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Biomedical subjects

W Gubisch

Publications and source records attributed to W Gubisch.

At least 37 records · Page 2Linked to original sources
PubMed1995

Functional and aesthetic nasal reconstruction in unilateral CLP-deformity.

The correction of nasal deformities in cleft patients presents a challenge in the secondary treatment of this malformation. The complexity of the nasal deformity in cleft patients partly depends on the congenital anomaly itself and partly on the surgical procedures which were previously carried out. The nasal deformities in unilateral CLP patients are typical. The nasal floor and the nostril sill are mainly constructed during primary lip repair. While the ala on the cleft side is repositioned, the septum deformity and the anterior spine dislocation are not touched. If large circular incisions are used at the time of primary operation to achieve symmetry, the situation usually deteriorates. One of the main characteristics of a classic cleft lip nose is the deviation of the external nose to the non-cleft side due to the typical septal deformity, where the anterior part of the septum and the caudal edge of the septum are subluxated to the non-cleft side (Fig. 1). Furthermore, there is a typical asymmetry of the nasal tip and the ala (Figs. 5 to 7). The columella is slanted and shortened on the cleft side. The ala cartilage on the cleft side is distorted and displaced. There are two important points in the concept of surgical rehabilitation: First, straightening the deviated nose, which often needs extracorporeal septum correction. This seems to be the prerequisite for correction of the external deviation. Second, rehabilitation includes the correction of the asymmetry of the tip and the nostril. A number of techniques have been suggested for this problem, which indicates that there is no ideal procedure. In our hands the triple-flap repair produced good and reliable results. There was no difference in the results, whether an open approach or an endonasal one was used.

Cleft Lip↗
PubMed1995

Experimental and clinical study on the vitality of orthotopic cartilage transplants.

Orthotopic cartilage transplants are performed in the course of numerous rhinosurgical operations. Precondition of a permanent success of the operation is preservation of vitality of the transplanted cartilage. Although numerous study results of heterotopic cartilage transplants exist, corresponding examinations in orthotopic transplants have not been done so far. Therefore, in 33 rabbits we did a partial submucous septumresection and put the cartilage back between the mucosal wall. After 1, 2, 3, 6, and 12 weeks, the animals were killed and the cartilage histologically proved. These results were compared to analogous human biopsies. Cartilage reintegration showed a characteristic picture. In the rabbit, the replanted cartilage was healed and stable after 3 months in each case. During reintegration, appositional growth started from the inner perichondrium. With microangiographical examinations, we were able to demonstrate that the speed of reintegration increased with decreasing distance of the cartilage cell from the blood vessels. We managed to confirm the experimental results in human cartilage biopsies.

Animals↗
PubMed1995

The extracorporeal septum plasty: a technique to correct difficult nasal deformities.

The severely deformed septum remains a problem. We recommend removing the whole septum and reconstructing a new, straight, septum plane that will be replanted (i.e., extracorporeal correction). Until April 1993 we had used this technique in 1012 patients with functionally as well as aesthetically encouraging results. All septal replants healed primarily. A problem may occur with this technique in reconstructing the dorsum and in stabilizing the replant. The exact technique is explained in detail, and the results are compared with those reported in the literature. Even with this radical procedure, the rate of complication was only 2.2 percent. Biopsies provided the histologic proof of cartilage survival.

Adolescent↗
PubMed1995

Comparative immunohistochemical distribution of amylin-like and calcitonin gene related peptide like immunoreactivity in the rat central nervous system.

Using the indirect immunofluorescence method with a polyclonal antiserum raised in rabbits and directed against amylin (AMY), we have investigated the distribution of AMY-like immunoreactivity (-ir) throughout the central nervous system of the rat. The widespread distribution of AMY-ir was much more abundant than that previously reported for calcitonin gene related peptide (CGRP) immunoreactivity. In most brain areas there was no overlap between AMY- and CGRP-ir cell body groupings, with the exception of the motor nuclei of the hindbrain and spinal cord, which were found to contain large numbers of AMY- and CGRP-immunoreactive cell bodies. Areas with a moderate to dense appearance of AMY-ir were the rhinencephalon, the nucleus of the diagonal band, the magnocellular, dorso- and ventro-medial and mammillary nuclei of the hypothalamus, the habenula, the compact part of the substantia nigra, the ruber and pontine nuclei, and the inferior olive and the cerebellar nuclei. The widespread immunohistochemical distribution of AMY-ir in the rat brain is in partial agreement with the distribution of AMY-binding sites.

