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This study set out to detect specific classes of potentially genotoxic aldehydes resulting from soybean-oil peroxidation in oil samples from 51 Trilucent implants in 26 patients and two factory-retained prostheses. The chemical analysis was performed independently of AEI inc. All of the implants showed evidence of shell deterioration suggestive of lipid absorption, and of lipid bleed throughout the implant shell. The mean implant weight loss was found to be almost 2% per year. Although none of the implants had actually ruptured in-situ, we identified specific problems with anterior and posterior patch delaminations, making the implant prone to rupture. Our data suggest that the soybean oil in all the explanted Trilucent implants and the two factory-retained prostheses had undergone peroxidation, yielding aldehyde by-products in millimolar concentrations. These concentrations are over 1000 times that thought to be potentially genotoxic. The clinical implications of these findings remain unclear. Capsular tissue was submitted to AEI Inc for histological and chemical analysis, but the data have not been forthcoming, which is disappointing as this may provide further evidence for the risks of long-term complications in these patients.

Steroids are often administered to paediatric craniomaxillofacial patients perioperatively to reduce postoperative facial swelling, although there is little evidence of their efficacy. Preoperative tumescent infiltration using 7 ml x kg(-1) of a solution consisting of 0.1 mg x ml(-1) triamcinolone acetate, 0.0125% bupivacaine, 0.025% lignocaine, 3 units x ml(-1) hyaluronidase and 1:1000000 adrenaline in Hartmann's solution was evaluated from a retrospective case controlled study of patients undergoing standard fronto-orbital remodelling for simple craniosynostosis (n = 20). Eye closure (i.e. inability to open the eyes) was used as a marker for severe facial swelling. Patients receiving the tumescent infiltration demonstrated significantly less eye closure (P < 0.005), implying that the tumescent infiltration had a significant effect on facial swelling. The avoidance of eye closure allowed more effective monitoring for neurological and ophthalmological complications, which is a significant clinical benefit. The infiltration solution has the advantage of a lower corticosteroid dose than previously reported dexamethasone-based perioperative regimens, thereby minimising any unwanted metabolic effects. The technique is advocated for the reduction of postoperative facial swelling in craniomaxillofacial surgical patients., (Copyright 2001 The British Association of Plastic Surgeons.)

Haematoma remains the most common complication of rhytidectomy and can lead to prolonged facial oedema or skin necrosis. The factors leading to haematoma formation remain unclear, and studies establishing causal relationships are lacking. The aim of this study was to determine which parameters were significantly associated with haematoma formation in a consecutive series of facelifts performed by two high-volume operators. The records of 1078 patients who underwent facelifting between 1994 and 1999 were reviewed and the parameters associated with haematoma formation were investigated using multivariate statistical analysis. In this series of 1078 patients, 45 haematomas occurred (4.2%). Analysis revealed significant associations between haematoma formation and anterior platysmaplasty (P= 0.009), systolic pressure (P= 0.02), gender (P= 0.03), aspirin or non-steroidal anti-inflammatory intake (P= 0.04) and smoking (P= 0.049). In addition the relative risk of each parameter was calculated. This allowed the haematoma risk for individual patients to be calculated and haematoma-prone patients were identified preoperatively. This is the first study to establish independent statistical risk factors for haematoma after rhytidectomy and to present a scoring system that calculates the haematoma risk preoperatively. The implications of these findings and possible measures for the prevention of haematoma are also presented., (Copyright 2001 The British Association of Plastic Surgeons.)

We report our findings in a retrospective study of patient satisfaction with soybean oil-filled mammary implants. Sixty-two women who had breast augmentation with Trilucent breast implants were sent a questionnaire to assess their satisfaction with implant placement; 19 of the 62 attended for clinical examination. Overall satisfaction with triglyceride implant placement was high: very pleased 45% (18/40), pleased 32.5% (13/40), content 12.5% (5/40). The majority of women felt that it had enhanced their body image and lifestyle (82.5%).

Distraction osteogenesis is increasingly recognised as a potentially useful technique to achieve the co-ordinated augmentation of craniofacial skeletal and soft tissue. A case is presented where bilateral maxillary distraction was successfully used to advance the midface in the treatment of recurrent ocular dislocation, in a 10-month-old boy with Pfeiffer's syndrome.

We report two children and a young adult who developed unilateral facial palsy shortly after injury to the external ear. In two instances the paralysis followed a prominent ear correction and in the other a laceration to the concha. The trauma-triggered facial palsy was most likely idiopathic although the anatomy of the facial nerve near the ear leads one to speculate on a possible pathway of a virally induced palsy (Bell's palsy). Each patient recovered over a period of 6 months.

A retrospective analysis of facelifting experience during the author's initial 8 years of consultant practice is presented. 137 procedures are reviewed and the surgical technique described. 70% were SMAS-platysma lifts, 24% skin only lifts and 6% subperiosteal (mask) lifts. Particular attention was paid to complications, most common of which was haematoma requiring surgical evacuation in 3.6% of patients.

Premature fusion of cranial sutures in craniosynostosis has been thought to lead to craniostenosis, which in turn may lead to increased intracranial pressures. In 41 consecutive patients with craniosynostosis, intracranial pressure and intracranial volume were measured. Of the 41 patients, 38 (92.6%) had raised intracranial pressure but only 4 (9.7%) had a decreased skull volume. In the present study, there is no correlation between intracranial volume and intracranial pressure. This study confirms that the measurement of intracranial volume, a non invasive procedure, cannot be used to assess intracranial pressure and to avoid an invasive procedure.

