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Biomedical subjects

M T Edgerton

Publications and source records attributed to M T Edgerton.

At least 19 recordsLinked to original sources
PubMed1992

Augmentation of the failed pharyngeal flap.

Pharyngeal flaps are frequently used with good results to eliminate hypernasality and/or nasal escape. In a small percentage of patients, however, cicatricial contracture of the flap occurs to such a degree that velopharyngeal incompetence returns. The authors have devised a method of augmenting the scarred flap with small, superiorly based flaps lateral and adjacent to the original flap. Four cases are presented in which speech analysis was conducted prior to the procedure and then for 9 to 24 months postoperatively. The postoperative speech results are all within normal limits.

Child↗
PubMed1991

Plastic surgery and psychotherapy in the treatment of 100 psychologically disturbed patients.

This paper reviews the senior author's long-term experience with the surgical-psychiatric treatment of 100 aesthetic surgery patients with significant psychological disturbances. Patients with psychological disturbances of a magnitude generally considered an "absolute contraindication" for surgery were operated on and later assessed to determine the psychological impact of surgery. Patient follow-up averaged 6.2 years (maximum follow-up 25.7 years). Of the 87 patients who underwent operation (7 patients were refused surgery and 6 voluntarily deferred surgery), 82.8 percent had a positive psychological outcome, 13.8 percent experienced "minimal" improvement from surgery, and 3.4 percent were negatively affected by surgery. There were no lawsuits, suicides, or psychotic decompensations. Patients with severe psychological disturbances frequently benefited from combined surgical-psychiatric treatment designed to address the patient's profound sense of deformity. This study suggests that plastic surgeons are "passing up" a significant number of patients who may be helped by combined surgical-psychological intervention.

Adult↗
PubMed1990

Patients seeking symmetrical recontouring for "perceived" deformities in the width of the face and skull.

This article describes plastic surgery patients who sought symmetrical recontouring of the width of the face and skull. The basic demographic and personality characteristics of these facial width deformity (FWD) patients and the surgical procedures performed on them are discussed. Details of the surgical and psychological management of three representative cases are given. Speculative conclusions regarding the general characteristics of the FWD population are offered. Suggestions are proposed for a combined surgical-medical psychotherapeutic collaboration in managing these patients.

Adult↗
PubMed1990

Floating C-shaped orbital osteotomy for orbital rim advancement in craniosynostosis: preliminary report.

A method of lateral orbital rim advancement is described for periorbital deformities associated with coronal and metopic synostosis in infants. The technique offers the advantages of a smooth lateral rim contour and improvement in accompanying malar recession. In 13 patients with follow-up periods of up to 2 years following surgery, improved orbital contour has been appreciated. Further observation is warranted to determine whether this improvement will last into adulthood.

Child, Preschool↗
PubMed1988

Reconstruction of full thickness chest wall defects.

Over the last 5 years, 14 patients were treated by wide en bloc resection of chest wall tumors with primary reconstruction. There were nine females and five male patients with an age range of 31-77 years. All patients had a skeletal resection of the chest wall. An average of 3.9 ribs were resected in the patients treated. In three patients a partial sternectomy was carried out in conjunction with the rib resections. Chest wall skeletal defects were reconstructed with Prolene mesh, which was placed under tension. Soft tissue reconstruction utilized selected portions of the latissimus dorsi musculocutaneous territory with fasciocutaneous extensions beyond the muscle itself. Primary healing was obtained in all patients and secondary procedures were not required. The average hospitalization was 23 days. All patients survived the resection and reconstruction and were alive 30 days after operation. In selected patients the preservation of a portion of the innervated muscle in situ or the transfer of the muscle with the preservation of its resting length has maintained the majority of the muscle function.

Adult↗
PubMed1988

Lambdoid synostosis: surgical considerations.

