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Biomedical subjects

D A Sherris

Publications and source records attributed to D A Sherris.

At least 19 recordsLinked to original sources
PubMed2001

Scar contractures, hypertrophic scars, and keloids.

A scar contracture is the result of a contractile wound-healing process occurring in a scar that has already been reepithelialized and adequately healed. Keloids and hypertrophic scars (HTSs) are fibrous tissue outgrowths that result from a derailment in the normal wound-healing process. The exact incidence of keloids and HTSs remains unknown. Beyond the common belief that trauma is the initiating event of keloid and hypertrophic scar formation, the remainder of the process remains uncertain. A combination of biochemical factors, skin tension, endocrinologic factors, and genetic factors are the likely culprits. Treatment begins by educating the patient about the etiology of the scarring process. All treatment protocols are individualized, but the standard approach to keloids and HTSs begins with corticosteroid injection followed by surgical excision, pressure dressings, and long-term follow-up.

Adrenal Cortex Hormones↗
PubMed2001

The anatomical basis of the Abbé flap.

OBJECTIVES: Objective of the study were 1) to determine the course, including specific relationship to the vermilion border, free margin of the lip, and orbicularis oris and number of the superior and inferior labial arteries, and 2) to discuss the relevance of this anatomy to design of the Abbé flap. STUDY DESIGN: Detailed anatomical dissections of the mid and lower face of injected cadaver heads. METHODS: Sixteen superior labial arteries and 15 inferior labial arteries in 9 adult cadaver heads ranging in age from 41 to 90 years were studied. RESULTS: The superior labial artery was a single vessel in all cases. At the oral commissure the vessel was superior to the vermilion border in 94% of the dissections. At the midline the vessel was within the vermilion border in 75% of dissections. The vessel was found within the orbicularis oris in 19% of dissections and between the mucosa and the orbicularis oris in 81% of dissections. The inferior labial artery was a single vessel in all dissections. Its course was variable in position relative to the vermilion border and to its take-off from the facial artery. In the central portion of the lip the vessel was found within the orbicularis oris in 13% of dissections and between the mucosa and the orbicularis oris in 87% of dissections. CONCLUSIONS: The superior labial artery is found within 10 mm of the free margin of the upper lip. The inferior labial artery is variable in its course, varying up to 15 mm from the free margin of the lower lip.

Adult↗
PubMed2001

Cervicofacial rhytidectomy after head and neck tumor removal.

OBJECTIVE: To compare intraoperative and postoperative complication rates of cervicofacial rhytidectomy after head and neck tumor removal with complication rates of rhytidectomy in the normal patient population. STUDY DESIGN: Retrospective chart review and literature review. METHODS: A sample of 11 patients treated by a single surgeon (D.A.S.) at an academic referral center who met the inclusion criteria was reviewed for previous head and neck surgical history, medical history, and surgical results and subsequent complications of the facial esthetic procedure. These rates were compared with the complication rates for cervicofacial rhytidectomy in normal patients as quoted in the general medical literature. RESULTS: Patients ranged in age from 48 to 75 years (mean age, 58 y). Of the 11, no patient experienced a major complication of rhytidectomy, and two experienced a minor postoperative complication. Both patients had received postoperative radiation for the treatment of their previous tumor, and both noted a small (<1.5 cm) area of wound dehiscence before postoperative day 10, which required no revision and healed without sequelae. No other intraoperative or postoperative complications were found. CONCLUSION: Cervicofacial rhytidectomy may be safely and effectively performed on postoperative patients with head and neck tumors without increased incidence of major complications when compared with patients without a surgical tumor history. The increased incidence of minor wound dehiscence experienced by 2 of the 3 patients who received postoperative radiation in this study may indicate that small areas of skin incision dehiscence are more likely in patients who have been radiated. Surgeons performing rhytidectomy on patients with head and neck tumors who were previously radiated should consider more meticulous subdermal closure to avoid such dehiscence. Patients should be informed of the slightly higher risk of dehiscence before surgery.

Adult↗
PubMed2000

Treatment of facial wounds with botulinum toxin A improves cosmetic outcome in primates.

