Biomedical subjects

B Guyuron

Publications and source records attributed to B Guyuron.

At least 37 records · Page 2Linked to original sources

PubMed1996

The role of DDAVP (desmopressin) in orthognathic surgery.

Desmopressin (1-deamino-8-D-argininevasopressin, DDAVP) is a synthetic analog of the antidiuretic hormone L-argininevasopressin. DDAVP has been shown to increase the plasma concentration of endothelial factor VIII, thus increasing coagulant activity. There is evidence from controlled clinical trials indicating that DDAVP can reduce blood loss and transfusion requirements for individuals with normal coagulation profiles undergoing various surgical procedures. This study was conducted to evaluate the efficacy of the DDAVP in reduction of blood loss during orthognathic surgery. Twenty patients, 15 females and 5 males, undergoing bimaxillary osteotomy were randomized into two groups of ten. Perioperatively, group 1 patients received 20 micrograms of DDAVP infused over one-half hour. Group II patients did not receive DDAVP. Hypotensive anesthesia (mean arterial pressure < 60 mm Hg) was routinely employed for both groups. On average, the blood loss in group I patients was 144 ml less per patient than group II patients (p < 0.50). Only 2 of 10 patients in group I lost in excess of 750 ml, while 6 to 10 group II patients experienced blood loss greater than 750 ml (p < 0.20). The average postoperative hematocrit for patients in group I dropped by 6.17 of the preoperative mean hematocrit (p < 0.001). The average drop in hematocrits among the group II patients was 11.61 (p < 0.001). When collated, this hematocrit drop of 11.61 for group II and 6.17 for group I (recipients of DDAVP) proved to be significantly different (p < 0.01). It is concluded from this study that patients receiving a standard dose of DDAVP prior to bimaxillary osteotomy would experience reduced intraoperative blood loss, providing that blood pressure is well controlled and fluid replacement is carefully managed. No significant adverse side effects of desmopressin acetate were observed.

Blood Loss, Surgical↗

PubMed1996

Comparison of polydioxanone and polyglactin 910 in intradermal repair.

A prospective clinical study was undertaken to compare the results of intradermal layer closure using two popular absorbable suture materials, polydioxanone and polyglactin 910. On an alternating basis, 6-0 polydioxanone and 6-0 polyglactin 910 were used to repair 80 surgical sites of the temple and occipital regions in 20 patients undergoing facial rhytidectomy. In all instances, the superficial skin layer was repaired with 6-0 plain catgut. These sites were evaluated by a double-blind method for erythema, induration, infection, scar spread, and hypertrophic scarring at approximately 5 months and at least 1 year postoperatively. Scar spread was indicated at widths greater than 1 mm. Any raised scar was labeled hypertrophic. Scar spread, as defined above, was observed in 6 of 38 incisions repaired with polyglactin 910, and 3 sites developed scar hypertrophy. Conversely, 3 of 38 incisions closed with polydioxanone revealed scar spread (p < 0.25), and 3 were hypertrophic (p < 0.35). Sixty-one sites healed with undiscernible scars. This study does not disclose any statistically significant difference in the quality of the scars when polyglactin 910 is used compared with polydioxanone.

Cicatrix↗

PubMed1996

Dynamic interplays during rhinoplasty.

One of the complicating factors in rhinoplasty procedures is its intricate dynamics. Not only is there a complex interaction between the soft tissue and nasal bone frame on each nasal zone, there is an intriguing interaction between the different zones of the nose and the surrounding facial structures. Understanding these interplays is mandatory to proper design and execution of the aesthetic surgical plans. This article has covered the dynamic effects that occur along the different nasal zones, elucidated the control that the nasal frame has on the soft tissue, and reviewed the different ways in which the intended aesthetic objectives can be obtained.

Esthetics↗

PubMed1996

Alar base abnormalities. Classification and correction.

