Graft survival and effectiveness of dermal substitution in burns and reconstructive surgery in a one-stage grafting model

Survival of the autograft and objective parameters for scar elasticity were evaluated after dermal substitution for acute burns and reconstructive surgery. The dermal substitute, which was based on bovine type I collagen and elastin-hydrolysate, was evaluated by intraindividual comparison in a clinical trial. The substitute was applied in a one-step procedure in combination with a split-thickness autograft. This treatment was compared with the conventional treatment, the split-thickness antograft. After 1 week, the percentage of autograft survival was assessed. The Cutometer SEM 474 was used to obtain objective measurements of skin elasticity parameters 3 to 4 months postoperatively. Forty-two pairs of wounds (31 patients, age 32.9 +/- 19.3 years; burned surface area, 19.8 +/- 14.5 percent) were treated because of acute burns. Reconstructive surgery was performed on 44 pairs of wounds (31 patients, age 33.9 +/- 17.5 years). Autograft survival was not altered by the substitute for reconstructive wounds, although a slight but significant reduction (p = 0.015) was established in the burn category for substituted compared with nonsubstituted wounds. However, the necessity for regrafting was not increased by substitution. Cutometer measurements of reconstructive wounds with a dermal substitute demonstrated a significant increase of pliability (50 percent, p < 0.001), elasticity (defined as immediate extension, 33 percent, p = 0.04), maximal extension (33 percent, p = 0.002), and immediate retraction (31 percent, p = 0.01), as compared with nonsubstituted wounds. After burn surgery, no improvement was found for the different elasticity parameters. Dermal substitution in a one-stage grafting model seems feasible with respect to graft survival. Skin elasticity was considerably improved by the collagen/elastin dermal substitute after reconstructive surgery.     

Prophylactic antibiotics in plastic and reconstructive surgery.

There is no consensus in the literature on the use of prophylactic antibiotics to prevent postoperative infection. This study was performed to investigate whether the use of prophylactic antibiotics has an effect on postoperative infection rates. A total of 1400 patients were classified into four groups based on their diagnosis. During the induction of anesthesia, half of each group received 2 g of a sulbactam-ampicillin combination and the other half received a placebo (saline solution) intravenously. Wound infection rates were observed in the postoperative period. Age, sex, and operative site of the patients with the same diagnosis were comparable in each group. The white blood cell count and the body temperature reading of each patient were recorded postoperatively. Wounds were observed daily in the postoperative period and graded according to a predetermined scale. Bacteriologic specimens were obtained from patients who had wound infections. According to our clinical experience, antibiotic prophylaxis is not necessary in plastic surgery. At the end of our 6-year study, a significant difference could not be found between the antibiotic prophylaxis and placebo groups.     

Cervical spine arthrodesis in rheumatoid arthritis: a long-term follow-up.

Forty-one patients with rheumatoid arthritis involving the cervical spine had a posterior cervical arthrodesis. They were followed for a minimum period of seven years. The diagnoses prior to surgery included cranial settling, atlantoaxial subluxation, subaxial subluxation, and any combination of these three. All patients had posterior arthrodesis, with or without methylmethacrylate, and iliac crest autogenous bone graft. In addition, one patient had an anterior vertebrectomy, and two had transoral resection of the odontoid. Follow-up consisted of a subjective questionnaire, standard radiographs, and physical examination, including a neurologic exam. This information was compared to preoperative data available in the patient''s medical record, postoperative data, and the information obtained in a similar study undertaken in 1987. At the time of follow-up, thirteen patients were known to be dead. One patient could not be located. Of the remaining twenty-six patients, eighteen underwent the full examination, including physical exam and radiographs. The remaining nine patients were contacted and interviewed, but were unavailable for exam and radiographs. All patients considered the operation a success. Only one patient at follow-up had a non-union. This was stable over time. No patient had a deterioration in neurologic function. There was no significant degeneration or instability seen at levels adjacent to the fused segments as compared to the rest of the cervical spine. Posterior cervical spine arthrodesis for rheumatoid involvement of the neck is a safe, efficacious procedure with no significant deterioration of effects over time.     

Skin expansion in head and neck reconstructive surgery.

We used a tissue-expansion technique to achieve soft-tissue reconstruction in congenital and acquired defects of head and neck. One hundred and fifty-five head and neck reconstructions have been performed, with a 6 percent rate of major complications. We present our planning and surgical approach for single areas. From a technical point of view, the only major difference from the rest of literature is the approach to the problem of periprosthetic capsule. In fact, we believe that complete removal of the capsule, which can be achieved without vascular risk thanks to a special technique, is necessary to obtain the best results.     

Neuroleptic malignant syndrome: occurrence in a child after reconstructive surgery

The occurrence of the rare but potentially fatal neuroleptic malignant syndrome must be considered by the surgeon treating a patient who develops hyperthermia, mental abnormalities, autonomic instability, and muscle rigidity after exposure to phenothiazines or other neuroleptic drugs. The dopamine agonist bromocriptine appears to be the treatment of choice in adults and seemed to be effective and well tolerated in our patient. Although the syndrome cannot be prevented, recognition is crucial, since effective general and specific therapy is available. Differentiating neuroleptic malignant syndrome from malignant hyperthermia allows early appropriate treatment with bromocriptine.     

Effectiveness of noise barriers on an interstate highway: a subjective and objective evaluation

The objective of this study was to determine the actual and perceived effectiveness of noise barriers along interstate highways. Using a 5-mile section of Interstate 71 in the greater Cincinnati area as the study area, traffic noise readings and opinions of residents living along the sections of the highway were recorded. Noise readings were taken before and after the noise barriers were erected. A questionnaire was designed to elicit noise-related annoyance of the residents in the areas adjoining the highway. The results indicated that, in general, noise barriers were effective as indicated by a reduction in noise levels by as much as 11 dBA. The barriers, however, failed to bring noise levels for locations closer to the highway within the levels desired by the government (67 dBA). Most residents living right next to the highway were very satisfied with the installation of noise barriers. In general, these individuals felt that the quality of life improved with the noise barrier installation. The same, however, was not true of residents living a few blocks away from the highway--they felt the noise barriers were a waste of money. There was no significant difference in traffic noise pattern during the weekdays or weekends. Noise readings taken in two different locations were observed to be similar.