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Biomedical subjects

P C Bonanno

Publications and source records attributed to P C Bonanno.

11 recordsLinked to original sources
PubMed2001

Temporal facelift and corrugator resection.

On a path analogous to other surgical disciplines, the progression of facial cosmetic surgery has trended toward shorter scars and less invasive techniques. This article outlines an approach to facelifting that limits the scar to the temporal scalp, preauricular area, and retroauricular sulcus. It will enable the reader to identify those patients who are candidates for a less invasive procedure compared with the conventional facelift approach. Specifically, the temporal facelift addresses the lateral brow, the middle one third of the face, and the upper neck. In addition, this article examines the various and current methods for treatment of the glabellar area of the forehead. Medical and surgical options are outlined for the correction of those rhytids induced by corrugator and procerus muscle activity.

Blepharoplasty↗
PubMed2001

The use of DDAVP desmopressin reduces the incidence of microhematomas after facioplasty.

The authors began to use 1-desamino-8-D-arginine vasopressin (DDAVP) Desmopressin Acetate routinely in their facelift patients who had a relatively high risk of bleeding, either from Von Willebrand factor deficiency, platelet dysfunction, aspirin intake, or ease of ecchymosis. Based on their observations that these patients had enhanced clotting and recovery times, they decided to undertake a prospective evaluation of the effects of Desmopressin Acetate when administered as a preoperative intravenous supplement during cosmetic facioplasty. A series of 200 consecutive patients undergoing surgery was divided into control and treatment groups. A total of 100 patients did not receive medication perioperatively, and 100 subsequent patients received preoperative DDAVP. All patients were observed for ecchymosis and swelling postoperatively and were graded by our postsurgical management team. Postsurgical ecchymosis was graded as mild (grade 1), moderate (grade 2), or severe (grade 3). Grade 4 indicated an expanding hematoma that required immediate surgical intervention. Grades 1 and 2 ecchymosis resolved within 3 weeks. Grade 3 ecchymosis or microhematomas required intervention such as needle aspiration or massage therapy. These small collections of blood generally required substantially longer to resolve and generated notable anxiety in the patients involved. Patients were excluded from the trial if there was a previous history of hypercoagulability or because treatment with DDAVP was medically contraindicated. A total of 23% of untreated patients required intervention for grade 3 ecchymosis compared with 3% of DDAVP-treated patients. No patients experienced any complications associated with DDAVP--namely, deep vein thrombosis, pulmonary embolus, electrolyte imbalance, or renal insufficiency. The authors undertook this study to determine whether DDAVP would help to decrease the incidence of microhematomas after facelift. Based on the results of their grading system and study, they think that the use of DDAVP is safe and efficacious in the prevention of troublesome microhematomas after facelift. Interestingly, although their male facelift patients challenged their efforts to obtain satisfactory hemostasis during and after surgery, the DDAVP-treated male patients responded with marked improvement in postoperative grading after treatment. Obtaining hemostasis intraoperatively was facilitated as well in these patients. This gender phenomenon was even more dramatic when compared with our female patient population.

Deamino Arginine Vasopressin↗
PubMed2001

Abdominoplasty with procedural sedation and analgesia.

The ability to perform abdominal cosmetic surgery in the ambulatory setting provides a more comfortable environment for the patient, ease of scheduling for the physician, and decreased costs. Avoiding the use of general anesthesia allows for quicker recovery, shorter length of hospital stay, and decreased rate of postoperative complications. The authors report 106 consecutive abdominoplasties, including fascial plication when indicated, using local anesthesia, with procedural sedation and analgesia. All procedures were performed with an anesthesiologist providing intraoperative monitoring of the patients. Their protocol uses procedural sedation and analgesia, which results in a depressed level of consciousness, but allows the patient to maintain airway control independently and continuously. The results of this approach were measured in terms of procedure time, length of hospital stay, rate of complications, total recovery time, and the level of patient satisfaction. Between January 1996 and January 1999, 106 patients underwent abdominoplasty (performed by one of the authors) under local anesthesia with procedural sedation and analgesia. All patients had an American Society of Anesthesiologists status of 1 to 3, and underwent a full abdominoplasty, including fascial plication. In 26% of the patients, allied procedures were also performed, most commonly liposuction or augmentation mammaplasty. The mean age in this series was 45 years, and all patients were available for follow-up at least 1 year after surgery. The mean operative time was 135 minutes, recovery room time was 68 minutes, and all patients were ambulatory. There were no surgical complications, including flap loss or wound dehiscence, and no complications related to anesthesia (cardiac, deep vein thrombosis, fat emboli, pulmonary embolism, etc.). Because paralytic agents were not used, none of the patients required catheterization postoperatively. Patients were generally pleased with the results of surgery. Although the extent of the surgery remains the same, this approach provided patients with an easier postoperative experience. In summary, abdominoplasty, including full fascial plication of the rectus and external oblique aponeurosis, can be performed safely and comfortably under local anesthesia with procedural sedation and analgesia. Patients are comfortable, recover quickly, and are very satisfied with their surgical result and overall experience.