Abnormalities of the alar base may be a consequence of base deformities, a secondary result of reduction of nasal base projection, or a consequence of maxillary abnormalities. A thorough clinical observation coupled with information procured from the analyzed lifesized photographs provides a consistent method for the evaluation of the alar base and the structures that affect its position. A critical step in choosing the surgical technique for correction is the classification of abnormalities. A systemic approach to such a classification is presented in this article and is accompanied by a description of the dynamic changes and optimal surgical procedures that would best benefit patients within each category.

Congenital Abnormalities↗

PubMed1995

Use of a rectus abdominis osteomyocutaneous double island flap based on internal mammary vessels.

A very rare condition of osteoma cutis was presented by a patient who required an unusual solution to an unusual problem. Multiple surgical procedures were performed during the treatment of the disease, thereby prohibiting the use of more common regional or distant flaps to achieve successful mandibular reconstruction. Microvascular tissue transfer was also not feasible because of two previously-failed free flaps and an operative field that was densely fibrotic. A pedicled rectus abdominis myocutaneous flap with incorporated vascularized rib graft is described as a last resort approach for simultaneous reconstruction of the mandible and oral soft tissue.

Adult↗

PubMed1995

Blepharolabioanal syndrome.

A previously unreported syndrome of congenital craniofacial and anorectal anomalies affecting a woman and her two daughters is described. Features include bilateral cleft lip, cleft palate, bilateral upper and lower lid lag, and imperforate anus. The findings are consistent with an autosomal dominant pattern of inheritance. There were no identifiable intrauterine fetal insults. A detailed description of these anomalies, the subsequent surgical corrections, and a discussion of previously unreported syndromes with isolated features are the subject of this report.

Abnormalities, Multiple↗

PubMed1995

Medical-grade tattooing to camouflage depigmented scars.

Scars are apparent, in part, as a result of the loss of cutaneous pigments. This disfigurement can be concealed successfully with medical-grade tattooing. This treatment was evaluated on 39 scars in 18 patients. The procedure was performed under local anesthesia on an outpatient basis, unless carried out in conjunction with other procedures. The medical-grade tattooing dye was selected during the initial consultation to match the skin color in a natural light ambiance. An electric tattooing machine was used to implant the medical-grade dye in the dermis. Successful concealment of the depigmented scars was achieved subsequent to the first procedure in all but 4 patients. Two of the 4 patients exhibited inadequate camouflage of scars, and 2 were judged to have excess pigmentation following treatment. Both these conditions required revision.

Adolescent↗

PubMed1995

Corrugator supercilii muscle resection through blepharoplasty incision.

Corrugator supercilii muscle resection through an upper blepharoplasty incision, with or without concomitant blepharoplasty, is suitable for patients who have significant corrugator hyperactivity and deep frown lines without eyebrow or forehead ptosis. This procedure is also appropriate for patients who decline a forehead rhytidectomy. After infiltration of local anesthesia with intravenous sedation, skin and fat are excised when a concurrent blepharoplasty is planned. The plane between the orbicularis oculi muscle and the orbital septum is dissected until the corrugator supercilii muscle is exposed. This muscle is identified immediately cephalad to the medial half of the superior orbital rim. The muscle is resected carefully to prevent injury to the supratrochlear nerve medially and the supraorbital nerve laterally. The resultant depression is eliminated with fat removed during the blepharoplasty, or fat or dermis from other sites should the aesthetic plan not include eyelid surgery. Eight patients, seven females and one male, underwent this procedure. The follow-up period ranged from 11 to 19 months, with a mean of 14.5 months. Patients' ages ranged from 25 to 66 years, with a mean of 51.3 years. A scale of 1 to 5, with 5 being excellent, was used to rate postoperative appearance, producing a mean of 4.25. The advantages of fewer skin incisions, less tissue mobilization, and a direct approach to the origin of the problem make this procedure a valuable adjunct to the cosmetic surgery armamentarium.

