The primary restoration of traumatically amputated digits is now routinely possible through the u... more The primary restoration of traumatically amputated digits is now routinely possible through the use of microvascular and microneural surgical techniques. The anatomy of the scalp, penis, ear, and nose makes them suitable subjects for application of these techniques. It has been the belief of many authors, as summarized by Grabb and Dingman, that venous congestion is the usual explanation for failure of replanted tissue without microsurgical repairs. Unsuitable veins of small caliber and venous congestion remain as the bane of the microsurgeon. The relative infrequency of these amputations makes it necessary to continue careful study of all reports regarding their microsurgical replantation. There is every reason to believe that increased surgical experience will result in more favorable outcomes.
Introduction: To evaluate the utility of a Web-based educational tool for women who have had or w... more Introduction: To evaluate the utility of a Web-based educational tool for women who have had or who are considering breast augmentation. Materials and Methods: A definitive Web-based resource, http://www.breastimplantcare.com , was developed for use by patients and physicians, which summarizes, in lay terminology, contemporary, evidence-based information for decision-making and long-term follow-up regarding breast augmentation. Urchin Web analytics v.5.7.03 data and Google Analytics for Web site traffic reporting were analyzed. Results: Over a 1-year period, the Web site received over 12 800 hits. Within 6 months, there were 2548 unique visitors. The number of daily visitors has ranged from 12 to 71. The average visitor looks at 5 to 6 pages of the site. Monitoring Your Implants is the most popular page viewed. Patients have contacted this site from a wide geographic area looking for immediate postoperative advice and for help with long-term problems. Those with immediate postoperat...
Background: Cosmetic breast augmentation is one of the most commonly performed cosmetic procedure... more Background: Cosmetic breast augmentation is one of the most commonly performed cosmetic procedures in the United States. Known complications have been described; however, there is a paucity of evidence-based data accurately characterizing the time frame for corrective measures and types of reoperative procedures required. This study aims to assess types of complications, define time to adverse events requiring intervention, and characterize types and frequency of operative interventions required over the life of patients receiving implants. Methods: Fifty-six consecutive patients undergoing revision procedures after initial cosmetic breast augmentation from January 2002 through December 2006 were identified from an institutional billing database. Procedures were performed at a single surgical center by surgeons (n = 5) board-certified in plastic and reconstructive surgery. A retrospective review of hospital records, operative sheets, pathology records, nursing notes, and office char...
Contraction is an important phenomenon in wound repair and hypertrophic scarring. Studies indicat... more Contraction is an important phenomenon in wound repair and hypertrophic scarring. Studies indicate that wound contraction involves a specialized cell known as the myofibroblast, which has morphologic characteristics of both smooth muscle and fibroblastic cells. In order to better characterize the myofibroblast, the authors have examined its cytoskeleton and surrounding extracellular matrix (ECM) in human burn granulation tissue, human hypertrophic scar, and rat granulation tissue by indirect immunofluorescence. Primary antibodies used in this study were directed against 1) smooth muscle myosin and 2) nonmuscle myosin, components of the cytoskeleton in smooth muscle and nonmuscle cells, respectively, and 3) laminin and 4) fibronectin, extracellular glycoproteins mediating cell-matrix attachment in smooth muscle and nonmuscle cells, respectively. Myofibroblasts can be identified by their intense staining of actin bundles with either anti-actin antibody or NBD-phallacidin. Myofibroblas...
Individuals over 60 and children under 2 form the two most burn-prone age groups in the United St... more Individuals over 60 and children under 2 form the two most burn-prone age groups in the United States. These figures are confirmed in other western cultures. The majority of injuries sustained in these two groups are preventable and relate to inadvertent scalding from hot water at the tap or spilled liquids in the kitchen and ignition of fabrics by faulty heaters or cigarettes. These injuries among the elderly lead to permanent change in health care status in over 40% of such accidents, and their prevention could significantly reduce morbidity associated with aging. Recommendations to promote burn prevention include reducing the temperature of hot water at the tap, introducing self-extinguishing cigarettes, and placing smoke detectors in all residences.
A computerized data base for collecting information on patients with pressure ulcers was develope... more A computerized data base for collecting information on patients with pressure ulcers was developed following a review of selected literature including Allman (1986), Bergstrom (1987), Barbenel (1977), Reichert (1986), Black (1987) and others. The data base was piloted, revised, and used for data collection on 103 patients admitted to two hospitals. Standardized data allowed for correlations of spinal cord injury (SCI) and location of pressure ulcers. Sacral ulcers were more prevalent with patients who had SCI at C4-T1 while ischial ulcers were more common with SCI at T11-L1. Some of the other correlations differ from prior research and warrant further investigation with a larger sample size from multiple institutions.
