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Biomedical subjects

D T Netscher

Publications and source records attributed to D T Netscher.

At least 55 records · Page 3Linked to original sources
PubMed1994

Capsular compliance: a measure of a "hard" prosthesis.

Capsular contracture prevents a natural "feel" to an augmented breast and is frequently a source of patient and physician dissatisfaction postoperatively. The degree of hardness of a breast is difficult to quantitate. We have developed a rodent model that measures the pressure rise in a capsule in response to increasing intraluminal volume, generating a pressure-volume curve. The curve's break point determines the volume contained within the capsule and the slope of the steep part of the curve to the right of the break point determines capsule resistance to stretch and deformation. In a group of 14 rats, resistance to distension increased progressively over a 14-week period whereas capsule surface area, break point volume, and resting intraluminal pressure remained relatively constant. This model allows the assessment of changes in capsule contracture over time without having to kill the animal.

Animals↗
PubMed1994

Smoking: adverse effects on outcomes for plastic surgical patients.

Smoking is known to have a potentially adverse effect on the outcomes of plastic surgical procedures and, in particular, on wound healing. Numerous clinical studies have substantiated that cigarette smokers are at increased risk for wound healing problems. Cigarette smoke contains a number of toxic products. Of these toxins, nicotine has been studied in detail and is known to inhibit macrophages and fibroblasts, potentiate vascular thrombosis, and cause vasoconstriction. Carbon monoxide combines with hemoglobin to form carboxyhemoglobin, which reduces oxygen availability to tissues. When operating on cigarette smokers a few options exist that may improve outcomes: less undermining with rhytidectomy; sympathetic blockades; limited use of alternate nicotine sources; and of course smoking cessation, which is ideal.

Humans↗
PubMed1994

Keratoacanthoma: when to observe and when to operate and the importance of accurate diagnosis.

Although keratoacanthoma regresses spontaneously, treating physicians seldom allow these lesions to progress through their natural course. We describe two cases of skin lesions, the first being a keratoacanthoma, which enlarged rapidly and then involuted with minimal scarring. The second lesion was initially misdiagnosed and failed to respond to medical management. An accurate diagnosis of squamous cell carcinoma was not made until the lesion had become deeply invasive. These two lesions have helped clarify our thoughts about the observation of keratoacanthomas, the need for frequent patient follow-up when a lesion is not surgically ablated, and the importance of providing the pathologist with an adequate biopsy specimen for diagnostic purposes.

Adult↗
PubMed1994

General principles of flap reconstruction: goals for aesthetic and functional outcome.

Plastic surgeons are often requested to reconstruct defects following traumatic injury or after tumor ablation. These defects most commonly occur in the head and neck region and in the extremities. Reconstructions must balance the aesthetic and functional goals against morbidity of the donor site. This article provides a better understanding of reconstructive flaps through application of general principles. Flaps are classified according to type. Characteristics of both the donor site and the reconstructive recipient site are then explored. Case examples serve to illustrate the general principles enumerated.

Esthetics↗
PubMed1994

Methods of reconstruction.

This article discusses methods of reconstruction, ranging from simple free-hand skin grafts to microvascular tissue transfer. The simplest reconstructive option must be chosen to suit the defect and to achieve the least possible donor morbidity. The most suitable reconstructive choices are discussed for each of the following situations: to provide a large surface area, to provide hair-bearing tissue, to fill "dead space," to restore motor function, or to provide composite bone and soft-tissue structures.

Humans↗
PubMed1993

A method for optimizing skin graft healing and outcome of wounds of the penile shaft and scrotum.

Split-thickness skin grafting provides the best functional and aesthetic result in the treatment of wounds of the penis and scrotum. Achieving graft adherence and take in this anatomically mobile region is challenging. A simple method of effectively stabilizing skin grafts in the treatment of penile and perineal wounds is described, and patients in whom complete graft take was achieved are discussed.

Bandages↗
PubMed1992

Reconstruction of calvarial defects.

