Bengt Nylén

Early Bone Grafting in Complete Cleft Lip and Palate Cases Following Maxillofacial Orthopedics: I. The Method and the Skeletal Development from Seven to Thirteen Years of Age

The methods of preoperative orthopedics: a T-traction procedure for unilateral clefts and a combined premaxillary pressure and expansion procedure for bilateral clefts and of early alveolar bone grafting: the Nordins four-flap technique, are described in detail. The subsequent effects of treatment according to those methods were studied with roentgencephalometric analysis in cleft patients from 7 to 13 years of age. They were divided into two unilateral and one bilateral complete cleft group, all having been early bone grafted. The unilateral groups were composed of one group of 39 children operated on during the period 1960-65 without preoperative T-traction, and another group, of 46 children, operated on in 1965-72 after preoperative T-traction. The bilateral group included 19 children operated on 1960-72 after preoperative orthopedics. The same degree of inhibited development of the facial skeleton as found in another Swedish early bone grafted cleft group was not present in our patients. The development of the skeletal profile in our bone grafted cases, especially those in the T-traction group, was well within the limits of non-grafted U.S. cases, but differed from non-clefts.

Treatment of Pilonidal Sinus by Radical Excision and Reconstruction by Rotation Flap Surgery Or Z-Plasty Technique

Defects after excision of large pilonidal sinuses were reconstructed by either rotation skin flaps or a Z-plasty technique. Altogether, 16 patients were operated on, 10 with a rotation flap and 6 with a Z-plasty technique. All the patients except one underwent a radical operation. The patient not having a radical operation had a recurrence. Two cases in the Z-plasty groups acquired an infection in the distal part of the wound necessitating reoperation on the resultant sinus. The disability after this more extensive surgery was not more pronounced than after ordinary surgical procedures. For large recurrent pilonidal sinuses, radical excision and primary suturing of the wound using a rotation flap is recommended as the method of choice.

Primary, Early Bone Grafting in Complete Clefts of the Lip and Palate: A Follow-up Study of 53 Cases

Fifty-three patients with complete unilateral and bilateral cleft lip and palate between the ages of 5 1/2 and 13 1/2 years have been followed up. Following preoperative jaw orthopedic treatment, when indicated, these cases were operated with lip closure and bone grafting with four mucoperiosteal flaps as described by Nordin (1960) and Backdahl & Nordin (1961). In the 14 bilateral cases this operation was done in two stages, one side at a time, in this series. At the follow-up, facial appearance, hearing, speech assessment, some facial angles and incidence of crossbites were examined. In the 39 unilateral cleft cases, 80% had an acceptable appearance while 20% needed secondary surgery of the lip and nose as rated independently by four doctors. In the 14 bilateral cases 50% needed secondary operation of the lip and nose. Speech assessment in the bone-grafted group was good or superior to that in a non-bone-grafted group of patients with clefts of the primary and the secondary palate. Open nasality and cons...

Effect of Phentolamine and Propranolol on the Survival of Experimental Skin Flaps

The effect of phentolamine and/or propranolol (alpha- and beta-receptor blocking compounds respectively) on the survival of skin flaps was studied in rats. Phentolamine and/or propranolol were injected intraperitoneally every 12 hours, starting one day before the flap operation, and continued for 5 consecutive days. One week after the operation the survival of the flaps was judged. Systemic treatment with either compound alone or in combination resulted in statistically significant increased survival of the flaps. The results demonstrate that both alpha- and beta-adrenergic receptors influence the survival of skin flaps in rats.

Repair of Incisional Hernias and Defects in the Anterior Abdominal Wall Using Dermal Grafts

The technique and results of using autografts of dermis to repair defects in the anterior abdominal wall is shown. Dermal grafting was used in althogether 15 cases, 7 with extremely large incisional hernias, and 8 with defects after malignant abdominal wall tumours. The surgical method is described and the follow-up 1 to 4 years postoperatively has shown a very satisfactory result in 13 cases. In one case there was a postoperative haematoma with subsequent graft necrosis and in the other there was a residual hernial defect. We recommend this method as one of choice in cases with large abdominal wall defects.

Warm Dry Air Treatment of 345 Patients with Burns Exceeding 20 Per Cent of the Body Surface

Two groups of patients with burns covering more than 20% of the body surface treated in a warm dry environment in two Burn Units in Sweden have been compared. The methods of treatment of the 345 patients were almost identical, using plasma and crystalloid solutions during the period of early intense therapy, use of frequent bathing and early debridement of the necrotic burned tissue and application of homo- or heterograft skin prior to the transplantation of autograft skin. The percentage mortalities in the two groups of patients (15.7% and 20.2%) were not significantly different, neither were the causes of the burn or the cause of death. Combination of the results and probit analysis did however show that treatment in a warm dry environment was associated with a lower rate of mortality in patients with very extensive burns than found in other studies not using these environmental conditions in Sweden prior to 1968 (by the same authors) in the United Kingdom and in the United States of America.

The age factor and reduction of open nasality following superiorly based velo-pharyngeal flap operation in 124 cases.

The improved speech results with special emphasis on the reduction of open nasality has been studied in 124 patients following superiorly based velo-pharyngeal flap operation used as a secondary procedure. This was judged by a listening test and graded on a four-point scale. We conclude from these studies that the best results regarding reduction of open nasality are obtained when the operation is performed around the age of 5 to 6 years. In this study, operative complications were also less frequent in the younger age group than in older patients.

A Clinical Comparison Between Adrenaline and Octapressin as Vasoconstrictors in Local Anaesthesia

In three different test series the local effect of Octapressin® Sandoz in a concentration of 5 I.U./30 ml Xylocaine® Astra was investigated.

Accidental burns with domestic fire-lighting fluid

The use of methyl alcohol (methanol) as an igniting fluid is very dangerous. Nineteen patients (17 males and 2 females), burned while using this fluid for lighting barbecues or filling lamps and stoves, have recently been treated at the Burn Unit at the Karolinska Hospital. A mean of 23% body surface was involved and many of the burns were deep dermal or full thickness. Ninety percent of the patients had facial burns. Hospital stay averaged 23 days with 2.2 operations. It seems that previous alarms ( Nordstr öm & Nyl én, 1975) remain unheeded by both manufacturers and consumers. The public must be warned about the dangers associated with the use of methanol. Briquettes as solid fuel for barbecues and safer ignition fluids ought to be popularized .

Burns Unit in Stockholm: A Report on Patients Treated 1971-1975 for Acute Burn Injuries

A review of 297 burn patients treated 1971--1975 is presented to illustrate burn problems in a West European, mainly urban population. Patients were treated by exposure and warm dry air. Tubbing usually started five days after injury. Sequential wound revisions were performed. Surgical excision was usually delayed until days 14--21. Autografting was performed as soon as possible. For temporary cover homografts were frequently used. The majority of the patients were adults. Twelve per cent were older than 65 years. The patients revealed many social problems. Cardiopulmonary disease, mental disorder and alcohol or drug addiction were fairly common. The most common cause of the burn was fire and a majority of the patients sustained injuries in leisure time. 28% were classified as due to accident. 43% were considered diagnosed in 17 patients (5.7%). Five patients died due to septicemia.