An outer-table suspension technique for endoscopic browlift

For the past 2 years, we have sought to develop a stable and reliable technique for soft-tissue suspension in the endoscopic browlift, while eliminating the need for permanent or temporary anchoring screws. To this end, we have developed an outer calvarial table fixation technique. This technique allows direct fixation of the periosteum or galea to the outer table of the frontal bone through the use of an outer table calvarial tunnel. The technique has been used in 34 patients, 21 of which were followed for more than a year. The results have been consistent and reliable. We feel this technique affords precise control of soft tissue suspension during endoscopic browlift, providing long-lasting elevation and lateral advancement of the brow complex.

Risk factors for complications in pediatric tissue expansion

Tissue expansion in children has been associated with complication rates of 20 to 40 percent. A critical analysis of 6 years' (1988-1993) experience with 180 expanders placed in 82 consecutive children was performed to identify those factors which predispose to complications. Major and minor complications each occurred in 9 percent of patients. The factors associated with a statistically significant increase in complications were burns and soft-tissue loss, patient age under 7 years, use of internal expander ports, and a history of two or more prior expansions. In addition, complications were significantly more likely to occur within the first 90 days than during any subsequent expansion. Factors that did not influence complication rate included patient gender, wound drainage upon expander insertion or removal, intraoperative use of antibiotic irrigation, number of expanders placed, use of customized expanders, and operating surgeon.

Development of alternative breast implant filler material: criteria and horizons

The introduction of the silicone gel-filled breast implant more than 30 years ago changed the nature of alloplastic breast augmentation and reconstruction. Over the last three decades, it is estimated that one million American women have undergone implantation with some variation of these devices. Recent medical, legal, and regulatory developments have forced a moratorium on the unrestricted uses of the silicone gel-filled implants, and it appears unlikely that its general use will return. However, there is a continued need for some type of breast implant in both aesthetic and reconstructive surgery. The Food and Drug Administration has proposed testing guidelines for the development of any new breast implant before unrestricted clinical use. These guidelines will direct the creation of new filler materials from their earliest stages, through long-term postimplantation follow-up studies. This article succinctly examines the central issues in the breast implant controversy in relation to the FDA's recommendations for the development of new implants, discusses breast implant filler materials currently under development, and offers guidelines fro the development of breast implant fillers that are safe and effective.

Brachioradialis muscle flap: clinical anatomy and use in soft-tissue reconstruction of the elbow

A detailed gross anatomical dissection of 53 upper extremities was performed to define the muscular and vascular anatomy of the brachioradialis muscle and to evaluate its arc of rotation with specific examination of its usefulness in covering soft-tissue defects of the elbow region. A consistent vascular anatomy was delineated, with a major pedicle found each time near the elbow arising (in descending order of frequency) from the radial recurrent, radial, and brachial arteries. A variable number of minor pedicles were found throughout the muscle's length. Pedicled proximally, the distal muscle could cover the elbow both anteriorly and posteriorly in each case; the proximal portion of the muscle (distally pedicled flap) could cover the anterior elbow consistently (100%) as well as the posterior elbow (in 91% of dissections). The muscle's arc of rotation encompasses the distal half of the arm and the proximal two thirds of the forearm, with a consistent ability to cover defects of up to 3 cm in the elbow region. Our studies confirm a consistent and robust vascular anatomy as well as an arc of rotation that allows predictable coverage of elbow defects in a one-stage procedure with minimal morbidity, no loss of upper extremity function, and no need to sacrifice the major vessels of the upper extremity.