Surgeons have constantly sought to achieve the most aesthetic scar. A major factor determining the final cosmetic appearance of a cutaneous scar is the tension acting on the wound edges during the healing phase. Since Theodor Kocher pioneered the alignment of skin incisions with Langer's lines in 1892, surgical techniques that attempt to overcome closing tension have become standard. Yet, no treatment has been available to minimize underlying muscle contractions, which are the major cause of this tension. Botulinum toxin A is a potent drug that produces temporary muscular paralysis when injected locally. It has proven to be safe and effective in the treatment of a variety of disorders, including hyperkinetic facial lines. The objective of this randomized, double-blind, placebo-controlled primate study was to investigate the efficacy of a single injection of botulinum toxin A to improve the cosmetic appearance of cutaneous scars. Symmetric pairs of standardized excisions were performed on either side of the forehead of six primates. The half foreheads were randomized to the botulinum toxin A treatment side versus the placebo injection side. A panel of three blinded facial surgeons assessed the cosmetic appearance of the mature scars 3 months postoperatively. The wounds that had been immobilized with botulinum toxin A were rated as significantly better in appearance than the control wounds (p < 0.01). Histologic examination confirmed that all scars were mature. Blinded, randomized, placebo-controlled human clinical trials are presently under way at the Mayo Clinic.

Animals↗
PubMed2000

Addition of an anesthetic agent to enhance the predictability of the effects of botulinum toxin type A injections: a randomized controlled study.

OBJECTIVE: To determine whether the paralyzing effect of botulinum toxin type A reconstituted in a solution of lidocaine with epinephrine is as effective as that of the same toxin reconstituted in saline and to determine whether the addition of lidocaine with epinephrine enhances the predictability of outcomes of botulinum toxin injections. SUBJECTS AND METHODS: This double-blind, within-subject, randomized controlled study was conducted in 10 volunteer subjects. Lidocaine was added to botulinum toxin type A to achieve an immediate paralyzing effect on the injected muscle, and epinephrine was added to minimize diffusion of the injected toxin to adjacent muscles. This combination of agents was injected to temporarily paralyze the frontalis, corrugator supercilii, and procerus muscles on 1 side of the forehead of the 10 volunteers. The contralateral side was injected with the same dosage of the toxin, reconstituted in an equal volume of saline, to serve as control. Photographic and video documentation of the drugs' effects was obtained before injection and at 5 to 10 minutes, 1 week, and 3 months after the injections. RESULTS: Immediate paralysis ensued on the experimental side (botulinum toxin type A + lidocaine + epinephrine) in all 10 volunteers. As assessed by 3 blinded evaluators, the extent of immediate paralysis resulting from the anesthetic agent was predictive of the extent of delayed paralysis resulting from the botulinum toxin. The botulinum toxin-induced paralysis wore off symmetrically in all subjects. CONCLUSION: The injection of botulinum toxin reconstituted in lidocaine with epinephrine provided the physician immediate feedback on the extent of paralysis to be expected from the chemodenervating action of the botulinum toxin. This may enhance the safety and predictability of botulinum toxin injections in many applications.

Anesthetics, Local↗
PubMed1999

Preoperative and postoperative topical tretinoin on high-tension excisional wounds and full-thickness skin grafts in a porcine model: A pilot study.

BACKGROUND: Tretinoin induces neovascularization and the formation of collagen when applied topically. OBJECTIVE: The goal was to determine whether preoperative and postoperative treatment with tretinoin enhances the healing of high-tension, full-thickness excisional wounds and the survival of full-thickness skin grafts. METHODS: A blinded, randomized, placebo-controlled pilot study involved high-tension excisional wounds and full-thickness skin grafts treated perioperatively with tretinoin in a porcine model. RESULTS: Perioperative treatment of high-tension excisional surgery sites with tretinoin appeared to have no consistent beneficial or adverse effects on wound healing or scar spreading. In the full-thickness skin graft model, a trend toward impaired wound healing was noted. CONCLUSION: The collagen-inducing effects of topical tretinoin do not appear to enhance the healing of high-tension excisional surgery wounds in a porcine model. Tretinoin does not appear to improve the survival of full-thickness skin grafts and, in fact, a detrimental effect was apparent in our model.

Administration, Topical↗
PubMed1999

The diagnosis and incidence of allergic fungal sinusitis.

