Biomedical subjects
D T Sharpe
Publications and source records attributed to D T Sharpe.
Tissue expansion: clinical applications.
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The role of ultrasound imaging in the diagnosis of breast implant rupture: a prospective study.
Breast ultrasound to assess possible implant rupture was performed on 24 consecutive patients (43 breasts) by the same radiologist immediately before revisional breast implant surgery. Comparison of the clinical, ultrasound and operative findings showed ultrasound to be three times as sensitive as clinical judgement in predicting implant rupture. The sensitivity of ultrasound in predicting impaired implant integrity was 70% (versus 23% for clinical examination) with a specificity of 96%. The ultrasound features indicating leakage are outlined later. The positive predictive value of an abnormal scan was 90% and that of a normal scan 87%. It is concluded that breast ultrasound is a simple, quick, non-invasive method which contributes significantly to the assessment of patients with suspected breast implant rupture.
Congenital breast asymmetry: subjective and objective assessment.
There is currently no standard objective method for the assessment of developmental breast asymmetry. The results of corrective surgery in 24 patients with congenital breast deformities were evaluated subjectively (symmetry scores by patients and panels of observers), and objectively (linear measurements of nipple position and stereophotogrammetrically determined breast volumes). The latter were obtained using a newly developed prototype computer based technique (Bodymap). This study is the first reported use of stereophotogrammetry in assessing results of surgery for the correction of congenital breast asymmetry. The results obtained, their clinical implications, and the usefulness of Bodymap in the objective measurement of breast asymmetry are discussed.
Determination of relative contributions of 'mechanical' and 'biological' creep in tissue expansion using in vivo pressure monitoring: a preliminary report.
This work outlines the theory underlying tissue deformation in response to an applied force and presents a model to evaluate relative contributions to tissue generation from mechanical and biological creep. Using in vivo pressure measurement, this model has been tested with clinical data generated from a heterogeneous series of 10 patients undergoing tissue expansion. Preliminary results indicate that the model proposed is able to fit accurately both in vitro and in vivo data. Extrapolation of the model, in time, may lead to a prediction of the relative contributions of 'biological' and 'mechanical' creep.
Silicone breast implant rupture: common/serious complication?
Of the potential health risks of silicone breast implants it is the concern about implant durability, life span and the possible association with connective tissue disease which has attracted most attention. A prospective study addressing these factors was therefore undertaken over an 11 month period. 51 patients presenting with significant capsular contracture, suspected prosthesis rupture or unrelieved implant-induced anxiety underwent revisional breast surgery after biochemical, haematological and immunological screening. Of these 51 patients (83 breasts), 14 (19 breasts) had ruptured implants (23% incidence). These were all smooth prostheses belonging to a cohort manufactured more than 10 years ago; their mean in situ duration being 12 years vs. 5.5 years for the intact group (p = 0.0024; Kruskal-Wallis one-way ANOVA). There were no systemic complications from implant rupture and the mean blood silicon level was normal. One patient with pre-existing pernicious anaemia had elevated autoantibodies. The mean ESR in the ruptured implant group was 6 mm/hour. It is concluded that rupture of breast implants is not as uncommon as hitherto thought and is strongly correlated with their in situ duration. In this study implant gel leakage was not associated with serious systemic effects.
The role of the contractile fibroblast in the capsules around tissue expanders and implants.
The occurrence, structure and contractility of myofibroblasts in the capsules around tissue expanders and static implants has been studied in the rat, pig and humans. The capsules showed a characteristic layered structure with myofibroblasts being the predominant cell type. Capsular strips contract in vitro in a manner characteristic of fibroblast contraction. The contractile ability decreased with the time since expander insertion; and increased with expander exposure, peri-expander infection and clinical evidence of adverse capsular contracture. An hypothesis is proposed that capsular contracture is analogous to wound contraction, and that intraimplant pressure usually inhibits capsular contraction. Evidence is shown from intraexpander pressure measurements to support this hypothesis. The clinical implications for tissue expansion and breast augmentation are discussed.
Gold eyelid weights in patients with facial palsy: a patient review.
Lid loading with gold weights inserted into a submuscular pocket in the upper eyelid is a useful, simple, and effective method for the treatment of lagophthalmos in patients with temporary or permanent facial nerve palsy. The incidence of complications in our series was high. The reason for this are discussed, and methods of reducing the rate of complications are suggested.
Postburn breast reconstruction: tissue expansion prior to contracture release.
Tissue expansion of the scarred chest following burns results in a poor breast mound shape with little projection or inframammary fold, since the expander, like normal developing breast tissue, is kept flat by the scarred skin envelope. We present a case that demonstrates that adequate projection of the breast and formation of an inframammary fold can be achieved by expansion if extensive release and skin grafting of contractures over the breast mound are performed after expansion. Maintained expansion will act as a stent reducing secondary contracture of the grafted-areas.
Immediate placement of tissue expanders in the management of large excisional defects on the face.
Where excision of a facial lesion leaves a defect too large for local flap reconstruction, tissue expansion is frequently a more desirable option than a skin graft, providing as it does tissue which exactly matches that which has been lost. For malignant skin lesions where removal should not be delayed by preliminary expansion of the flap, the expander can be placed simultaneously with tumour excision thus keeping the reconstruction to two stages. A temporary skin graft is employed in the interim. Our experience with this approach in five patients with large facial malignancies is presented and discussed.
Management of burns in major disasters.
This paper discusses the problems of handling major burns in disasters with particular reference to the disaster that occurred in Bradford. Several major features of the Bradford fire, in which 56 people died, made its management much simpler than might be expected in subsequent burns disasters; these are discussed. Lessons that have been learned from handling this disaster are indicated.
The use of a latissimus dorsi myocutaneous flap to cover an axillobifemoral vascular prosthetic graft.
We describe a case of seroma formation with skin necrosis overlying an axillobifemoral dacron graft, which was treated by excision of the affected skin and closure using a latissimus dorsi myocutaneous flap.
Tissue expander tube exteriorization using a stylet.
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Tissue expansion in perspective.
Tissue expansion is a recent advance in skin cover technique. Its empirical use has enabled many previously difficult reconstructions to be completed without recourse to distant flaps. Its high complication rate and lack of basic scientific understanding at present restrict its use to selected cases, but the quality of repairs possible by this method encourage further serious scientific study.
Management of burns in major disasters.
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Experience with an external valve in small volume tissue expanders.
Tissue expansion has been a reconstructive technique for nearly 10 years. All published work has described serial expansion by percutaneous injection into a buried reservoir. This paper reviews a small series of patients who had tissue expansion using small volume expanders with an external valve. The complications with small expanders are discussed. The external valve is shown to be satisfactory and free from infection in this series.
Calcium alginate as a temporary recipient bed dressing prior to the delayed application of split skin grafts.
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Custom-made nipple-areola prostheses in breast reconstruction.
The nipple-areola prosthesis is a useful temporary or permanent adjunct to breast reconstruction. The commercially available prostheses, however, are unable to reflect the remarkable normal variation in this anatomical feature. We describe the production and use of custom-made prostheses using the remaining nipple-areola complex as a template. Their success in 72 patients has led us to adopt such prostheses as routine in breast reconstruction.