Biomedical subjects

B Guyuron

Publications and source records attributed to B Guyuron.

At least 55 records · Page 3Linked to original sources

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↗

PubMed1994

Gustatory rhinorrhea--a complication of septoplasty.

A previously unreported complication of septoplasty, which is the profuse flow of thin clear nasal drainage on mastication, is described. Of a combined group of 1332 patients with septoplasty and septorhinoplasty, 6 females and 1 male presented with gustatory rhinorrhea after surgery. The average age of the patients who experienced this complication was 44.43 years. Three patients tested the efficacy of antihistamines, which proved helpful in reducing the severity of this condition. The cause of gustatory rhinorrhea is postulated as inadvertent injury to the nasopalatine nerve within the septal layers after removal of the deviated portion of the vomer and the perpendicular plate of the ethmoid bone during septoplasty. It is the authors' supposition that regenerating nerve sprouts are inappropriately directed toward nasal, rather than palatal, target receptors. Consequently, rhinorrhea results while eating. The pathophysiology of this new finding is not dissimilar to gustatory sweating after parotidectomy. Although this complication is not life-threatening, it is socially disturbing to patients. The authors believe that awareness of this sequela will lead to the discovery of a larger patient population and a potential treatment or prevention.

Adult↗

PubMed1994

The nasolabial fold: a challenge, a solution.

A prominent nasolabial fold results from a combination of relaxation and thinning of the facial skin and selective fat deposits lateral to the fold. The surgical approach described herein has been used to correct the pronounced nasolabial fold for the last 3 years. First, the temple incision is positioned at the anterior hairline rather than in the hair-bearing skin. This permits removal of the maximum amount of skin without concern for posterior transposition of the temple hair, and, more important, it transmits a more effective pulling force to the nasolabial fold due to the more advantageous proximity. Second, a strip of fat is added under the fold in the subcutaneous plane (immediately under the fold) after extensive undermining of the skin through a rhytidectomy flap. Third, removal of the fat lateral to the fold reduces the buccal projection and thereby lends an appearance of flatness. This report covers 35 patients (8 males and 27 females) who underwent this problem-oriented approach with an average follow-up of 23 months. Complications included one localized hematoma (managed conservatively) and one expanding hematoma (which required evacuation). Two incidents of graft dislodgment were discovered early in the study, following which all grafts were fixed to the overlying nasolabial groove with a through-and-through 5-0 catgut suture. Partial resorption of the graft was considered the rationale for undercorrection in 6 patients (17.1 percent). The remaining 29 patients (82.9 percent) had good to excellent results.

Adipose Tissue↗

PubMed1993

Clinical office anesthesia: the use of propofol for the induction and maintenance of general anesthesia.

Ambulatory surgery has become routine for many plastic surgery procedures. Anesthesia techniques including general anesthesia by inhalation and intravenous infusion and the dissociative technique have all been used successfully for outpatient anesthesia. Propofol (Diprivan), a relatively new agent, has proven to be a safe and effective general anesthesia agent for outpatient surgery. We report on our experience with propofol as an induction agent and continuous drip for general anesthesia maintenance in 100 consecutive outpatient, plastic surgery procedures performed in an office facility. Assessment factors were recovery-room time, nausea and vomiting in the recovery room and at home, hallucinations, patients' recollection of anesthesia experience, and overall patient satisfaction.

Ambulatory Surgical Procedures↗

PubMed1993

Causes for cancellation of aesthetic and reconstructive procedures.