We subdivide the calvarium into three zones, each with its special reconstructive requirements. Based on our experience with calvarial defects in 13 patients, we favor use of autogenous material, especially in the face of previous infection or a scarred recipient bed. Alloplasts give excellent forehead contour but alloplastic reconstruction should be delayed for 1 year after injury. Vascularized bone grafts maintain contour well. They are best suited to large periorbital defects. At other locations we favor split calvarial free bone grafts. Occasionally, the defect may be so large as to warrant grafts from multiple donor sites. Use of vascularized muscle helps eradicate infection, provides a vascularized bed for free bone grafts, and fills dead space. The frontal sinus is managed either by cranialization (if the posterior wall is involved) or by mucosal stripping with obliteration of the nasofrontal duct. Additional technical considerations include rigid bone fixation, surgical exposure through a bicoronal incision, and meticulous handling of bone grafts.

Adolescent↗
PubMed1992

Management of residual cranial vault deformities.

The aims of calvarial reconstruction are to restore anesthetic contour and to provide protection for the underlying central nervous system structures. The authors present their algorithm of reconstructive options. Important considerations are the anatomic location of the defect and the duration since the original injury.

Adult↗
PubMed1991

Mercury poisoning from intravenous injection: treatment by granuloma resection.

Intravenous injection of mercury is a rare event. Mercury administered by this route may have several different consequences. In addition to elevated serum mercury levels, the diagnosis may be made by radiographic detection of metallic densities in the chest and at the sites of injection. Death due to mercury intoxication is unusual. Impairment of renal and hepatic function may occur. Our patient presented with gingivitis and a dentoalveolar abscess. Dense granulomas occur at the sites of injection. Treatment for these patients should include granuloma excision as the benefit of chelating agents, for chronic mercury intoxication is questionable. Skin and granuloma resection may leave vital structures exposed, necessitating flap coverage.

Adult↗
PubMed1990

Timing and decision-making in the treatment of congenital upper extremity deformities.

With growth and development, the hand undergoes profound structural and functional changes. Congenital anomalies lead to development of aberrant functional patterns. Appropriate timing of surgical correction is essential to minimize deformity and prevent development of aberrant function before set patterns of cortical control have occurred. By the same token, certain anomalies should not be treated surgically since such treatment may interfere with function. A clearer understanding of pathologic anatomy of deformities such as radial club hand, hypoplastic thumb, and thumb duplication has enabled a more rational surgical approach. Microsurgery has an increasing role to play in the treatment of these deformities.

Age Factors↗
PubMed1990

Normal and abnormal development of the extremities and trunk.

Normal and abnormal embryologic and postnatal development of the extremities, chest wall, breasts, and abdominal wall are described. Knowledge of development anatomy is helpful in forming a rational basis for planning and timing of surgical intervention. Clinical and potential clinical applications are described.

Foot↗
PubMed1989

Squamous cell carcinoma arising in previously burned or irradiated skin.

Squamous cell carcinoma (SCC) arising in previously burned or irradiated skin was reviewed in 66 patients treated between 1944 and 1986. Healing of the initial injury was complicated in 70% of patients. Mean interval from initial injury to diagnosis of SCC was 37 years. The overwhelming majority of patients presented with a chronic intractable ulcer in previously injured skin. The regional relapse rate after surgical excision was very high, 58% of all patients. Predominant patterns of recurrence were in local skin and regional lymph nodes (93% of recurrences). Survival rates at 5, 10, and 20 years were 52%, 34%, and 23%, respectively. Five-year survival rates in previously burned and irradiated patients were not significantly different (53% and 50%, respectively). This review, one of the largest reported series, better defines SCC arising in previously burned or irradiated skin as a locally aggressive disease that is distinct from SCC arising in sunlight-damaged skin. An increased awareness of the significance of chronic ulceration in scar tissue may allow earlier diagnosis. Regional disease control and survival depend on surgical resection of all known disease and may require radical lymph node dissection or amputation.

Adolescent↗
PubMed1989

Adjunctive agents to facilitate rapid tissue expansion.

