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Biomedical subjects

F Nahai

Publications and source records attributed to F Nahai.

At least 19 recordsLinked to original sources
PubMed2000

Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: maximizing results and minimizing complications in a 5-year experience.

During the past 5 years, the authors have used a direct trans-lower lid blepharoplasty subperiosteal approach to the lower lid and midface for the purpose of correction of midfacial aging in 757 patients. In a smaller but significant group, this approach has proven valuable in difficult reconstructive situations. The purpose of this article is twofold: (1) to provide a comprehensive retrospective evaluation of the value and promise of the technique and (2) to provide a comprehensive discussion of the pitfalls and complications that have been associated with use of this technique. In addition, technical modifications that may lower the rate of morbidity associated with the use of the procedure are described.

Adult↗
PubMed1999

Transconjunctival upper blepharoplasty.

Transconjunctival lower lid blepharoplasty now has an established role as an option in rejuvenation of the lower eyelid. Transconjunctival upper lid blepharoplasty, or transconjunctival removal of medial upper eyelid fat, also has a role in rejuvenation of the upper eyelid. However, this is a rather limited role. We have found this approach safe and efficacious as a primary as well as a secondary procedure for removal of excess medial upper eyelid fat. We report on 20 patients who have undergone this operation: 5 as a primary procedure and 15 as secondary. There were no complications, no revisions, and the patients have been uniformly happy with their results.

Blepharoplasty↗
PubMed1999

Positioning for ultrasound-assisted lipoplasty.

Although the positioning facilitates UAL and SAL, it is essential to pad the patient appropriately, especially on the pressure points. Equally important is the maintenance of fluid balance and body temperature during these procedures.

Humans↗
PubMed1999

Equipment and instrumentation for ultrasound-assisted lipoplasty.

Ultrasound energy has been applied in many areas of medicine for some time, but ultrasound energy, equipment, and instrumentation for liposuction are new to plastic surgeons. The technique and equipment differ in many ways from suction-assisted lipoplasty and practitioners of ultrasound-assisted lipoplasty must gain a thorough understanding of the physical principles, the equipment, the limits, and the potential problems before using this technique. Basic components of all systems include a generator, connecting cable, vacuum pump, and activation control. Some units also require the use of a skin protection.

Catheterization↗
PubMed1998

The sentinel vein: an important reference point for surgery in the temporal region.

An intimate knowledge of the anatomy of the face is essential to the aesthetic surgeon. It is this knowledge that ultimately improves results and minimizes complications. The major morbidity associated with brow lifts is trauma to the temporal branch of the facial nerve. The general course of this nerve has been well documented, but exact details are still lacking. This anatomic study was designed to further elucidate its path. Dissections were performed on each side of 10 fresh cadaver heads. These dissections revealed a consistent relationship between the temporal branch of the facial nerve and the sentinel vein. The sentinel vein is reliably located and preoperatively easily defines the "zone of caution", enabling the surgeon to operate rapidly and with confidence until the zone is reached, at which time the dissection is slower as the vein is approached. In the patient in whom the sentinel vein is not easily visualized externally, it may be identified through fixed skeletal landmarks.

Aged↗
PubMed1998

Inferior gluteal free flap breast reconstruction.

This article discusses the indications for and anatomy, technique, and results of breast reconstruction with the inferior gluteal free flap. The authors also present the results of their 25 inferior gluteal flap operations performed in the last decade.

Buttocks↗
PubMed1997

The tensor fascia lata free flap in abdominal-wall reconstruction.

The pedicled tensor fascia lata flap (TFL flap) is a method of choice for abdominal-wall reconstruction. Frequently, the size and location of the defect produce this option. Microsurgical transfer may overcome these disadvantages. Therefore, the ability of the TFL free flap to reconstruct complex abdominal wounds was evaluated. Seven patients with full-thickness abdominal-wall defects reconstructed by TFL free flaps were reviewed. Their average age was 44.6 years (range: 27 years to 59 years); follow-up averaged 10.5 months (range: 2 months to 18 months). Fifty-seven percent of the wounds were either infected or contaminated; the defect averaged 15 cm x 26 cm Six 85.7 percent) of the wounds involved the epigastrum. No total flap loss was seen, but three flaps developed distal tip necrosis (42.9%). Microsurgical transfer of the TFL free flap overcomes the limitations of the arc of rotation seen with the pedicled flap. It increases the vascularity of the distal portion of the flap. The TFL free flap is therefore an option in abdominal wounds, particularly those with defects of large size or supraumbilical location.

Abdominal Injuries↗
PubMed1997

Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience.

