Biomedical subjects

B S Bauer

Publications and source records attributed to B S Bauer.

At least 19 recordsLinked to original sources

PubMed2001

Full-thickness surgical excision for the treatment of inflammatory linear verrucous epidermal nevus.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a benign cutaneous hamartoma characterized by intensely erythematous, pruritic, inflammatory papules that occur as linear bands along the lines of Blaschko. Because of its chronic and unremitting symptomatology, patients with ILVEN seek medical treatment for relief of discomfort as well as concerns regarding cosmetic appearance. Reported therapeutic approaches include topical agents, dermabrasion, cryotherapy, laser therapy, and partial-thickness excision. Unfortunately, no one therapy has been successful consistently. Medical management is often unsatisfactory, because improvement tends to be temporary. Surgical modalities have met with better success in relief of symptoms but at the risk of marked scarring and a high rate of recurrence. Furthermore, the occurrence of extensive ILVEN or localization to certain anatomic regions has been considered previously a relative contraindication to excision. The authors report 4 patients with extensive ILVEN treated successfully with full-thickness surgical excision. Our report underscores the effectiveness of this surgical modality for the definitive treatment of ILVEN.

Adult↗

PubMed2001

The role of tissue expansion in the management of large congenital pigmented nevi of the forehead in the pediatric patient.

The authors present a cohort of 21 consecutive patients who had congenital pigmented nevi covering 15 to 65 percent of the forehead and adjacent scalp and who were treated at their institution within the last 12 years. All patients were treated with an expansion of the adjacent texture- and color-matched skin as the primary modality of treatment. The median age at presentation was approximately 1 year; mean postoperative follow-up was 4 years. Nevi were classified according to the predominant anatomic areas they occupied (temporal, hemiforehead, and midforehead/central); some of the lesions involved more than one aesthetic subunit. The authors propose the following guidelines: (1) Midforehead nevi are best treated using an expansion of bilateral normal forehead segments and advancement of the flaps medially, with scars placed along the brow and at or posterior to the hairline. (2) Hemiforehead nevi often require serial expansion of the uninvolved half of the forehead to minimize the need for a back-cut to release the advancing flap. (3) Nevi of the supraorbital and temporal forehead are preferentially treated with a transposition of a portion of the expanded normal skin medial to the nevus. (4) When the temporal scalp is minimally involved with nevus, the parietal scalp can be expanded and advanced to create the new hairline. When the temporoparietal scalp is also involved with nevus, a transposition flap (actually a combined advancement and transposition flap because the base of the pedicle moves forward as well) provides the optimal hair direction for the temporal hairline and allows significantly greater movement of the expanded flap, thereby minimizing the need for serial expansion. (5) Once the brow is significantly elevated on either the ipsilateral or contralateral side from the reconstruction, it can only be returned to the preoperative position with the interposition of additional, non-hair-bearing forehead skin. Expansion of the deficient area alone will not reliably lower the brow once a skin deficiency exists. (6) In general, one should always use the largest expander possible beneath the uninvolved forehead skin, occasionally even carrying the expander under the lesion. Expanders are often overexpanded.

Facial Neoplasms↗

PubMed1997

Congenital primitive neuroectodermal tumor of the hand: a case report.

A congenital peripheral primitive neuroectodermal tumor of the hand demonstrating aggressive behavior by rapid growth and ulceration, as well as early diffuse metastasis is presented. Management consisted of below-elbow amputation and chemotherapy. Despite the tumor's initial response, intracranial metastases occurred 7 months later. The patient died shortly thereafter, 15 months after presentation.

Female↗

PubMed1994

Release of acquired syndactylies in Kindler syndrome.

Kindler syndrome is a rare, blistering skin disease characterized by acral bullae, poikiloderma, and diffuse cutaneous atrophy. Kindler syndrome has been established as a separate entity from epidermolysis bullosa; however, controversy still remains as to whether Kindler syndrome can be differentiated from Weary's hereditary acrokeratotic poikiloderma. Fusion of the digits secondary to blistering and scarring, "pseudosyndactyly," has been reported in several patients with Kindler syndrome; however, surgical correction of the syndactylies in these patients has not been described. In this report, a patient with Kindler syndrome underwent surgical treatment of acquired syndactylies. Treatment included a tailored approach to preparation of the patient for surgery, surgical separation of fused tissues, selection of donor site for skin-graft harvest, postoperative dressings, splinting, and therapy. Results in our patient 2 years after correction demonstrate that syndactyly release in Kindler syndrome can be accomplished effectively, with improvement in both function and appearance.

