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Biomedical subjects

T E Goodacre

Publications and source records attributed to T E Goodacre.

At least 19 recordsLinked to original sources
PubMed2000

The management of nasoseptal perforation.

The most recent comprehensive review of the literature on repair of nasoseptal perforations dates back to 1985, since then there have been developments in the repair of very large perforations, previously thought to have been untreatable by surgical methods. The purpose of this article is to review the various methods which have been used to repair perforations, and their reported efficacies, with particular reference to the problem of large perforations. The article reviews the methods in use for providing mucosal cover for perforations; the options for a supporting layer; and the more recent solutions to mending perforations greater than 4 cm diameter. In conclusion, nasoseptal perforations of up to 4 cm diameter have been reported to be closed reliably with bilateral mucoperichondrial flaps and a connective tissue autograft. However, for larger perforations the only methods successfully used have been a three stage, composite graft and intranasal tissue expanders.

Connective Tissue↗
PubMed2000

Does MRI contribute to the investigation of palatal function?

The results of a pilot study into the value of MRI scanning in investigation of velopharyngeal function are discussed. MRI offers potential advantage over naso-endoscopy in being noninvasive and over video fluoroscopy in avoiding radiation. However, it requires costly equipment and patient cooperation, which limits its use in young patients. Ten normal volunteers and 15 patients with speech problems underwent MRI of the velopharyngeal port at rest and during sustained phonation of word /a/. Optimal planes for scanning were determined. Images were obtained in mid-sagittal, coronal and horizontal planes at the level of the hard palate and in the plane of the levator axis. Computer assisted measurements were possible of the velopharyngeal closure, forward movement of posterior pharyngeal wall, velar lift, velar extensibility and medial movement of the lateral pharyngeal wall. MRI has a potential role in investigation of velopharyngeal incompetence and planning its surgical repair.

Adolescent↗
PubMed2000

Vertical extended hemi crico-laryngectomy and reconstruction with a prefabricated tracheal free flap--initial results.

We describe our experiences of treating three patients with recurrent T3 squamous cell carcinoma of the larynx, following initial treatment with radiotherapy; using the technique of partial crico-laryngectomy and autologous pre-fabricated tracheal flap reconstruction as described in 1998 by Delaere (1). We have found the technique to be technically challenging. The patients require extensive speech and swallowing rehabilitation following surgery, but the functional result offers significant advantages over the other surgical salvage procedures of total or near-total laryngectomy. We describe our early results of three patients that we have treated using this technique.

Aged↗
PubMed1997

Osteomyelitis occurring in the zygomatic bone.

Osteomyelitis of bones in the middle third of the face is rare, especially in westernized populations. The actiology is usually due to odontogenic sources or infected fracture sites. An unusual case of osteomyelitis of the zygomatic bone resulting from the use of radiotherapy in the management of recurrent basal cell carcinoma is presented. This illustrates a late complication of therapy for a cancer which commonly occurs in the head and neck region and is rapidly increasing in incidence in the UK.

Basal Cell Carcinoma↗
PubMed1996

Demographic and epidemiological aspects of plastic surgery: profile of a supradistrict specialty.

The workload of plastic surgery is often poorly understood by the public and those responsible for financing health care. The authors have used linked statistical data to analyse demographic and epidemiological profiles of workload in plastic surgery in Oxfordshire. The analyses were constructed for residents of the district and for patients treated from other districts. The former provides a profile of workload generated for plastic surgery from a geographically-defined population. The latter complements this by adding information about 'imported' workload. Admission rates for plastic surgery were higher for children and elderly people than for other age groups; higher for males than females; and they increased during the 11 years of the study. Most of the increase represented an increase in people treated by the service, rather than an increase in readmissions, although there was a modest increase in the latter too. Lengths of stay per admission and total time spent in hospital per person declined considerably. The bulk of the workload in plastic surgery is concerned with the treatment of trauma (including burns), cancer and congenital malformations. The main clinical conditions treated by the specialty are documented distinguishing, for each condition, the extent to which the patients came from outside the authority in which the provider unit is cited.

Adolescent↗
PubMed1995

Surgical management of regional lymph nodes in primary cutaneous malignant melanoma.

The management of regional lymph nodes in the patient with primary cutaneous malignant melanoma remains a contentious issue. Early removal of nodes, which may harbour occult microscopic disease before the development of clinically detectable malignant lymphadenopathy, is thought by some to confer a survival advantage and/or improve locoregional tumour control. While tumour burden at lymphadenectomy has been shown to correlate with prognosis, there are conflicting reports regarding the efficacy of elective lymph node dissection (ELND) compared with a regimen of delayed therapeutic dissection for clinically detectable nodal involvement. Evaluation of arguments for and against ELND, together with consideration of surgical morbidity and the predictability of lymphatic drainage patterns, has allowed a clinical algorithm to emerge which may identify patients who may benefit from prophylactic surgery. A chronological summary of the relevant studies is presented and the overall division of opinion regarding the efficacy of ELND is discussed.

Head and Neck Neoplasms↗
PubMed1995

EMLA cream on the ears--is it effective? A prospective, randomised controlled trial of the efficacy of topical anaesthetic cream in reducing the pain of local anaesthetic infiltration for prominent ear correction.

