[Show abstract][Hide abstract] ABSTRACT: The purpose of this review is to summarise the commonly used formulae for fluid resuscitation in major burns and to discuss the controversy surrounding the use of protein-based colloids as a component of these types of formulae. Fluid resuscitation in major burns is one of the most critical steps in managing this type of injury. In practice, a wide variety of formulae for fluid resuscitation has been suggested. Some propose only the use of crystalloids, while others combine the colloids together with crystalloids. A review was performed of the literature addressing fluid resuscitation formulae and our experience using our formula is presented. At the authors' burn centre a unique formula is in use, which combines plasma and crystalloids. Our experience using this specific formula extends over a period of 15 years and 356 patients with major burns have been resuscitated using this protocol. At our centre, 27 deaths were recorded, 19 of which had third degree burns of more than 80% total body surface area (TBSA). The protein-based colloids are included in most of the formulae and the beneficial effect is considered to be higher than the potential side effects. We are in favour of administering colloids during the resuscitation period for major burns, starting in the early period after injury.
[Show abstract][Hide abstract] ABSTRACT: Most treatment with hyperbaric oxygen (HBO) in plastic surgery is for wounds, burns, crush injuries, and infections. We aimed to find out if HBO increases the survival of composite grafts in rats. Twenty Sprague-Dawley rats were randomly assigned to two equal groups (treatment and control). A template 30 x 30 mm was placed on the skin and a composite graft taken from the upper back was harvested and then resutured to the fascia in situ. The treated group was placed in a hyperbaric chamber set at 202 kPa and 100% oxygen for 90 minutes daily for two weeks. Control animals were given no treatment. After death the mean surviving internal surface area of the graft was 372.5 (117.9) mm2 in the control group and 561.3 (85.7) mm2 in the experimental group (p=0.001). Treatment with HBO improved the surviving area of composite grafts in rats, and the beneficial effect was prominent only on the inner surface of the graft.
No preview · Article · Feb 2006 · Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery
[Show abstract][Hide abstract] ABSTRACT: The use of suctioned fat grafts for correction of soft tissue defects is a widespread procedure in esthetic and reconstructive surgery. The main disadvantage of this simple and sensible procedure is the unpredictable absorption rate of the fat graft. A lot of research has been performed aiming for enhancement of the take of the fat grafts.
Our study was performed to find if there is any favorable donor site for fat harvesting.
This in vivo experiment using the nude mice model enables the study of the long-term survival of human fat in an animal model. The fat was harvested from three donor areas: the thigh, abdomen, and breast of a 48-year-old woman who came for an elective esthetic procedure. After centrifugation, 1 cc of fat was injected subcutaneously into the scalp of the nude mouse. There were 15 mice in each of the three groups, according to the selected donor sites. The animals were sacrificed 16 weeks after the procedure. The extracted fat was evaluated in terms of weight, volume, and six histologic parameters: integrity, vascularization, cyst formation, fibrosis, necrosis, and inflammation.
This study could not find any statistically significant differences between the three investigated donor sites in the evaluated parameters.
On the basis of this study, there is no favorable area for harvesting fat grafts. The donor site can be chosen according to the preference of the surgeon and the patient.
No preview · Article · Nov 2005 · Dermatologic Surgery
[Show abstract][Hide abstract] ABSTRACT: Background: The use of suctioned fat grafts for correction of soft tissue defects is a widespread procedure in esthetic and reconstructive surgery. The main disadvantage of this simple and sensible procedure is the unpredictable absorption rate of the fat graft. A lot of research has been performed aiming for enhancement of the take of the fat grafts. Objective: Our study was performed to find if there is any favorable donor site for fat harvesting. Methods: This in vivo experiment using the nude mice model enables the study of the long-term survival of human fat in an animal model. The fat was harvested from three donor areas: the thigh, abdomen, and breast of a 48-year-old woman who came for an elective esthetic procedure. After centrifugation, 1 cc of fat was injected subcutaneously into the scalp of the nude mouse. There were 15 mice in each of the three groups, according to the selected donor sites. The animals were sacrificed 16 weeks after the procedure. The extracted fat was evaluated in terms of weight, volume, and six histologic parameters: integrity, vascularization, cyst formation, fibrosis, necrosis, and inflammation. Results: This study could not find any statistically significant differences between the three investigated donor sites in the evaluated parameters. Conclusion: On the basis of this study, there is no favorable area for harvesting fat grafts. The donor site can be chosen according to the preference of the surgeon and the patient.
