Tissue Surgery - part 7 potx

96 Tissue Surgery i]Z [ZbdgVa VgiZgn VcY kZ^c# H]dgi"iZgb a^bW ^hX]Zb^V]VhVegZXdcYî^dc^c\Z[[ZXidcÒVeh# )+!),  I]jh! adc\Zg"iZgb a^bW ^hX]Zb^V b^\]i Vahd ^cÒjZcXZÒVe^hX]Zb^VÄgZeZg[jh^dc^c_jgn# GZXZcian!6YY^hdcZi Va# ). XdcÑgbZY djgYViV dci]ZZ[[ZXi^kZcZhhd[cdc^ckVh^kZVXjiZgZbdiZ >E[dg\adWVaegdiZXi^dcd[h`ZaZiVabjhXaZV\V^chi ^hX]Zb^XcZXgdh^h^cVaVg\ZVc^bVabdYZa#I]gZZ &%"b^cjiZXnXaZhd[dXXajh^dcVcYgZeZg[jh^dc^c Ve^\]^cYa^bWjh^c\Vidjgc^fjZih^\c^ÑXVcian gZYjXZY^c[VgXi^dchd[i]ZaVi^hh^bjhYdgh^!\gVX" â^h!VcYgZXijhVWYdb^c^hbjhXaZhWn**!+%! VcY **! gZheZXi^kZan! XdbeVgZY id V Xdcigda \gdje#L]Zi]Zg gZbdiZ ^hX]Zb^XegZXdcYî^dc" ^c\XdjaYWZ^cYjXZYWnVaViZbZX]Vc^hb lVh VahdYZiZgb^cZY# *% 6gVi]^cYa^bWlVhhjW_ZXiZY id &% b^cjiZh d[ ^hX]Zb^V VcY (% b^cjiZh d[ gZeZg[jh^dc lî] V idjgc^fjZi ') ]djgh WZ[dgZ ÒVe^hX]Zb^V#I]^hegdidXda^cXgZVhZYgZYWaddY XZaa kZadXîn ^c i]Z XVeâaVg^Zh VcY Ñghi"dgYZg VgiZg^daZh VcY kZcjaZh VcY ^cXgZVhZY XVeâaVgn Òdl!VhlZaaVhYZXgZVhZYaZj`dXniZhi^X`^c\^cV XgZbVhiZg bdYZa VcY i]jh! ViiZcjViZY ZVgan ^hX]Zb^V"gZeZg[jh^dc^c_jgn^cbjhXaZÒVeh#Dc i]Zdi]Zg]VcY!îY^Ycdi^begdkZÒVehjgk^kVa ^cVYêdXjiVcZdjhÒVeh#I]ZhZÑcY^c\h^cY^XViZ Figure 8-2. Clamping the femoral artery is as effective at preconditioning the flap as a noninvasive tourniquet applied to the rat hind limb followed by 30 minutes limb reperfusion. 27 Average flap necrosis was 68.2% (q18.1%) in the control group (CG), 11 q 8.38% in the preclamping group (PG), 12.5 q 5.83% in the femoral ischemic group (FG), and 24 q 11.75% in the tourniquet group (TG). All preconditioned animals had a significantly smaller area of flap necrosis than did the control animals (*p < 0.001 vs. CG). The differences between PG, FG and TG groups were not significant. 0 10 20 30 40 50 60 70 80 90 100 CG PG* FG* TG* *p<0.001 vs. CG Figure 8-3. Both classic and remote acute ischemic preconditioning improve microcir- culation of muscle flaps after ischemia in a rat model. 47 Capillary flow results; capillary flow was significantly higher in the groups with classic ischemic preconditioning (cIP) and remote ischemic preconditioning (rIP) than in the control group (p < 0.02). The difference within the groups cIP and rIP was not significant. 0 1 2 3 4 5 6 7 8 CG cIP rIP *p<0.02 vs. CG mm/s*cap Remote Ischemic Preconditioning of Flaps: Current Concepts 97 i]Vi VXjiZ VcY aViZ gZbdiZ >E VgZ ^cYjXZY Wn Y^[[ZgZcibZX]Vc^hbh# 6 [Zl hijY^Zh ]VkZ [dXjhZY dc i]Z edhh^WaZ bZX]Vc^hbhd[gZbdiZ>E#IV`Vd`VZiVa#^ckZhi^" \ViZY i]Z ^ckdakZbZci d[ VYZcdh^cZ gZXZeidgh ^ci]ZbZX]Vc^hbd[ gZbdiZ>E d[i]Z]ZVgiWn gZcVa^hX]Zb^V#I]Z^begdkZbZcid[bndXVgY^Va ZcZg\n bZiVWda^hb ^cYjXZY Wn XaVhh^X VcY gZbdiZ>ElVhVWda^h]ZY^cgVWWîhWnWadX`^c\ VYZcdh^cZgZXZeidgh# *& 9^X`hdcZiVa#edhijaViZY i]VigZbdiZ>E^h^cî^ViZYWnV]jbdgVabZX]V" c^hbWZXVjhZi]ZkZcdjhZ[ÒjZci[gdbVegZXdc" Yî^dcZY ]ZVgi d[ V Ydcdg gVWWî! igVch[jhZY