Endoscopically assisted lipoma removal.
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Adult↗
Biomedical subjects
O M Ramirez
Publications and source records attributed to O M Ramirez.
The severely twisted nose. Treatment by separation of its components and internal cartilage splinting.
Adequate treatment of the deviated nose requires a detailed evaluation of the deformity present. A new method of component separation with internal cartilage splinting has been used with success to correct the severely deviated nose. The separation of the components allows detection and correction of all areas of cartilage deviation. The internal cartilage splinting allows long-term support and avoidance of mid-vault collapse.
Adolescent↗
Endoscopically assisted biplanar forehead lift.
The standard subgaleal coronal incision used for brow lifting is limited to patients with low foreheads. The subcutaneous hairline brow lift used for patients with high foreheads has a high rate of vascular complications. However, the main advantage of the subcutaneous approach is preservation of sensation posterior to the incision line. The subperiosteal approach, on the other hand, allows a better periorbital remodeling. I have combined the subperiosteal and the subcutaneous approach to take advantage of and minimize the disadvantages of each individual approach. The advent of the endoscopic technique has allowed more accurate and controlled periorbital dissection and brow depressor muscle modification. The operation is indicated in every patient in whom the anterior hairline incision is indicated. It is a good method for decreasing the height of the forehead. The dissection is done initially in the subcutaneous plane, and about halfway on the forehead slit incisions through the galea-periosteal layer and through the temporoparietal fascia are made to continue the dissection in the deep plane. The periosteal dissection and release at the arcus marginalis is done under endoscopic control. Likewise, the brow depressor muscle modification is done under endoscopic magnification. Deep anchoring sutures fix the brow in the elevated position. Trimming and closure of the cutaneous layer are done with minimal tension. The biplanar subperiosteal-subcutaneous forehead lift has been used in 24 patients with very satisfactory results. Complications have been of a minor nature. Patients have maintained sensation posterior to the hairline incision. The height of the forehead has been decreased in every case. Frontalis muscle function has been preserved.
Adult↗
The subperiosteal approach for the correction of the deep nasolabial fold and the central third of the face.
The nasolabial fold is one of the most difficult problems to correct with the traditional skin-SMAS rhytidectomy. This article presents a technique for the correction of the deep nasolabial fold and the central third of the face. Key steps of the operation include (1) a wide subperiosteal dissection with extension under the intermediate temporal fascia and the fascia of the masseter muscle, (2) subperiosteal release of the lower margins of the malar and maxillary areas, and (3) upward lifting and fixation of the deep structures in an almost vertical orientation. These surgical principles can be applied to the open, pure endoscopic, or endoscopic-assisted biplanar facelift.
Female↗
The anchor subperiosteal forehead lift.
The coronal incision used for brow lift procedure has a high rate of localized alopecia, widening, and depression of the scar at the suture line. Other sequelae of the standard coronal brow lift incision procedure are "stretch-back" with a recurrent brow ptosis, poor brow elevation, and numbness beyond the incision line. Factors causing alopecia are tension, use of a monopolar cautery, use of key sutures with undue tension, one-layer closure, and sutures left too long. Recurrent brow ptosis may be due to anterior displacement of the posterior scalp flap, stretching of the anterior frontal skin flap, or insufficient power of the weakened frontalis muscle. Poor brow elevation may be due to unsatisfactory dissection on the glabella and orbital rims. Numbness and itching beyond the incision line are due to a low coronal incision. To avoid these problems, the following principles were followed: (1) If not contraindicated, the incision is made high on the vertex of the head, posterior to a biauricular line. (2) The pericranium is included in the frontal flap starting at the incision lines. (3) The subperiosteal dissection is continued down to the orbital rims and nasal bones. (4) The release of the periosteum at the arcus marginalis or just above allows repositioning of the brow structures. (5) The inelastic pericranium maintains the position of the elevated structures and avoids stretching of the frontal skin. (6) The integrity of the frontalis muscle is maintained completely. (7) Two large triangles of scalp resected in the posterior flaps allow fixing the position of the posterior scalp and match better the length of the anterior flap. (8) The galea periosteal rim flap allows anchoring of the frontal flap to the undersurface of the posterior scalp flap. This stabilizes the closure with minimal tension on the hair-bearing portion of the scalp. The wide surface of contact avoids depression and widening at the suture line. (9) Closure with skin staples avoids constriction of the hair follicles. (10) Hemostasis is done with a bipolar cautery. (11) No through-and-through key sutures are used. Some of these principles were introduced to the endoscopic subperiosteal forehead lift. The modifications mentioned above have been used in 92 open brow/face lift procedures with excellent aesthetic and functional results and minimal complications.
Adult↗
Endoscopic subperiosteal browlift and facelift.
