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Biomedical subjects

E H Caldwell

Publications and source records attributed to E H Caldwell.

13 recordsLinked to original sources
PubMed2000

Secondary reduction mammaplasty: is using a different pedicle safe?

Reduction mammaplasty is a frequently performed procedure and one with consistent patient satisfaction. Few patients present for revisional procedures, and even fewer present for a secondary or repeated reduction mammaplasty. This study defines secondary reduction mammaplasty as performing an additional reduction using a pedicled nipple-areola complex. Few reports of secondary reduction are found in the literature. Operative guidelines for secondary reduction mammaplasty have been published recently. However, the experience of others has differed from these guidelines, and herein is presented another experience with secondary reduction mammaplasty. Ten cases of secondary reduction over a 37-year period were identified and reviewed. The initial reductions were performed using six different techniques. An average of 307 g of tissue per breast (range, 130 to 552 g) was removed at the initial operations. The secondary reductions were performed using four different techniques, and an average of 458 g of tissue per breast (range, 147 to 700 g) was removed at the secondary operations. Three of the 10 patients underwent initial and secondary reduction with the same technique. An average of 4 years (range, 1 to 10 years) separated these surgeries. Seven of the 10 patients underwent initial and secondary reductions with different technique. An average of 15 years (range, 5 to 19 years) separated these procedures. There was an average 5-year follow-up (range, 1 to 20 years) in this series. Four of the 10 patients experienced self-limiting complications after secondary reduction, including delay in wound healing, delay in the return of nipple sensitivity, and mild fat necrosis. Three of the four patients with complications had undergone secondary reduction with a different pedicle technique. No significant or long-lasting skin, pedicle, or nipple-areola complex compromise was found after secondary reduction mammaplasty. In contrast to the recently published guidelines, this study demonstrates that secondary reduction mammaplasty is a safe and viable option when performed with either similar or different technique. This finding allows secondary reduction mammaplasty to be tailored to the individual breast type and to the abilities of the specific surgeon.

Adolescent↗
PubMed1997

Outcome for patients with bulimia and breast hypertrophy after reduction mammaplasty.

OBJECTIVES: To determine the outcome of patients with bulimia nervosa and symptomatic breast hypertrophy (macromastia) who had reduction mammaplasty and to identify factors that were associated with positive outcomes. DESIGN: Case series with semistructured, retrospective, personal interviews performed an average of 4 years after the procedure. SETTING: University hospital-based adolescent eating disorder program. PATIENTS: Five adolescent and young adult females who had been treated for bulimia nervosa and underwent reduction mammaplasty. OUTCOME MEASURES: Presurgical and postsurgical report of physical symptoms, body image and weight control habits, ability to exercise, psychosocial functioning and self-esteem. RESULTS: All patients experienced improvement in physical symptoms (pain and inframammary dermatitis), in their posture, and in their ability to find clothes that fit properly, to exercise, and to avoid embarrassment in social situations. Preoperative eating disorder habits were a dysfunctional attempt to achieve more "normal" body proportions; postoperatively, symptoms of an eating disorder were completely eliminated or greatly reduced. Factors related to favorable outcome included professional validation of patient's symptoms, realistic patient expectations from the surgical procedure, supportive family dynamics, and ongoing treatment for the eating disorder. CONCLUSION: This series of patients with bulimia nervosa and macromastia experienced significant improvement in symptoms related to their eating disorder and their breast hypertrophy following reduction mammaplasty.

Adolescent↗
PubMed1997

Reduction mammaplasty in patients with bulimia nervosa.

Women with eating disorders have been disqualified as candidates for plastic surgery. We present a group of 6 young women with bulimia nervosa who presented with clinically symptomatic evidence of macromastia. All patients reported that dysfunctional eating habits, at least in part, where due to breast enlargement. Five patients underwent bilateral reduction mammaplasty. Patients were interviewed postoperatively and reported relief of physical symptoms and improvement in psychological well-being. Symptoms of eating disorders were completely eliminated or greatly reduced. This series has supported the contention that macromastia can produce a distortion of body image and become a secondary cause of eating disorders. Surgical correction of large breasts has improved body image, leads to the amelioration of associated eating disorders, and may in part represent a surgical treatment for a psychological abnormality. The presence of an eating disorder should not, therefore, automatically exclude a patient from surgical consideration. Routine preoperative evaluation of young women seeking plastic surgery should include a set of standard questions regarding eating behaviors.

Adolescent↗
PubMed1994

Efficacy of prophylactic antibiotics in reduction mammoplasty.