Amyloid↗
PubMed1994

[Tissue transplantation in the face. Indications and value of various procedures].

Malignant tumors of the skin are on the increase, worldwide. As a result, the repair of facial defects is of growing concern to the plastic surgeon, who has a range of operative techniques at his disposal. The aim of surgery must be to achieve not merely a good functional reconstruction, but also a pleasing esthetic appearance.

Esthetics↗
PubMed1994

[The large nose--an esthetic, but also a functional problem].

The term "Big Nose" describes many deformities caused by hypertrophy of the bone or the cartilagenous framework of the nose or both. This leads to disharmony of the face, which discomforts the patients. By diminution of the naso-labial angle as for example in a "Pinocchio nose" or by the reduced angle of the inner valve like in a tension nose, a "Big Nose" presents not only an aesthetic problem but a functional one too. An exact analysis of the deformity is necessary to choose the adequate operative procedure. The reduction of the nose should lead to an improvement in "looks" as well as in breathing. The most challenging factor in nose reduction is the diminution of the tip projection. Two different methods are mainly available: the technique according to Goldman and to Lipsett. The pros and cons of both are compared and a few refinements suggested.

Cartilage↗
PubMed1994

[A personal rhinoplasty concept for patients with cleft lip, jaw, palate].

In the treatment of patients with cheilognathouranoschisis, rhinoplasty is a great challenge, since the cleft lip and palate will also produce nasal deformation requiring surgical correction. Unilateral cleft lip and palate is usually associated with a pronounced septal deformity resulting in "crooked nose" as well as typical asymmetry of the apex of the nose and of the nasal vestibule. The anterior part of the septum is dislocated in the direction of the unaffected side and the lower border of the septum is at the same time subluxated to the opposite side. The dorsal part of the septum presents with a convex deformity towards the cleft side extending in horizontal and vertical direction. Severe septal deformities cannot usually be adequately corrected on the spot, i.e. loco, but since septal correction is of paramount importance for the appearance and functioning of the nose we performed an extracorporeal correction of the septum in 191 cleft patients during the period from January 1980 through May 1993. Another characteristic feature of the cleft nose is the oblique modiolus, or columella cochleae, which is shortened on the cleft side, and the S-shaped deformity of the lateral alar cartilage, which presents with a cranial dislocation in the dome, caudal deviation in the lateral part, and an overhanging ala. After correction of the entire cartilaginous nasal framework the surgeon is usually confronted with asymmetry of the soft tissue. Satisfactory correction can be achieved by means of a three-flap technique in the region of the modiolus, nasal ala and vestibular skin: A modiolus-based transpositional flap results in a symmetrical height of the modiolus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Indications and value of various techniques of nasal alar reconstruction].

Reconstruction of the ala of the nose is a very common task for the plastic surgeon. Many different techniques are available, but as in all reconstructive procedures in the face it is important to consider the combination of function and aesthetics. It is not only important to close the defect, but how it looks afterwards. According to these criteria the various methods were analysed and local flaps were found to be the most favorable technique due to their identical texture and colour match to the surrounding tissue. On the nose, the skin of the tip and the ala is very tight which makes it difficult to use local flaps there. However, there is a surplus and looseness of skin in the glabella region. This skin can be transferred by an axial fronto-nasal flap, pedicled on a branch of the angular artery as described by Marchac. With this flap any point of the nose can be reached. In our opinion, this flap appears preferable to all others. The new technique of ala reconstruction based on this axial fronto-nasal flap is demonstrated. The skin defect is covered by this flap and for the inner lining a mucosal flap from the septum can be used which includes a strip of cartilage for stabilisation. In addition the surplus of tissue at the point of rotation, which normally has to be resected as a Burow's triangle, can also be used for the inner lining.

