Biomedical subjects

B Michelow

Publications and source records attributed to B Michelow.

4 recordsLinked to original sources

PubMed1998

Delayed healing of rhytidectomy flap resurfaced with CO2 laser.

Combining facial rhytidectomy with laser resurfacing, theoretically, provides the best opportunity for achieving an optimal facial rejuvenation result. Previous studies have demonstrated the pernicious effect of a deep peel on a skin flap, but the safety of treating the rhytidectomy flap with laser has not been investigated. This study was conducted to investigate the safety of using these techniques concomitantly. Sixty sites were selected on three Yucatan minipigs, a species of swine chosen because of its hairless nature and opportunity to raise a true skin flap (without the panniculus carnosus). The healing time of 20 laser-treated sites without flap elevation was compared with that of 20 areas treated with laser following flap elevation, shortening (to emulate a more realistic rhytidectomy process), and repair. Twenty flaps were elevated and shortened without laser treatment to serve as a control. The CO2 laser parameters were set at 500 mJ, 50 watts, and a density of 5. Two passes were made to penetrate the upper dermis. The mean healing time for areas treated with laser alone was 12.05 days, ranging from 11 to 14 days. In comparison, the healing time for the laser-treated areas subsequent to flap elevation averaged 17.95 days, with a range of 14 to 24 days (p < 0.05). Two flaps treated with laser (10 percent) failed to heal completely in 24 days. At the time that all 20 of the areas treated solely with laser had re-epithelialized completely, only one of the flaps treated with laser had re-epithelialized completely (p < 0.001). A delay in healing, as well as return of pigment, was demonstrated in the distal portions of all flaps receiving laser treatment. The control flaps all healed normally except for a 5-percent superficial loss on a single flap. It was concluded from this study, and from clinical observation of delayed healing on six of seven patients who underwent concomitant rhytidectomy and laser resurfacing at a conservative laser setting, that laser resurfacing of the rhytidectomy flap is unsafe and results in delayed re-epithelialization. This combination should be avoided altogether or performed with extreme prudence on patients undergoing a deeper plane facial rhytidectomy or by using very low laser settings.

Animals↗

PubMed1995

Blepharolabioanal syndrome.

A previously unreported syndrome of congenital craniofacial and anorectal anomalies affecting a woman and her two daughters is described. Features include bilateral cleft lip, cleft palate, bilateral upper and lower lid lag, and imperforate anus. The findings are consistent with an autosomal dominant pattern of inheritance. There were no identifiable intrauterine fetal insults. A detailed description of these anomalies, the subsequent surgical corrections, and a discussion of previously unreported syndromes with isolated features are the subject of this report.

Abnormalities, Multiple↗

PubMed1994

Gustatory rhinorrhea--a complication of septoplasty.

A previously unreported complication of septoplasty, which is the profuse flow of thin clear nasal drainage on mastication, is described. Of a combined group of 1332 patients with septoplasty and septorhinoplasty, 6 females and 1 male presented with gustatory rhinorrhea after surgery. The average age of the patients who experienced this complication was 44.43 years. Three patients tested the efficacy of antihistamines, which proved helpful in reducing the severity of this condition. The cause of gustatory rhinorrhea is postulated as inadvertent injury to the nasopalatine nerve within the septal layers after removal of the deviated portion of the vomer and the perpendicular plate of the ethmoid bone during septoplasty. It is the authors' supposition that regenerating nerve sprouts are inappropriately directed toward nasal, rather than palatal, target receptors. Consequently, rhinorrhea results while eating. The pathophysiology of this new finding is not dissimilar to gustatory sweating after parotidectomy. Although this complication is not life-threatening, it is socially disturbing to patients. The authors believe that awareness of this sequela will lead to the discovery of a larger patient population and a potential treatment or prevention.

Adult↗

PubMed1994

The nasolabial fold: a challenge, a solution.

A prominent nasolabial fold results from a combination of relaxation and thinning of the facial skin and selective fat deposits lateral to the fold. The surgical approach described herein has been used to correct the pronounced nasolabial fold for the last 3 years. First, the temple incision is positioned at the anterior hairline rather than in the hair-bearing skin. This permits removal of the maximum amount of skin without concern for posterior transposition of the temple hair, and, more important, it transmits a more effective pulling force to the nasolabial fold due to the more advantageous proximity. Second, a strip of fat is added under the fold in the subcutaneous plane (immediately under the fold) after extensive undermining of the skin through a rhytidectomy flap. Third, removal of the fat lateral to the fold reduces the buccal projection and thereby lends an appearance of flatness. This report covers 35 patients (8 males and 27 females) who underwent this problem-oriented approach with an average follow-up of 23 months. Complications included one localized hematoma (managed conservatively) and one expanding hematoma (which required evacuation). Two incidents of graft dislodgment were discovered early in the study, following which all grafts were fixed to the overlying nasolabial groove with a through-and-through 5-0 catgut suture. Partial resorption of the graft was considered the rationale for undercorrection in 6 patients (17.1 percent). The remaining 29 patients (82.9 percent) had good to excellent results.

Adipose Tissue↗