OBJECTIVE: The purpose of the study is to define those patient variables that contribute to morbidity and mortality of median sternotomy wound infection and the results of treatment by debridement and closure by muscle flaps. BACKGROUND: Infection of the median sternotomy wound after open heart surgery is a devastating complication associated with significant mortality. Twenty years ago, these wounds were treated with either open packing or antibiotic irrigation, with a mortality approaching 50% in some series. In 1975, the authors began treating these wounds with radical sternal debridement followed by closure using muscle or omental flaps. The mortality of sternal wound infection has dropped to < 10%. METHODS: The authors' total experience with 409 patients treated over 20 years is described in relation to flap choices, hospital days after sternal wound closure, and incidence rates of morbidity and mortality. One hundred eighty-six patients treated since January 1988 were studied to determine which patient variables had impact on rates of flap closure complications, recurrent sternal wound infection, or death. Variables included obesity, history of smoking, hypertension, diabetes, poststernotomy septicemia, internal mammary artery harvest, use of intra-aortic balloon pump, and perioperative myocardial infarction and were analyzed using chi square tests. Fisher's exact tests, and multivariable logistic regression analysis. RESULTS: The mortality rate over 20 years was 8.1% (33/49). Additional procedures for recurrent sternal wound infection were necessary in 5.1% of patients. Thirty-one patients (7.6%) required treatment for hematoma, and 11 patients (2.7%) required hernia repair. Among patients treated since 1988, variables strongly associated with mortality were septicemia (p < 0.00001), perioperative myocardial infarction (p = 0.006), and intra-aortic balloon pump (p = 0.0168). Factors associated with wound closure complications were intra-aortic balloon pump (p = 0.0287), hypertension (p = 0.0335), and history of smoking (p = 0.0741). Factors associated with recurrent infection were history of sternotomy (p = 0.008) and patients treated for sternal wound infection from 1988 to 1992 (p = 0.024). Mean hospital stay after sternal wound reconstruction declined from 18.6 days (1988-1992) to 12.4 days (1993-1996) (p = 0.005). To clarify management decisions of these difficult cases, a classification of sternal wound infection is presented. CONCLUSIONS: Using the principles of sternal wound debridement and early flap coverage, the authors have achieved a significant reduction in mortality after sternal wound infection and have reduced the mean hospital stay after sternal wound closure of these critically ill patients. Further reductions in mortality will depend on earlier detection of mediastinitis, before onset of septicemia, and ongoing improvements in the critical care of patients with multisystem organ failure.

Debridement↗
PubMed1996

Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous (TRAM) flap.

BACKGROUND: The management of state III breast cancer is challenging; it often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate transverse rectus abdominis musculocutaneous (TRAM) flap in 21 patients treated for stage III breast cancer. METHODS: Data have been collected retrospectively on 21 patients diagnosed with stage III breast cancer between 1987 and 1994. All patients had mastectomy and immediate TRAM reconstruction. Thirteen patients received primary systemic therapy, 10 patients received postoperative consolidation radiotherapy to the operative site, and 3 patients received preoperative radiation. RESULTS: Mean follow-up for the group was 26 months. Two patients died with disseminated disease: neither of them developed local disease recurrence in the operative site; 82% of the patients followed for at least two years are free of disease. Sixty-two percent of the patients received preoperative chemotherapy, the remaining patients received postoperative multiagent chemotherapy and/or radiation therapy. Two of the patients received autologous bone marrow transplants after their adjuvant therapy. Ten patients had postoperative radiotherapy for consolidation; three patients received preoperative radiation. CONCLUSIONS: Immediate TRAM reconstruction for stage III breast cancer is not associated with a delay in adjuvant therapy or an increased risk of local relapse. It facilitates wide resection of involved skin without skin grafting. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of stage III breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.

Breast Neoplasms↗
PubMed1996

Intrathoracic muscle transposition. Surgical anatomy and techniques of harvest.

The transposition of extrathoracic muscle and soft tissue to the thoracic cavity is well established in the treatment of various congenital and acquired thoracic conditions. Precise understanding of the surgical anatomy of these muscles/soft tissues is vital to the safe and effective utilization of these techniques. Their use follows the basic surgical principles of tissue repair without tension, filling dead space, and using well-vascularized tissues for surgical closures. Close cooperation between the thoracic surgeon and the plastic surgeon is vital in the treatment of these difficult, and sometimes life-threatening, situations.

Humans↗
PubMed1996

Endoscopic abdominoplasty and endoscopically assisted miniabdominoplasty.

Recent developments in abdominal contouring procedures have included the extensive use of liposuction and the use of modified or limited scars, producing in effect a "downsizing" of the operative procedures for many patients. The use of minimally invasive techniques based on endoscopic technology and instrumentation represents a logical extension of this trend. Endoscopic visualization and dissection facilitate musculofascial repair through a very small incision and, combined with liposuction, allows significant improvement in abdominal recontouring in selected patients. Patient selection parameters, instrumentation, operative techniques, and complications of this developing procedure are described.

Abdomen↗
PubMed1995

Amputation neuromas of the great auricular nerve after rhytidectomy.