A prospective, randomised, double blind trial was carried out to test whether or not the application of topical anaesthetic cream (EMLA cream) before infiltration of local anaesthetic would decrease the discomfort of correction of prominent ears under local anaesthetic. 23 patients were entered into the trial. They acted as their own controls, one ear having EMLA cream applied approximately 2 h prior to surgery, and the other Aqueous cream. Immediately after surgery, the patients were asked to complete two scales describing the amount of pain they had felt in each ear, both at the time of injection of local anaesthetic and during the surgery. They were also asked whether they thought the inconvenience associated with the use of the EMLA cream was worth any improvement they felt. The results showed that, compared to the placebo cream, EMLA cream significantly decreased the pain felt both at the time of injection (p < 0.005) and during the surgery (p < 0.01). However, only 62% of patients asked felt that the inconvenience associated with the use of EMLA cream was worth the benefits that it conveyed.

Administration, Topical↗
PubMed1991

Survival of irradiated glutaraldehyde preserved bovine cartilage in nasal reconstruction: a retrospective study.

Chondroplast, bovine irradiated glutaraldehyde preserved cartilage, has been available in the UK for facial contour surgery since 1986. Eighteen patients who had implants for nasal reconstruction during a 3-year period were reviewed. The mean follow up was 21 months. There was a high rate of graft loss with significant resorption in 7 cases, and loss from infection in 4. There was survival of graft in 7 cases. A prospective study is recommended to determine the reliability of this graft material in reconstructive surgery.

Adult↗
PubMed1990

Donor site morbidity following osteocutaneous free fibula transfer.

Nine patients who had undergone free fibula transfer were reviewed to determine the incidence of donor site complications. Problems identified included distal oedema, cold intolerance, sensory loss and weakness. However, the functional deficit was not great and most patients were not troubled by their symptoms. More serious potential complications from raising this flap are considered.

Adult↗
PubMed1990

Congenital alveolar fusion.

Five cases are described of a condition in which the maxilla is fused to the mandible at birth, together with details of associated anomalies. A review of the literature provides a further nine single case reports that have appeared previously. An hypothesis of the possible embryological derivation of this condition is proposed.

Abnormalities, Multiple↗
PubMed1990

Free vascularised toe joint transfer for reconstruction of the metacarpo-phalangeal joint.

Two single and two double free vascularised joint transfers from the foot to hand have been undertaken in four patients over a period of four years. All were to replace metacarpo-phalangeal joints in young patients in whom the use of prosthetic devices was considered unsuitable. All the transfers were successfully completed, but one failed late in the second post-operative week due to sepsis. The results of the remaining three transfers compare favourably with prosthetic arthroplasty and continue to improve. Donor site morbidity in the foot has been minimal and is reviewed.

Adolescent↗
PubMed1989

The fate of meshed allograft skin in burned patients using cyclosporin immunosuppression.

Three patients with burns of 35%, 60% and 25% were treated with cyclosporin after the application of allograft skin. Biopsies of the allografts were taken at appropriate intervals. The drug was continued for 3 weeks, 3 months and 3 weeks respectively without ill-effects on the patients. The allografts survived during cyclosporin treatment but were rejected 12 days after cessation of treatment in Case 1 and 5-7 days in Case 2. In Case 3 where a meshed auto/allograft 'sandwich' technique was used, there was no visible evidence of rejection. It is likely that the allograft was replaced by a "creeping substitution" in the sandwich technique. The Langerhans cell is probably not solely responsible for allograft rejection.

Adult↗
PubMed1989

When radiotherapy offers no more: the surgical management of advanced breast malignancy.

Recurrent local carcinoma of the breast can present a challenging problem of control and reconstruction to the surgeon. The pattern of ulceration, which may extend over a wide area of the chest wall and deeply into the ribs and pleura, is often similar in appearance to the sequelae of excessive radiation therapy, which can therefore be considered as a similar management problem. Advanced carcinoma of the breast can make the last few months of life miserable. Surgery can greatly assist in the amelioration of appearance, smell, and discharge from the ulcer. We report 41 patients managed surgically between 1978 and 1987.

Breast Neoplasms↗
PubMed1988

Split skin grafting using topical local anaesthesia (EMLA): a comparison with infiltrated anaesthesia.

The analgesic efficacy of EMLA cream was compared with that produced by infiltration of lignocaine solution when used to provide anaesthesia for cutting of skin grafts. The study was performed as an open parallel group comparison in 80 patients. Pain felt during administration of the anaesthetic and during cutting of the graft was assessed using visual analogue and verbal rating scales. During graft cutting, the anaesthesia produced by EMLA was at least as effective as infiltration. On administration, infiltration produced varying amounts of pain in all patients, but in contrast EMLA produced no discomfort. In view of this lack of discomfort and the consequent greater freedom afforded regarding the area of donor site anaesthetised, EMLA can be considered the treatment of choice when skin grafts are harvested under local anaesthetic.

Administration, Cutaneous↗
PubMed1987

Tropical ulcers.

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Female↗