Cancellation of plastic surgical procedures has several deleterious effects, including emotional distress and economic ramifications. This prospective study, conducted over a 12-month period in a solo practice, reviewed the factors that contributed to surgical cancellations. Cancellations occurred despite many strict measures such as at least two preoperative visits, in-depth counseling and reinforcement by surgeon and staff, laboratory testing done 2 weeks prior to surgery, detailed evaluation of medical background, extensive written and verbal instructions to avoid medications that adversely affect surgery, and thorough discussion of payment plans and insurance coverage, including predetermination of any third-party coverage. Of the 952 patients (667 males, 285 females) scheduled for surgery, 113 experienced cancellation of the operation, either by the surgeon and staff or by the patient. Cancellations were proportionally fewer in male patients (p < 0.025). The total number of scheduled procedures was 1590 (some patients scheduled for more than one procedure); 727 of these were cosmetic (46 percent), and 863 were reconstructive (54 percent). Of the 205 procedures canceled, cosmetic procedures were more likely to be canceled (p < 0.001), since 123 (16.9 percent) cosmetic procedures were canceled in contrast to 82 (9.5 percent) canceled reconstructive procedures. Because of multiple cancellations, there were a total of 119 cancellations for 113 patients. Thirty of the 113 patients were rescheduled at a later date. Of these 30, 24 did undergo surgery, while 6 canceled for a second time. Thirty-two of the 113 canceled patients (28.3 percent) were patients in their fifth decade of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

G syndrome: a review of the literature and a case report.

In 1969, Opitz et al. reported the first case of G Syndrome (Opitz-Frias Syndrome). They presented their clinical observations on 4 brothers from the 'G Family' who shared a constellation of findings with a generalised tendency to midline defects. Major manifestations of this multiple congenital anomaly syndrome include hypertelorism, prominent forehead, cleft lip and palate, narrow palpebral fissures with epicanthal folds, dysphagia, stridor, laryngotracheal oesophageal clefts, and hypospadias. The most significant manifestation of a midline field developmental defect in these infants is aspiration which poses the greatest threat to life. Urgent evaluation should include a water-soluble contrast oesophagram and aerodigestive endoscopy. In addition to repair of the laryngeal cleft, which occurs in approximately 30% of the cases, a tracheostomy, feeding gastrostomy, and Nissen fundoplication are often needed. We report a male infant born with G. syndrome. BBB Syndrome (Opitz Syndrome) is also discussed which bears a striking resemblance to the G Syndrome; in fact, they may be variants of the same allelic syndrome.

Abnormalities, Multiple↗

PubMed1992

Noncompression unicortical miniplate osteosynthesis of mandibular fractures.

The use of transoral noncompression unicortical miniplates in treating 42 consecutive patients with 64 displaced mandibular fractures (excluding subcondylar) was reviewed. Titanium miniplates (Wurzburg) were used for fixation. The principles set forth by Champy and colleagues, with two plates for body and symphyseal fracture fixation and one plate superiorly along the oblique ridge for angle fractures, were performed. Intermaxillary fixation was not used postoperatively. Results compared favorably with other forms of treatment with no evidence of postoperative malocclusion, with an overall complication rate of 3%. The advantage of no external incision, avoidance of intermaxillary fixation, and normal postoperative incisal opening and occlusion make this technique our treatment of choice.

Adolescent↗

PubMed1992

A comparison of absorbable and nonabsorbable suture materials for skin repair.

This prospective clinical study was conducted to compare the outcome of elective surgical wound repair in the occipital region during rhytidectomy using absorbable and nonabsorbable suture materials. On an alternative basis, 6-0 polypropylene and 6-0 plain catgut were used to repair the incisions on the upper and lower half of the surgical wounds in 80 sites. These sites were then compared for stitch marks, erythema, hypertrophic scars, infection, and wound necrosis. This study revealed slightly visible stitch marks in 4 of 40 (10 percent) sites repaired with catgut and in 10 of 40 (25 percent) sites repaired with polypropylene material (p less than 0.10); however, this was not statistically significant. There were five incidences of suture-site erythema (12.5 percent) noted in the group of catgut repairs in comparison with three incidences (7.5 percent) in the group repaired using polypropylene. Furthermore, there was no statistically significant difference in hypertrophic scarring or infection rate between these groups. The incidence of erythema following repair with catgut was higher, but this was also not statistically significant. Considering these findings, coupled with the avoidance of patient discomfort, suture removal, and time spared for the surgeon and staff when absorbable suture material is used, the superiority of plain catgut over nonabsorbable material becomes evident.

