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Biomedical subjects

R A Ersek

Publications and source records attributed to R A Ersek.

At least 19 recordsLinked to original sources
PubMed1992

Bioplastique: a new biphasic polymer for minimally invasive injection implantation.

The search for prosthetic materials that are biocompatible, nontoxic, and permanent led the authors to develop a micronized, inert, biphasic polymer particle for permanent soft tissue augmentation which neither migrates nor is absorbed by the body. Placed in a bioexcretable gel carrier, these textured microparticles are easily implanted using a specially designed blunt-tipped cannula with local anesthesia on an outpatient basis. Research using this implant material, Bioplastique (Bioplasty, St. Paul, MN), in rabbits has shown that when the textured particle size is maintained within a critical range, neither particle migration nor storage disease occurs. The gel carrier is rapidly phagocytized and replaced by fibrin matrix within a few days. Host collagen then gradually forms a fibrotic capsule around each textured particle, making use of the naturally occurring foreign body reaction to create a stable inplant. After being followed for over two years, Bioplastique has proven to be useful in many clinical applications with few complications.

Animals↗
PubMed1992

Mammalian response to subdermal implantation of textured microimplants.

The development of small, textured implant particles suspended in a hydrogel has allowed for subdermal injection therapy to fill tissue defects. The microimplant particles were placed subdermally into the ears of white New Zealand rabbits in order to characterize the foreign body response and the permanence of the implant. Serial micrometer readings were performed on the implant sites to determine any change in thickness of the augmentation following baseline measurement. An initial increase in the thickness was noted approximately 20-30 days postimplantation, as expected. A stable thickness was noted for the remainder of the experiment. Serial histological sections were performed at irregular intervals from one week to one year. Histology demonstrated a mild foreign body response with collagen surrounding each individual microimplant particle. The response was stable after 30-40 days and has remained stable for over one year. It was determined that the histology demonstrated a Boros 1A type, or nonimmunogenic, low-turnover foreign body reaction.

Animals↗
PubMed1992

Results of reaugmentation with MISTI prostheses after failure of smooth silicone prostheses.

In 1988 and 1989, we replaced smooth silicone double-lumen implants with Molecular Impact Surface Textured Implants (MISTIs) in 28 of our patients. Of these, 20 had experienced recurrent capsular contracture and sought an alternative prosthesis that would provide long-term relief from this problem, and 8 simply wanted larger prostheses. Among the reaugmentation patients who had experienced recurrent contractures, 4 have had problems with the texturized implants; 1 developed an infection, and 3 developed unilateral fibrosis within weeks of surgery. The infection was resolved with antibiotics, and the fibrosis was resolved with capsulectomy, biweekly methylprednisolone irrigation in the surgical pocket, and lenticular suction drainage over a 3-week period. After a 2-year follow-up, these 4 problematic patients have remained soft and asymptomatic following their treatment, and the remaining 16 patients have remained soft and asymptomatic since their surgery.

Adult↗
PubMed1991

Obesity can be treated by suction lipoplasty when combined with other procedures.

The development of serial suction lipoplasty enables us to remove substantial amounts of subcutaneous fat safely and dependably on an outpatient basis, and free our patients of the worry of exogenous blood transfusion. Many practitioners and researchers do not advocate suction for the treatment of obesity, but rather regard it as a means of treating localized small deposits of fat or "figure faults." The reason for their caution is that the amounts of fat to be removed from the obese patient would require extensive hospitalization, transfusion, and increased risk of complications. Liposuction, when performed as a series, can make the treatment of obesity as safe as the treatment of smaller figure faults. We now use serial suction as an adjunct to other surgical and dietary methods for the control of obesity.

Adult↗
PubMed1991

Comparative study of dermabrasion, phenol peel, and acetic acid peel.