Adolescent↗

PubMed1994

Resection of lymphatic malformation of the scrotum.

It is important for clinicians to consider lymphatic malformations in the differential diagnosis of chronic skin lesions, no matter where they appear anatomically. We report a case of deep surgical excision of an extensive lymphatic malformation of the scrotum using regional flaps from uninvolved scrotal tissue. Removal of the lesion not only allowed the patient more comfort but also may have ultimately cured his symptomatology.

Adult↗

PubMed1993

Expanded full-thickness skin grafts in children: case selection, planning, and management.

Since our initial presentation of our experience with tissue expansion as a means of harvesting large full-thickness skin grafts in children in 1987, we have continued to "expand" both the size of full-thickness skin grafts harvested and the range of reconstructive problems to which we have applied the technique. Sixteen expanded full-thickness grafts have been used for immediate reconstruction following giant nevus excision and in postburn reconstruction. Patients ranged in age from 6 months to 15 years, with follow-up ranging from 6 months to 6 1/2 years. Grafts ranging in size from approximately 60 cm2 (excluding the dimensions of one submental graft) to greater than 700 cm2 were harvested from expanded donor sites on unilateral or bilateral groin/lower abdomen, clavicular, and a single submental expansion. Five expanded full-thickness grafts were used in facial reconstruction for single aesthetic unit coverage, multiple unit, and one single-sheet full facial graft. One expanded full-thickness graft was used on the breast. Three grafts were used in dorsal hand and finger coverage, and seven were used on the lower extremity, including an entire plantar surface and toes. Graft loss was confined to a 6.25-cm2 area on one cheek in the full facial expanded full-thickness grafts and a 9-cm2 area on the non-weight-bearing area of the full plantar graft. Donor-site complications were negligible. The anatomic confines of the donor sites and size of the patient may require expander replacement (in situ serial expansion) in order to obtain a large enough graft and accomplish primary donor-site closure. Expander and injection port placement in children for ease of injection and planned expander change must be anticipated. Our protocol from preoperative teaching through graft take is reviewed. Experience has demonstrated that expanded full-thickness grafts maintain all the characteristics of non-expanded full-thickness skin grafts and are an excellent reconstructive option in children.

Adolescent↗

PubMed1992

Bulky naevocytoma of the perineum: a singular variant of congenital giant pigmented naevus.

We describe two instances of a previously unrecognized variant of congenital giant pigmented naevus (GPN), presenting as a bulky naevocytic tumour in the perineal region. In both cases the lesion was present at birth and attained massive dimensions. In addition to the characteristic histological patterns found in GPN, which included extensive areas with a neural appearance, these tumours presented an uncommon tendency to form pseudo-follicular structures lined by naevus cells. No features suggestive of malignant transformation were found. Because GPN may associate with an underlying malignancy, accurate diagnosis of this lesion is important in clinical practice.

Humans↗

PubMed1992

Tissue expansion in a patient with extensive nevus comedonicus.

Nevus comedonicus is a rare developmental abnormality of the pilosebaceous apparatus that presents as an aggregation of dilated follicular orifices filled with pigmented keratinous material. Occurrence of extensive or giant lesions is even more rare. Indications for treatment include recurrent infections and cosmetic reasons. Therapeutic approaches include topical keratolytic agents, manual extraction of comedones, dermabrasion, and excision of smaller lesions. Increasing clinical experience with tissue expansion has suggested that it might be used effectively in the definitive treatment of an extensive nevus comedonicus previously considered too large to excise without the use of a skin graft, despite the potential risk of infection within the lesion during the course of expansion. We report the first patient with giant nevus comedonicus to be treated using tissue expansion. This patient demonstrates that prompt treatment of cellulitis and abscesses within the lesion will keep this process isolated from the adjacent expanders and will not compromise a planned excision and reconstruction.

