Context:Laser tissue bonding (LTB) is believed to have certain advantages over conventional sutures such as fluid-tight closure and minimal scarring and fibrosis.Aim:The aim of the present study was to evaluate the bond strength of laser tissue welding and laser tissue soldering in mucosal and vascular repair.Materials and Methods:A total of 85 samples of bovine oral mucosa and 85 bovine aortas were bonded using a CO2 laser and different laser powers. Human serum albumin was used as solder. The breaking load for mucosal samples and the bursting pressure for aorta samples were evaluated. Few specimens were evaluated histologically for thermal damage and other microscopic changes.Statistical Methods:Two-way ANOVA was performed as the data were normally distributed and analyzed for significant differences between the groups. This was followed by Simple Main effects (Tuckey's post hoc test) to determine the individual variation between groups and also the significant differences within the groups.Results:Significantly higher values of breaking load (44.2 ± 3.03 g) and bursting pressure (70.8 ± 12.33 mmHg) were noted when 50% albumin was used. When reinforcing sutures were given the bond strength was further increased (68.0 ± 4.0 g for breaking load) (108.0 ± 12.56 mmHg for bursting pressure). Microscopically, a bridge of solder coagulum formed across the wound. Thermal damage was restricted to the top layers only although it did extend much more laterally adjacent to the wound edges. Few areas of vacuolization and carbonization were seen.Conclusion:LTB seems to be a promising new method of wound closure and warrants further evaluation in the form of in vivo and clinical studies.
PurposePost operative monitoring is crucial for the success of microsurgical free tissue transfer. Sophisticated and expensive methods are available for monitoring. We propose a novel technique using digital photography and the internet as a reliable and cost effective method to monitor free tissue transfers.
Methods163 micro-vascular procedures were monitored using this technique over 8 months. Serial photographs taken to show flap color. Capillary refill time, pin prick-bleed time and color and hand held Doppler signal was recorded in the movie mode of a standard 5 mega pixel camera with duration of 15 seconds. Data was sent to the surgeon at regular intervals and or as deemed necessary.
ResultsAnalysis of the 67 cases is presented. 5 re-explorations were done. The early diagnosis of venous congestion was possible using this technique. Timely intervention contributed to the success of the re-explorations and these flaps could be salvaged. The file size of images was in the range of 1 MB-6 MB. The file size of an entire set of images ranged about 7 MB-9 MB. These were sent across the ADSL internet lines.
ConclusionThe use of the digital images and the internet allow reconstructive surgeons to have a reliable picture of the state of their free tissue transfers. This permits decrease in observer error and saves valuable time which otherwise needs to be spent to verify situations of doubt and offers an ideal solution to the logistic problem of having to visit the patient in case of doubt.Calcium Alginate dressings have been used for many years as the standard dressing for donor sites. They require a secondary absorbent dressing which is not waterproof, will frequently leak blood and are difficult to remove and heal. Polyurethrane film dressings have also been used routinely with excellent healing rates, are waterproof, but highly prone to leakage.We present the results of a prospective randomized controlled trial using a new dressing, Tegaderm Absorbent, which provides all the regular benefits of a Polyurethrane film dressing but with absorptive capacity. Tegaderm Absorbent (TA) consists of a conformable acrylic pad enclosed between 2 layers of transparent film. The film in contact with the wound surface is perforated to allow uptake of the wound fluid by the absorptive acrylic pad.Forty patients were randomized to receive either Tegaderm Absorbent (3M) or Kaltostat Alginate dressing (Convatec)/gauze/combine/Mefix dressing.Twenty females and 16 men, with a mean age of 72 years (11-94 years), 19 with TA and 17 with Kaltostat, completed the trial. TA dressings were significantly easier to apply (89% vs. 31% very easy to apply), less painful on the first two days postoperatively (mean pain score 0.3 vs. 1.9 at Day 1 and 0.2 vs 2.7 Day 2), were easier and less painful to remove (mean pain score 0.5 vs. 2.9), healed quicker (99.7% vs. 58.9% healed at 10-16 days) and were more convenient for the patients to manage. Eight dressings leaked in the Kaltostat group and 5 in the TA group. To avoid this a dressing change may be...
Multiple neurofibromatosis (NF) or von Recklinghausen's disease is an autosomal dominant disorder affecting the growth of neural tissues, caused due to the mutation of the gene located at 17q11.2 chromosome, known as neurofibromatosis type I (NF1) gene. The gene product neurofibromin serves as a tumor suppressor; hence, decreased production of this protein results in a myriad of clinical features, which include café au lait spots, multiple skin tumors, axillary and inguinal freckling, optic glioma, and Lisch nodules (pigmented hamartomas of the iris). Besides the functional troubles, it is an esthetically devastating disease. Like other genetic diseases, it has no definitive treatment and surgical corrections have a bleak prospect in improving cosmesis and only help in creating a lesser monster.In this article, we discuss the etiopathogenesis, clinical features, and the intricacy of the surgical management of the craniofacial involvement of von Recklinghausen's disease along with two case reports.
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