Biomedical subjects
Publications and source records attributed to M C Robson.
a simple technique to correct the lax oral sphincter has been developed. A wedge resection of the bulky, atonic lower lip is performed leaving a pedicle flap of orbicularis oris muscle on either side of the resection. The muscle flaps are tunnelled submucosally toward the opposit commissures and anchored. This gives excellent stability to the lower lip and prevents drooling.
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An approach to the patient with a recurrent head and neck cancer following prior combined radiation, surgery, and possibly, chemotherapy has been outlined. Following a detailed evaluation of the patient's symptoms, the local extent of the recurrence, and the search for distant disease, resection of the recurrent tumor with immediate reconstruction of the resulting defect is advocated. Although reconstructive efforts may be taxing because of prior use of optimal tissue, imaginative planning and improvisation will allow functional and cosmetic restoration in many cases. Illustrative cases have been included to demonstrate the efficacy of this approach in treating patients with recurrent cancer of the head and neck.
We have used a modification of a mucoperiosteal flap described by Lane for cleft palates in 3 patients with oral cavity defects from tumor ablations. The flap provides excellent lining for repairs when alternative flaps are unavailable. The vascularity of the flap and its texture allow a watertight closure which does not hinder the patient's ability to talk or eat.
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All measures must be taken to enhance conservation of energy in patients with burns so that they can withstand the stresses imposed upon them. Many environmental factors can be regulated to decrease these stresses. Room temperature can be regulated to 29 degrees Celsius (84 degrees F) to decrease evaporative cooling and fluid loss. Humidity can be regulated to approximately 30 percent. Water temperature can be maintained between 35 and 37 degrees Celsius (95-98 degrees F) to encourage mobility and relaxation and to minimize shivering. Proper concentration of sodium can be used in the tank to minimize leaching to the electrolyte from the wound into the water. These measures for conserving energy help to provide the patient with the maximal metabolic efficiency necessary for wound healing and recovery.
It is a biologic fact that all open wounds contain bacteria and remain contaminated with varying levels of bacteria until successful wound closure has been accomplished. The sine qua non in the management of the contaminated wound has been and remains adequate sharp debridement. In a standardized experimental model, three methods of irrigation were compared employing quantitative bacteriology of tissue to evaluate their effectiveness at decreasing bacterial levels and reducing wound infection. The pulsating jet lavate was found to be significantly better than gravity flow irrigation or wound irrigation with a bulb syringe. These data on tissue biopsies support previous reports using surface and wound exudate cultures.
A series of 2,389 Emergency Department surgical admissions was assessed for quantitative indices of actual services rendered and time spent. Auto accident-related patients were compared to other Emergency Department surgical patients. The average diagnostic index for auto accident patients was 48 units compared to 25 units for all patients. Their workload for Emergency Department personnel was twice the average for non-automobile accident patients. Although they made up to 7.9% of all patients, they accounted for 15% of the total diagnostic services, 12% of the total therapeutic services, and 14% of the overall services rendered during the period of study. These data suggest strongly that auto accident-related patients are different from the average Emergency Department surgical patient and are quantitatively treated differently from other surgical patients.
A questionnaire distributed to plastic surgeons to determine their patterns of usage of systemic prophylactic antibacterial agents was answered by 1,025 respondents (73.7 percent). The patterns of usage among the respondents were determined for 29 circumstances and operations for the time of administration, and as influenced by 11 modifying factors. The data present the patterns of antibacterial use by plastic surgeons at this time.
The history of scalp avulsions is presented, and one case is reported. A treatment plan for scalped patients is outlined.
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