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Biomedical subjects

Karol A Gutowski

Publications and source records attributed to Karol A Gutowski.

15 recordsLinked to original sources
PubMed2006

Management of gestational gigantomastia.

BACKGROUND: Gigantomastia of pregnancy is a rare, severely debilitating condition characterized by massive enlargement of breasts and resulting in tissue necrosis, ulceration, infection, and, occasionally, hemorrhage. Typically, resolution of breast hypertrophy to near prepregnancy size occurs in the postpartum period. Treatment is controversial. METHODS: The authors present a patient with gestational gigantomastia for whom nonoperative management failed and who subsequently required bilateral mastectomies. In addition, the authors performed a comprehensive review of reported cases and generated a treatment algorithm. RESULTS: The patient tolerated the mastectomies well and went on to deliver a healthy child. Postpartum delayed breast reconstruction with tissue expansion and implant placement yielded good results. The literature review demonstrates that medical management has successfully avoided surgery during gestation in 39 percent of cases since 1968. However, 35 percent of patients eventually underwent breast reduction (12 percent) or mastectomy (88 percent) during pregnancy. Spontaneous or elective termination of the pregnancy accounted for 30 percent of outcomes. Patients who underwent breast reduction and then became pregnant had a 100 percent (four of four patients) chance of recurrence. Two women had mastectomy and subsequent pregnancies. One woman developed multiple small areas of recurrence that were surgically excised. The other woman had two additional pregnancies with no recurrence of symptoms. CONCLUSIONS: Medical therapies to manage gestational gigantomastia are inconsistent in outcome. Since some patients respond, these therapies are worth trying. However, if the patient and/or fetus are experiencing significant morbidity, then surgical intervention is warranted. Breast reduction or mastectomy with delayed reconstruction is the preferred procedure. If the mother is considering future pregnancies, mastectomy offers the lowest risk of recurrence.

Adult↗
PubMed2006

Aesthetic and functional breast surgery.

Approximately 500,000 cosmetic breast operations will be done in 2006. The majority of these are for cosmetic reasons and include breast augmentations, mastopexies, and breast reductions. Augmentations are most commonly performed using saline implants in strictly cosmetic situations and occasionally silicon implants in select cases. Complications are unusual, breast feeding is usually possible and mammographic cancer detection is accurate provided that specific mammographic views are obtained. Most cosmetic breast surgery is not covered by insurance with the exception of breast reduction.

Breast↗
PubMed2006

Facial rejuvenation.

Nonsurgical facial rejuvenation is often used as an alternative to more invasive procedures. Topical agents improve cell maturation and cell turnover, chemical peels and microdermabrasion improve poorly textured skin and pigment anomalies. Surgical facial rejuvenation provides dramatic changes but requires more recovery time.

Antioxidants↗
PubMed2006

Surgical improvement of the aging forehead and eyelids.

Periocular reconstruction is limited to the upper lid, lower lid, and brow. Although many of the same principles apply as in other facial rejuvenation procedures, special techniques are involved frequently using microsurgical procedures. Although the majority of oculoplastic procedures are done for cosmetic purposes, occasionally patients with extreme distortion in periorbital anatomy may benefit from this procedure. These include patients with profound ptosis and severe cases of lower lid distortion who have visual compromise.

Blepharoplasty↗
PubMed2006

Bariatric surgery.

It is estimated that more than 5% of US adults are morbidly obese (body mass index higher than 40). Morbid obesity is associated with adverse health conditions including prolonged morbidity and early mortality while affecting people of lower socioeconomic means. A variety of surgical procedures have evolved over the past 30 years to address this problem with varying degrees of success and longevity. For those patients achieving dramatic weight loss, reconstructive cosmetic surgery is often necessary or desirable. Techniques to achieve this are described.

Adult↗
PubMed2006

Laser hair removal.

Many techniques are currently available for hair removal. Techniques for permanent hair removal, however, remain elusive. Laser hair removal has become a popular technique in both cosmetic and reconstructive procedures. Laser hair removal can be performed on an outpatient basis. The efficacy of hair removal is difficult to study given the tremendous variation in laser techniques, but short-term data is promising.

Hair Removal↗
PubMed2006

Breast reconstruction.

With over 200,000 new cases of invasive breast cancer treated each year, various types of breast reconstruction have become popular and safe. Immediate breast reconstruction seems to confer both benefit and patient satisfaction. A variety of techniques including subcutaneous expanders/implants, flap transfers, and free tissue transfers are described.

Breast Neoplasms↗
PubMed2006

Management of mandible fractures.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Review the incidence and etiology of mandible fractures. 2. Discuss indications and techniques for closed and open treatment of mandible fractures. 3. Review complications of mandible fractures. BACKGROUND: Mandible fractures are among the most common types of facial fractures treated by plastic surgeons. They must be managed carefully to maintain the function of the mandible, reestablish proper occlusion, and minimize secondary complications. METHODS: Current methods of management include combinations of soft diet, intermaxillary fixation, open reduction with plate fixation, and, rarely, external fixation. RESULTS: Decision-making depends on the age of the patient, type of fracture identified, and concomitant medical conditions or injuries. CONCLUSION: The authors review the diagnosis and current trends in management of mandible fractures.

Adult↗
PubMed2006

Neck rejuvenation revisited.