OBJECTIVE: To reevaluate the current criteria for diagnosing allergic fungal sinusitis (AFS) and determine the incidence of AFS in patients with chronic rhinosinusitis (CRS). METHODS: This prospective study evaluated the incidence of AFS in 210 consecutive patients with CRS with or without polyposis, of whom 101 were treated surgically. Collecting and culturing fungi from nasal mucus require special handling, and novel methods are described. Surgical specimen handling emphasizes histologic examination to visualize fungi and eosinophils in the mucin. The value of allergy testing in the diagnosis of AFS is examined. RESULTS: Fungal cultures of nasal secretions were positive in 202 (96%) of 210 consecutive CRS patients. Allergic mucin was found in 97 (96%) of 101 consecutive surgical cases of CRS. Allergic fungal sinusitis was diagnosed in 94 (93%) of 101 consecutive surgical cases with CRS, based on histopathologic findings and culture results. Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of AFS patients. CONCLUSION: The data presented indicate that the diagnostic criteria for AFS are present in the majority of patients with CRS with or without polyposis. Since the presence of eosinophils in the allergic mucin, and not a type I hypersensitivity, is likely the common denominator in the pathophysiology of AFS, we propose a change in terminology from AFS to eosinophilic fungal rhinosinusitis.

Diagnosis, Differential↗
PubMed1998

Comprehensive treatment of the aging face--cutaneous and structural rejuvenation.

As people age, characteristic changes occur in the skin, the soft tissue envelope, and the bony skeleton of the face and result in the aging face syndrome. An understanding of the pertinent biomechanical and histologic changes is necessary for developing an appropriate treatment plan. The advent of many new techniques, including cosmetic exfoliation, laser skin resurfacing, open rhinoplasty, and endoscopic, multiplane plastic surgical procedures, has enhanced therapy for the aging face syndrome. Treatment protocols should be individualized for each patient's needs and desires. Several of these recent treatments for facial rejuvenation are reviewed herein.

Blepharoplasty↗
PubMed1998

Spectrum of cartilage grafting in cutaneous reconstructive surgery.

BACKGROUND: The use of cartilage grafts in cutaneous reconstructive surgery is becoming increasingly common among dermatologic surgeons. OBJECTIVE: Our purpose was to describe the indications, technical application, results, and complications associated with cartilage grafting in cutaneous reconstructive surgery. METHODS: The spectrum of cartilage grafting is reviewed, and illustrative examples are provided. RESULTS: A well-planned application of cartilage grafts in cutaneous reconstructive surgery can provide exceptional results, permitting restoration of impaired anatomic free margins as well as maintenance of the functional patency of key anatomic structures such as the nasal valve. CONCLUSION: Cartilage grafting in cutaneous reconstructive surgery is an important method to ensure optimal reconstructive outcomes. Dermatologists involved in reconstructive surgery will experience improved results through the application of these techniques.

Cartilage↗
PubMed1998

An algorithm for maxillectomy defect reconstruction.

A maxillectomy defect creates a communication from oral cavity to nasal cavity that may extend to the orbit. Functional deglutition and speech problems with a significant soft tissue deficit ensue. This paper defines the reconstruction options for the spectrum of inferior partial maxillectomy defects to midface-orbital exonerations. Treatment protocols from maxillectomy patients treated in January 1991 to February 1996 at a major tertiary care institution were reviewed (n = 108). An ascension of care from dental obturator, nonvascularized graft, local flap, regional flap, and free tissue grafts (n = 28) is described. These data and experience were organized to provide a treatment algorithm to assist in presurgical planning for maxillectomy reconstruction.

Algorithms↗
PubMed1998

Mandibular reconstruction with transforming growth factor-beta1.

