[Our surgical heritage. Pioneers of plastic surgery in the Renaissance (1)].
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Biomedical subjects
Publications and source records attributed to D J Hauben.
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A cutaneous horn (Cornu Cutaneum) is a relatively rare tumour, most often arising on sun-exposed skin in elderly men, usually after the Vth decade. The tumor is often conical, consisting of marked retention of stratum corneum. This lesion can be caused by many primary underlying processes that may be benign, premalignant or malignant, thus the importance of accurate determination of the nature of the conditions at the base of the lesion. Surgery is the treatment of choice. We describe an illustrative case with cutaneous horn of the forearm. We also review various known causes of cutaneous horn and the pertinent literature.
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The surgical technique of using the vastus lateralis as a musculocutaneous flap is described in 5 paraplegic patients. Good padding and closure are provided at the recipient site, and the donor site is closed primarily. This method enables use of other musculocutaneous flaps if required in the trochanteric area.
Liston's background and life during the 19th century are described. Highlights in his career are reviewed in an attempt to provide an understanding of the man and his work. His work and his contributions to plastic surgery are presented.
A procedure is described in which a direct approach to the underlying pathology of the inverted nipple is undertaken. The inverted nipple is raised as desired by freeing it from the surrounding tissue by vertical and horizontal undermining and then is stabilized by purse-string suture. It can be performed as an office procedure under local anesthesia. This procedure is simple, reliable, not time-consuming, leaves no visible scars, and requires no special or bulky dressing.
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The subpectoral approach, better called retropectoral, in breast augmentation procedures has been used in 52 patients with either hypoplastic or ptoticatrophied breasts, with excellent results. Breasts remained soft in all but 1 patient (who disregarded instructions regarding arm activity). Capsular formation was avoided and no lateral displacement when the arms were elevated has been observed. Postoperatively there is a superior bulging of the breast, but this subsides within 4 to 6 weeks and the breast assumes a normal, pleasant contour.
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Repeated postaugmentation capsular formation following retromammary silicone implantation led surgeons to seek an alternative procedure. In 1968 Dempsey and Latham first reported the "subpectoral" route for location of the implant. Since then little data has been published comparing retromammary and retropectoral breast augmentation. The aim of this study is to compare the two procedures in terms of various factors affecting the physical and emotional well-being of the breast-augmented patient; breast firmness (according to Baker's classification), patient approval, the surgeon's judgment, and the husband's or partner's evaluation are all weighed. The study included 40 patients, 20 of whom underwent retromammary augmentation, the remaining 20 retropectoral augmentation. All 40 responded to a questionnaire designed to elicit comparative data. A detailed analysis of the results was made, leading to the following conclusions: first, patient approval was largely the same in the two groups, although slightly higher in the retropectoral group. However, both surgeons and husbands preferred the retropectoral method of prosthesis insertion.
Skin graft procedures had already been performed prior to Reverdin's great discovery. Skin grafting apparently originated with the Hindus 3,000 years ago, but until the beginning of the nineteenth century only a few trials were reported. In the first half of the nineteenth century, skin graft procedures were done by Baronio, Cooper, Bünger, and Dieffenbach. Bert's experimental work in 1963 opened the way for the pioneers Reverdin, Ollier, Wolfe, and Thiersch, who contributed the free skin graft.
The authors have investigated the constituents of fresh frozen plasma stored in citrate phosphate dextrose (CPD) at -20 degrees C. The results indicate abnormal characteristics of several of the constituents, whereas some others remain within normal values. This is attributed to preparation procedures with the addition of a CPD solution. Fresh frozen plasma being hyperosmolal, hypernatremic, hyperglycemic, hyperphosphatemic, normokalemic and containing normal values of protein, calcium, magnesium, and water carries a clinical implication for the physician as a guide for the treatment of the critically ill patient when large amounts of plasma are needed.