Abdominal Muscles↗
PubMed2000

Prophylaxis against Frey's syndrome in parotid surgery.

In 1990 the authors reported their preliminary study of the prevention of Frey's syndrome in 55 patients utilizing a superficial musculoaponeurotic system (SMAS) flap in parotid gland surgery. During the past 10 years, numerous studies have supported their original thesis that interposition of living tissue between the resected gland bed and the skin could prevent the development of this complication. The authors have expanded their own patient population and now consider this a definitive study on the prevention of Frey's syndrome. A total of 160 patients are presented with a follow-up period of 5 to 22 years. All patients underwent subtotal or total parotidectomy performed by one of the authors. A history was acquired and testing for Frey's syndrome (Minor's starch iodine test) was performed. As a result of this approach, and in spite of the intensive search for it, no cases of Frey's syndrome were encountered. The hoped-for secondary benefit of preventing the postparotidectomy retromandibular depression was somewhat less satisfactory, although most patients remain satisfied with their appearance. The debilitating symptoms in Frey's syndrome, which is reported to have an incidence of 5% to 50% in the typical parotidectomy patient, can be avoided with thoughtful preoperative planning. The authors favor an aesthetic incision followed by the development of an SMAS flap. The parotidectomy is then performed using the surgeon's preferred technique. The SMAS flap is then placed into the bed of the resected parotid gland. This institutes a protective tissue barrier guarding against the aberrant anastomotic communication between the postganglionic secretomotor fibers intended for the parotid gland, and the now adjacent sweat glands. Their patient population is large enough to provide significant evidence that Frey's syndrome can be prevented, compared with a meta-analysis of parotid patients in multiple other studies in the literature. Assuming the patient's history and pathology does not preclude its use, the SMAS flap should be considered the standard of care for preventing Frey's syndrome in the postparotidectomy patient. If the SMAS flap is not available, a temporoparietal fascial flap has proved to be a good alternative.

Female↗
PubMed1994

Safe dosages of lidocaine for facial analgesia.

A prospective study of serum lidocaine levels in cosmetic facial surgery patients was undertaken. The findings challenge the currently accepted minimal lethal dose (MLD) for lidocaine. Complete simultaneous facial analgesia (CSFA) was accomplished in an average of 15 minutes and the recommended dosage of lidocaine was exceeded by a mean of 52.8%. This study establishes a possible basis for redefining the maximum safe dosage for lidocaine in human subjects.

Anesthesia, Local↗
PubMed1992

Frey's syndrome: a preventable phenomenon.

Gustatory sweating, or Frey's syndrome, is a fairly common sequela of partial or radical parotidectomy, submaxillary gland surgery, or radical neck dissection. It is caused by an anastomotic communication with facial sweat glands by parasympathetic secretomotor nerve fibers intended for the excised parotid gland; treatments, whether surgical or topical, generally have been less than satisfactory. We present the first documented prophylactic approach to Frey's syndrome that is performed during and as part of parotidectomy. The surgery involves use of the superficial aponeurotic system (SMAS) as an interposing flap to interrupt the anastomotic nerve communication with the sweat glands. The SMAS is derived from the fascia in the periauricular cheek and neck area that is continuous with the platysma muscle. In a prospective study in 55 patients undergoing elective parotidectomy, the SMAS flap was elevated during the beginning of the operative procedure once it had been determined that fashioning of the flap would in no way compromise tumor excision. In all cases, at follow-up, there has been no clinical evidence of development of Frey's syndrome. We have shown that the development of the SMAS flap in parotid gland resections is an effective new approach both as a preventative measure against Frey's syndrome and as an aesthetic improvement over the usual defect typical of parotidectomies.

Humans↗