Reconstructive surgery of deep burns of the lips.
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Biomedical subjects
Publications and source records attributed to G F Maillard.
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Hypertrophic scars and contractures following 3rd degree burns originate in an excessive production of myofibroblasts from the granulation tissue. Early tangential excision and grafting helps in fighting the multiplication of these cells and hence some later complications. Conservative treatment of the scars is achieved by "Jobst" compressive masking and neck splints. Corrective surgery is accomplished by means of skin grafts or flaps. The authors' own methods are described for reconstructing destroyed organs such as scalp, eyebrows, eyelids, lips, chin, ears and nose.
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It is surprising that in a recently published symposium on reconstruction of the nose, not one article mentioned the tempororetroauricular flap described by Washio. In our experience, this method is a very useful tool for difficult nasal reconstructions in young individuals. It is a safe procedure (not to be compared with free flaps of the same region), and it provides thin skin and cartilage that can be adapted for different types of defect. Exceptionally, it may provide a sufficient amount of tissue for a total nose reconstruction. As compared with most other techniques, it leaves no additional scar on the face.
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For big breasts I no longer use classic Strõmbeck, McKissock or Dufourmentel techniques, because we can be faced with problems of the areolar complex. On the other hand to achieve a good, long lasting result we need to realize a very important reduction. The drawing is done high at 17 +/- 1 cm with the long Wise pattern and the McKissock lazy-S. Only the upper part of the dermis flap is prepared for bed of the areolar complex and for reinforcement of the vertical part of the T scar. This technique of modeling mammectomy is perhaps one of the quickest and safest method of breast reduction. We present our experience after 50 bilateral reductions.
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Today the treatment of choice in hemifacial palsy is selective neurectomy of the branches of the facial nerve. Palliative surgery has improved experience in the treatment of facial palsy. An anatomical finding is reported which could contribute to a better understanding of the etiology of facial spasm.
A wider use of reconstructive surgery of the breast has become possible since Patey-modified mastectomy has been preferred to Halsted classic radical mastectomy for operable breast cancer and routine use of postoperative radiotherapy discontinued in patients eligible for adjuvant chemotherapy. Reconstructive techniques are reviewed and pitfalls subjected to careful scrutiny. It is thought that women might be encouraged to seek earlier medical advice after noticing a lump in the breast if they are alive to the prospect of possibile restoration of the contours of the breast after ablative surgery.
The "plastic" aspect of surgery in precancer and cancer of the lips, and, where feasible, its advantage over radiotherapy are described. The techniques of vermillectomy, Abbé flaps and Estlander flaps are discussed.
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