No preview · Article · Oct 2005 · Dermatologic Surgery
[Show abstract][Hide abstract] ABSTRACT: Reconstruction of the nose, the most prominent feature of the face, is a substantial challenge for the plastic surgeon. Currently, many types of flaps are used for this purpose. The forehead flap is frequently used for larger nose defects because of its similarity in color, mobility, and suitability to substitute extensive defects. The flap thickness and problems that may occur in the donor area closure are the shortcomings of this type of flap. In this article, we introduced a novel approach to overcome these obstacles. Seventeen patients underwent nose reconstruction vising our approach for the paramedian forehead flap, which involves applying a method that is regularly used for the hairline cut subcutaneous forehead lift. The flap dissection was started by an incision along the temporal and frontal hairline and was continued within the subcutaneous plane, leaving the frontalis muscle untouched. During the dissection the supratrochlear vessels were clearly seen traveling within the subcutaneous plane. The flap was trimmed "on-site" according to the nasal defect, enabling a greater precision in estimating the amount of tissue needed. Direct vision of the vessel pathway enabled the development of the whole flap on a very narrow pedicle without endangering its blood supply. After the flap was inset, the remaining two lateral forehead flaps were rotated and advanced toward the midline to close the donor area primarily. The flap pedicle was disconnected 2 to 3 weeks later. All flaps survived and the donor areas were closed primarily. Ten patients needed small revisions. For three patients, this included slight defatting of the proximal part of the flap for better inset; for the other seven, only minor scar revision of the previous flap's stalk was required between the eyebrows. There was one partial necrosis of the distal edge of the flap, one small dehiscence at the flap's pedicle inset, and one instance of cellulitis of the donor area. All patients were satisfied with their results. This approach for nasal reconstruction with the forehead flap has the advantages of safe dissection under vision of the vessels, on-site design of a thinner flap compared with those previously described, and primary closure of relatively large donor areas.
No preview · Article · May 2005 · Plastic and Reconstructive Surgery
[Show abstract][Hide abstract] ABSTRACT: Adipose tissue injection as a free graft for the correction of soft-tissue defects is a widespread procedure in plastic surgery. The main problem in achieving long-term soft-tissue augmentation is partial absorption of the injected fat and hence the need for overcorrection and re-injection. The purpose of this study was to improve the viability of the injected fat by the use of interleukin-8. The rationale for the use of interleukin-8 was its abilities to accelerate angiogenesis and attract inflammatory cells and fibroblasts, providing the injected adipocytes more feeding vessels and a well-established graft bed to enhance their viability. Human adipose tissue, obtained by suction-assisted lipectomy, was re-injected into the subcutis in the scalp of nude mice. Interleukin-8 (0.25 ng) was injected subcutaneously to the scalp as a preparation of the recipient site 24 hours before the fat injection and was added to the fat graft itself (25 ng per 1 cc of injected fat). In the control group, pure fat without interleukin-8 was injected and no interleukin-8 was added for the preparation of the recipient site. One cubic centimeter of fat was injected in each animal in both the study and control groups. There were 10 animals in each group. The animals were euthanized 15 weeks after the procedure. Graft weight and volume were measured and histologic evaluation was performed. In addition, triglyceride content and adipose cell sizes were measured as parameters for fat cells viability. Histologic analysis demonstrated significantly less cyst formation in the group treated with interleukin-8. No significant differences were found between the groups with regard to graft weight and volume or the other histologic parameters investigated. No significant differences were demonstrated in adipose cell sizes and their triglyceride content. In conclusion, less cyst formation, indicating improved quality of the injected fat, can be obtained by the addition of interleukin-8. Further studies of various dosages of interleukin-8 and their long-term effect are required before these encouraging results could be applied clinically.
