Biomedical subjects
Publications and source records attributed to G G Hallock.
It is not uncommon following reduction mammoplasty that the nipple-areola vasularity becomes compromised. If simple maneuvers do not restore circulation, then a free nipple graft becomes mandatory to minimize morbidity. Occasionally, nipple congestion that recurs as the areola is inset might best be managed by delayed closure. The advantages of this technique are described.
Skin and soft tissue defects of the antecubital fossa may present problems in reconstruction. Two cases are presented in which radial forearm flaps with a proximal vascular leash are used to cover such defects without the need for microsurgical expertise. The use of local tissues made early mobilisation and rehabilitation easy.
Variations of the extensor tendons of the fourth dorsal compartment are usually single anomalous tendons to multiple digits or multiple anomalous tendons to a single digit. They are not uncommon. However, while exploring a dorsal wrist mass, we discovered that it was a tenosynovitis presumably secondary to the 12 tendons found in this compartment rather than the expected five extensor tendons.
Suction-assisted lipectomy is a useful adjunct technique that allows the microsurgeon to debulk composite tissue transfers safely, without fear of compromising flap viability. The functional and aesthetic results of free flaps can often be enhanced in a single stage, which may not be possible using other conventional procedures.
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The high incidence of complications during tissue expansion may be related to overexpansion with subsequent tissue necrosis and implant extrusion. Subjective parameters such as pain or capillary fill may be poor guidelines for determining the end point of a given session of expansion. In an attempt to rectify this problem, we have shown in a prospective study of eight consecutive patients that noninvasive objective monitoring utilizing transcutaneous measured oxygen levels, local perfusion, and implant pressures allowed us to quickly and safely expand each patient. Although perhaps cumbersome for routine use, this system proved valuable in complicated situations where subjective parameters could not be observed.
The magnitude of the morbidity and the complexity of the required reconstructive efforts associated with severe lower-extremity traumatic injuries dictate that they be considered as a distinct entity. Microsurgical tissue transfers are usually indicated as the only viable solution for salvage of these significant injuries. Guidelines need to be established to facilitate the proper decision making prior to considering these complex reconstructive alternatives v the benefits of early extremity amputation.
The blunt-tipped suction lipectomy cannula has proven to be quite effective and is now readily available for dissection of soft tissue spaces. Several clinical examples demonstrating the versatility and utility of this instrument are presented.
Body contour surgery for the patient who has experienced massive weight loss requires extensive and multiple operations. Any means of reducing the number of such procedures while obtaining optimal results would be most beneficial to both surgeon and patient. Combined brachioplasty, thoracoplasty, and mammoplasty has proven to be safe, effective, and appropriate toward achieving these goals.
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A dual photography background system consisting of a quadrilled format on one side and a plain background on the other is described. It is mobile and efficient as a space- and time-saving device for medical photography.
Reconstructive in utero microsurgery for repair of unilateral cleft lips has been technically achieved in the A/J mouse fetus. The period of gestation was undisturbed, and following birth, the gross and histologic appearance of the lips was nearly normal with no evidence of scar formation. The absence of a lip scar after human cheiloplasty may require the as yet undefined advantages of fetal wound healing.
Two representative cases of repair of forehead defects using a modification of the subcutaneous pedicle flap are reported. Complications are minimal if proper technique is followed. Application of this flap to include difficult donor areas, such as the scalp and forehead, should be considered.
Single-stage debulking of flaps using suction-assisted lipectomy in combination with skin excision is a safe and reliable procedure with results comparable to conventional multistaged surgical techniques. Three representative cases are presented that demonstrate the efficacy of suction-assisted lipectomy as an adjunctive procedure for flap defatting.
The rare entity of nontraumatic metastatic gas gangrene is commonly associated with occult gastrointestinal malignancies. Normally the patient's course is fulminant, with rapid demise prior to ascertaining the correct etiology at autopsy. An unusual case is presented in that 65 days following hip disarticulation for gas gangrene the diagnosis of colonic cancer was appropriately suspected and then proven.
Degloving injuries of the external nose are severe soft tissue avulsions requiring meticulous repair to prevent airway embarrassment and to provide the best aesthetic result. Usually the underlying nasal scaffolding remains intact, but associated facial fractures or other facial injuries are common and must not be overlooked. Two representative cases are reported to provide an overview of the salient features in the pathogenesis of injury and to reiterate the proper approach for treatment.
Massive defects of the cheek and simultaneous involvement of both eyelids preclude the use of local flaps and standard techniques for total lower eyelid replacement. Regional flaps may not provide enough coverage nor bulk, or they may require multiple delay procedures. Sagittal splitting of the temporalis muscle and anterior rotation of its lateral head deserves consideration for reconstruction of uncommon, large periorbital defects. A case is presented in which globe salvage was possible using this technique as a single stage procedure.
Cerebrospinal fluid rhinorrhea, whatever the etiology, is a serious and life-threatening problem. We present a case following rhinoplasty. To our knowledge, this specific complication has not been reported, most likely because it has gone unrecognized, since most cerebrospinal fluid leaks cease spontaneously. Surgeons performing rhinoplasty should be aware of this potential complication, how to confirm the diagnosis, and methods for its treatment.