Biomedical subjects
Publications and source records attributed to I T Jackson.
This article explores the wide range of chemical facial peels, which include phenol, trichloroacetic acid, and alpha-hydroxy acids. The application of these substances will be described in addition to the contraindications to this type of treatment.
Temporary hyperexpansion at each filling session has previously been confirmed to increase the inflation volume in a conventional expansion procedure. This study employed eight young pigs to evaluate the effect of hyperinflation of this type in rapid expansion performed on 10 consecutive days. Hyperinflation to 120 mmHg for 4 minutes and deflation to 40 mmHg for 2 minutes was repeated five times on the experimental side. This cycled hyperinflation was found to increase the filling volume by 49 percent when compared with the contralateral side, which was not cycled or hyperinflated (control) (p < 0.01). The increase in surface area of the entire skin over the balloon was 178.1 percent in the hyperinflation group and 132.8 percent in the controls (p < 0.01). The actual expansion in surface area was not significantly different: 44.4 percent in the hyperinflation group and 45.7 percent in the control group. The additional gain of skin by cycled hyperinflation was the result of recruitment. The control group required 5 more days to achieve the same amount of skin but resulted in more true expansion and less recruitment. It is concluded that the cycled hyperinflation technique may shorten the time period of the whole reconstruction procedure but may produce an aesthetic deformity and flap necrosis.
A total of 207 patients with hemangiomas, vascular malformations, and lymphovenous malformations were treated by the same surgeon from 1980 to 1990. Thirty-seven patients with true hemangiomas underwent surgical treatment. Only those hemangiomas which caused functional or developmental disturbances or those with complications were treated; many more were allowed to regress spontaneously. Sixty-five patients with low-flow and 16 with high-flow vascular malformations were treated by using a variety of surgical approaches. In low-flow lesions, sclerosant therapy can be extremely effective, either alone, in small lesions, or combined with surgical resection or embolization, in larger lesions. Preoperative embolization and surgical excision are the treatment of choice in high-flow malformations. Twenty-seven patients with lymphovenous malformations had only surgical excision with a high success rate. Sixty-two patients with acquired "senile hemangiomas" underwent a single local excision with excellent results. When indicated, angiography has been of great value as a diagnostic procedure to provide information about the vascular dynamics and the extent of these lesions, although magnetic resonance imaging is now being used more frequently for this purpose. Selective angiography also was used as a therapeutic modality when embolization was part of the treatment protocol. A new classification based on clinical, histologic, and vascular flow characteristics of these lesions has been used to simplify the present nomenclature and to help in selection of the most appropriate treatment. It has the added value of being in the language of the radiologist, who should be a member of the vascular anomalies team.
In localized orbitotemporal neurofibromatosis, the treatment depends very much on the type and severity of the orbital involvement and on the functional state of the eye. The condition can be conveniently divided into three groups, each requiring different treatment: (1) orbital soft-tissue involvement with a seeing eye, (2) orbital soft-tissue and significant bony involvement with a seeing eye, and (3) orbital soft-tissue and significant bony involvement with a blind or absent eye. A total of 24 patients with a maximum of 12 years recurrence-free follow-up are presented.
Histologically, benign sinus diseases can behave aggressively, potentially causing sight- and life-threatening conditions requiring surgical treatment. Four patients illustrating acute and chronic infection, single and multiple sinus polyposis, and mucoceles are presented and discussed to illustrate how the principles of craniofacial exposure, resection, and reconstruction may be employed to treat aggressive sinus disease. The bicoronal and buccal sulcus approaches minimize visible scarring; wide exposure of the orbital contents and dura reduce the risk of excessive bleeding, neurologic complications, and orbital volume derangements. Immediate cranial bone grafting and the well-vascularized galeal-frontalis myofascial flap obliterate the dead space and isolate the extradural space from contaminated facial cavities, diminishing the risk of infection. The craniofacial surgical approach is particularly appropriate for the management of aggressive frontoethmoidal and multiple sinus involvement because it allows the treatment of sinus cavities under direct vision and complete resection of sinus disease.
Squamous cell carcinoma of the lacrimal sac is rare. We report a case of a 45-year-old Caucasian woman with a squamous cell carcinoma of the right lacrimal sac, initially presenting at an early stage. A critical review of the literature is also presented with specific regard to operative and postoperative management. Treatment of these lesions is predominantly surgical. The role of radiation therapy is not yet fully defined. Successful management requires a high index of suspicion as well as aggressive and early intervention.
Most reconstructive surgeons will not commonly need to use the transverse cervical tube pedicle flap in facial reconstruction but this straightforward and simple technique can be very useful in certain instances. Some of the techniques of reconstructive surgery which have stood the test of time should not be forgotten even when the most recent reconstructive options are available.