No clear data exist as to the efficacious use of antibiotics during the perioperative period for ... more No clear data exist as to the efficacious use of antibiotics during the perioperative period for repair of pressure ulcers. Results of a survey from 50 university departments of plastic surgery and spinal cord injury centers revealed that 58% reported routine use of antibiotics for flap surgery with cephalosporins as the choice at 69% of the centers. Clinical experience with 35 patients perioperatively showed good results with a third generation cephalosporin.
This paper presents the use of the expanded myocutaneous flap for the reconstruction of the diffi... more This paper presents the use of the expanded myocutaneous flap for the reconstruction of the difficult pressure ulcer. The results of expanded myocutaneous flaps on 10 patients with a variety of locations of pressure ulcers showed few complications. A review of the literature on the use of expanded flaps indicates the potential for this technique to be more frequently used.
Ethical and psychosocial considerations in caring for patients with pressure ulcers are explored ... more Ethical and psychosocial considerations in caring for patients with pressure ulcers are explored in relation to the consequential and the nonconsequential schools of ethical thought. The principles of ethical decision making are related to wound management in terms of beneficence, nonmaleficence, justice, veracity and confidentiality, autonomy and liberty. Allocation of scarce resources and the conduct of research influence ethical decision making in wound management.
On a path analogous to other surgical disciplines, the progression of facial cosmetic surgery has... more On a path analogous to other surgical disciplines, the progression of facial cosmetic surgery has trended toward shorter scars and less invasive techniques. This article outlines an approach to facelifting that limits the scar to the temporal scalp, preauricular area, and retroauricular sulcus. It will enable the reader to identify those patients who are candidates for a less invasive procedure compared with the conventional facelift approach. Specifically, the temporal facelift addresses the lateral brow, the middle one third of the face, and the upper neck. In addition, this article examines the various and current methods for treatment of the glabellar area of the forehead. Medical and surgical options are outlined for the correction of those rhytids induced by corrugator and procerus muscle activity.
The primary restoration of traumatically amputated digits is now routinely possible through the u... more The primary restoration of traumatically amputated digits is now routinely possible through the use of microvascular and microneural surgical techniques. The anatomy of the scalp, penis, ear, and nose makes them suitable subjects for application of these techniques. It has been the belief of many authors, as summarized by Grabb and Dingman, that venous congestion is the usual explanation for failure of replanted tissue without microsurgical repairs. Unsuitable veins of small caliber and venous congestion remain as the bane of the microsurgeon. The relative infrequency of these amputations makes it necessary to continue careful study of all reports regarding their microsurgical replantation. There is every reason to believe that increased surgical experience will result in more favorable outcomes.
Introduction: To evaluate the utility of a Web-based educational tool for women who have had or w... more Introduction: To evaluate the utility of a Web-based educational tool for women who have had or who are considering breast augmentation. Materials and Methods: A definitive Web-based resource, http://www.breastimplantcare.com , was developed for use by patients and physicians, which summarizes, in lay terminology, contemporary, evidence-based information for decision-making and long-term follow-up regarding breast augmentation. Urchin Web analytics v.5.7.03 data and Google Analytics for Web site traffic reporting were analyzed. Results: Over a 1-year period, the Web site received over 12 800 hits. Within 6 months, there were 2548 unique visitors. The number of daily visitors has ranged from 12 to 71. The average visitor looks at 5 to 6 pages of the site. Monitoring Your Implants is the most popular page viewed. Patients have contacted this site from a wide geographic area looking for immediate postoperative advice and for help with long-term problems. Those with immediate postoperat...
Background: Cosmetic breast augmentation is one of the most commonly performed cosmetic procedure... more Background: Cosmetic breast augmentation is one of the most commonly performed cosmetic procedures in the United States. Known complications have been described; however, there is a paucity of evidence-based data accurately characterizing the time frame for corrective measures and types of reoperative procedures required. This study aims to assess types of complications, define time to adverse events requiring intervention, and characterize types and frequency of operative interventions required over the life of patients receiving implants. Methods: Fifty-six consecutive patients undergoing revision procedures after initial cosmetic breast augmentation from January 2002 through December 2006 were identified from an institutional billing database. Procedures were performed at a single surgical center by surgeons (n = 5) board-certified in plastic and reconstructive surgery. A retrospective review of hospital records, operative sheets, pathology records, nursing notes, and office char...