HYPOTHESIS: Transforming growth factor-beta1 (TGF-beta1) plus demineralized bone matrix (DBM) will reconstruct a critical mandibular defect devoid of periosteum in a canine model. STUDY DESIGN: Randomized, blinded, placebo-controlled, prospective animal pilot study. METHODS: Canine critical mandibular defects devoid of periosteum were reconstructed with DBM (group 1, n = 3) and DBM plus TGF-beta1 (250 microg TGF-beta1/g DBM) (group 2, n = 3). Radiologic, histologic, and biomechanical testing was performed on the test group and control group specimens at 12 weeks after implantation. RESULTS: A palpable bone bridge was present in the group 2 subjects 5 to 6 weeks after implantation and was never present in the group 1 subjects. Radiologic and histologic examination at the time of harvest (12 weeks after implantation) demonstrated a solid bone bridge in the group 2 subjects and a fibrous union in the group 1 subjects. Group 2 specimens demonstrated failure in four-point bending testing at an average maximum moment of 9.9 +/- 2.2 N-m. This value was 9.4% of the maximum moment of the contralateral nonoperated side. Group 1 specimens were palpably flexible on plate removal and had a biomechanical strength of 0. The difference in strength between group 1 and group 2 was statistically significant (P < 0.02), supporting the hypothesis that the addition of TGF-beta1 to the DBM carrier resulted in the formation of significantly stronger bone in the critical gap. CONCLUSION: The addition of TGF-beta1 to DBM results in healing of a critical bone defect devoid of periosteum in a higher mammalian model.

Animals↗
PubMed1996

Expanded polytetrafluoroethylene augmentation of the lower face.

Most options for rejuvenation of the lower face use soft-tissue fillers that augment the appropriate sites. Each of these options has associated risks and benefits. The U.S. Food and Drug Administration recently approved the use of expanded polytetrafluoroethylene (E-PTFE) as a soft-tissue filler in the face. From January 1991 through December 1993, the authors used E-PTFE soft-tissue patches for lower facial augmentation in 41 patients at 115 implant sites. Postsurgical follow-up has ranged from 2.5 to 4.5 years; during this time, complications have occurred in 4 patients. One implant had to be removed because of a seroma (1 patient), 4 implants required further secondary augmentation (2 patients), and 1 implant required revision because of malposition (1 patient). There have been no cases of implant infection, extrusion, long-term inflammation, or capsule formation. In this article, the authors review the technical aspects of E-PTFE use and discuss issues relating to the long-term efficacy of this new option for soft-tissue augmentation. The technique is also compared with other options for rejuvenation of the lower face.

Face↗
PubMed1995

Esthetic refinements in forehead flap nasal reconstruction.

OBJECTIVE: To identify refinements in forehead flap nasal reconstruction that consistently provide better esthetic and functional results. DESIGN: Case series of patients undergoing forehead flap nasal reconstruction from July 1, 1987, to May 31, 1994. SETTING: University hospital ambulatory surgery department. PATIENTS: Thirty-two patients with various nasal defects. INTERVENTIONS: Modifications of currently accepted techniques of paramedian forehead flap nasal reconstruction, namely, flap harvest and contouring, W-plasty closure of the superior forehead donor site, and creation of soft-tissue triangles. The principles of open-structure rhinoplasty are incorporated into cartilaginous reconstruction of the nasal tip and columella. The alar rim is reconstructed with cartilage grafts placed at the nasal rim. MAIN OUTCOME MEASURES: Esthetic and functional results of nasal reconstruction were subjectively graded by three otolaryngologists (V.C.Q., D.A.S., and M.F.R.) and the patients. RESULTS: Improved esthetic and functional nasal reconstruction. The most common nasal subunits reconstructed were as follows: ala, 27 patients (84%); side-wall, 22 patients (69%); dorsum, 18 patients (56%), and tip, 15 patients (47%). The esthetic results ranged from average to excellent (3 to 5 on a scale of 5), the functional results ranged from improved to much improved over preoperative breathing (4 to 5). Two patients required unplanned surgical revisions. Forty-seven percent of patients chose to undergo dermabrasion. Five patients required postoperative intradermal injection of triamcinolone acetonide (Kenalog). Three patients required preoperative tissue expansion. Flap or graft loss, infection, or hematoma did not occur. CONCLUSIONS: The predictability of the techniques in providing excellent results in patients undergoing nasal reconstruction decreases the need for revision procedures and helps the patient and the surgeon achieve the desired outcome.

Aged↗
PubMed1995

The extended Abbé flap.

Large upper lip defects that include the surrounding aesthetic subunits of the midface are difficult to reconstruct. Abbé flaps have been a popular method of dealing with small upper lip defects but, as classically described, they are insufficient for larger defects. We performed cadaver injections to evaluate the vascular territory supplied by the inferior labial artery with particular attention to the submental area. Extended Abbé flaps were then designed and used in combined upper lip and midfacial reconstruction. Three cases and guidelines for the use of the extended Abbé flap are presented.

Aged↗