Premature closure of the lambdoid suture may result in abnormalities in skull shape not only in the parieto-occipital region, but also in the frontal region and at the vertex of the skull. Although most of these abnormalities are mild, some constitute significant abnormalities in shape and therefore require specific surgical correction. In this report, we describe our approach from five patients we have treated and followed for 6 to 24 months with abnormalities characteristic of unilateral and bilateral lambdoid synostosis. We describe our approach to the simultaneous correction of frontal, occipital, and abnormal vertical height skeletal abnormalities in one operative procedure. To date, no negative neurologic sequelae have resulted from this operative approach, but significant improvement in skull form has been appreciated.

Craniosynostoses↗
PubMed1987

Barrel stave osteotomy for correction of turribrachycephaly craniosynostosis deformity.

The "barrel-stave" osteotomy procedure addresses the characteristic excessive height and reduced anteroposterior projection of the turribrachycephalic skull in one operative procedure. Four quadrant craniectomies are followed by barrel stave-like osteotomies in the parietooccipital region. The parietooccipital bone undergoing osteotomy is displaced posteriorly, thereby opening up the posterior fossa and effectively increasing the potential volume of the cranial vault. This increased capacity allows for notable reduction in skull height and reshaping of the skull along the anteroposterior axis.

Child↗
PubMed1987

Late surgical treatment of unilateral coronal synostosis using methyl methacrylate.

Three techniques combining the shaping of calvarial and facial bone with onlay of methyl methacrylate are presented for use in the late treatment of unilateral coronal synostosis deformities. The procedures described are suggested as possible alternatives to extensive bone repositioning procedures. They have the advantage of being quicker and are therefore potentially safer operations. Acrylic is malleable and does not resorb; thus, permanent superior esthetic results may be achieved. The two most serious risks when using this technique are infection and limitation of growth. The risk of infection may be reduced by attaching the acrylic implant securely to surrounding bone, under sterile conditions, beneath well-vascularized skin. Growth limitation may be obviated by not placing acrylic across sutures in children with enlarging skulls.

Adult↗
PubMed1986

The gender identity movement: a growing surgical-psychiatric liaison.

The evaluation and treatment of individuals with gender identity problems has resulted in an interesting and productive collaboration between several specialties of medicine. In particular, the psychiatrist and surgeon have joined hands in the management of these fascinating patients who feel they are trapped in the wrong body and insist upon correcting this cruel mistake of nature by undergoing sex reassignment surgery. Over the last two decades, some 40 centers have emerged in which interdisciplinary teams cooperate in the evaluation and treatment of these gender dysphoric patients. The model for this collaboration began at The Johns Hopkins Hospital, where the Gender Identity Clinic began its operation in 1965 (Edgerton, 1983; Pauly, 1983). This "gender identity movement" has brought together such unlikely collaborators as surgeons, endocrinologists, psychologists, psychiatrists, gynecologists, and research specialists into a mutually rewarding arena. This paper deals with the background and modern era of research into gender identity disorders and their evaluation and treatment. Finally, some data are presented on the outcome of sex reassignment surgery. This interdisciplinary collaboration has resulted in the birth of a new medical subspecialty, which deals with the study of gender identification and its disorders.

Consumer Behavior↗
PubMed1986

Surgical management of vascular malformations of the head and neck.

The evaluation and treatment of non-involuting hemangiomas with arteriovenous components and arteriovenous malformations of the head and neck remain difficult. Surgical excision is still the most important and effective method of controlling these lesions. Radiotherapy should never be used. It is ineffective, dangerous, and often complicates any later operation that may be required. Evaluation of vascular malformations with computerized tomography, arteriography, magnetic nuclear imaging, and Doppler mapping will aid diagnosis. Adjunctive hypotensive anesthesia, intraoperative embolization with Gelfoam, and temporary peripheral suture ligations have made the surgical task more manageable. The integration of reconstructive techniques into the surgical program is essential if optimum results are to be obtained. Incisions must be planned so that future flap patterns are preserved. Axial vessels may be needed later. Fascial slings, muscle transfers, nerve grafts, and tissue expansion of adjacent normal tissue may be needed to maintain and restore function and features. Above all, the treatment of each patient requires individual planning. The most common errors in the treatment of vascular hemangiomas result from missed diagnoses and faint-heartedness in tackling the surgical removal of such highly vascular tumors. Many patients go for years without finding a surgeon who will help them. We believe that aggressive surgical treatment offers much to many of these patients.