Six areas of the face and forehead of a 36-year-old white female presenting with a benign congenital blue nevus of the skin were treated by dermabrasion, bichloracetic acid, and the classic phenol peel. Comparative results at six months showed each of these methods to be approximately equal in the depth of penetration and in the quality of skin on healing. However, in these small test sites, dermabrasion appeared to remove pigment slightly more efficiently. Therefore, her forehead and cheeks were treated with dermabrasion and subsequently with chemical peel. An attempt was made to touch up the dermabraded areas with acetic acid. Full thickness burns occurred, which resulted in thick scarring that required many months to finally heal. We conclude that at least in the treatment of pigmented lesions, the modalities of phenol, acetic acid, and dermabrasion are approximately equal.

Adult↗
PubMed1991

Transaxillary subpectoral placement of textured breast prostheses.

Textured breast implants are difficult to introduce through a small incision. We have developed two new retractors and a new positioning regimen that enables us to use the transaxillary subglandular or subpectoral approach for breast augmentation. These retractors enable us to bluntly dissect the plane beneath the gland or the pectoralis muscle and then adduct the arm so that the relaxed pectoralis or subglandular space can be retracted to allow atmospheric pressure, gravity, and the surgeon's finger to work in unison.

Breast↗
PubMed1991

Rate and incidence of capsular contracture: a comparison of smooth and textured silicone double-lumen breast prostheses.

Capsular contracture results in dissatisfaction and deformity among the 2 million women who have had silicone implants. The literature describes contracture rates as high as 74 percent. I present a comparison of rates and incidences of contracture in patients augmented with smooth and textured double-lumen silicone implants. A total of 165 "smooth" and 63 "textured" implant patients were included in this study, which spans 12 years, 1978-1990. All patients underwent bilateral aesthetic augmentation performed by the same surgeon. Of the 165 smooth implant patients, 74 (44.8 percent) experienced contractures requiring treatment. Of the 63 textured implant patients, 3 (4.8 percent) previous contracture patients experienced sudden fibrosis within 3 months. All others remained soft. It appears that deeply textured silicone surfaces delay or decrease the rate and incidence of clinical capsular contracture, at least for 2 years.

Breast↗
PubMed1991

Radiolucent prosthetic gel.

The successful use of silicone breast implants is complicated by their interference with mammography. We have evaluated clinically available implant filling materials and found that a new Bio-Oncotic gel approximates the radiolucency of normal breast tissue. Silicone implants completely obscure areas of the breast in mammography. Recently proposed as a filler material, peanut oil is significantly more radiolucent than normal tissue. Physiologic saline solution compares favorably as a tissue-density-simulating substance. However, saline's lack of lubricating properties results in leakage, making it less than optimal. Bio-Oncotic gel is biologically compatible. We conclude that this gel is the most appropriate filler for breast prostheses. Clinical studies are indicated.

Arachis↗
PubMed1991

Interrelationship of capsule thickness and breast hardness confirmed by a new measurement method.

All implants initiate a foreign-body response that leads to their encapsulation by scar tissue. In order to better understand this encapsulation process and the differences between soft (comfortable) and firm (contracted) breasts, we studied 22 patients who had come in for reaugmentation during a 2-year period. The capsules removed were prepared and measured using a new method. The capsules were (1) removed and stored in physiologic solution until the time of measurement (30 minutes to 2 hours) and (2) measured using a Mitutoyo dial-thickness gauge (MDTG) that employs a uniform pressure of 85 gm. The measurements revealed that soft breasts (Baker 1) have the thinnest scar-tissue capsules, which ranged in thickness from 0.002 to 0.010 inches. Firm breasts yielded the thickest capsules. Baker 3 measured between 0.010 and 0.078 inches thick, and Baker 4 measured between 0.018 and 0.162 inches thick. We also compared the precision of measurement between the MDTG and a standard (screw-type) micrometer by taking a series of readings on a soft, pliable substance (textured silicone rubber).

Breast↗
PubMed1991

Transplantation of purified autologous fat: a 3-year follow-up is disappointing.