Full-text · Article · Apr 2005 · Plastic and Reconstructive Surgery
[Show abstract][Hide abstract] ABSTRACT: Injection of aspirated fat for the correction of tissue defects is a common procedure in plastic surgery. The reported rates of fat cell survival vary greatly in the medical literature, and different techniques of harvesting, processing, and reinjecting the fat cells are claimed to be responsible for these differences. However, there is no agreement concerning the best way to process the harvested fat before reinjection. The present study was initiated to examine and evaluate the effect of a simple method of isolating the fat particles on the outcome of fat graft survival. In this study, the nude mouse model was used to examine the survival and take of the fat graft concentrated before injection by the cumbersome recommended closed centrifugation technique in comparison with the authors' recommended open method, using an operating room cotton towel as a platform for concentrating the fat cells and separating them from fluids, oil, and debris. One milliliter of concentrated human fat cells preprocessed by towel separation was injected into the nuchal subcutis of 11 nude mice in the study group, and the same amount of fat that was preprocessed by centrifugation was injected into 11 control mice. Injected fat survived in both groups. No significant differences were found regarding fat graft weight and volume, although a tendency for better survival was noticed in the experimental group. Histologic evaluation of the grafts revealed significantly less fibrosis within the study group, meaning that the quality of the fat grafts was better. The authors found this method to be simple, cheap, and friendly to the surgeon in comparison with traditional processing using the centrifuge.
No preview · Article · Feb 2005 · Plastic and Reconstructive Surgery
[Show abstract][Hide abstract] ABSTRACT: Applications for intense pulsed light (IPL) for hair removal are gaining favor among other methods, including lasers, because of its noninvasive nature, versatility regarding different skin and hair types, safety, and ease of use. Hair removal using IPL was performed from January 2002 to December 2003 on 108 consecutive patients. Eighty of these patients answered a questionnaire and were enrolled in the study group. The investigated parameters were hair and skin type, number of pulses, fluence, pulse duration, pulse delay, the filters used, and the treated area. The patient assessment of improvement (satisfaction) rate was graded from 1 to 5 points: 1, worse; 2, no improvement; 3, mild improvement; 4, good result; and 5, excellent result. The patients had between 1 and 13 treatments most of them during 2 to 6 sessions. Sixty-seven percent of the patients reported no complications. Prolonged erythema for more than 7 days was reported by 16.25%, blisters by 6.25%, temporary hyperpigmentation by 8.75%, leukotrichia was present in 1 case, and 1 case of persistent hypopigmentation was noted in a young girl. An increased number of complications and a decreased satisfaction rate were noted with higher skin types, but it was not statistically significant. Patients who underwent fewer treatments (1-3 treatments) were more satisfied compared with those who had more than 7 treatments (P < 0.02). Sixty percent of the patients rated their satisfaction to be good to excellent and 65% would ill recommend this treatment to their friends. To minimize the complication rate the authors found that the preset parameters should be adjusted at every treatment session according to the skin response at the previous one. Permanent hair removal cannot be guaranteed and it is not possible to predict the improvement rate. Nevertheless, based on patient satisfaction rate in this study, the authors recommend using IPL for hair removal.
No preview · Article · Feb 2005 · Annals of Plastic Surgery
[Show abstract][Hide abstract] ABSTRACT: Adipose tissue injection as a free graft for the correction of soft tissue defects is a widespread procedure in plastic surgery. The main problem in achieving long-term soft tissue augmentation is partial absorption of the injected fat, and hence the need for over-correction and re-injections. Lidocaine, used for local anesthesia, has been suspected as an inhibitor of growth of adipocytes in culture and slowing down glucose transport and lipolysis in adipocytes. In addition, reduced blood supply by local application of epinephrine was accused of having a negative effect on the graft. The purpose of this study was to examine the effect of local anesthesia, administered to the fat donor site, on the take of the injected fat. Human adipose tissue, obtained by suction-assisted lipectomy, was injected subcutaneously into the scalp of nude mice. Local anesthesia of the fat donor site consisted of a solution with 600 mg of lidocaine (0.06%) and epinephrine 1:1000000. In a control group, normal saline with no local anesthesia or epinephrine was administered to the donor site. One cc of fat was injected after centrifugation into each animal scalp. There were 10 animals in each group. The animals were sacrificed 15 weeks after the procedure. Graft weight and volume were measured, and histologic evaluation was performed. No significant differences were demonstrated between the groups in regard with the grafts' weight and volume and the histologic parameters investigated. In conclusion, local anesthesia solution, consisting of lidocaine and epinephrine, does not alter the take of fat grafts, and has no influence on the adipocytes viability.