Buttocks↗

PubMed1991

Anaesthetic management of Miller's syndrome.

Miller's syndrome is a rare congenital disorder with facial features similar to that of Treacher-Collins syndrome. This report details the anaesthetic management of an infant during multiple surgical procedures, beginning with pylormyotomy at one month of age. Airway management was difficult because of severe micrognathia and was accomplished using an awake intubation with a conventional straight blade modified for continuous administration of oxygen ("oxyscope"). Due to recurrent upper airway obstruction and the anticipated need for multiple surgical procedures in the first years of life, a tracheostomy was placed. Because of the multiple airway, orthopaedic, and nutritional difficulties, it is important that a prospective, multidisciplinary approach be used in these patients' care. Consideration should be given to early tracheostomy for airway maintenance.

Anesthesia, Inhalation↗

PubMed1990

The role of tissue expansion in reconstruction of the ear.

The following guidelines are suggested for the use of tissue expansion in ear reconstruction based on both personal experience and my evaluation of the reported results of expansion in the hands of other surgeons experienced in ear reconstruction: 1) Cases should be carefully selected to avoid those with excess scarring from previous surgery or trauma as well as avoid the other common contraindications to the use of tissue expansion. 2) In most congenital cases the expander should be placed through a remote incision within the postauricular hairline, and excision of the cartilage vestige delayed until expansion is completed and the framework is ready for placement. 3) A remote valve expander of a crescent shape with a volume of 60-100cc is ideal; low profile expanders may even be safer. 4) The pocket for the expander should be dissected immediately above the fascia and against the cartilage remnant. 5) Rapid expansion should be avoided; ideally injections should be carried out one time each week and with relatively small quantities (5-10cc per injection). 6) At the time of expander removal and placement of the cartilage framework the capsule should be meticulously excised to allow tight skin-cartilage coaptation. This is further enhanced by effective suction drainage following wound closure.

Burns↗

PubMed1990

The role of tissue expansion in pediatric plastic surgery.

The ability to increase available local tissue by controlled soft tissue expansion (TE) has led to a rapid increase in the use of TE in clinical practice. This article reviews some general guidelines when using TE in children and addresses some of the concerns previously expressed regarding the effects of TE on growth in infants and children.

Adolescent↗

PubMed1989

Treatment of mandibular fractures in children.

Thirty-seven mandibular fractures were treated in 25 patients between January 1984 and January 1988. The patients' ages ranged from 4 months to 16 years (6.9 +/- 4.6 years [mean +/- standard deviation]). Nineteen of the patients were male and 6 were female, indicating a significant gender predilection (p less than 0.05). A treatment approach based on the patients' dental maturity and fracture location has evolved that stresses rapid restoration of osseous continuity and preoperative occlusion while striving to minimize risk to unerupted dentition.

Adolescent↗

PubMed1989

Maintenance of airway patency following treatment of choanal atresia.

Airway patency following repair for choanal atresia is effectively maintained utilizing Argyle polyethylene chest tubes as stents. Retrograde placement of the tubes from the mouth into the nasal passage is accomplished so that once secured, the largest diameter of the tubes is wedged against the posterior portion of the nasal ostium. This approach limits anterior migration of the tubes, preserving the columella and nasal rims while ensuring maintenance of airway patency following treatment of choanal atresia.

Airway Obstruction↗

PubMed1988

An approach to excision of congenital giant pigmented nevi in infancy and early childhood.

Complete prophylactic excision of "large" and "giant" congenital nevocellular nevi (CNCN) often involves multiple surgical procedures begun in early infancy and not completed until late adolescence. Timely use of combined modalities of excision and reconstruction, beginning in infancy, and recognizing the benefits and limitations of each technique in each body region may allow completion of the excision of even the most extensive lesions in early childhood. In addition to minimizing the risk of malignant transformation, early complete excision may minimize the late psychologic stress caused by the appearance of the lesion and the late decision to attempt total excision. Tissue expansion and extensive excision and grafting in infancy and early childhood may significantly improve the final cosmetic result following treatment of these extensive lesions.

