Faculty Bibliography

Clinical reports on the incidence and clinical significance of intracapsular fluid are lacking in the literature. It remains unknown whether the presence of intracapsular fluid has any relation to implant infection or colonization. The purpose of this study was to determine the frequency and type of intracapsular fluid, specifically, whether intracapsular fluid causes implant infection, implant rupture, or bacterial colonization. A total of 139 implants from 72 symptomatic patients were entered into the prospective clinical study. Our study demonstrated the presence of intracapsular fluid in 21 of 139 (15%) implants. Positive microbial cultures were identified in 39% of the implants in the positive intracapsular fluid group, compared to 43% in the negative fluid group. There was no statistically significant difference between these groups. Also, no adverse clinical relationship was demonstrated between local symptoms and presence of intracapsular fluid. There was, however, a positive trend toward the presence of fluid when implant shell types were nonsmooth (polyurethane and textured silicone implants). Further studies are indicated to elucidate the fluid production mechanism and possible secretory activity of prosthetic capsules interfacing the textured breast implant surface

The current controversy surrounding the safety of silicone gel breast implants has resulted in an increasing number being removed. Although previous reports have suggested that remnants of the implant capsule are reabsorbed after explantation surgery, the persistence of the capsule in fact may be associated with implant fragments and silicone gel leakage. In this study we have used magnetic resonance imaging (MRI) to identify residual silicone gel and silicone granulomas following the removal of silicone gel breast implants. Four representative clinical case reports are presented. These patients, who had residual silicone present in their bodies, presented to us with breast pain, palpable masses, or abnormal calcific mass densities apparent on a mammogram. High-resolution MRI images were found to be helpful in identifying local and remote collections of silicone gel, silicone granulomas, and residual capsules that were incompletely removed from previous explantation surgery. MRI breast images demonstrated high resolution and provided the accurate anatomical locations of residual silicone gel and silicone granulomas in all the regions of breast parenchyma, chest wall muscles, and axillae. Patients with persistent local symptoms following explantation surgery may benefit from an evaluation of the breast using MRI

Laser techniques for joining tissue, in combination with other surgical technologies, will be a hallmark of surgery in the next century. At present, there are many clinical applications of tissue welding and soldering which are beginning to achieve wide spread acceptance. These exciting clinical developments are the result of many advances which have been made in the past few years in our understanding of the mechanism of laser tissue welding. Also contributing to this progress are many important technical refinements such as tissue solders and feedback control of the laser device. In this article, we describe in depth the history and development of laser tissue welding including key theoretical concepts as well as crucial experiments which have added to our insight into this phenomenon. We also review the evolving concepts of its clinical application and indicate clinical applications which are likely to become more important in the future

The present study examined the histochemical characteristics of the orbicularis oculi muscle (OOM) in the rat, in order to better understand the target muscle of the blink reflex-specifically, the motor endplate distribution and number in the normal, denervated, and reinnervated OOM. Assessment of the number of endplates needed to accomplish eye closure would provide critical information in the microsurgical restoration of the blink reflex in facial paralysis. Results demonstrated a 50% increase in the number of endplates of reinnervated rats, compared to denervated animals

The attempts to reconstruct a transected trunk nerve with a free nerve graft of equal diameter have been hindered by the problem of delayed establishment of blood supply to the nerve graft and development eventually of central necrosis and finally failure of nerve regeneration. The transfer of a nerve graft which maintains its blood supply through its vascular pedicle that is microsurgically anastomosed to the recipient site vessels, provided the reconstructive microsurgeon with a new perspective to the clinical problem. A vascularized nerve graft diminishes endoneurial scarring by maintaining the Schwann cell population and decreasing fibroblast infiltration providing, thus, an optimal nutritional environment that results in an increased rate of axonal regeneration

In the paraplegic patient who has had previous surgeries for pressure sores, local tissue is frequently unavailable for further use. The posterolateral aspect of the thigh, however, is almost always available and provides an excellent reconstructive alternative for this difficult problem. In 1983, Baek described the skin territory supplied by the third perforator of the profunda femoris artery. A musculocutaneous flap can be raised consisting of the same skin territory and a portion of the biceps femoris muscle (short head) through which the third perforator courses. In addition, the distal part of the vastus lateralis muscle, which is supplied by a muscular branch of the same perforator, can be included in the flap. The flap is elevated as an island based on the profunda femoris artery and accompanying venae comitantes. A substantial soft-tissue mass can be transposed easily to the perineum. Standard latex injection techniques were used in 12 fresh cadaver dissections prior to use of this flap in 16 clinical cases. Selective india ink injections into the third perforator of the profunda femoris artery in 6 cadavers confirmed the perfusion of the overlying skin territory. Recurrent ischial and perineal wounds were closed successfully with this musculocutaneous flap in all 16 clinical cases