Full-text · Article · Jan 2005 · Journal of drugs in dermatology: JDD
[Show abstract][Hide abstract] ABSTRACT: The authors' experience using intense pulsed light for skin rejuvenation is summarized and analyzed with regard to its efficacy, safety, and complications. Rejuvenation using intense pulsed light was performed on 59 patients over a 6-month period (January of 2002 to July of 2002); these patients served as the study group. The areas treated were the face, neck, chest, hands, and legs. The parameters used during the procedure, patient satisfaction, and complications are described. Ninety-five percent of the patients included in the study had one or two sessions. Good to very good results were reported by 93.1 percent. Most patients had minor side effects and only three patients (5 percent) experienced complications (hyperpigmentation or scars). Intense pulsed light is an effective and safe method for skin rejuvenation. Its efficacy is mainly manifested by eliminating senile pigmentation and telangiectasias and a achieving a younger and fresher appearance of the skin. Although in the literature intense pulsed light skin rejuvenation is mainly reported for the face, the authors have obtained good results by using it for other areas of the body. The majority of the patients were satisfied. The authors conclude that intense pulsed light skin rejuvenation is a safe and effective method for facial and nonfacial rejuvenation.
No preview · Article · Jun 2004 · Plastic & Reconstructive Surgery
[Show abstract][Hide abstract] ABSTRACT: The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated harvesting and injection. Fat preservation for future re-injection is indicated to avoid repeated fat harvesting procedures. A previous study has shown that fat obtained by suction can be preserved by freezing for at least 2 weeks. The purpose of the present study was to investigate the effect of freezing autologous free fat for 7 months on the take of the fat graft. Human fat obtained by suction-assisted lipectomy was centrifuged and stored in a domestic refrigerator at -18 degrees C for 7 months. After thawing, the fat was injected into the scalp of 10 nude mice, which served as the study group. In the control group (n = 10), fresh fat was injected. Fifteen weeks later, the fat grafts were dissected out. Volumes, weights, and histological parameters were compared between the groups. The injected fat survived in both the study and the control groups but the histological parameters were significantly inferior in the frozen fat. The weight of the frozen fat was also significantly less compared with the fresh fat. The volume of the frozen fat was inferior but not significantly. Based on this in vivo experiment, it is suggested to refrain from using fat that has been frozen for 7 months or longer. The longest period and the optimal conditions for fat preservation should be further investigated.
No preview · Article · Jan 2004 · Journal of drugs in dermatology: JDD
[Show abstract][Hide abstract] ABSTRACT: The present study assesses the impact of "sports anemia" on screening tests performed on participants in an endurance-training program. Medical charts of 48 naval Special Forces trainees and 48 submarine trainees were reviewed. We compared the results of red blood cell count, hemoglobin concentration, hematocrit (Hct), and mean corpuscular volume performed at recruitment and after 2 years. No differences were noted between baseline values. The Hct and red blood cell count decreased significantly in the Special Forces trainees after 2 years of training (p = 0.002 and p = 0.05, respectively), remaining unchanged in the submariners. Hct decreased by 2 +/- 4.14%, whereas red blood cell count decreased by 0.13 +/- 0.44 M/microL. A reduction in Hct may be expected in Special Forces trainees engaged in long-term endurance training. Because these lower values were not seen in an otherwise identical group of submarine trainees, they could be attributed to the endurance training.
Full-text · Article · Mar 2003 · Military medicine
[Show abstract][Hide abstract] ABSTRACT: A simple method for closure of a defect in the forehead area by four parallel flaps along the forehead wrinkle lines is illustrated. The main advantage of this method lies in its simple design, which enables the surgeon to close large defects with no elevation of the eyebrow, while preserving the hairline, and most of the suture lines are parallel to the forehead wrinkle lines.
