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Biomedical subjects

G A Sisson

Publications and source records attributed to G A Sisson.

At least 37 records · Page 2Linked to original sources
PubMed1988

The prevention of carotid artery rupture with isobutyl-2-cyanoacrylate.

Carotid artery exposure and rupture is one of the most feared complications of head and neck surgery. The ideal method for preventing rupture of an exposed artery should be easy to perform, safe, effective and should spare local and regional flaps for later use in reconstruction. Isobutyl-2-cyanoacrylate (Bucrylate) is a commercially available compound that appears to meet these criteria. Test animals were divided into two groups. The carotid arteries of 12 dogs (group A) were exteriorized bilaterally and coated with Bucrylate unilaterally. Group B (four dogs) underwent the same procedure except that the vessels were bilaterally coated. Wounds were dressed twice daily with moist-to-dry gauze. No antibiotics were given. Nine of the 12 unprotected arteries in group A ruptured within 2 weeks, and one unprotected artery ruptured on postoperative day (POD) 29. Two dogs healed over both vessels. In group B, three dogs ruptured their arteries within 2 weeks. One dog healed over both vessels. Gross and histologic examination of the arteries showed a striking difference between coated and uncoated vessels. We believe that Bucrylate and cyanoacrylate adhesives hold promise in the clinical protection of exposed carotid arteries.

Animals↗
PubMed1987

Mortality and morbidity of gastric 'pull-up' for replacement of the pharyngoesophagus.

Forty-two patients have undergone gastric interposition to replace the pharyngoesophagus; 39 patients had primary or recurrent malignant tumors of the hypopharynx, cervical esophagus, postcrioid area, or tracheal stoma, while three patients had benign disease. The operation consisted of resection of the local neck disease, along with a transhiatal esophagectomy and gastric "pull-up" for restoration of gastrointestinal tract continuity. Eight hospitalized patients died, for a mortality rate of 19%, of which six patients died of complications from local sepsis. The more common nonfatal complications were related to the neck wound, the anastomosis, and the stomach. The complication rate per patient, excluding postoperative deaths, was 40%. The average length of stay was 44 days for the patients with nonfatal complications and 23 days for those without complications. The success rate of the operation with relief of the patients' presenting symptoms was 81%.

Adult↗
PubMed1986

Chin reconstruction with pectoralis myocutaneous flap.

Chin reconstruction after radical surgery for carcinoma of the oral cavity is a complex and controversial problem. We have developed a simple, single-stage, primary procedure for chin reconstruction. It is easily mastered and is based on a simple modification of the pectoralis major myocutaneous flap. Our experience includes seven cases, including two with total chin reconstructions. The number and type of complication is low and consistent with the magnitude of the surgical procedure. This operation provides acceptable aesthetic and functional results to patients undergoing partial or total resection of the chin.

Aged↗
PubMed1986

The mechanical spread of viable tumor during surgery.

The "mechanical" spread of tumor is that which occurs through physical trauma, such as during surgical resection. There has been a waxing and waning of interest in this concept over the past 70 years. We have collected the blood that comes off the surgical field during major head and neck resections and separated and plated all nucleated cells in the tumor stem cell assay of Hamburger and Salmon. In one of six such preparations, we demonstrated the presence of viable, colony-forming tumor cells. Two were contaminated and three did not grow. We demonstrated, therefore, that the blood that bathes the raw open surgical field contains tumor cells that are viable and potentially capable of producing new foci of tumor.

Aged↗
PubMed1986

Extracranial neurogenic tumors of the head and neck.

The vast majority of head and neck nerve tumors are benign. Proper management involves accurate preoperative evaluation and a high degree of suspicion. Ideal treatment involves complete resection but debulking procedures have a definite role. Microneural dissection and reconstruction should be attempted in all cases. Malignant tumors of neural tissue are aggressive and are treated with radical surgical resection followed by radiation. Chemotherapy is reserved for unresectable or metastatic disease.

Adult↗
PubMed1985

Combined functional oral rehabilitation after radical cancer surgery.

Formerly, patients requiring extensive reconstruction of the oral cavity and oropharynx after radical, ablative oncologic surgery faced the unhappy prospect of lengthy, multistaged repair to enjoy acceptable cosmesis and a functional oral cavity. The advent of the pectoralis major myocutaneous flap has made soft-tissue, single-stage closure of large oral cavity and oropharyngeal defects a reality. Unfortunately and frequently, restoration of mucocutaneous continuity of the mouth does not result in acceptable function. Advances in the materials and design of prostheses suggested the combination of myocutaneous flap reconstruction and functional, prosthetic restoration as a method of returning the patient with head and neck cancer to a state of acceptable function and appearance soon after major resection.