107 children undergoing transcranial craniofacial surgery in a paediatric hospital have been reviewed to assess the incidence and type of complications which arose. This represents the first 4 years' experience of the craniofacial team. There were no deaths or permanent adverse sequelae of surgery. A total of 53 complications were seen in 42 patients. In 9.3% of patients they were potentially life-threatening, serious in 12.1% and of a minor nature in 28%. The more serious complications were related either to haemorrhage and/or vasovagal shock at operation or to infection post-operatively. Infants undergoing monoblock frontofacial advancements and those with tracheostomies were at particular risk.

A method is described for predicting the outcome of experimental free flaps at the time of surgery using a directional ultrasound Doppler flowmeter. Tests of both arterial and venous anastomoses have been developed. Provided that both anastomoses are individually assessed, the technique is 100% accurate and is recordable. Spectral analysis of truly directional Doppler signals has provided knowledge of the peripheral resistance within a flap.

A technique based on reflection spectrophotometry has been tested for use as a monitor of the cutaneous circulation in experimental skin flaps. A very rapid indication was given of either arterial or venous insufficiency in a previously healthy flap. Post-operative monitoring produced characteristic traces for successful and unsuccessful free flaps. The ability of this method to discriminate between a satisfactory flap, an arterial failure, and a venous failure was highly significant (P less than 0.001).

Two cases are reported in which the smoking of a cigarette on the 5th day after revascularisation of the thumb produced immediate vascular insufficiency in a previously viable digit.

The treatment of scalp lesions induced by ionising radiation in four patients is described. In each case the technique used was different. Three required several operations and a prolonged hospital stay. The fourth patient, in whom a free flap was used, underwent a single operation. In selected patients with reasonable general health free tissue transfer may provide the best solution to such difficult management problems.

Intradermal interstitial fluid pressure (IFP) in the rat epigastric flap has been measured under varying conditions of blood flow. Pressure changes were not as expected. An attempt has been made to explain these anomalous results using radiolabelled isotopes.

The effectiveness of the "floating forehead" operation for treating brachycephaly in infants has been assessed. All children who had undergone this procedure at the Hôpital des Enfants Malades between 1977 and 1984 were reviewed retrospectively by an independent observer. Particular attention was paid to the effects on cranial growth, facial growth and morphology.

Block dissection of the inguinal lymph nodes is associated with a high incidence of complications, the most frequent of which are related to wound healing. To determine the optimal surgical approach, a review of our experience over the last 10 years was undertaken. Fifty inguinal lymph node dissections are presented. The patients were divided into four groups according to the surgical incision used. The duration of hospital stay and incidence of complications were compared. We conclude that the optimal surgical approach is an elliptical incision removing a 4 cm width of skin over the inguinal nodes. Incisions that did not sacrifice at least a 4 cm width of skin had an inordinately high complication rate and a prolonged hospital stay. Approaches to wound closure, the management of bulky disease and primary lesions in continuity with the groin, and the use of adjunctive measures to reduce morbidity are discussed.

An experimental investigation is presented into the use of pulsed ultrasound Doppler flowmetry with a percutaneously implanted probe as a monitor of microvascular anastomotic patency. The method accurately indicated and distinguished between experimental arterial and venous occlusion in epigastric island flaps. In free flaps it had advantages over manipulative, intraoperative tests of anastomotic patency and was a reliable post-operative monitor of flap circulation in the experimental model. The technique appears to have great potential as a post-operative monitor for free flaps, including those without a visible surface.

A method for the repair of defects in small blood vessels is described, using an oversized onlay autogenous vein patch tacked to the adventitia. The technique has been evaluated experimentally and it has been shown that vessels repaired with a patch remain patient with normal blood flow. By contrast, vessels repaired by direct suturing have a high incidence of mural thrombus formation and sluggish flow. The clinical usefulness of the method is illustrated by a case report describing the salvage of a free flap with a damaged vascular pedicle.

The scapular flap is a medium-sized flap combining many of the good qualities of others, such as thinness and minimal donor site deficit, with the potentialities of a consistently long pedicle that allows combination with other adjacent flaps. The anatomy of the flap and its application in nine clinical cases is described.

Acute ischaemia of the hand following the elevation of a radial forearm flap despite a satisfactory preoperative Allen's test is reported. Circulation to the hand was restored by a vein graft. The importance of ensuring that peripheral circulation is adequate after raising such a flap is stressed.

An instrument for monitoring the blood flow in skin flaps by temperature measurement is described. This compares the temperature of the flap with adjacent normal skin. An experimental assessment of the technique is presented. Although many of the problems associated with absolute temperature measurement were eliminated, the reaction to circulatory change within a flap was slow. However, with further refinement, the principle may have a place in clinical practice, especially in replantation surgery.

A preliminary report is presented of a free-flap monitoring technique using the Doppler shift of Laser light. It has provided useful information in five patients with free flaps. The technique is non-invasive and the apparatus is compact, portable and simple to use. Although a long term evaluation with a larger number of patients is required the technique has many advantages over others currently available and is sufficiently promising to warrant further investigation.