The subperiosteal facelift is an excellent technique for remodeling particularly the central third of the face. The endoscope has allowed us to perform rejuvenation of the upper face or the total face without incisional scars. On the other hand, the introduction of the endoscopic techniques to the biplanar surgery allowed us to perform the deep dissection with more safety and accuracy and to eliminate or decrease some of the undesirable sequelae of the traditional approaches such as the numbness on the forehead beyond the hairline or scalp incisions. In the lower face, the endoscopic techniques allowed us to protect the marginal mandibular branch of the facial nerve, and, on the neck, these techniques allowed us to perform a very accurate subplatysma dissection. The endoscope has allowed us to create a new technique for facial rejuvenation that can be equal to and perhaps in some cases even more versatile than other traditional, nonendoscopic approaches. In this way, we can tailor the operative procedure to the patient's needs rather than to give one type of operation to every patient that walks in for an office consultation. It will become imperative to outline the indications, contraindications, and limitations of each variation and to determine the appropriate role of the endoscope in facial rejuvenation. Only then will we better serve our colleagues and our patients.
Adult↗
Endoscopic full facelift.
This article demonstrates the efficacy of endoscopic techniques in total facial rejuvenation. The author has introduced the total subperiosteal dissection to the endoscopic forehead lift. This concept has been extended to the rejuvenation of the central and lower third of the face. Patients up to the late 40s can have a total facelift without skin excisions. In older patients, the introduction of endoscopic techniques helps to minimize some of the undesirable sequelae of the traditional open procedures such as alopecia, scalp paresthesias, and facial edema of the subperiosteal lift. The author also introduces a new, more efficacious method of midface suspension.
Adult↗
Endoscopic techniques in facial rejuvenation: an overview. Part I.
The use of endoscopic techniques in orthopedic, gynecological, and general surgery has had a significant effect on the traditional techniques in those specialties. The introduction of those techniques to plastic surgery, particularly to aesthetic surgery, has been very slow. However, recent interest in using endoscopic techniques in forehead plasty, corrugator-procerus resection, and breast augmentation has opened up countless possibilities in these and other areas of aesthetic and reconstructive surgery.
Anesthesia, General↗
Aesthetic craniofacial surgery.
The concepts of craniofacial surgery developed by Paul Tessier have evolved through four different phases: reconstruction, restoration, remodeling, and rejuvenation. Subperiosteal undermining of the upper, mid, and lower face allowed surgeons not only to reposition the soft tissues at the level of the bony insertion but also to remodel the craniofacial skeleton by either reduction or augmentation. Subperiosteal undermining of the face can be applied to treat a series of aesthetic defects of congenital, traumatic, or degenerative conditions.
Adult↗
Abdominal herniorrhaphy.
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Abdominal Muscles↗
The subperiosteal rhytidectomy: the third-generation face-lift.
The subperiosteal frontal rhytidectomy described by Tessier was the departure point for a new approach for facial rejuvenation. Psillakis described the subperiosteal face-lift "as an improved concept for correction of the aging face." However, this technique has a high incidence of frontal nerve injury and because of the limitations in the subperiosteal dissection, the facial soft tissues cannot be lifted reliably to the desired position. Other authors have repeated the Psillakis experience with the same frustrations and complication rate. In this report, I describe the evolution of the subperiosteal face-lift and the significant modifications that I have introduced, making this procedure safer and improving results in the degree of facial rejuvenation. My approach of subperiosteal rhytidectomy has been used in 34 patients with a minimal complication rate. This technique also addresses the rejuvenation of the central portion of the face and the restoration of tension of the facial mimetic musculature not obtained by current brow/face-lift procedures.
Adult↗
The extended subperiosteal face lift: a definitive soft-tissue remodeling for facial rejuvenation.
The subperiosteal face lift described by Psillakis has been criticized for not showing a more dramatic improvement over conventional brow/face lift procedures. His approach also has a significantly high incidence of nerve injury. This study reports our anatomic findings and surgical modifications, which have permitted a significant improvement in the safety of execution and clinical results using the subperiosteal face lift concept. Pertinent points of applied local anatomy and dissection techniques are as follows: First, we use extensive interconnected subperiosteal dissection that includes the entire zygomatic arch. This allows better repositioning of the deep soft tissues of the entire upper face, most of the midface, and indirectly, key structures of the lower face. Second, the upward pull of the muscles of the cheek and mouth will produce an elevation of the corner of the mouth, affecting positively the smiling mechanism, the oral frowning, and the jowls. Third, the dissection deep to both layers of the temporal fascia decreases the risk of injury to the frontalis nerve. Fourth, the temporal fascia is used as a lifter and anchoring element of the entire cheek-perioral soft tissues as opposed to the periorbital fibrofatty tissues. This will decrease the risk of injuring the frontal and zygomatic branches of the facial nerve. These modifications have been used in 28 patients. Our rate of patient satisfaction has been high, and no complications with regard to nerve injury have been observed. This compares favorably with our initial 60 patients, in whom the Psillakis or Tessier approach was used. In these patients, there was an 11 and 20 percent rate of nerve injury, respectively.