The idea of autologous fat microtransplants has recently resurfaced because of interest by the press. Past experiments have shown that small amounts of fat may be transplanted with an expected survival rate between 10 and 50 percent without ectodermis. A great fund of knowledge exists showing that skin grafts will survive quite dependably if their thickness is up to about 0.0020 inch. For the first week or so, they live by diffusion and inosculation, and then neovascularization enables them to continue viability. I have developed a technique whereby fat is harvested through a blunt cannula with minimal vacuum to prevent explosion of the cellular fat globules. Fibrin and cellular debris are removed, and the fat globules are separated from the free fat, blood, and other constituents of the aspirate. Individual, free-floating 1- to 3-mm adipose fragments are then suspended in nutrient solution and injected through an 18-gauge needle. Multiple radial pathways, with each fat segment being separated from the other by host tissue, maximizes the host-prosthesis interface and the possibility for exchange of nutrients. I have attempted this procedure in more than 100 patients with widely varying results. In acne pits of the face, no significant improvement could be noted 6 weeks after injection. For the first few weeks, a near-perfect result was obtained, but none of these transplants in scarred areas of this kind have been of benefit. Injection of 10 to 50 cc in other areas has resulted in some cells (perhaps 10 percent) surviving over 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1991

Firestorm fibrosis: the fast fibrotic phenomenon.

Whenever implants are placed within the human body, a fibrous capsule is formed by the host to isolate the implant. If the chemical composition of the implant is inert and stable, the fibrous capsule will be thin and ignored by the body. In some instances, as a reaction of overhealing, however, a rapid fibrosis occurs and a thick contracted capsule forms within a few weeks. We have encountered this in 3 patients who were previous failures of smooth surfaced breast implants, when a new textured silicone implant was placed in the surgical pocket after complete capsulectomy. A thick, fibrotic capsule formed within a few weeks, necessitating re-removal. We treated these patients with aggressive sudden fibrosis with suction drainage and irrigation with methylprednisolone biweekly for 3 weeks. In these 3 consecutive patients, further fibrosis was prevented by this therapy; and all remain soft and asymptomatic after more than 1 year of follow-up. In patients with firestorm fibrosis, aggressive treatment with constant suction drainage and methylprednisolone irrigation warrants further study.

Adult↗
PubMed1991

Bioplastique: a new textured copolymer microparticle promises permanence in soft-tissue augmentation.

Migration, absorption, or toxicity of prosthetic materials has always plagued the plastic surgeon attempting to ameliorate soft-tissue deficiencies and other contour abnormalities. Our previous work to develop textured-surface breast prostheses has led to the development of micronized, inert, biphasic copolymer particles that neither migrate nor become absorbed by the body. These particles are textured, of critical dimension, and, when mixed with a bioexcretable gel vehicle, can be implanted using a special blunt-tipped cannula. Our experimentation in rabbit ears has shown that the bioexcretable gel component is rapidly phagocytized and is replaced by fibrin-like matrix within 3 days. The fibrin is then replaced by host collagen that gradually converts into a fibrotic encasement around each texturized particle. Clinical use of the substance in a variety of soft-tissue deficiencies has been generally effective, with only a few complications, when followed for 1 year.

Adult↗
PubMed1990

Subcutaneous pseudobursa secondary to suction and surgery.

Suction lipectomy has been used throughout the regions of the body to remove vast amounts of subcutaneous fat. The blunt technique allows for a multiplicity of small (4 to 6 mm) channels to be created and the fat removed by suction with little disturbance of the overlying skin, the supporting septa, vessels, or nerves. Abdominolipectomy has been successfully performed for decades, in which large amounts of skin and subcutaneous fat are removed by sharp dissection. The undermining involved in an adbominolipectomy extending from the xiphoid to pubis and laterally to the level of the iliac crest and then supplemented by the suction technique has led to the formation, in some cases, of chronic seromas not relieved by multiple aspirations. Healing and contractions of these seromas causes a deformity of the overlying skin, because it is puckered and drawn upon itself. This results in the formation of a subcutaneous pseudobursa lined by collagen sheets but no epithelial cells. We present 9 patients who have demonstrated this phenomenon. We suggest that in the largest resections, safety is best served by waiting a period of at least 6 weeks between suction and subsequent resection.

Abdomen↗