Catgut↗

PubMed1992

Reaction to stainless steel wire following orthognathic surgery.

A patient is reported in whom, following orthognathic surgery, developed a bilateral burning sensation and pain along the masseteric muscles and preauricular region in the sight of the mandibular osteotomy where the lateral segment was tied to the medial segment using a single wire loop. This patient also had previous Kirschner wires used for a metatarsal osteotomy that needed to be removed because of similar symptoms. Removal of the mandibular wires resulted in elimination of the symptoms from the mandibular region as well. The patient's subsequent skin test proved a nickel allergy.

Adult↗

PubMed1992

Problem neck, hyoid bone, and submental myotomy.

Despite significant attention to the cervical region over the last two decades, the hyoid bone has not received deserved recognition. In this report, the anatomy and role of the hyoid bone and suprahyoid muscles in cervicomental morphology are reviewed. From an analysis of cephaloxerograms on 54 patients, it was concluded that on a balanced neck, the most caudal border of the hyoid body is located at or above a line parallel to the Frankfort horizontal line passing through the most caudal border of the mandibular symphysis (menton). Of the muscles that control the position of the hyoid bone, the anterior belly of the diagastric, geniohyoid, and mylohyoid muscles pull the hyoid bone cephalad and anteriorly. The stylohyoid muscles, on the other hand, pull this bone cephalad and posteriorly, while the sternohyoid and omohyoid muscles pull it caudally. Transection of the first three muscles at their attachment to the posterior aspect of the mandible in patients with dysmorphic necks due to caudal and anterior hyoid position will allow posterior and cephalad relocation of this bone, which improves the neck contour. Sixteen patients, with an average follow-up of 27 months, have undergone this procedure, with cervicomental contour improvement in all cases. The degree of improvement ranged from 1 to 5 (5 being excellent): One patient was ranked 1, two patients were ranked 2, two patients were ranked 3, and the rest were ranked 4 or 5. One patient had overcorrection as a result of an aggressive concomitant submental lipectomy. Another patient had central depression in the submental area. None of the patients had difficulties with mandibular movement or swallowing.

Adult↗

PubMed1992

Unpredictable growth pattern of costochondral graft.

Costochondral grafts have gained increasing popularity in reconstruction of the temporomandibular joint and condyle in children. This is a report on the long-term follow-up of eight adolescent patients who underwent reconstruction of the temporomandibular joint and ramus for correction of hemifacial microsomia or trauma-related temporomandibular joint ankylosis during varying periods of growth. Six patients had hemifacial microsomia, and two suffered from posttraumatic temporomandibular joint ankylosis. Average follow-up was 80.4 months. Four patients had excessive growth of the graft, one patient had suboptimal growth, and three patients had no growth. In addition, one patient had undergone four procedures for significant graft overgrowth. Based on this study and review of the literature, we have concluded that the growth pattern of the costochondral graft is extremely unpredictable, ankylosis is a common problem following a temporomandibular joint reconstruction with costochondral graft, and mandibular overgrowth on the grafted site can actually be more troublesome than the lack of growth. Furthermore, maxillary growth is proportionately influenced by vertical mandibular growth of the graft, while the horizontal maxillary growth is not altered. Ankylosis is a result of ossification of the cartilaginous portion and the three-dimensional graft overgrowth, aggressively extending beyond the cartilage graft boundary. Based on this study, we recommend that this procedure be performed only on severe deficiencies. Adequate amounts of soft tissue should be retained between the skull base and the graft, and we further recommend harvesting the graft from the fourth or fifth rib, which may reduce the potential for overgrowth.(ABSTRACT TRUNCATED AT 250 WORDS)

Ankylosis↗

PubMed1992

The role of flaps in the management of contracted eye sockets.