PURPOSE: Restoration of the aesthetic neck contour is an integral component of facial rejuvenation. Multiple deformities of the neck and chin complex can make treatment of the cervical region daunting. An algorithmic approach to neck rejuvenation based on individual anatomic and clinical analysis is prudent. The authors created a simplified anatomic approach to the most common cervical deformities encountered in the patient seeking facial rejuvenation. METHODS: Retrospective analysis of the senior author's (R.J.R.) technique evolution over the last 15 years was performed. The operative techniques used in neck rejuvenation were evaluated and the long-term postoperative results were reviewed. RESULTS: Recurrent patterns of cervical deformity are present in patients presenting for facial rejuvenation. These patterns can be classified into categories based on specific anatomic deformities. CONCLUSIONS: Facial rejuvenation requires appropriate identification of deformity to effect the desired changes. Cervical deformities are classified into clinically useful categories based on careful preoperative analysis. A thorough understanding of the anatomic bases for the deformities allows the surgeon to choose the appropriate treatments to achieve consistent and reliable results.

Botulinum Toxins, Type A↗
PubMed2005

Fracture management of civilian gunshot wounds to the hand.

Civilian gunshot wounds to the hand are typically caused by low-velocity weapons, which create a localized pattern of soft-tissue and bone injury that usually allows for early definitive treatment. A retrospective chart review of 72 patients treated for 98 gunshot wound fractures at an urban level I trauma center was conducted to evaluate the results of limited debridement and early definitive fracture fixation of urban gunshot wound fractures of the hand. The incidence of hand fractures, means of fracture fixation, number of operations, occurrence of infection, and level of patient compliance were determined. Twenty-nine fractures were managed definitively with reduction and splinting in the emergency department or intensive care unit. Sixty-eight fractures were treated surgically, at a mean of 2 days after injury. Eleven patients required more than one operation. The overall infection rate was 8 percent and was not influenced by the fracture fixation method. All infections were superficial and resolved with antibiotics alone. Thirty-nine percent of patients were lost to follow-up after hospital discharge and 85 percent of patients were lost to follow-up before documented fracture healing. Twenty-six percent of patients were lost to follow-up with a removable fixation device in place. Limited debridement and early definitive fracture fixation are associated with low rates of complications for typical civilian handgun wound fractures. Cases with extensive injury or contamination do require a staged approach to treatment. Poor patient compliance in the urban trauma setting should be expected and may affect the management plan.

Bone Transplantation↗
PubMed2005

Otoplasty.

BACKGROUND: Auricular deformities, specifically, prominent ears, are relatively frequent. Although the physiologic consequences are negligible, the aesthetic and psychological effects on the patient can be substantial. METHODS: Otoplasty techniques are used to correct many auricular deformities, including the prominent ear, the constricted ear, Stahl's deformity, and cryptotia. Various treatments and techniques have been developed for the correction of these deformities, including methods that excise, bend, suture, scratch, or reposition the auricular cartilage. RESULTS: The multitude of different approaches indicates that there is not one clearly definitive technique for correcting these problems. CONCLUSIONS: This article reviews the history of otoplasty, its anatomical basis and a method for evaluation, techniques for the correction of the deformity, and potential complications of the procedure.

Adolescent↗
PubMed2003

High-pressure hand injection injuries caused by dry cleaning solvents: case reports, review of the literature, and treatment guidelines.

A previously unreported subset of high-pressure injection injuries, namely those involving solvents used in the garment dry cleaning industry, is presented. Dry cleaning solutions contain isoparaffinic hydrocarbons, methoxypropanol, and dichlorofluoroethane. Although these solvents have limited potential for systemic toxicity, severe local toxicity causing tissue necrosis often results in loss of the injured digit. Proper treatment includes prompt surgical exploration, careful débridement and irrigation, intravenous antibiotics, and in selected cases, high-dose systemic corticosteroids.

Accidents, Occupational↗
PubMed2002

Closed-catheter irrigation is as effective as open drainage for treatment of pyogenic flexor tenosynovitis.

Surgical treatment of pyogenic flexor tenosynovitis traditionally consists of open drainage (OD) and irrigation of the flexor tendon sheath. An alternative, less traumatic method of closed-catheter irrigation (CCI) has been advocated, but no comparative studies have been reported. The authors reviewed 47 cases of pyogenic flexor tenosynovitis to determine whether a difference in outcomes exists between these two methods. OD was used in 32 patients and CCI was used in 15 patients. Complications appeared to be more common in the OD group (N = 9) compared with the CCI group (N = 3), but this difference was not significant. This study supports the use of CCI as the preferred treatment for pyogenic flexor tenosynovitis because it provides thorough mechanical tendon sheath irrigation and causes smaller wounds with less scarring, which may offer a more rapid return to function.

Adolescent↗
PubMedDate not supplied

A recurrent foot ganglion managed with extensor digitorum brevis muscle flap coverage.

The case of a 42-year-old woman with a persistent ganglion cyst of the dorsolateral aspect of the foot is presented. After multiple aspirations and 4 attempts at excision, the lesion degenerated into a painful, persistently draining wound with communication to the calcaneocuboid joint. The case was treated with dissection of the lesion to the joint, excision, and coverage of the defect with an extensor digitorum brevis muscle flap. The rationale for this surgical approach and the literature regarding recurrent ganglia are discussed.

Adult↗