The use of prophylactic antibiotics in reduction mammoplasty has been random and its efficacy unproven. This study reviewed 106 consecutive inferior pedicle technique reduction mammoplasties. Two groups were identified; 47 patients received prophylactic antibiotics and 59 patients did not. The decision of who received prophylactic antibiotics was random based on resident rotation and resident preoperative orders. The demographics were equal between the antibiotic group and the control group. The wound infection rate and the rate of delayed healing were examined in both groups. There were no statistically significant differences in the infection rate or the rate of delayed wound healing in either the antibiotic group or the control group. Individual risk factors were also studied in each group. These risk factors included obesity, older age, smoking history, and large reductions. The use of prophylactic antibiotics did not reduce the infection rate in any of these high-risk groups. Comparing the individual risk factors for the remainder of the patient population showed that the infection rate was higher in obese patients but was unaffected by prophylactic antibiotics. Delayed healing was also higher in larger reductions but also was unaffected by the use of prophylactic antibiotics. We conclude that the use of prophylactic antibiotics in reduction mammoplasty is not efficacious in reducing the rate of wound infection or delayed healing.

Adult↗
PubMed1986

Treatment of a giant congenital hairy nevus of the ear.

A split-thickness skin graft from the abdomen was successfully used to resurface the entire auricle following full-thickness excision of a congenital nevocellular nevus. We found no previous report describing the use of skin grafts to successfully resurface the entire ear and achieve an acceptable aesthetic result.

Abdomen↗
PubMed1986

Large periocular keratoacanthoma: the case for definitive treatment.

Keratoacanthoma can usually be distinguished from squamous cell carcinoma. However, some tumors share certain characteristics of both lesions. There is a large group of actinic keratoacanthomas cytologically identical to squamous cell carcinomas. In locations other than the ocular adnexae, conservative therapy is often recommended for keratoacanthomas since these lesions tend to regress spontaneously. Two patients with large periocular keratoacanthomas illustrate some of the diagnostic and therapeutic dilemmas related to rapidly growing potentially malignant lesions about the eye. Extensive tissue destruction and possible recurrence following excision favor definitive surgical therapy in these cases.

Aged↗
PubMed1983

Skin necrosis as a consequence of coumadin therapy.

Skin necrosis secondary to Coumadin-congener therapy is a rare, unpredictable complication. A case is reported of a patient given sodium warfarin therapy following coronary artery bypass who developed skin necrosis of the trochanteric region, bilaterally, and the right breast on the fourth day following administration of Coumadin. The Coumadin therapy was discontinued, and the areas of skin necrosis went on to slow, spontaneous healing. However, significant subcutaneous induration persisted, although the areas were no longer painful.

Breast↗
PubMed1979

Malignant transformation of a Warthin tumor: case report, review of the literature, and discussion of pathology.

Papillary cystadenoma lymphomatosum (Warthin's tumor) is generally considered to be a benign tumor. However, a few well-documented cases of malignant transformation have been reported. In each case, the patient had received radiotherapy to the neck region where the tumor later developed. This paper reports a case of malignant transformation of a papillary cystadenoma lymphomatosum (PCL) in a patient who had not received radiotherapy. Light and electron microscopy documented this transformation and clearly identified the malignant portion of the tumor as having its origin in a benign PCL. The literature is reviewed and a discussion of pathology presented.

Adenolymphoma↗
PubMed1976

Complete scalp avulsion.

Complete scalp avulsion results in serious consequences, including hospitalization, economic loss, devasting disfigurement, and psychological effects on the patient. Three patients suffering complete scalp avulsion are discussed. Each case involved injury from farm tractors and occurred in young girls with long hair. In each of them we successfully employed split thickness skin graft for repair of the extensive scalp loss. Excellent aesthetic results were obtained with the use of a wig. Other reported experiences using replacement of the avulsed scalp have been almost uniformly unsuccessful. With recent advancements in microsurgery, the potential for replantation of a completely avulsed scalp has become a hope for the future.

Adolescent↗
PubMed1976

Desmoid tumor: musculoaponeurotic fibrosis of the abdominal wall.

A 26-year-old woman developed a desmoid tumor of the lower abdominal wall shortly after the birth of her fourth child. It measured 15 by 17 cm. and involved most of the lower abdominal wall of this small-framed woman. Operative removal would have been mutilating and almost surely doomed to failure. No treatment was given. Over a 5 year period, the tumor regressed and has disappeared almost completely. It was and has remained entirely asymptomatic. Desmoid tumors of the abdominal wall never metastasize, are asymptomatic, and may regress spontaneously. Since surgical treatment so often fails, it is felt that extensive or mutilating operations are not justified.

Abdominal Muscles↗