A rodent model was used to study tissue expansion. Three chemical agents--hyaluronidase, prostaglandin E2, and colchicine--were administered and their effects on tissue expansion studied. Hyaluronidase and colchicine both enhanced the rate of expansion when compared with results in control animals (p less than 0.05). Although prostaglandin E2 had less effect on expansion rate, it did significantly enhance tissue oxygen tension of expanded skin when compared with controls (p less than 0.05). Clinical implications include the possibility of pretreating patients with these agents to increase the rate of expansion and to improve the safety of current methods of expansion.

Animals↗
PubMed1989

Complications of TRAM flap breast reconstruction in obese patients.

The records of 82 women who had undergone unilateral breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap at the University of Texas M. D. Anderson Cancer Center were analyzed to determine what effect obesity had on the rate of complications and the aesthetic quality of the ultimate result. The patients were divided into four groups--thin, average, moderately obese, and markedly obese--based on a weight/height index derived by dividing the weight in kilograms by the height in meters. In the thin group (13 patients), the complication rate was only 15.4 percent. In the average group (22 patients), the complication rate was 22.7 percent. In the moderately obese group (35 patients), the complication rate was 31.4 percent. In the markedly obese group (12 patients), the rate was 41.7 percent. Aesthetic results in the abdomen tended to be better in the nonobese group, but in the breast they correlated better with the number of revisions performed than with degree of obesity. The findings in this study suggest that the complication rate of TRAM flap breast reconstruction does increase in proportion to the degree of obesity. Surgeons can therefore avoid many of the complications from TRAM flap surgery by not operating on very obese patients. Reports of complication rates from different authors may vary in part depending on their mix of obese and nonobese patients.

Abdominal Muscles↗
PubMed1985

Early excision of major burns in children: effect on morbidity and mortality.

The advantage of early excision and grafting in the treatment of limited full-thickness burns has been clearly established. The goal of the present study was to evaluate the role of early burn wound excision in major pediatric burns. Of the 470 pediatric burn admissions between 1979 and 1984 that were reviewed, 53 patients met the criteria of deep second or third degree burns greater than 25% total body surface area (TBSA). Of these, 20 had burn wound excision within 7 days (Early) and 33 had delayed excision and grafting (Late). The Early group, despite having greater transfusion requirements (69.4 v 36.2 cc/kg), had shorter hospital stays (35.3 v 49.1 d, P less than 0.05), fewer metabolic complications (20% v 79%, P less than 0.001), and less burn wound contamination (55% v 90%, P less than 0.01) than the Late group. Mortality was lower in the Early group (0% v 12%), but this was not statistically significant. Early excision and grafting are therefore recommended in the care of major burns in children.

Adult↗
PubMed1985

Epithelial lining methods in esophageal repair: a comparative study using pedicle flaps in cats.

Methods of restoring luminal lining in repair of partial-circumferential esophageal defects were evaluated to compare incidences of strictures and fistulas and quality of surface lining. In cats 50% and 67% circumferential esophageal defects were repaired by direct closure or pedicle flaps (latissimus dorsi) that were unlined (lining restored by epithelialization from wound margins) or that carried lining of normal skin (myocutaneous flaps), skin grafts, or mucosal grafts. Repairs were evaluated for esophagocutaneous fistulas, luminal stricture, flap luminal surface area, and quality of epithelial surface 6 weeks after surgery. Direct closure of 50% circumferential defects was as satisfactory as any flap repair method. Direct closure of 67% circumferential defects caused high incidences of fistulas and strictures, which were lessened by flap reconstructions. Among flap lining methods, normal skin (myocutaneous flaps) gave the lowest incidence of fistulas and strictures and the highest surface quality, but a high incidence of skin paddle loss occurred in this model. Split-thickness epithelial grafts were nearly as satisfactory as myocutaneous flaps, and less lining loss occurred. Epithelialization of unlined flaps gave the poorest results since lining was thin and often incomplete, and wound contraction produced loss of surface area and strictures. The findings are discussed from a perspective of wound healing physiology, and implications for clinical application are presented.

Animals↗