No preview · Article · Nov 2002 · Annals of Plastic Surgery
[Show abstract][Hide abstract] ABSTRACT: Many hyperbaric facilities use infusion pumps inside the chamber. It is therefore important to ensure that this equipment will perform accurately during hyperbaric conditions. The authors tested the function and accuracy of the Imed 965 and Infutec 520 volumetric infusion pumps, the Easy-pump MZ-257 peristaltic infusion pump, and the Graseby 3100 syringe pump.
The authors calculated the deviations of infused volumes at low and high rates (12-18 and 60-100 ml/h) on three different hyperbaric protocols (up to 2.5, 2.8, and 6 atmospheres absolute [ATA]), resembling a standard hyperbaric oxygen treatment and US Navy treatment tables used for decompression illness and for arterial gas embolism. Two examples of each pump model were examined in every experiment.
The Easy-pump MZ-257 failed to function completely beyond a chamber pressure of 1.4 ATA, making it unsuitable for use inside the hyperbaric chamber. The Graseby 3100 failed to respond to all keyboard functions at 2.5-2.8 ATA, making it unsuitable for use in most hyperbaric treatments. The Imed 965 performed within an acceptable volume deviation (< or =10%) during most hyperbaric conditions. During the compression phase of the profiles used, and for the low infusion rates only, exceptional volume deviations of 20-40% were monitored. The Infutec 520 demonstrated an acceptable deviation (within 10%) throughout all the hyperbaric profiles used, unaffected by changes in ambient pressure or infusion rate.
Commercially available infusion pumps operating during hyperbaric conditions demonstrate substantial variations in performance and accuracy. It is therefore important that the hyperbaric facility staff make a careful examination of such instruments to anticipate possible deviations in the accuracy of the equipment during use.
[Show abstract][Hide abstract] ABSTRACT: Background. The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated procedures.Objective. To examine the role of frozen storage as a means of preserving the fat obtained by suction-assisted lipectomy for repeated procedures.Methods. Human adipose tissue obtained by suction-assisted lipectomy was stored in a domestic refrigerator at –18°C for 2 weeks. After thawing, the fat was injected into nude mice. In the control group, the fat was injected immediately after the harvesting procedure. Grafts were dissected out and compared 15 weeks postinjection.Results. Injected fat survived in both study and control groups. No significant differences were found between fat graft weight and volume, or in any of the histologic parameters examined.Conclusion. Fat obtained by suction-assisted lipectomy may be preserved for future use by freezing.
Full-text · Article · Jun 2001 · Dermatologic Surgery
[Show abstract][Hide abstract] ABSTRACT: The diagnosis of skin burns on various body sites following surgical intervention is not rare, and was traditionally attributed to a thermal or chemical mechanism following the use of diathermy. The causes described were poor plate contact and high electric resistance at the indifferent electrode, the use of volatile solutions which might be inflammable, and a chemical reaction between the scrub preparations, the indifferent electrode and the patient's skin. Several cases of "burns" detected after surgery were referred to our department. Investigating the cause of these injuries revealed several common facts: the injuries occurred during lengthy surgical procedures with a long anaesthesia time, the majority were vascular operations with low peripheral perfusion, and prolonged local pressure was applied to the site of the damaged tissue. These facts suggested a different mechanism for skin and soft tissue injuries, namely the patient's immobility during lengthy procedures and the development of increased local pressure at contact points between the patient and the operating table, which indicated that the damage was due to an "acute" pressure sore. Measures for the prevention of decubitus ulcers should be considered before surgery, and will be discussed.