id Vc gZXê^Zci Vc^bVa! aZVY id i]Z hVbZ Z[[ZXi Vh ÅegZXaVbe^c\Æ^cVXdcigda\gdje# *' >cXdcigVhi! HX]dZbV`ZgVcYkVc =Z^_c^c\ZcdWhZgkZY i]Vi VciV\dcô^c\ i]Z WgVYn`^c^c ' gZXZeidg VWda" ^h]ZYi]ZegdiZXi^kZZ[[ZXid[gZbdiZXVgY^VX>E! l]ZgZVh V h^bjaVi^dc d[ WgVYn`^c^c gZaZVhZ Wn adXVa^cigV"VgiZg^Va^c[jh^dcXdjaYb^b^XgZbdiZ >E ^c V gVi bdYZa# I]ZhZ gZhjaih hjeedgi i]Z ]nedi]Zh^hi]VigZbdiZ>EVXihi]gdj\]hZchdgn cZgkZhi^bjaVi^dc^c^hX]Zb^Xdg\Vch# *( DjgYViVh]dli]Vi^hX]Zb^XegZXdcYî^dc^c\ VcYZc]VcXZbZcid[ÒVehjgk^kVaXVcWZVX]^ZkZY cdidcanWnegZXaVbe^c\i]ZÒVeeZY^XaZWjiVahd Wn^cYjX^c\Vc^hX]Zb^VÄgZeZg[jh^dcZkZci^c VWdYn VgZVY^hiVci[gdb i]ZÒVeWZ[dgZZaZkV" i^dc# I]ZhZ ÑcY^c\h ^cY^XViZ i]Vi gZbdiZ >E ^c ÒVehbjhiWZVhnhiZb^Xe]ZcdbZcdcVcYcdi bZgZanVadXVagZVXi^dc^ci]ZÒVeîhZa[# The Role of Nitric Oxide in Preconditioning I]ZZmVXibZX]Vc^hbd[XaVhh^XVhlZaaVhgZbdiZ >E ^h cdi nZi YZiZgb^cZY# Ild iZbedgVaan VcY bZX]Vc^hi^XVaanY^hi^cXiineZhd[egdiZXi^dcVgZ ^cYjXZY Wn egZXdcYî^dc^c\ hi^bja^/ VXjiZ VcY YZaVnZY# *)!** KVg^djh[VXidgh!hjX]Vhcîg^Xdm^YZ CD! **!*+ ]ZVih]dX`egdiZ^ch! *,Ã*. VYZcdh^cZ! +%!+&  6IE"hZchî^kZ@X]VccZah! +' XnXaddmn\ZcVhZ"'! +(  dg WgVYn`^c^c i]gdj\] hZchdgn cZgkZ hi^bjaV" i^dc! *( hZZbidWZ^ckdakZY^c^hX]Zb^XegZXdc" Yî^dc^c\#=dlZkZg!i]ZegdiZXi^kZZ[[ZXihd[VXjiZ egZXdcYî^dc^c\VgZ^cYZeZcYZcid[egdiZ^chnc" i]Zh^h!l]ZgZVhYZaVnZYegZXdcYî^dc^c\gZfj^gZh YZcdkdegdiZ^chnci]Zh^h# ** Cîg^Xdm^YZbVnWZXZcigVaidi]ZbZX]Vc^hb d[^hX]Zb^XegZXdcYî^dc^c\#EZgVaiVZiVa#[djcY ^c VgVi bdYZa d[ ]ZeVi^X ^hX]Zb^V"gZeZg[jh^dc i]Vi VYZcdh^cZ dg CD VYb^c^higVi^dc WZ[dgZ ^hX]Zb^Vh^bjaViZYi]ZZ[[ZXid[egZXdcYî^dc^c\! l]ZgZVh ^c]^Wî^dc d[ CD hnci]Zh^h Za^b^cViZY i]Z egdiZXi^kZ Z[[ZXi d[ ]ZeVi^X egZXdcYî^dc" ^c\# +) LZXdcÑgbZYi]ZhZYViV^cildhijY^Zhd[ VYêdXjiVcZdjh +* VcYbjhXaZ ++ ÒVeh#>cXdcigVhi iddjgYViV!EZgVaiVZiVa#dWhZgkZYVXdci^cj^c\ egdiZXi^kZZ[[ZXid[Zmd\ZcdjhCDV[iZgZcYd\Z" cdjhCDhnci]Zh^hlVhWadX`ZYWnC<"Cîgd"A" Vg\^c^cZ"bZi]naZhiZg]nYgdX]adg^YZA"C6B:# LZ[djcYi]ViZmd\ZcdjhCD!^cVYdhZh^bâVg id i]Vi jhZY Wn EZgVaiV Zi Va#! Y^Y cdi Zc]VcXZ ÒVe hjgk^kVa V[iZg A"C6B: VYb^c^higVi^dc# 6 Figure 8-4. Leukocyte count. 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a^[i! Vh edejaVgôZY Wn 6jhi^cVcYLZhi^c!lâaXdggZXii]ZYdlcijgcZY XdgcZgh d[ i]Z bdji]# ))  I]^h iZX]c^fjZ ^h Figure 9-3. The gull-wing excision at the base of the nose to shorten the upper lip and lip-lift procedure by direct excision of skin above the vermilion-cutaneous junction. (Reprinted from Plastic Surgery 2/e, Mathes SJ, chapter: Face Lift (Lower Face): Current Techniques by Fardo D, Zins JE, Nahai F, ©2005 Elsevier Inc. With permission from Elsevier.) [...]