Adolescent↗
PubMed1986

Augmentation of critical skin flap survival following ibuprofen therapy.

Much research effort has attempted to identify pharmacological agents that will augment random skin flap survival. Unfortunately, the vast majority of these agents have been administered preoperatively, and as such their routine use is not often justified. Ibuprofen administered in the postoperative period significantly augments random skin flap survival in the rat.

Animals↗
PubMed1986

External cranial vault molding after craniofacial surgery.

Many congenital cranial vault deformities are only incompletely corrected by currently available surgical techniques. The supplementary use of external cranial vault molding devices after these surgical techniques, however, has resulted in consistently improved cranial vault from over what could be achieved by operation alone. These devices are inexpensive, easily individualized to abnormal skull shapes, and well tolerated by young patients.

Abnormalities, Multiple↗
PubMed1986

A new surgical technique for phalloplasty in patients with exstrophy of the bladder.

Posterior pelvic osteotomy has not been a satisfactory operation to provide penile length in the repair of defects associated with bladder exstrophy. The authors are proposing a new technique based on the movement of the halves of the symphysis and pubic rami (en bloc with the attached corpora cavernosa) to the midline. This is accomplished by osteotomies of the superior and inferior rami and bone grafting of the resulting defects in the superior rami only. The hip joints are not disturbed, risk of complications appears to be reduced, and increased effective penile length is obtained. Cadaver dissections confirmed the practicality of this operation and a successful case is reported. The anatomy and physiology of penile function that is important to surgeons is reviewed.

Adult↗
PubMed1986

Skull expansion in experimental craniosynostosis.

Bilateral coronal suture immobilization was performed in 9-day-old rabbits to simulate the brachycephaly deformity characteristic of coronal synostosis. Growth abnormalities were documented by serial radiographic cephalometry. A "corrective" linear craniectomy procedure was performed on the rabbits with an immobilized coronal suture at 60 days of age. The degree of amelioration of the induced abnormalities by the surgery in these animals was compared with a similar group of animals that had the same surgery plus supplemental implantation of a spring expansion device at the coronal suture craniectomy site. The mean marker separation at the coronal suture was significantly greater (5.61 mm +/- 0.52 SE versus 2.53 mm +/- 0.38 SE; p less than 0.05) following spring expander implantation than with linear craniectomy alone. Similarly, induced anterior cranial base shortening and distortion of craniofacial cephalometrics were more significantly improved by the additional use of the spring expansion device.

Animals↗
PubMed1986

External cranioplasty: historical perspectives.

Selective external cranial vault remodeling has been practiced since antiquity. The variations, methods, and desired results of external cranioplasty are as pervasive as the practice is old.

Aged↗
PubMed1985

A digit replantation model.

A simple, inexpensive, reproducible, and reliable model for digital replantation is described utilizing the rabbit ear. When compared to the human digit, it provides benefits over previous models. It is of similar tissue type and characteristics. The vessels closely approximate the digit in size and number. Results are easily quantified and the opportunity for a paired control in the same animal exists. Therefore, experimental design and statistical calculations may be simplified. The model can function for either replantation or revascularization with only slight changes in its preparation. Survival rates have been over 90%. In addition, the model provides an excellent forum for the development of technical expertise in the aspiring microvascular surgeon.

Animals↗
PubMed1985

Tissue expansion in reconstructive hand surgery: case report.

A 22-year-old musician requested the correction of his digital syndactyly deformity without the use of skin grafts. Failure of the original correction to heal primarily resulted in the formation of dense scar tissue. A small, custom-designed tissue expander was inserted within the web space and was slowly expanded. The additional expanded tissue permitted reconstruction of the web space and the sides of the fingers without the use of skin grafts.

Adult↗