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Biomedical subjects

M P Solomon

Publications and source records attributed to M P Solomon.

At least 37 records · Page 2Linked to original sources
PubMed1994

The relationship of angiogenesis to biological activity in human squamous cell carcinomas of the head and neck.

Tumor angiogenesis has recently been related to tumor growth and metastasis, which determine the clinical outcome of the patient. This study was designed to determine the relationship between angiogenesis in primary squamous cell carcinomas (SCC) of the head and neck and the development of recurrent or metastatic disease, or both. Different SCC of the head and neck were studied. Microvessels were selectively stained using a monoclonal antibody for factor VIII. Microvessel counts were performed in the tumor, in the tissues immediately adjacent, and in normal tissues of similar topographies. Microvessel counts were then correlated with clinical outcome (development of recurrent or metastatic disease, or both). Recurrent or metastatic disease, or both, developed in patients with high microvessel counts (mean, 121.25) in the tissues adjacent to the tumor 7 to 16 months after initial treatment. Those with low microvessel counts (mean, 33.75) were disease-free for 16 months to 6 years (p < 0.01). Microvessel counts inside the tumor were also higher in those in whom recurrences or metastasis, or both, developed, but were not statistically significant. In this study, angiogenesis was directly related to clinical outcome. Thus, angiogenesis may be an independent predictor of recurrent or metastatic disease, or both, which could help in the selection of patients with SCC of the head and neck for aggressive therapy.

Carcinoma, Squamous Cell↗
PubMed1994

Management of infected laminectomy wounds.

Wound infection after lumbar, thoracic, or cervical laminectomies is a rare but potentially devastating complication. It can range in severity from superficial wound infection to an extensive wound dehiscence. The usual treatment of these wounds consists of intensive local care, debridement, and appropriate antibiotic therapy. Secondary healing can result in chronic, painful wounds that are difficult to manage and can create the potential for osteomyelitis. Seven cases of infected dehiscent laminectomy wounds are presented. Either critical structures were exposed, or the patients did not heal after secondary or delayed primary closures. In each case, full healing was attained by means of reconstruction with a regional muscle flap. We propose that muscle flap reconstruction offers an excellent alternative for the reconstruction of difficult postlaminectomy wounds.

Adult↗
PubMed1994

Wound care in the elderly patient.

Wound care in the elderly population requires careful attention to the medical status of the patient. The patient's underlying medical condition can often dictate what reconstructive options are appropriate. Many reconstructive techniques are available to repair a wide variety of wounds.

Aged↗
PubMed1993

The cross-leg flap revisited.

Although free flaps are currently the gold standard for distal lower extremity reconstruction, situations occasionally arise when alternative methods are needed. We present three cases of cross-leg flaps, which have been modernized with current external fixation technology and current understanding of vascular anatomy. All cross-leg flaps were based on the axial blood supply of the posterior descending subfascial cutaneous branch of the popliteal artery. This axial flap afforded considerable length and well-vascularized tissue. All patients were placed in external fixation devices. Adjacent lower extremity joints were exercised during the period of attachment. There were no major complications or flap failures. All patients were ambulatory postoperatively. We conclude that the cross-leg flap, using external fixation techniques and axially based flaps, can be successfully and expeditiously used to cover defects of the lower extremities.

Adult↗
PubMed1993

Reconstruction of radiation-induced chest wall lesions.

Radiation-related ulcers of the chest wall provide a great challenge to reconstructive surgeons because of the necessity of protecting the underlying vital structures and the difficulty in repairing irradiated tissues. To evaluate the efficacy of treatment, 24 patients who underwent reconstruction of radiation related ulcers of the chest wall were retrospectively reviewed. A variety of muscle and musculocutaneous flaps as well as omentum and microvascular tissue transfers were used to reconstruct these defects. The defects in the chest wall arose from spontaneous breakdown of irradiated tissue, tumor recurrence, or nonhealing after surgical procedures performed in the irradiated field. Our treatment protocol consisted of aggressive debridement of all affected tissues including skeletal tissues when necessary. The application of a tension free closure using a flap was then performed. Skeletal support was provided in three reconstructions. There were no mortalities, the morbidity rate was 29% (six minor, one major complication), and the mean hospital stay was 10.9 days. None of the patients required prolonged ventilator support. In all but 2 patients, who were left with small chronic granulating nonhealing wounds, complete wound healing was achieved. We conclude that chest wall reconstruction of radiation-related ulcers can be achieved with minimal morbidity in an acceptable period of inpatient hospital care using a variety of vascularized tissue transfers.

Aged↗
PubMed1993

Radiation-related wounds of the chest wall.