Based on the pathology of the eye socket and periorbital deficiencies, three distinct classes of patients can be recognized: I. Those who solely have eye socket deficiency with normal orbital and periorbital tissue. The suggested surgical treatment for this class of patient would be a skin or mucosa graft. II. Patients who have inadequate lining, as well as orbital volume deficiency. The preferred reconstructive approach includes cartilage (rib or ear) with or without fat graft, and skin or mucosa grafts for eye socket expansion. III. For failed reconstructions of classes I and II or for patients with severe orbital and periorbital deficiencies, the choice is one of three flaps: If the superficial temporal vessels and the postauricular skin is intact, the ideal flap is postauricular fasciocutaneous. If the postauricular skin has previously been used yet the superficial vasculature is intact, a secondary flap is the better choice. In cases where both postauricular skin and superficial temporal vessels have been sacrificed the recommended flap is a free flap with microvascular anastomosis.

Adipose Tissue↗

PubMed1992

Subcutaneous approach to forehead, brow, and modified temple incision.

Placing the incision at the hairline or just posterior to the boundary of the hair, with subcutaneous elevation of the flaps, is a more effective way to correct the aging upper face, whether it be "crow's feet," excess forehead skin, or eyebrow ptosis. Furthermore, by placing the facial rhytidectomy incision at the sideburn boundary caudally and anteriorly, the sideburn can be preserved, regardless of the amount of skin removed. Patient selection and procedure have been described. Patients who are candidates for this type of surgery include those who have a long forehead, a short forehead, deep wrinkles, or thinner skin, as well as patients with deep frown lines and hyperactive corrugator muscles. The scars are generally minimal but can be camouflaged in one of many ways if they are visible. The most effective method is medical-grade tattooing. There are many advantages to the technique, the most important of which is control of forehead length and preservation of sensory and motor nerves. The results are far superior to most other available techniques in properly selected cases. In today's world of aesthetic surgery finesse, those who have expertise with a variety of approaches are more equipped to best serve the patients, and the techniques described here should be part of the aesthetic surgery armamentarium.

Female↗

PubMed1991

Mycobacterial infection following blepharoplasty.

A case of exceedingly rare mycobacterial infection following blepharoplasty is recorded. This nursing home employee underwent a combined blepharoplasty, eyelid ptosis correction, and replacement of breast implants. One month later, she developed localized abscesses of both eyelids. Cultures revealed nontuberculous mycobacterial infection. The infection was controlled after ten months of antibacterial therapy using doxycycline. We believe that the patient's exposure to debilitated individuals due to her nursing profession and the presence of a Jones tube in the right lacrimal system were major contributing factors.

Abscess↗

PubMed1991

The role of lidocaine, epinephrine, and flap elevation in wound healing after chemical peel.

We have observed 5 patients with hypertrophic scarring at the lateral boundaries of the chemically peeled area when circumoral peel was combined with facial rhytidectomy. Some of the potential contributory factors include flap elevation, epinephrine, and lidocaine hydrochloride. To discover whether any one of these three factors or a combination played a role, a rat model study was designed. Initially, 40, 400-gm Sprague-Dawley rats were divided into 4 groups, each comprised by 10 rats. Injections with lidocaine or lidocaine with epinephrine, and chemical peel were done in 2 groups. The same injections were used in the remaining 2 groups together with simultaneous preliminary flap elevations and chemical peeling. After the review of the initial study results, another 40 Sprague-Dawley rats were used to repeat the study and compare on a larger scale the effects of lidocaine with and without epinephrine on the depth of chemical peel. The findings of the rat model studies indicate that preliminary injections with lidocaine containing solution (with or without epinephrine) result in a major delay in healing time. Flap elevation and chemical peeling were associated with major morbidity and mortality in the test rats. The presence of epinephrine in lidocaine solution had no significant role in increasing the delay in the healing process.

Animals↗