Adult↗

PubMed1995

The armamentarium to battle the recalcitrant nasolabial fold.

The nasolabial fold is the consequence of thinning of the skin, ptosis or deposition of fat laterally, and presence of excess skin. The ideal procedure for combatting this defiant and undesirable aging change would be to eliminate the excess skin, add to the thickness of the skin under the crease, and shield the bands from adherence to the dermis, with or without repositioning or resection of the fat laterally. However, under particular conditions, the patient or physician may choose alternative techniques. These include injection of fat, addition of fat graft, or direct excision. Patients with extremely thin skin are better candidates for direct excision, whereas those with thicker skin may more suitably benefit from fat injection or fat graft.

Adipose Tissue↗

PubMed1995

The chin: skeletal and soft-tissue components.

The quantity of soft tissue overlying the symphysis menti affords an important attribute that can aid in determination of the correct surgical approach for optimal facial harmony. Xerograms of the facial profile of 100 patients with normal occlusion were analyzed by accepted radiographic cephalometric techniques. The relative contribution of skeletal structures and soft tissue of the chin was evaluated. All linear measurements were noted to be larger in males than in females, but in both groups, facial features were in proportion. In both males and females, the average thickness of the soft tissue overlying the symphysis menti progressively increased from the B point to midway between the B point and the pogonion. The soft tissue at the pogonion was thinner than at the B point. The soft tissue over the chin in males was significantly thicker than in females in all areas measured. When compared with patients over 60 years of age, the soft tissue at the B point was significantly thinner in patients 50 years of age and younger (p = 0.005), while the soft tissue at the pogonion was significantly thinner in patients 40 years of age and younger (p = 0.04). Pseudomacrogenia was noted in 6 percent of the patients, a diagnosis only possible with cephalometric analysis. An understanding of the relative contribution of the soft tissue to the chin can aid in the diagnosis and appropriate surgical management of chin incongruity. Furthermore, there is significant variation in skin thickness, which will influence the soft-tissue response to skeletal alteration. This has to be considered in planning a predictable surgical result.

Adolescent↗

PubMed1994

Management of intraoperative nasal septal tears and perforations.

An organized technique for managing intraoperative septal tears was developed based on 98 patients who endured septal tears. Small nonopposing perforations are allowed to heal spontaneously. Opposing tears, with sizes varying from less than 1 cm to greater than 2 cm, are repaired first on one side of the mucoperichondrium with the reinsertion of a straight piece of septal cartilage; the other side of the mucoperichondrium is then repaired.

Female↗

PubMed1994

The fate of fresh and preserved, noncrushed and crushed autogenous cartilage in the rabbit model.

This study was conducted to investigate volume retention and chondrocyte survival rate in autogenous fresh noncrushed, fresh crushed, preserved noncrushed, and preserved crushed cartilage grafts in rabbits. During the first phase of this investigation, cartilage was harvested from the right ear of 20 New Zealand white rabbits, then preserved. Four months later during the second phase, two 6-mm discs of previously harvested and preserved cartilage, one crushed and one noncrushed, were applied to the right ear. At the same time, two 6-mm discs of fresh cartilage graft were harvested from the left ear and then placed at a higher level on the same side, one crushed and one noncrushed. Three months after implantation, the rabbits were sacrificed and the grafts were evaluated. The preserved noncrushed cartilage retained 91.34% of the volume (SD = 2.46). Although most of the chondrocytes were nonviable, vascular ingrowth occurred with a significant repopulation of chondrocytes peripherally, in association with vascular endothelial ingrowth. The preserved crushed cartilage retained 74.19% of the volume (SD = 3.06). Most of the original chondrocytes were lost, but vascular ingrowth did occur and some osteoid formation occurred on the crushed cartilages. All chondrocytes on the fresh noncrushed cartilage grafts were viable and the grafts retained 94.54% of the volume (SD = 2.46). Crushed fresh cartilage retained 69.73% of its volume and the amount of viable chondrocytes ranged from 70% to 90% in the specimens evaluated (SD = 5.15). Although there is no question that noncrushed cartilage is superior, crushed cartilage can be used with a fair degree of predictability to attain the aesthetic goal.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1994

The role of preserved autogenous cartilage graft in septorhinoplasty.