A 56-year-old woman presented with complaints of a tender nodule in the anterior triangle of her left neck. The nodule, which was easily palpable through the skin, was approximately 1 x 1.5 cm in size and was, at first, thought to be a lymph node. At operation, a large neuroma of the distal terminus of the transected great auricular nerve was found. Significantly, the patient had undergone a full rhytidectomy some 9 years previously, and it appears that the neuroma was a consequence of iatrogenic injury to the nerve at that time.

Face↗
PubMed1995

TRAM flap vascular delay for high-risk breast reconstruction.

The purpose of this study was to evaluate the intraoperative changes in physiologic blood pressure following vascular delay of the TRAM flap. Ligation of the superficial and deep inferior epigastric vessels 2 weeks prior to the TRAM flap was performed. The incidence of fat necrosis was 4.3 percent in 23 high-risk patients who underwent 30 immediate breast reconstructions. Direct measurement of blood pressure in the deep inferior epigastric artery and vein was performed in a control group without delay consisting of 13 low-risk patients and in the study group of 7 high-risk patients who underwent vascular delay. Changes in TRAM flap perfusion pressure were examined following the change in location of the flap from the abdomen to the chest. Blood pressure measurements demonstrated that arterial pressure in the proximal stump of the deep inferior epigastric artery was 64 percent in the study group prior to delay and 72 percent in the control group. The physiologic response to vascular delay included an overall increase in arterial pressure with a decrease in venous congestion. TRAM flap perfusion pressure was significantly increased from 13.3 mmHg (control) to 40.3 mmHg (delayed) in the region of the midrectus perforators (p < 0.05). These data suggest that the technique of TRAM flap delay may increase the reliable tissue volume and improve the safety of the TRAM flap.

Adult↗
PubMed1995

Instrumentation and setup for endoscopic plastic surgery.

The use of endoscopic techniques mandates the need for basic understanding of endoscopic instrumentation and operating room setup in order to avoid procedural delays and surgeon frustration. The electronic systems for endoscopic surgery-cameras, light sources, monitors, and so on-have been well developed for other specialties and are fully adaptable to endoscopic plastic surgical procedures. Hand instruments, however, are in the early phases of refinement for subcutaneous plastic surgical procedures and will undoubtedly improve over the next several years. Adaptation of existing instrumentation and development of new operating tools continue and promise to make endoscopic plastic surgical procedures of the future more ergonomic and efficient. Similarly, while operating room setup for endoscopic plastic surgical procedures varies depending on individual circumstances, application of a few basic principles will help in making this step quick and simple. The knowledge and experience of scrub technicians and nurses experienced in endoscopic techniques can be invaluable to the surgeon just beginning to use endoscopic techniques in plastic and reconstructive surgery.

Endoscopy↗
PubMed1995

Endoscopic techniques in aesthetic breast surgery. Augmentation, mastectomy, biopsy, capsulotomy, capsulorrhaphy, reduction, mastopexy, and reconstructive techniques.

Endoscopy is a new tool in the armamentarium for surgery of the breast. Endoscopic techniques may offer decreased scarring and morbidity rates for a variety of aesthetic and reconstructive procedures. Whereas initial clinical experiences are encouraging, most endoscopic procedures of the breast remain developmental, both in technique and instrumentation. Additional development, refinement, and experience will be required to define fully the utility of endoscopic techniques.

Adult↗
PubMed1994

Endoscopic transaxillary subpectoral breast augmentation.

The transaxillary approach to breast augmentation is an established technique that offers the advantage of a remote incision in an aesthetically acceptable area. The main disadvantage to this approach is the lack of visualization of the implant pocket, necessitating blind, blunt dissection of the pectoral muscle origins. Occasionally, this limitation may result in improper implant placement and poor aesthetic results. In order to address this shortcoming, we have explored the use of minimally invasive endoscopic techniques in transaxillary augmentation to allow division of the pectoral muscle origin under direct visualization, effectively lowering the inframammary crease. Initial dissections and instrument development were performed in five unpreserved female cadavers. Subsequently, 103 implants have been placed in 53 patients utilizing the endoscopic transaxillary approach. Follow-up ranges from 2 weeks to 20 months. There have been no hematomas, infections, capsular contractures, or other complications. Aesthetic results have been good, and patient acceptance is high. By providing predictable and reproducible control of the inframammary crease, endoscopic dissection has allowed us to expand our indications for the transaxillary approach to breast augmentation. Surgical technique and brief clinical experience are described.

Adult↗
PubMed1994

The gluteal free flap breast reconstruction. Making it work.

The inferior gluteal flap represents our second choice for free autologous tissue breast reconstruction when the TRAM is unavailable. The safety and reliability of the inferior gluteal flap has been demonstrated in 25 consecutive flaps. To make the free gluteal flap work, careful elevation and preparation of recipient vessels with the liberal use of vein grafts, and proper insetting are important factors.

Buttocks↗