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Biomedical subjects

Robert L Walton

Publications and source records attributed to Robert L Walton.

7 recordsLinked to original sources
PubMed2005

Microsurgical reconstruction of the nasal lining.

BACKGROUND: Reconstruction of isolated nasal lining defects can be extraordinarily daunting. This report defines the uniqueness of the surgical challenges inherent to reconstruction of the nasal lining and overviews the authors' approach to management. METHODS: A retrospective review was performed of 11 consecutive patients presenting for reconstruction of the nasal lining alone during the period from October of 1996 through March of 2003. There were four men and seven women with an average age of 49.2 years. The average follow-up was 4.2 years. RESULTS: Five patients required reconstruction of the total nasal lining (floor, columella, vestibule), and the remaining reconstructions involved subtotal components. Coincidental necrosis of the nasal lining during total/subtotal nasal reconstruction was the most common cause. A single microsurgical free flap was used in eight patients (six radial forearm flaps). Three patients required two free flaps. There were no flap failures. Thirteen of 14 free flaps healed primarily. Dehiscence of the flap/nasal septal juncture occurred in one cocaine-injured nose. Ten of 11 patients demonstrated patent, functional nasal airways postoperatively. CONCLUSIONS: Reconstruction of the nasal lining, alone, is a very challenging endeavor that demands careful surgical planning and precise technical execution. The use of microsurgical transfer for these defects allows considerable latitude for duplication of the missing complex three-dimensional anatomy and avoids sullying the adjacent facial soft tissues. Because of the adverse condition of the local tissues, the majority of these cases could not have been brought to a successful conclusion without the use of free tissue transfer, and this is particularly relevant in the cocaine-injured nose.

Adult↗
PubMed2005

Salvage of infected cartilage grafts for nasal reconstruction with a through-and-through irrigation system.

Development of a wound infection after nasal reconstruction can place the entire reconstructive effort in jeopardy. The approach to management in these cases has traditionally entailed wound drainage, removal of involved graft material, and debridement of nonvital tissue. Following adequate wound healing, delayed reconstruction is then performed, with the final result often compromised in form and function. We present a case of a postoperative wound infection following reconstruction of a traumatic nasal deformity utilizing autologous cartilage grafts. Treatment consisted of hospitalization with administration of culture-specific parenteral antibiotics and continuous through-and-through antibiotic irrigation of the wound via an indwelling catheter. The infection was completely eradicated and all cartilage grafts were salvaged utilizing this technique. At 3 years postoperatively, the patient has maintained the shape and quality of her reconstruction, without evidence of recurrent infection.

Cartilage↗
PubMed2004

De novo adipose formation in a vascularized engineered construct.

While the field of tissue engineering is a burgeoning one, progress with fat engineering has lagged, due in large part to problems associated with nurturing and sustaining this unique tissue in vivo. In a pilot study using an experimental rat model, we induced liponeogenesis with a combination of Matrigel and basic fibroblast growth factor in an fibrovascular scaffold, isolating the construct to a pedicled blood supply (the superficial inferior epigastric vessels) via a silicone housing, creating an engineered three-dimensional adipose tissue construct. Adipose tissue and vascular ingrowth were assessed histologically and followed by serial study at 4-week intervals for 16 weeks. We demonstrated persistence of shaped adipose tissue constructs over time, and postulate that incorporating a vascular supply may enhance the durability of experimentally induced fat constructs and potentially provide a means for microsurgical transfer of the construct.

Adipose Tissue↗
PubMed2003

Progress in adipose tissue construct development.

Although the field of tissue engineering has been the focus of a great deal of promise and study, only recently has significant attention been given to the engineering of soft tissues. The applicability of an engineered adipose construct as a basic science model and a reconstructive tool is unquestioned; yet, there have been limitations in previous work, specifically issues of construct size and maintenance over time. This article briefly overviews the pivotal factors necessary for adipocyte growth and differentiation, optimal scaffolds for the engineering of soft tissues, and a means of providing vascular support for these highly demanding cells. Clinical science and bioengineering concepts that may provide the foundation toward the successful in vivo engineering of an adipose tissue construct that maintains its complex three-dimensional shape over time are critically reviewed.

Adipocytes↗
PubMed2003

Early rehabilitation of facial defects using interim removable prostheses: report of two clinical cases.

Postsurgical facial defects often pose a challenge to patient rehabilitation. Such defects can have a severe adverse effect on patient perceptions of body image and self-esteem. When immediate surgical repair of the defect is not feasible, an interim removable facial prosthesis may be considered. This prosthesis can be fabricated and placed as soon as several days after surgery to provide a cosmetically acceptable appearance, permitting the patient to more comfortably and confidently resume social interactions during the postoperative healing period. This article presents two case reports describing the use of interim facial prostheses to provide rapid patient rehabilitation.

Aged↗
PubMed2002

Auricular reconstruction for microtia: Part II. Surgical techniques.

Reconstruction of the microtic ear represents one of the most demanding challenges in reconstructive surgery. In this review the two most commonly used techniques for ear reconstruction, the Brent and Nagata techniques, are addressed in detail. Unique to this endeavor, the originator of each technique has been allowed to submit representative case material and to address the pros and cons of the other's technique. What follows is a detailed, insightful overview of microtia reconstruction, as a state of the art. The review then details commonly encountered problems in ear reconstruction and pertinent technical points. Finally, a glimpse into the future is offered with an accounting of the advances made in tissue engineering as this technology applies to auricular reconstruction.

Adolescent↗