Previous reports have established the role of fresh autogenous cartilage grafts harvested at the time of surgery. This report describes the value of autogenous preserved cartilage, removed and stored at the time of initial surgery, for use in secondary surgery. This study also compares fresh and preserved cartilage used in crushed and noncrushed states in secondary rhinoplasties. From 1983 to 1990, 256 of 1,185 patients who had undergone septorhinoplasty required a revision procedure. Cartilage graft was used in 186 (72.7%) patients. Cartilage removed during the primary surgery was stored in a saline and antibiotic solution at 0 degree F to 2 degrees F. The average time interval from primary to secondary surgery was 11.97 months (SD, 10.63 mo). Follow-up after graft placement averaged 44.71 months (SD, 26.21 mo). Two hundred seventy-seven pieces of cartilage were used, consisting of 16 noncrushed fresh, 136 crushed fresh, 8 noncrushed preserved, and 117 crushed preserved. Graft success rate was 93.8% for noncrushed fresh cartilage grafts, 87.5% for crushed fresh, 87.5% for noncrushed preserved, and 85.5% for crushed preserved graft. We conclude that preserved autogenous cartilage retains almost as much graft volume as fresh cartilage in rhinoplasties and eliminates the need for harvesting a graft. Cartilage removed during nasal surgery, particularly when a septoplasty is being performed, is valuable and should be stored for possible later use.

Adult↗

PubMed1994

von Willebrand's disease and plastic surgery.

Von Willebrand's disease (VWD) is the most commonly inherited coagulopathy. In a group of 1,000 plastic surgery patients, 8 or 9 individuals are affected by this disease, making basic knowledge of VWD and its management imperative. In this investigation, 1,000 plastic surgery patients were studied for details of their clinical evaluation, history of bleeding and bruising, and excessive bleeding during or after surgery. If the patient reported a history of easy bleeding or bruising, in addition to routine coagulation studies such as PT, PTT, and platelet count, the bleeding time was measured. When the index of suspicion dictated, more extensive coagulation studies, such as factor VIII assay, were conducted. This resulted in the detection of VWD in 9 patients (8 female and 1 male). All patients had a positive history of easy bleeding or bruising. Six of the 9 patients had a bleeding time greater than 6 minutes. Seven patients were diagnosed to have VWD type I, 1 had type II-a, and 1 suffered from type II-b disease. Perioperative bleeding was controlled in all patients in this study with the administration of 0.3 microgram/kg of body weight (usually a total dose of 20 micrograms) of 1-deamino-8-D-arginine-vasopressin intravenously every 12 hours for the first 24 hours. Two patients with type II VWD required fresh frozen plasma and cryoprecipitate 1 week subsequent to surgery to control late bleeding.

Adolescent↗

PubMed1994

A comparison of different suture techniques for microvascular anastomosis.

Of the various techniques known, simple interrupted sutures remain the gold standard in the microanastomosis of vessels. Tying many knots, however, is time consuming. This may be of more significance with tissue such as the jejunum, which is significantly effected by ischemia time, or when several vessels are to be anastomosed. In this study, 60 femoral arteries of rabbits were divided into three equal groups. The arteries were then divided and repaired using simple interrupted, simple continuous, and continuous locked sutures. Application of the Bonferroni t-test revealed that both groups of arteries repaired using continuous sutures exhibited a statistically significant (p < 0.02) reduction in anastomosis time (50%) compared with interrupted suture techniques. However, there also was a 45% incidence of reduction in flow (9 of 21 anastomoses) when the simple running suture technique was utilized, giving the running locked suture unquestionable superiority.