Child↗

PubMed1988

Dermal and epidermal response to soft-tissue expansion in the pig.

To evaluate the dermal and epidermal response to soft-tissue expansion in the pig, round tissue expanders were placed dorsally under tattooed patterns and inflated over 6 weeks. Surface area, skin thickness, histologic changes, and collagen content were evaluated at 6-week intervals. Epidermal thickening and dermal thinning were observed. Dermal thinning persisted 36 weeks after expansion. Dermal collagen content was decreased, although collagen density remained unchanged. Total collagen content calculated within an expanded square grid increased. These data support a theoretical gain in the dermal layer as well as epidermal layer in response to tissue expansion.

Animals↗

PubMed1988

Levator repositioning and palatal lengthening for submucous clefts.

Submucous clefts of the palate may present with velopharyngeal incompetence (VPI) or a history of recurrent otitis media. Many surgeons have favored a pharyngeal flap as primary treatment of the velopharyngeal incompetence associated with this disorder. The increasing number of case reports of sleep apnea and airway compromise associated with pharyngeal flaps prompted the use of levator muscle repositioning with palatal lengthening as initial therapy in 15 patients in an attempt to correct the pathologic anatomy while avoiding the postoperative sequelae. Patients were divided into two groups: group A (N = 8) had surgery before age 2 (11.8 +/- 5.7 months), and group B (N = 7) had surgery after 2 years of age (64.3 +/- 24.2 months). No patient in group A required a secondary operative procedure for velopharyngeal incompetence. Normal speech was obtained in 75 percent (N = 6), and slight velopharyngeal incompetence not requiring secondary correction was obtained in 25 percent (N = 2). Group B obtained less dramatic speech results: normal in 14 percent (N = 1), slight velopharyngeal incompetence in 58 percent (N = 4), and no improvement or severe velopharyngeal incompetence requiring a secondary procedure in 28 percent (N = 2). Patients with preoperative otologic disorders (N = 10) obtained significant improvement in 90 percent of cases (p = 0.002). Early surgical intervention in patients with abnormal speech prior to age 2 appears to result in normal speech in the majority of instances. Late repair with levator repositioning and palatal lengthening provided improved speech in 72 percent of patients.

Age Factors↗

PubMed1988

Craniofacial dermoids.

Thirty-two patients with nasal dermal sinuses and cysts were treated during the 10-year period from 1978 to 1987. These patients presented with midline cysts (N = 18) or sinus ostia (N = 14). Only 6 of the 32 patients manifested intracranial extension (19 percent). All the patients with intracranial extension exhibited an intracranial mass on preoperative CT scans. Ten patients with no CT evidence of intracranial mass were noted to have only a fibrous cord extending to the base of the foramen cecum. In 4 of these 10 patients, craniotomy confirmed that there was no intracranial extension of the dermoid. Four other patients presented with sinus ostia at the base of the columella. None of these 4 patients had intracranial extension. Clinical examination and preoperative CT scans provide most of the information needed to determine the nature, course, and extent of these lesions.

Adolescent↗

PubMed1988

An approach to excision of congenital giant pigmented nevi in infancy and early childhood.

This paper presents a timely coordinated approach to complete excision of congenital giant pigmented nevi in infancy and early childhood based on a review of 78 patients with giant pigmented nevi of the head and neck, trunk, and/or extremity. Giant pigmented nevi in those selected for review measured from a minimum of 2 percent up to 45 percent total body surface (TBS). Giant nevi of the scalp were treated most effectively using tissue expansion, beginning as early as 3 months of age. Expanded forehead and neck flaps in combination with expanded full-thickness skin grafts were used in early excision of giant pigmented nevi of the face. Giant nevi of the trunk were treated using a combination of abdominoplasty technique, tissue expansion, and split-thickness skin graft, with early "large segment" excision and grafting being the most effective treatment of giant nevi covering the posterior trunk. Giant nevi of the extremities were treated most effectively with excision and graft. Expanded full-thickness skin grafts gave excellent coverage on the hands and feet.

Child, Preschool↗