... after anterior lipectomy and platysmaplasty Advances in Facial Aesthetic Surgery: New Approaches to Old Problems and Current Approaches to New Problems Postbariatric Surgery 111 112 Tissue Surgery Figure 9-1 0 Preoperative a) frontal and b) lateral view of a 76 -year-old man who underwent direct skin excision of the neck with Z-plasty and platysmaplasty c) Frontal and d) lateral view of the patient 6... The patient 1 year later Advances in Facial Aesthetic Surgery: New Approaches to Old Problems and Current Approaches to New Problems a 1 07 b Figure 9-6 a) Preoperative view of a 68-year-old woman who underwent a facelift and perioral phenol-croton oil peel using 50% phenol and 1.1% croton oil b) The patient 1 year later (Reprinted from Plastic Surgery 2/e, Mathes SJ, chapter: Face Lift (Lower Face):... Elsevier.) The Neck 108 Tissue Surgery a b Figure 9 -7 An anterior lipectomy and platysmaplasty a) Platysmaplasty completed through a submental incision The dotted line indicates the extent of dissection b) Postauricular incision for access to the posterior neck Advances in Facial Aesthetic Surgery: New Approaches to Old Problems and Current Approaches to New Problems 109 Figure 9-8 Preoperative a) frontal... Approaches to New Problems 109 Figure 9-8 Preoperative a) frontal and b) lateral view of a 63-year old woman with moderate skin laxity c) Frontal and d) lateral view of the patient 6 months after anterior lipectomy and platysmaplasty 110 Tissue Surgery Figure 9-9 Preoperative a) frontal and b) lateral view of a 50-year old woman with substantial submental and submandibular fat and mild skin laxity c)... distance from “A” is 5 mm for minimal lip elevation, 7 mm for moderate elevation (most common), and 9 mm for high elevation (Reprinted from Plastic Surgery 2/e, Mathes SJ, chapter: Face Lift (Lower Face): Current Techniques by Fardo D, Zins JE, Nahai F, ©2005 Elsevier Inc With permission from Elsevier.) Figure 9-5 a) Preoperative view of a 59-year-old woman with downturned corners of the mouth b) The...106 Tissue Surgery Figure 9-4 a) Corner of the lip lift performed by marking the commissure b) Drawing a line from the commissure 11 mm long medially along the vermilioncutaneous junction and drawing a second line from “A” laterally toward the top of the ear These lines create a triangle with the apex of the triangle at “A” and the base at “B-C.” The vertical distance from . gZk^" h^dccZX`a^[iVcYZmX^h^dcd[i]ZcVhdaVW^Va[daYh! bVnVahdWZ^cdgYZg# 112 Tissue Surgery   Figure 9-1 0. Preoperative a) frontal and b) lateral view of a 76 -year-old man who underwent direct skin excision of the neck with Z-plasty and platysmaplasty HX]dZbV`ZgG<!kVc=Z^_c^cc8A#7gVYn`^c^cbZY^" ViZhXVgY^VXegZXdcYî^dc^cViVY^hiVcXZ#6b?E]nh^da =ZVgi8^gXE]nh^da#'%%%0' ,- */=&*,&Ã&*,+# *)# 9Vlc 7!  7daa^ G# IdlVgY. heZgb^cZ$cîg^X dm^YZXdbeaZm^cZc]VcX^cÒVehjgk^kVa^cVgVibdYZa# 7g?EaVhiHjg#'%%'0***/)(%Ã)((# ,&# <]VaZ] 7! I^hh^ZgG!7ZgYZVjm6#Cîg^Xdm^YZVcYbnd" XVgY^Va^hX]Zb^XegZXdcYî^dc^c#?HdX 7^ da#'%%%0&.)(Ã )/&(,Ã&)&# ,'#

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