immobility, and nutrition of the graft. Scalpel excision of the skin graft can be associated with hemostatic difficulties and laser treatment of the skin graft bed can provide hemostasis. Abrasion of the bed after laser treatment may then be a means of opening small lymphatic and blood vessels to maintain the graft. Laser treatment followed by abrasion of the bed may provide an ideal graft base before suturing of the skin graft. MATERIAL AND METHODS. Full-thickness skin grafts were taken with a scalpel at three sites on the dorsal skin of 24 guinea pigs. The three beds were prepared with pressure alone to provide hemostasis, laser vaporization followed by abrasion with gauze to produce pinpoint bleeding, and laser vaporization alone. The original skin from each of the sites was then sutured back in place. At postoperative days 1, 3, 5, 10, 21, and 35 the graft sites were assessed clinically for 'take.' Laser Doppler measurements were also made to evaluate blood flow. Histologic sections of the three sites were prepared. Immunohistochemical analysis was performed to evaluate cell proliferation and angiogenesis. RESULTS. For the animals sacrificed through day 10 the rate of take for the sites that were not lased was 100%. For the sites that were lased alone and lased and abraded the rate of take was 71% with no difference between the two techniques. The lased sites demonstrated increased inflammatory response and graft necrosis. Immunohistochemical analysis showed increased cellular proliferation and angiogenesis in the bed. DISCUSSION. Grafts take best on a scalpel-prepared bed. Laser preparation of the bed, with or without abrasion, demonstrates decreased 'take.' Therefore the carbon dioxide laser is not a recommended means to take a graft or prepare the graft bed