Irradiation-associated chest wall lesions pose a significant health hazard to the patient. The principles of management include (1) biopsy of any open wounds to rule out the recurrence or persistence of tumor, (2) aggressive debridement of all offending tissues, and (3) reconstruction with well-vascularized flap tissue. Numerous questions arise regarding the practical management of these patients. The controversies that have arisen during our management of more than 100 of these patients have been discussed. It is appropriate to perform reconstruction following nonhealing of a superficial ulcer or immediately following the excision of a full-thickness chest wall defect. Hyperbaric oxygen can serve as a useful adjunct. It is rarely necessary to use a prosthetic material for the purpose of chest wall stabilization during the reconstruction of full-thickness defects. Paradoxic chest wall movement in the postoperative period does not significantly affect pulmonary function tests and is generally a transient problem. Subtotal excisions are frequently necessary. As long as all of the necrotic or tumor-bearing tissue has been fully removed, these wounds can be expected to heal in most instances by placing vascularized tissue into the defect. Operative sites in previously irradiated chest wall tissue can be expected to heal if proper and careful surgical technique is employed. Nevertheless, there is a risk of wound breakdown following any surgery in irradiated tissue. Finally, we believe it is appropriate to proceed with aesthetic recontouring of chest wall deformities associated with irradiation exposure.

Adult↗
PubMed1993

Management of radiation-associated pelvic wounds.

Radiation-associated pelvic wounds should be managed by complete excision of all affected tissues and reconstruction with a vascularized flap. The complex anatomy and function of the perineum and pelvis create a variety of reconstructive demands. This article attempts to demonstrate the diversity of the problems that can occur in this region as well as to describe the varied options for reconstruction.

Female↗
PubMed1992

Posttraumatic upper extremity wound coverage utilizing the extended deep inferior epigastric flap.

The extended deep inferior epigastric artery (DIEA) flap was used in 4 patients with traumatic mid upper extremity wounds. Although there are numerous flaps available for resurfacing upper extremity defects, including the groin, thoracoepigastric, and a host of microvascular flaps, in each of these patients a preoperative consideration necessitated a novel approach. The DIEA flap is based on an axial vascular watershed resulting in a long, thin, well-vascularized, supple skin flap, which proved extremely effective in solving the reconstructive needs of these patients. The flap is technically simple to elevate and quite versatile. In all patients, the flaps survived and healing of the wounds was achieved. The DIEA flap should be considered a valuable reconstructive alternative when faced with elbow and forearm defects.

Abdominal Muscles↗
PubMed1992

Pencil-core granuloma.

Noncaseating granulomas present as a delayed foreign-body reaction to retained pencil-core fragments. The clinical appearance of the lesion can closely resemble melanoma. Surgeons who use pencils as surgical marking implements should be aware that there is a potential risk of developing late pencil-core granulomas. This risk can be reduced by carefully removing any pieces of pencil lead from the wound.

Adult↗
PubMed1991

Unremitting pain to the mandible secondary to metastatic breast cancer: a case report.

The most common site of distant primary tumor metastasis to the jaw bones is the breast. The clinical signs and symptoms, and radiographic appearance of these lesions can be extremely variable. Histologic examination, however, will usually resemble the tissue from the primary tumor. In the case presented, the biopsy specimen was consistent with adenocarcinoma of the breast.

Adenocarcinoma↗
PubMed1990

Plastic surgery in the elderly.

Plastic surgery has an ever-increasing role in the management of medical problems in the elderly. These procedures can be performed with minimal risk to the patient in order to maximize the quality of life for these patients and their families.

Aged↗
PubMed1988

Necrotizing sialometaplasia masquerading as residual cancer of the lip.

Necrotizing sialometaplasia is a benign disorder that histologically can mimic carcinoma. It is thought to develop as a result of ischemia or adjacent tissue injury. A patient is described who underwent a Mohs' micrographical fresh-tissue excision of one-third of the upper lip for basal cell carcinoma. By the time she was ready for reconstruction, a marked eczematous reaction developed to a polymyxin neomycin preparation (Neosporin ointment) at the wound edges. Reexcision of the wound margins before a flap reconstruction revealed necrotizing sialometaplasia on histopathological examination. This incidental finding fortunately was not mistaken for residual tumor. To prevent over-diagnosis and over-treatment of presumed malignancies, an awareness of necrotizing sialometaplasia is essential for all surgeons operating on mucosal surfaces in the head and neck.

Aged↗
PubMed1984

Leiomyoma of the esophagus.

Esophageal leiomyoma, while rare, is the most common benign tumor of the esophagus. Nine cases from a large teaching hospital are reviewed with long-term follow-up. Steps in the diagnosis and management of this lesion are discussed.

Adult↗