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This study was performed to investigate how the perivenous areolar tissue affects survival of the rat inferior epigastric venous flap model designed by Yuen and Leung (1991). Five groups of flaps were studied; group A--flap based on an inferior epigastric vein and areolar tissue; group B--flap with a skeletonised vein; group C--control, nonvascularised flap; group D--flap based on perivascular areolar tissue alone; group E--flap with a skeletonised artery and vein. Each group included 40 flaps; 20 of them had a silicone sheet placed under the flap, the other 20 did not. All flaps of group E survived. The success rate of group A with and without a silicone sheet was 60% and 90% respectively. All flaps of the other groups (B, C, D) necrosed. Histological examination of the pedicle showed that many minute vascular channels (single-cell-layered capillaries) were present apart from the inferior epigastric vein. This result confirms the importance of the perivenous areolar tissue in perfusion of the skin island, at least, in the inferior epigastric venous flap in the rat.
It is now accepted that calvarial bone is a suitable material for grafting in the facial area. From an extensive experience of using calvarial grafts in all regions of the face, the orbit has been singled out for this study. A group of 222 patients who underwent 279 calvarial grafts has been examined. The majority of patients had post-traumatic or congenital deformities. Reconstructions were performed with split-thickness cranial bone grafts and in some cases, the full-thickness of the cranium was used. The follow-up period ranged from 3 months to 4 years with an average of 20 months. After the first operation, 86% of the sample attained satisfactory aesthetics on clinical examination. There were 13 (4.6%) complications, most occurring during harvesting full-thickness calvarial grafts. From this study it is seen that orbital reconstruction can be performed using calvarial bone to obtain satisfactory aesthetic and functional results. This can be accomplished with minimal donor site morbidity.
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Over a 24-month period, 18 patients had 33 expanders placed in the extremities. Twelve expansions were performed in the upper extremity, and 21 in the lower extremity. Indications for expansion include scarring, excision of skin grafts, tumor excision, burn scars, tattoos, or unacceptable incisional scars for revision. Of the 12 expansions performed in the upper extremity in seven patients, nine were successful. Nine expansions in the thigh and two expansions in the region of the knee were completed without complication. Three expansions were performed in the distal lower extremity following crush injury to remove scarring, and all three failed. Seven expansions were performed in the foot for removal of scarred tissue. There was one infection, two skin necroses on the dorsum of the foot, and one implant exposure. Seven complications in the lower extremity occurred in these areas with an infection rate of 20%. The remaining 23 expansions were performed for soft tissue defects in the upper extremity or in the lower extremity above the level of the mid-calf, with only two complications of implant exposure or infection. Therefore, the infection rate and complication rate in the upper extremity and above the knee was only 6%. Overall, 23 of the 33 expansions, or 70%, were taken to completion with a successful advancement of expanded flaps. Overall, complications occurred in 30% of patients, all eventually requiring removal of the expander.(ABSTRACT TRUNCATED AT 250 WORDS)
This study compared the vascularity and resorption of calvarial bone flaps based on an undisturbed pedicle and on a previously (4 weeks) detached pedicle of the superficial fascia (galea) and periosteum and free calvarial bone grafts. Nine adult pigs were used, in three of which a silicone rubber compound was injected intravascularly immediately after the transfer confirmed the vascularity of both pedicled bone flaps. In six pigs, volume changes were assessed intraoperatively by a water displacement method and also 12 weeks postoperatively. Both pedicled bone flaps preserved their original volume, whereas free skull grafts showed approximately 50% of volume loss (p less than 0.001). Decalcified hematoxylin and eosin sections of the specimens obtained 12 weeks postoperatively showed a normal calvarial appearance in both pedicled bone flaps and extensive fibrous tissue infiltration into free grafts. It is suggested that a previous detachment of galea and periosteum does not interfere with the use of vascularized calvarial bone graft, which may provide a more predictable result than a free bone graft.
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Twenty adult rabbits were used to evaluate the biocompatibility and osteoconductivity of Bio-Oss, an inorganic bovine bone mineral, in the reconstruction of full-thickness skull defects. Skull defects were treated with either autogenous bone dust, porous hydroxyapatite granules, Bio-Oss particles, or were left untreated as controls. Histological examination of decalcified sections showed incorporation of Bio-Oss into the host tissue without a significant inflammatory reaction. Measurement of the profile area occupied by the bone revealed that Bio-Oss, hydroxyapatite, and the control had the same amount of bone ingrowth, whereas autogenous bone dust produced a greater amount of bone (p < 0.01). We conclude that Bio-Oss, like porous hydroxyapatite, has sufficient osteoconductive properties and can also be used as a bone substitute material.
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A study to assess the effects of an intraluminally placed tissue expander in the rabbit jejunum was performed. Oval expanders (8 cm3) were placed via a midline coeliotomy through an enterotomy on the antimesenteric border of the jejunum. The reservoir was tunnelled subcutaneously through the abdominal wall. Expansion was carried out through this port at 7-10-day intervals using 0.5-cm3 increments. At the end of the experiment, angiography was performed and routine haematoxylin and eosin-stained sections were produced. Angiography revealed an increase in vessel diameter and vascular density of the specimen. Histology showed an increase in villi size, an increase in the number of goblet cells and a marked increase in the thickness of the muscular layer. The possible applications of this technique are discussed.