Adult↗
PubMed1985

Immediate reconstruction after total laryngopharyngoesophagectomy and mediastinal dissection.

Advanced or recurrent carcinoma surrounding the tracheostoma in a previously laryngectomized patient is most effectively treated with transsternal radical dissection of the upper mediastinum and relocation of the trachea to the upper chest. The use of the pectoralis major myocutaneous flap, now enables the head and neck surgeon to perform immediate reconstruction and provide protection for the great vessels after mediastinal dissection for stomal recurrence. Formerly, patients with stomal recurrence also involving the cervical or upper thoracic esophagus were poor surgical candidates. Frequently, patients succumbed to their disease before the continuity of the digestive tract could be re-established. Currently, at our institution, this vexing reconstructive problem is solved with immediate, one-stage reconstruction. The esophagus is replaced by transposing the stomach through the posterior mediastinum and anastomosing to the tongue base, "gastric pull-up." The mediastinal defect is closed with the concomitant use of the pectoralis myocutaneous flap. The muscular portion of the myocutaneous flap provides excellent coverage for the great vessels of the upper mediastinum. Our experience with 39 patients who underwent this procedure between 1979 and 1983 is presented.

Esophageal Neoplasms↗
PubMed1985

Staging system by sites. Problems and refinements.

Staging by sites has been met with varying degrees of acceptance by the medical community. Only painstaking application of these guidelines will provide the necessary information for revision of the present system.

Head and Neck Neoplasms↗
PubMed1985

Management of recurrent head and neck cancer.

The management of recurrent head and neck malignancy can be one of the most frustrating experiences faced by the head and neck surgeon. A recent study indicates that twice the number of patients succumb to distant metastasis from primary tumors than did 20 years ago. This article discusses the operative management of these patients and the role of radiotherapy and chemotherapy in their treatment.

Head and Neck Neoplasms↗
PubMed1984

Voice preservation in postcricoid and cervical esophageal cancer.

Total laryngopharyngectomy has been the standard surgical treatment for postcricoid and cervical esophageal cancer. Of patients undergoing standard laryngectomy, 30% will develop esophageal speech and a substantial number of the remainder can be rehabilitated by use of the electrolarynx or tracheoesophageal puncture. However, the vast majority of patients who undergo laryngopharyngectomy with current methods of reconstruction remain voiceless. Reconstruction of the hypopharynx and cervical esophagus has been a formidable challenge to head and neck surgeons. Various types of reconstruction have been used: skin grafts, local neck flaps, deltopectoral flaps, free bowel grafts, myocutaneous flaps, etc. Gastric pull-up reconstruction of the hypopharynx and cervical esophagus is superior to other methods. A new technique uses this procedure, allowing immediate vocal rehabilitation. Five patients underwent pharyngolaryngoesophagectomy for malignant lesions of the postcricoid area and/or cervical esophagus. Reconstruction of the digestive tract using the stomach and immediate voice restoration by a tracheogastric shunt retaining the anterior half of the larynx and upper part of the trachea represent a new surgical method after pharyngolaryngoesophagectomy.

Carcinoma, Squamous Cell↗
PubMed1984

Potential applications of photoradiation therapy in head and neck surgery.

Current theories of carcinogenesis suggest that premalignant changes should be expected in any area of the mucous membrane exposed to a carcinogen. The place of triple endoscopy in the workup and management of head and neck malignant neoplasms has been well established. Hematoporphyrin derivative has been shown to lend reproducible results in the study of tumor fluorescence. This compound has been used in in vitro and in vivo diagnosis and in the treatment of various tumors. It has not been used extensively in the head and neck, but its properties are ideal for diagnosis and treatment of selected head and neck tumors. Potential applications of photoradiation therapy in otolaryngology-head and neck surgery include detection of small primary tumors, delineation of resection margins, detection of early recurrences, and palliative and curative therapy of lesions.

Antineoplastic Agents↗
PubMed1984

Transmandibular exposure of the skull base.

The combined transmandibular-transcervical approach to the skull base ensures a wide field exposure to the lateral and midline compartments of the middle cranial fossa with attendant vascular control. Splitting the lip and mandible in the midline and dividing the floor of the mouth structures along the lateral border of the tongue exposes the parapharyngeal space, infratemporal fossa (lateral compartment), and clivus, nasopharynx, and cervical spine (midline compartment). A variety of benign and malignant intracranial and extracranial skull base lesions have been treated using this approach.

Adolescent↗