Faculty Bibliography

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

Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. The objective of this study was to ascertain the risks, benefits, and effects on transfusion rates associated with the use of intraoperative autologous transfusion (IAT) in this patient population. The Haemonetics Cell Saver 4 (Haemonetics Corporation, Braintree, MA) autotransfusion system was used to salvage blood in 18 patients undergoing the release of stenosed calvarial sutures. In a prospective, nonrandomized study, these patients were compared with a control group of similar age, gender, weight, and surgical procedures. There were 10 male patients and 8 female patients; the mean age was 7.2 months, the mean weight was 8.67 kg, and the mean surgical time was 3.15 hours. The mean amount of homologous blood transfused to the control group was 189 ml, compared with 87.69 ml for the IAT group, which was a decrease of 46.3%. The mean amount of autologous blood transfused was 150 ml (range, 50-250 ml). Thirty-three percent of the patients in the IAT group did not require homologous blood transfusion. No complications were observed with the use of the Cell Saver in the IAT group. The use of the Cell Saver was associated with a significant decrease in the amount and rate of homologous blood transfusions. Its use appears to be safe in pediatric patients undergoing craniosynostotic surgery

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

Treatment of the short nerve gap remains a challenge for the reconstructive surgeon, but it is a clinical problem that can be addressed by nerve expansion. In the present study, the effects of slow nerve expansion on the walking behavior of the rat were examined. When expansion was applied on a normal sciatic nerve or on a transected nerve at either the proximal or the distal segments, permanent 30% elongation could be achieved. The recovered function from the expanded nerve stumps was compared with such classical methods of nerve reconstruction as nerve graft, coaptation under moderate tension, and tensionless repair. The results compared favorably between the expanded groups and the time-honored methods of nerve repair. Analysis of the behavioral data indicated that any amount of expansion affected the functional capabilities of the involved nerve. However, expansion of a normal nerve and/or proximal segment of a transected nerve was better tolerated than distal segment expansion, which suggests that the presence of an axon may have a beneficial effect in minimizing the deforming mechanical insult. Slow nerve expansion appears to have a definite role in the microsurgical management of the short nerve gap

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

We present two cases of massive gingival enlargement and osteolysis of alveolar bone in a 30-year-old female and a 36-year-old male. The etiology could not be established in either case. Histologically, both lesions contained hyperplastic fibrous connective tissue and intense plasma cell infiltrates. Both patients responded well to extensive gingivectomy, extraction of all teeth, and alveoplasty