Endoscopic frontal branch neurectomy, corrugator myectomy, and brow lift for forehead asymmetry after facial nerve palsy.
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Aged↗
Biomedical subjects
F F Eaves
Publications and source records attributed to F F Eaves.
The transverse orbicularis oculi myocutaneous flap: its use as nasal lining.
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Aged↗
Endoscopically assisted plastic surgical procedures in the pediatric patient.
Endoscopically assisted surgery has gained wide popularity in plastic surgery. Its major uses have been in aesthetic procedures. In this article we demonstrate the safety and utility of these techniques to a pediatric population. All patients younger than 20 years who underwent an endoscopically assisted plastic surgical procedure by one of the authors were pooled and their medical records reviewed. Complications were determined. For those children having an excision of a forehead mass, the duration of the procedure, length of incision, specimen size, and length of hospital stay were determined. Additionally, parents of these children were contacted by telephone after the excisions to determine satisfaction with the procedures. Sixteen patients' records were reviewed. Patients' ages ranged from 6 months to 15 years (mean, 5.8 years). The procedures performed included removal of forehead mass (n = 9), placement of tissue expanders (n = 5), excision of gynecomastia (n = 1), and malar soft tissue elevation (n = 1). All procedures were completed with endoscopic assistance. One procedure had to be converted to an open technique. No hematomas were observed. For forehead mass excisions, the average duration of the procedure was 46.9 min. Incision length was 1.1 cm, and specimen volume was 0.5 cm3. Parent satisfaction with the endoscopic procedures was high, with 100% responding favorably. No significant complications were observed. Many of the procedures were performed as outpatients. Parental acceptance of and satisfaction with the endoscopic techniques was high. Our experience supports the use of endoscopic techniques in the pediatric plastic surgical patient.
Adolescent↗
Subcutaneous, video-assisted saphenous vein harvest: report of the first 30 cases.
Harvest of the saphenous vein is a commonly performed procedure in cardiovascular surgery. The incision required for its removal is the longest used anywhere. In this report, the authors describe a minimally invasive technique for removal of the vein. This has been used in 30 patients undergoing peripheral arterial bypass (n = 27), venovenous bypass (n = 2), and a saphenopopliteal fistula (n = 1). There were three perioperative complications: skin necrosis over tunnel (one), bulla (one), and saphenous vein injury (one). Harvest time averaged 1.25 h. There was minimal postoperative discomfort in the harvest site and minimal scarring. Endoscopic harvest of the saphenous vein differs from most laparoscopic procedures because of its linear course. Consequently, visualization and dissection is coaxial rather than triangulation. This study demonstrates the technical feasibility of vein harvest. Development of appropriate instrumentation for opening the optical cavity and vein manipulation will reduce operative times.
Dermatologic Surgical Procedures↗
Endoscopic abdominoplasty and endoscopically assisted miniabdominoplasty.
Recent developments in abdominal contouring procedures have included the extensive use of liposuction and the use of modified or limited scars, producing in effect a "downsizing" of the operative procedures for many patients. The use of minimally invasive techniques based on endoscopic technology and instrumentation represents a logical extension of this trend. Endoscopic visualization and dissection facilitate musculofascial repair through a very small incision and, combined with liposuction, allows significant improvement in abdominal recontouring in selected patients. Patient selection parameters, instrumentation, operative techniques, and complications of this developing procedure are described.
Abdomen↗
Primary temporal melanoma without diffuse leptomeningeal involvement: a variant of neurocutaneous melanosis.
Plastic surgeons who treat congenital giant nevi should be aware of the neurocutaneous melanosis syndrome and its variants. When neurologic symptoms are present concurrent with MRI evidence of central nervous system involvement, treatment of the cutaneous lesion must be tempered by knowledge of a poor prognosis. In the otherwise asymptomatic patient, the plastic surgeon should consider screening with MRI imaging, realizing that the clinical significance of a positive MRI scan without neurologic symptoms is unknown.
Humans↗
TRAM flap vascular delay for high-risk breast reconstruction.
