Biomedical subjects
Publications and source records attributed to D T Sharpe.
Experience with sixteen consecutive cases of lower leg skin loss has confirmed the reliability of Pontén's fascio-cutaneous or "super flap" (1981) in the management of these difficult injuries. The technique has several important advantages compared with the conventional lower leg flaps of both the ipsi-lateral and cross-leg variety.
Costal cartilage was harvested from cadavers less than 55 years old, stored in Cialit at a temperature of 4 degrees C and kept in a "cartilage bank" for no longer than one year. The cadaver cartilage was used largely for nasal augmentation and this paper describes the results of 67 cartilage homograft implants in patients who have been followed up for 1-8 years. These suggest that Cialit preserved cartilage homograft should be the first choice of material in nasal augmentation.
Histological study of all radical neck dissection specimens from 98 patients with clinically operable intra-oral squamous cell carcinoma has been carried out since 1973 to establish not only the presence of positive nodes but their site in the neck. All cases treated primarily by other methods such as radiotherapy or chemotherapy were excluded. Positive lymph nodes, found in 73 specimens, were grouped according to the site of the primary lesion. In no patient were nodal metastases found in the posterior triangle or in the submental region. No tumour deposits were found in the salivary glands nor were any found either in or superficial to the sternomastoid muscle. Obviously several factors must be taken into account in deciding the place of "functional" as distinct from radical neck dissection in the treatment of intra-oral malignancy, but the findings in this survey provide evidence in favour of the simpler less radical approach.
Binder's syndrome consists of nasomaxillary hypoplasia with a characteristic nasal deformity. Occlusion may be normal or class III. The cephalometric appearances are almost characteristic. The Le Fort II osteotomy is ideal for correcting the problem, though initial results were not entirely satisfactory because of incomplete correction of the nasal deformity. Over the past few years the periosteum of the floor and lateral walls of the pyriform cavity has been widely dissected to obtain adequate nasal advancement. The alar base, nostril sill, and nasal spine area have been selectively augmented with carved bone or cartilage grafts. Lengthening of the columella has been achieved by advancement of bilateral nostril sill flaps into the columella. Advancement of the maxilla with a previously normal occlusion may require orthodontic treatment, either preoperatively or postoperatively, to ensure normal occlusion. The authors have treated 26 patients with this condition over the last ten years.
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This study examines the hypothesis that textured surface silicone implants reduce the incidence of adverse capsular contracture in breast augmentation. A total of 53 patients were entered into a prospective study; they were randomly assigned to receive either smooth or textured implants which were placed in the submammary plane. Of these, 50 patients were assessed at 12 months by a panel of observers who did not know which type of implants had been used. Adverse capsular contracture (Baker grades 3 and 4) was found in 28 breasts augmented with smooth surface implants (58%) and in 4 breasts in the textured surface implant group (8%). This reduction in adverse contracture using textured surface implants was highly significant (p less than 0.0001). Careful trial design is essential in studies of this sort in order that we can obtain useful data regarding the causes and prevention of adverse capsular contracture.
It has been suggested that delay between expansion and insertion of the definitive prosthesis in breast reconstruction reduces the incidence of adverse capsular contracture. We have carried out a prospective trial to examine this hypothesis. 65 patients were randomly allocated into two groups; in one, insertion of the definitive prosthesis was 2 weeks following expansion ("immediate") and in the other, 6 months ("delayed"). The incidence of adverse capsular contracture assessed both by the Baker Scale and a linear analogue scale showed no difference between the two groups. A new objective method for measuring ptosis using a specially designed template is described. The degree of ptosis was not affected by the delay.