Anastomosis, Surgical↗

PubMed1994

Does rhinoplasty make the nose more susceptible to fracture?

This study was conducted to investigate the vulnerability of the nasal bones following rhinoplasty. The incidence of nasal bone fracture in the general population was reviewed from the data available from the National Center for Health Statistics (NCHS). The NCHS report indicates an average of 51,200 nasal bone fractures each year for an average yearly population of 239,328,200 over a 5-year period for the United States, producing an average rate of 0.021 percent per year. The history of 1121 patients who had undergone routine rhinoplasty or septorhinoplasty on an elective basis was then investigated for possible fractures following rhinoplasty. Of this group, 24 patients (16 females and 8 males) sustained a total of 28 nasal bone fractures following rhinoplasty over a mean follow-up period of 4 years. This yields an actual or crude rate of 0.624 percent per year, as compared with the age-standardized rate of 0.485 percent, according to the indirect adjustment method. The time interval between the first nasal procedure and subsequent fracture varied greatly, spanning from 1 month to 6 years. The average time interval between the first nasal procedure and the subsequent fracture for 16 patients was less than 1 year. Over 70 percent of the patient population (n = 17) who sustained post-rhinoplasty fracture were under 30 years old at the time of the fracture. On the basis of the study, it was concluded that the incidence of nasal bone fracture following rhinoplasty (0.624 percent actual and 0.485 percent adjusted) is higher than that of fracture in the general population (0.021 percent) (p < 0.001).

Adolescent↗

PubMed1994

Aesthetic indications for botulinum toxin injection.

A clinical trial was undertaken to evaluate the effects of commercially available botulinum toxin on 14 hyperactive corrugator muscles, 14 procerus muscles, one case of congenital aplasia of the depressor labii inferioris muscle, and one case of iatrogenic injury to the ramus mandibularis branch of the facial nerve with paralysis of the depressor labii and mentalis muscles. Of the 31 muscles injected, 28 were appropriately paralyzed with the initial injection. The desired results were obtained in the 3 remaining muscles following a second injection. The ability to frown was nullified in all subjects, resulting in the elimination of glabellar lines. Facial symmetry was achieved in both patients with muscle imbalance. The average duration of the paralysis was 8 weeks, with a range of 2 to 16 weeks. However, this period was prolonged in the latter part of the study with an adjustment of the toxin dose. Our results demonstrate that botulinum toxin injected into overactive facial muscles does produce a predictable and reversible paralysis and eliminates or ameliorates deep frown lines. We also illustrate its use in achieving facial symmetry in one patient with congenitally absent depressor labii inferioris and platysma muscles and in another with postrhytidectomy facial nerve paralysis.

Adult↗

PubMed1994

Oculonasal synkinesis.

A phenomenon the authors have termed oculonasal synkinesis has been observed in 13 individuals in two independent practices. This complex presents as simultaneous contraction of the orbicularis oculi and the compressor narium minor muscles. When the patient blinks, the compressor narium minor muscle contracts, causing depression of the ala. Its etiology is postulated as the formation of anomalous connections between the temporal and zygomatic branches of the facial nerve, innervating the orbicularis oculi muscle, and the buccal branches of the facial nerve, innervating the compressor narium minor muscle. All 13 individuals who exhibited this phenomenon are female. This anomaly was displayed bilaterally in 7 patients, on the right side in 2 patients, and on the left side in 4 patients. A 2-month-old daughter of one of the patients who had bilateral presentation, also displayed the phenomenon. In 6 patients who underwent rhinoplasty, resection of the compressor narium minor muscle resulted in complete elimination of the abnormal muscle movement. The plastic surgeon who performs rhinoplasty should be cognizant of the synkinesis and discuss its presence with the patient, since a patient may consider this a surgical sequela upon discovering the condition postoperatively. Furthermore, this unintentional muscle function is aesthetically displeasing.

Adolescent↗