No preview · Article · Jan 2001 · Rivista Italiana di Chirurgia Plastica
[Show abstract][Hide abstract] ABSTRACT: Autologous free-fat injection for the correction of soft-tissue defects has become a common procedure in plastic surgery. The main shortcoming of this method for achieving permanent soft-tissue augmentation is the partial absorption of the injected fat, an occurrence that leads to the need for both overcorrection and repeated fat reinjection. Improving the oxygenation of the injected fat has been suggested as a means of helping to overcome the initial critical phase that occurs postinjection (when the fat cells are nourished by osmosis), increasing phagocyte activity, accelerating fibroblast activity and collagen formation, and enhancing angiogenesis. In addition, the hyperbaric oxygen-mediated decrement in endothelial leukocyte adhesion will decrease cytokine release, thereby reducing edema and inflammatory responses. The purpose of the present study was to examine the effect of hyperbaric oxygenation on improving the viability of injected fat. Adipose tissue obtained from human breasts by suction-assisted lipectomy was injected into the subcuticular nuchal region in nude mice. The mice were then exposed to daily hyperbaric oxygen treatments, breathing 100% oxygen at 2 atmospheres absolute (ATA) for 90 minutes. The duration of the administered hyperbaric oxygen therapy was 5, 10, or 15 days, according to the study group. Mice exposed to normobaric air alone served as the control group, and each group included 10 animals. The rats were killed 15 weeks after fat injection. The grafts were dissected out, weight and volume were measured, and histologic evaluation was performed. In all of the study groups, at least part of the injected fat survived, giving the desired clinical outcome. No significant differences could be found between the groups regarding fat weight and volume. Histopathologic examination of the dissected grafts demonstrated a significantly better integrity of the fat tissue in the group that received hyperbaric oxygen for 5 days (p = 0.047). This finding was manifested by the presence of well-organized, intact fat cells, along with a normal appearance of the fibrous septa and blood vessels. The worst results were found in animals treated by hyperbaric oxygenation for 15 consecutive days. An inverse correlation was found between an increased dose of the high-pressure oxygen and fat tissue integrity (r = -0.87, p = 0.076). The toxic effects of highly reactive oxygen species on fat cells might explain the failure of an excessively high dose of hyperbaric oxygen to provide any beneficial outcome. The clinical relevance of these results should be further investigated.
Full-text · Article · Dec 2000 · Plastic & Reconstructive Surgery
[Show abstract][Hide abstract] ABSTRACT: Primary healing is the main goal in soft tissue coverage. Different techniques are available, namely direct suture, tissue expansion, grafts and flaps. In certain areas secondary healing proves as good as primary healing. We report a series of patients with ear defects following surgery that were left open for secondary healing. The remaining cartilage around the defect provides a frame for excellent secondary healing without scar contracture and no ear distortion. Secondary spontaneous healing may be a good option for ear defects and should be in our armamentarium.
No preview · Article · Jan 2000 · Rivista Italiana di Chirurgia Plastica
[Show abstract][Hide abstract] ABSTRACT: The single-pedicle transverse rectus abdominis myocutaneous (TRAM) flap is frequently associated with partial flap necrosis. Hyperbaric oxygen has previously been shown to increase the survival of skin flaps, although there has been no investigation of possible beneficial effects of hyperbaric oxygen on survival of the TRAM flap. The present study compares the effectiveness of hyperbaric oxygen therapy, normobaric 100% oxygen, a hyperbaric air-equivalent mixture, and no treatment at all (control group), in the prevention of TRAM flap necrosis in a rat model. Forty-eight animals were randomly assigned to one of the four above-mentioned groups. The surviving area of the flap was evaluated 7 days after surgery. The hyperbaric oxygen treatment protocol consisted of five 9-minute sessions breathing 100% oxygen at a pressure of 2.5 atmospheres absolute during the first 48 hours, starting within 1 hour of surgery. The areas of surviving skin paddles ranged from 38.5 percent in the control group to 52.5 percent in the group treated with hyperbaric oxygen. One-way analysis of variance indicated that flap area survival was significantly greater in the hyperbaric oxygen group (F = 2.69, p = 0.05). Tukey's pairwise comparison and the two-sample t test indicated that the group treated with hyperbaric oxygen differed significantly from the control group (Tukey's critical value = 3.8, rejection level = 0.05, t test p = 0.01). Our results suggest that the hyperbaric oxygen treatment protocol used improves survival in the rat TRAM flap. However, the optimal treatment protocol to achieve this objective even in the rat seems to be variable, and further studies are required before extrapolating these data to human applications.