Adolescent↗
PubMed1993

[Reconstruction of nose defects with a glabella flap].

The closure of defects in the areas of the nasal tip and ala, most commonly resulting from the excision of tumors or loss of tissue secondary to trauma, presents a frequent problem. The use of adjacent skin for tissue replacement is limited, because it lacks mobility and elasticity. Regional flaps often produce undesired results due to the difference in texture. The use of regional transposition flaps from the forehead is time-consuming. Therefore, a method originally described by Marchac and Toth, using a vascularized pedicled glabella rotation flap, is recommended.

Adult↗
PubMed1993

[Postoperative management with pulsed high frequency electromagnetic energy. A clinical study of 38 patients with rhinoseptoplasty].

The effect of high frequent electromagnetic radiation pulse (PHEE) on the resorption of postoperative hematomas was investigated in 38 patients who underwent rhinoseptoplasty. 18 patients were treated twice a day using a diapulse equipment, whereas the patients in the control group did not get radiation. In the radiated patients, measurements of the infraorbital hematoma showed accelerated resorption-contrary to the course of the supraorbital hematoma. Diapulse radiation also prevented the enlargement of hematomas that usually proceeds until the third postoperative day. Results of undiminished resorption in the upper eyelid may be caused by inadequate penetration of PHEE or a methodical mistake in the analysis. Additionally, patients treated with PHEE needed a shorter course of postoperative antiphlogistic treatment when compared to the control group. The treatment might further be improved by preoperative use of PHEE or additional radiation of the liver, spleen, and adrenal gland. The results of our investigation showed the improvement of wound healing by using PHEE.

Electromagnetic Fields↗
PubMed1992

[New techniques for correction of the difficult septum].

In badly deformed septums we recommend an extracorporal correction. We used this technique in more than 800 patients. There are less complications than in the common techniques and the results are encouraging. The technique is explained in details and the results are compared with the literature.

Cleft Lip↗
PubMed1992

[Implants in rhinoplasty--value and indications].

Many materials have been used as nasal implants. In our opinion, autogenous material only should be used for nasal augmentation and reconstruction. The indications and techniques for cartilage grafts from the rib, auricle, or septum are discussed.

Adult↗
PubMed1991

Various techniques of secondary nose correction in unilateral cleft-lip procedure.

Several technical details of secondary nose correction in unilateral cleft lip procedure are presented. A new technique of total removal of distorted septal cartilage is described, correcting it under full vision and replanting it afterwards into the nose, thus clearing both airways and reshaping the nose profile at the same time. Also different cartilage-mucosal flaps are described as a way to create symmetry in the nasal tip region and both ala nasi.

Adolescent↗
PubMed1991

[Possibilities in lower eyelid reconstruction].

Reconstruction of the lower lid is associated with aesthetic and functional problems. Different techniques are proposed. From 1985 to 1988, 17 patients have been treated by a bridge flap technique from the upper lid combined with a composite graft from the septum. In our opinion, this method is indicated in smaller through-and-through defects as well as in total lid reconstruction. The advantages of the technique are discussed and demonstrated.

Aged↗
PubMed1991

[Anastomosis of free flaps to the inferior epigastric artery].

The inferior epigastric vessels are a reliable and easily accessible vascular pedicle for free tissue transplantation to the perineum, genital area, and the abdominal wall. Two cases serve to illustrate the procedure: the first involves a post-radiation ulcer following recurring carcinoma of the vulva with loss of the symphysis; the second involves a reconstruction of the abdominal wall employing a two-fold latissimus dorsi flap in a patient with malignant fibrous histiocytoma.

Abdominal Muscles↗
PubMed1990

[Orbital reconstruction].

Orbital reconstruction by local flaps, distant flaps, free skin transplants or mucosal transplants, means numerous operations. Good results are often spoiled by postoperative shrinking, especially, when the patient previously had radiation. Therefore we use nowadays free flaps (forearm flap, dorsalis pedis flap) as fascio-cutaneous or fascio-mucosal flaps. By this procedure, reconstruction can be done in one or two stages and postoperative shrinking can be avoided. Our experience in 4 cases is demonstrated.

Adolescent↗