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To evaluate the ability of the expanded polytetrafluoroethylene (ePTFE) cervical sling to improve results of surgery on the aging neck in the short term as well as its ability to achieve long-term cosmesis through its secondary adjustability. Design: A retrospective analysis. Setting: A private facial plastic surgery practice. Patients: The first 100 consecutive patients who underwent placement of the ePTFE cervical sling with a minimum follow-up of 36 months. Intervention: Placement of a preplatysmal, mastoidto-mastoid, ePTFE cervical sling sutured to the fascia overlying the insertion of the sternocleidomastoid bilaterally in conjunction with a graded surgical approach appropriate for each patient. This included lipoplasty, midline platysmal plication, and rhytidectomy. Outcome Measures: Aesthetic appearance of the neck was evaluated by comparison of preoperative and postoperative photographs at 1 year. Appraisal of secondary adjustability was similarly assessed 1 month after sling tightening. Patient satisfaction was recorded via self-assessment of both procedures for cosmesis and comfort. Complications specific to sling placement and tightening were reviewed. Results: One year after initial surgery, 85 patients had significant or marked improvement. More than 90% of patients felt that the procedure met or exceeded their cosmetic expectations, while 99 patients felt no residual discomfort. Secondary to rebound tissue relaxation, 9 of 100 patients required sling tightening a mean interval of 14 months after primary surgery. All 9 of these had either a significant or marked improvement, with similarly high patient satisfaction in cosmesis (n=9; 100%) and comfort (n=8; 89%). Two patients had postauricular infections necessitating sling removal. There were no complications with sling tightening. Conclusions: Placement of the ePTFE cervical sling is a safe and effective procedure to aesthetically improve short-term surgical results on the aging neck. By virtue of its secondary adjustability, it offers a safe, long-term solution to rebound tissue relaxation and associated submental laxity.

The failing free flap remains a major problem for the reconstructive surgeon. Many and varied pharmacologic agents have been utilized to reverse the effects of ischemia in these flaps. Treatments have been aimed at inhibiting presumed causative factors in the no-reflow phenomenon. Therapy has generally been single in nature and designed to affect only one of these presumed factors. In this study, several pharmacologic agents were utilized individually or in combination therapy as postischemic washouts, in an effort to attack the multiple causative factors in the no-reflow phenomenon and to improve flap survival in a rat abdominal skin flap model. The treatment agents included lactated Ringer's, superoxide dismutase, and urokinase, with each used independently as a postischemic perfusion washout. Combination therapy utilized an initial postischemic perfusion with urokinase, followed by a second perfusion washout with superoxide dismutase. After 18 hr of primary ischemia, there was increased flap survival in the animals undergoing perfusion washout with either superoxide dismutase alone or with combined urokinase and superoxide dismutase washouts, compared to all other treatments (p < 0.001). It was found that flaps undergoing combined urokinase and superoxide dismutase postischemic perfusion washouts demonstrated significantly improved survival after 20 hr of primary ischemia, compared to all other therapies (p < 0.05). By demonstrating improved survival when a thrombolytic agent is used in conjunction with an oxygen free radical scavenger, these findings may have implications in the treatment of clinically failing free flaps.

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Background: Low back ache, a common orthopedic morbidity caused due to lumbar disc disease. Fenestration discectomy as a surgical procedure is less time consuming, with lesser blood loss, lesser post-operative complications and does not compromise with stability of spine when compared to other procedures. Objectives: To assess the functional outcome in terms of pain relief and the neurological recovery following the procedure of fenestration discectomy among the cases with lumbar disc disease. Methods: Cross sectional study was conducted among the patients admitted with lumbar disc disease in