The purpose of this study was to evaluate the intraoperative changes in physiologic blood pressure following vascular delay of the TRAM flap. Ligation of the superficial and deep inferior epigastric vessels 2 weeks prior to the TRAM flap was performed. The incidence of fat necrosis was 4.3 percent in 23 high-risk patients who underwent 30 immediate breast reconstructions. Direct measurement of blood pressure in the deep inferior epigastric artery and vein was performed in a control group without delay consisting of 13 low-risk patients and in the study group of 7 high-risk patients who underwent vascular delay. Changes in TRAM flap perfusion pressure were examined following the change in location of the flap from the abdomen to the chest. Blood pressure measurements demonstrated that arterial pressure in the proximal stump of the deep inferior epigastric artery was 64 percent in the study group prior to delay and 72 percent in the control group. The physiologic response to vascular delay included an overall increase in arterial pressure with a decrease in venous congestion. TRAM flap perfusion pressure was significantly increased from 13.3 mmHg (control) to 40.3 mmHg (delayed) in the region of the midrectus perforators (p < 0.05). These data suggest that the technique of TRAM flap delay may increase the reliable tissue volume and improve the safety of the TRAM flap.
Adult↗
Instrumentation and setup for endoscopic plastic surgery.
The use of endoscopic techniques mandates the need for basic understanding of endoscopic instrumentation and operating room setup in order to avoid procedural delays and surgeon frustration. The electronic systems for endoscopic surgery-cameras, light sources, monitors, and so on-have been well developed for other specialties and are fully adaptable to endoscopic plastic surgical procedures. Hand instruments, however, are in the early phases of refinement for subcutaneous plastic surgical procedures and will undoubtedly improve over the next several years. Adaptation of existing instrumentation and development of new operating tools continue and promise to make endoscopic plastic surgical procedures of the future more ergonomic and efficient. Similarly, while operating room setup for endoscopic plastic surgical procedures varies depending on individual circumstances, application of a few basic principles will help in making this step quick and simple. The knowledge and experience of scrub technicians and nurses experienced in endoscopic techniques can be invaluable to the surgeon just beginning to use endoscopic techniques in plastic and reconstructive surgery.
Endoscopy↗
Endoscopic techniques in aesthetic breast surgery. Augmentation, mastectomy, biopsy, capsulotomy, capsulorrhaphy, reduction, mastopexy, and reconstructive techniques.
Endoscopy is a new tool in the armamentarium for surgery of the breast. Endoscopic techniques may offer decreased scarring and morbidity rates for a variety of aesthetic and reconstructive procedures. Whereas initial clinical experiences are encouraging, most endoscopic procedures of the breast remain developmental, both in technique and instrumentation. Additional development, refinement, and experience will be required to define fully the utility of endoscopic techniques.
Adult↗
Endoscopic transaxillary subpectoral breast augmentation.
The transaxillary approach to breast augmentation is an established technique that offers the advantage of a remote incision in an aesthetically acceptable area. The main disadvantage to this approach is the lack of visualization of the implant pocket, necessitating blind, blunt dissection of the pectoral muscle origins. Occasionally, this limitation may result in improper implant placement and poor aesthetic results. In order to address this shortcoming, we have explored the use of minimally invasive endoscopic techniques in transaxillary augmentation to allow division of the pectoral muscle origin under direct visualization, effectively lowering the inframammary crease. Initial dissections and instrument development were performed in five unpreserved female cadavers. Subsequently, 103 implants have been placed in 53 patients utilizing the endoscopic transaxillary approach. Follow-up ranges from 2 weeks to 20 months. There have been no hematomas, infections, capsular contractures, or other complications. Aesthetic results have been good, and patient acceptance is high. By providing predictable and reproducible control of the inframammary crease, endoscopic dissection has allowed us to expand our indications for the transaxillary approach to breast augmentation. Surgical technique and brief clinical experience are described.
Adult↗
Subfascial endoscopic perforator surgery: new life for an old procedure?
BACKGROUND: Division of incompetent perforating veins has long been regarded as an appropriate approach for treatment of venous stasis ulcers. The development of endoscopic techniques using standard laparoscopic instrumentation has permitted the application of this therapy without the need for long open incisions, fraught with complications. METHODS: We report our experience with 20 cases of subfascial endoscopic perforator surgery (SEPS) in 19 patients. Seventeen limbs had active ulceration at the time of operation. A gas insufflation technique with two 10 mm ports was used in most cases. RESULTS: An average of four perforating veins were divided in each case. Mean operating time was 1.5 hours. At a mean follow-up of eight months, initial complete healing occurred in 14 of 17 ulcers, three ulcers improved, and three healed ulcers at the time of SEPS have remained healed. One patient developed a small area of recurrent ulceration after initial healing. There were no thromboembolic complications. One procedure was technically unsuccessful because of morbid obesity. One patient developed a wound infection, and one patient required re-exploration for a subfascial hematoma. CONCLUSION: SEPS is a safe, minimally invasive procedure which should become an important part of the surgical armamentarium in treating patients with venous ulcers.
Adult↗