Aged↗
"Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study.
Closure of large abdominal-wall defects usually requires the transposition of remote myocutaneous flaps or free-tissue transfers. The purpose of this study was to determine if separation of the muscle components of the abdominal wall would allow mobilization of each unit over a greater distance than possible by mobilization of the entire abdominal wall as a block. The abdominal walls of 10 fresh cadavers were dissected. This demonstrated that the external oblique muscle can be separated from the internal oblique in a relatively avascular plane. The rectus muscle with its overlying rectus fascia can be elevated from the posterior rectus sheath. The compound flap of the rectus muscle, with its attached internal oblique-transversus abdominis muscle, can be advanced 10 cm around the waistline. The external oblique has limited advancement. These findings were utilized clinically in the reconstruction of abdominal-wall defects in 11 patients, ranging in size from 4 x 4 to 18 x 35 cm. This study suggests that large abdominal-wall defects can be reconstructed with functional transfer of abdominal-wall components without the need for resorting to distant transposition of free-muscle flaps.
Abdominal Muscles↗
Reconstruction of nonmarginal defects of the ear with chondrocutaneous advancement flaps.
Marginal defects of the ear are usually reconstructed with the Antia's chondrocutaneous flap. Reports of reconstruction of nonmarginal defects are scanty. The antia chondrocutaneous flap was adapted for reconstruction of defects up to 2 cm located in the triangular fossa, scapha, and the anthelix. For larger defects, the technique was further modified using composite chondrocutaneous flaps. The technique uses the principle of separation of the ear elements and redistribution for closure of defects in the nonmarginal areas of the ear with minimal sacrifice of the tissue, ear size, and ear shape. This technique is reliable, relatively simple, and a one-stage operation, as demonstrated in our series of seven patients.
Aged↗
The gluteus maximus muscle: experimental and clinical considerations relevant to reconstruction in ambulatory patients.
The gluteus maximus muscle and other haemodynamically related structures have been used for the reconstruction of significant defects in the perineum, sacrum, lumbar area and hip in 35 patients. The preservation of muscle function was achieved in all of 20 ambulatory patients and documented by gait analysis, muscle strength testing and EMG studies. Dye injection studies of the first perforating artery, inferior gluteal artery and superior gluteal artery led to the design of new flaps based on this arterial system. They include: medial advancements with extension above the sacrum, lateral advancements, lower gluteus advancements, the tensor fasciae latae gluteal extension and modifications of the gluteal thigh flap. These findings significantly increase our ability to close difficult wounds within the perineal, sacral, lumbar and trochanteric regions.
Adult↗
The distal gluteus maximus advancement musculocutaneous flap for coverage of trochanteric pressure sores.
Large trochanteric pressure sores can be reconstructed with the superolateral advancement of the distal gluteus maximus-posterior thigh myofascial cutaneous flap. The flap has a dual blood supply derived from the gluteal system and the deep femoral artery. This makes the distal gluteus maximus advancement flap very reliable and versatile. It can be designed on the musculocutaneous perforators of the gluteal system alone or on its dual circulation. It has several advantages over previously described flaps for trochanteric pressure sores.
Adult↗
A new surgical approach to closure of large lumbosacral meningomyelocele defects.
A new method for the reconstruction of large thoracolumbar and lumbosacral meningomyelocele defects is described in which latissimus dorsi and gluteus maximus myocutaneous units are advanced medially and reapproximated in the midline, permitting primary closure of the defect in three layers. The flaps are based on the thoracodorsal and superior gluteal vessels and the intervening thoracolumbar fascia, providing tension-free, durable, and viable soft-tissue coverage over the dural repair. No lateral relaxing incisions, delays, or skin grafts are necessary. This technique has been used successfully in the repair of nine large meningomyelocele defects, and uncomplicated wound closure was achieved in all cases. The anatomic basis, technique, advantages, and functional implications of our approach are described. The flaps described do not alter the nerve supply of the muscles and merely redefine the muscle origins; therefore, no functional deficit from the reconstructive surgery is anticipated.
Follow-Up Studies↗
Technical and aesthetic considerations in the horseshoe incision and approach in axillary node dissection.
Previously described incisions for axillary dissection suffer from several drawbacks--extended dissection, limited exposure and visible scars. We have designed the horseshoe incision and approach to obviate some of the problems described. The incision is in the hair bearing area. The direct approach to the axillary content makes exposure excellent and the dissection is circumscribed to the axillary area. Our experience with this technique is encouraging.
Axilla↗