Contraction is an important phenomenon in wound repair and hypertrophic scarring. Studies indicat... more Contraction is an important phenomenon in wound repair and hypertrophic scarring. Studies indicate that wound contraction involves a specialized cell known as the myofibroblast, which has morphologic characteristics of both smooth muscle and fibroblastic cells. In order to better characterize the myofibroblast, the authors have examined its cytoskeleton and surrounding extracellular matrix (ECM) in human burn granulation tissue, human hypertrophic scar, and rat granulation tissue by indirect immunofluorescence. Primary antibodies used in this study were directed against 1) smooth muscle myosin and 2) nonmuscle myosin, components of the cytoskeleton in smooth muscle and nonmuscle cells, respectively, and 3) laminin and 4) fibronectin, extracellular glycoproteins mediating cell-matrix attachment in smooth muscle and nonmuscle cells, respectively. Myofibroblasts can be identified by their intense staining of actin bundles with either anti-actin antibody or NBD-phallacidin. Myofibroblas...
Individuals over 60 and children under 2 form the two most burn-prone age groups in the United St... more Individuals over 60 and children under 2 form the two most burn-prone age groups in the United States. These figures are confirmed in other western cultures. The majority of injuries sustained in these two groups are preventable and relate to inadvertent scalding from hot water at the tap or spilled liquids in the kitchen and ignition of fabrics by faulty heaters or cigarettes. These injuries among the elderly lead to permanent change in health care status in over 40% of such accidents, and their prevention could significantly reduce morbidity associated with aging. Recommendations to promote burn prevention include reducing the temperature of hot water at the tap, introducing self-extinguishing cigarettes, and placing smoke detectors in all residences.
A computerized data base for collecting information on patients with pressure ulcers was develope... more A computerized data base for collecting information on patients with pressure ulcers was developed following a review of selected literature including Allman (1986), Bergstrom (1987), Barbenel (1977), Reichert (1986), Black (1987) and others. The data base was piloted, revised, and used for data collection on 103 patients admitted to two hospitals. Standardized data allowed for correlations of spinal cord injury (SCI) and location of pressure ulcers. Sacral ulcers were more prevalent with patients who had SCI at C4-T1 while ischial ulcers were more common with SCI at T11-L1. Some of the other correlations differ from prior research and warrant further investigation with a larger sample size from multiple institutions.
No clear data exist as to the efficacious use of antibiotics during the perioperative period for ... more No clear data exist as to the efficacious use of antibiotics during the perioperative period for repair of pressure ulcers. Results of a survey from 50 university departments of plastic surgery and spinal cord injury centers revealed that 58% reported routine use of antibiotics for flap surgery with cephalosporins as the choice at 69% of the centers. Clinical experience with 35 patients perioperatively showed good results with a third generation cephalosporin.
This paper presents the use of the expanded myocutaneous flap for the reconstruction of the diffi... more This paper presents the use of the expanded myocutaneous flap for the reconstruction of the difficult pressure ulcer. The results of expanded myocutaneous flaps on 10 patients with a variety of locations of pressure ulcers showed few complications. A review of the literature on the use of expanded flaps indicates the potential for this technique to be more frequently used.
Ethical and psychosocial considerations in caring for patients with pressure ulcers are explored ... more Ethical and psychosocial considerations in caring for patients with pressure ulcers are explored in relation to the consequential and the nonconsequential schools of ethical thought. The principles of ethical decision making are related to wound management in terms of beneficence, nonmaleficence, justice, veracity and confidentiality, autonomy and liberty. Allocation of scarce resources and the conduct of research influence ethical decision making in wound management.
On a path analogous to other surgical disciplines, the progression of facial cosmetic surgery has... more On a path analogous to other surgical disciplines, the progression of facial cosmetic surgery has trended toward shorter scars and less invasive techniques. This article outlines an approach to facelifting that limits the scar to the temporal scalp, preauricular area, and retroauricular sulcus. It will enable the reader to identify those patients who are candidates for a less invasive procedure compared with the conventional facelift approach. Specifically, the temporal facelift addresses the lateral brow, the middle one third of the face, and the upper neck. In addition, this article examines the various and current methods for treatment of the glabellar area of the forehead. Medical and surgical options are outlined for the correction of those rhytids induced by corrugator and procerus muscle activity.
Uploads