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Biomedical subjects

G E Rauscher

Publications and source records attributed to G E Rauscher.

12 recordsLinked to original sources
PubMed1996

Endoscopic-assisted midface lift utilizing retrograde dissection.

Endoscopic facial surgery is gaining wide acceptance, as results are providing comparable if not superior to the standard, superficial musculoaponeurotic system rhytidectomy, with minimal scarring. Frontal branch facial nerve injury remains a troublesome complication. The purpose of our study was to determine if a subciliary retrograde dissection would decrease facial nerve injury and allow for more accurate midfacial suspension. Fresh cadaver dissections were performed using endoscopic equipment. Anterograde temporal incisions in the scalp and retrograde subciliary incisions were studied. The anterograde temporal dissection was developed deep to the superficial layer of the deep temporal fascia. Retrograde subciliary dissection was subperiosteal. Forty-nine endoscopic-assisted midface lifts were performed. Midfacial suspension was accomplished with nonabsorbable sutures placed in the suborbicularis oculi fascia, anchored to the deep temporal fascia. Two of three endoscopic-assisted procedures done in the anterograde fashion, without a subciliary incision, experienced transient frontal branch injury, which resolved within 6 weeks. The remaining forty-six patients, operated with a combined subciliary and temporal approach, experienced no frontal branch injuries. We have found that the retrograde dissection through a subciliary incision substantially reduced the incidence of facial nerve injury, provided direct visualization of the suborbicularis oculi fascial layer (allowing more accurate midfacial suspension), and reduced total operative time.

Aged↗
PubMed1996

Does ganglionectomy destabilize the wrist over the long-term?

Previous publications have described persistent postganglionectomy symptomatology. One report demonstrated scapholunate instability in a small number of patients. We specifically examined our ganglionectomy patients for wrist instability. Ninety-one consecutive cases of wrist ganglionectomy performed from 1987 through 1993 by the senior author (FMW) were studied. Most patients were contacted by telephone and questioned with a standardized interview format. Postoperative course, job changes and occupational restrictions, and patient satisfaction were queried. Range of motion, grip strength, scaphoid mobility, and radiographs were studied to characterize scapholunate static and dynamic relationships. Seventy-one percent (N = 61) of the operated patients were interviewed at an average postoperative interval of 44 months. Twenty-five percent (N = 21) had wrist symptoms. There was no late ganglion recurrence. Twenty of the 21 symptomatic patients (95%) had normal ranges of motion and no carpal instability. Grip strengths averaged 12% below normal in 45% of the dominant operated hands. Radiographs demonstrated no scapholunate dissociation or dynamic instability patterns. Wrist ganglionectomy does not destabilize the wrist, particularly the scapholunate joint. Thorough and meticulous extirpation of the ganglion is warranted. Additional minor problems, both as consequences of the operation and as unrelated concomitants, do occur and deserve attention. Hand surgeons assume cure of the problematic wrist because of the patient's failure to report tolerable problematic sequelae. A late revisit may reveal (1) treatable problems emanating from the dynamic forces contributing to original ganglion formation; (2) additional, unanticipated, treatable conditions resulting and not resulting from the ganglionectomy itself; and (3) ganglion recurrence.

Female↗
PubMed1996

Are type IIIC lower extremity injuries an indication for primary amputation.

There are few large series of the long-term results of severe devascularized, open fractures to the lower extremity. Therefore, we retrospectively reviewed our experience with 35 consecutively admitted patients who sustained Gustilo Type IIIC injuries and who presented to our Reimplantation Center between 1984 and 1987. To our knowledge, this group of patients represents the largest series of this injury reported to date. The review included 21 patients who required primary amputation and 14 patients who underwent vascular, orthopedic, and delayed soft tissue reconstruction. This report details the treatment protocol used to result in our 93% success rate in the 14 patients with Type IIIC injuries who were successfully revascularized. Our initial management approach to the devascularized lower limb includes immediate revascularization with temporary shunts to minimize ischemia time, followed by revascularization with vein grafts beyond the zone of injury and external fixation. Subsequent management included liberal use of microsurgical free transplantation to overcome soft tissue defects; bone grafting as soon as infection and soft tissue coverage permitted and delayed wound closure. Our approach differs in that definitive wound closure is avoided for 4 to 6 weeks to allow resolution of myonecrosis secondary to initial ischemia and subsequent reperfusion injury. Contraindications to this aggressive revascularization approach are poor patient health before injury, completely severed limb, segmental tibial loss greater than 8 cm, ischemia time greater than 6 hours, and severance of the posterior tibial nerve.

Amputation, Surgical↗
PubMed1995

Computer analysis of the African-American face.

An anthropometric study was devised to examine the facial proportions of the African-American. Two hundred African-American subjects between the ages of 18 and 30 years were studied. Objective data were gathered, and standard proportions of the African-American face were obtained. Previous anthropometric studies were performed using direct measurements of facial proportions. Farkas used direct measurements of young adult North American Caucasians and compared them with those of the neoclassical canons. Xeutong evaluated facial proportions of young adults of the Han nationality by direct measurement. The data derived from these studies are compared with our results. Measurements were obtained by standard photographic technique and scanned onto computer diskette. Computer analysis of the objective data was acquired. Thirteen measurements assessing the facial dimensions were used. We observed similar vertical proportions in the African-American face and the Caucasian face. Horizontal dimensions varied significantly between racial groups. Our conclusions will assist the aesthetic surgeon caring for the African-American patient.

Adolescent↗
PubMed1991

The treatment of atypical lipoma with liposuction.

Large lipomas may best be treated with liposuction. Once a lipoma enlarges to 4 cm or more, liposuction has several advantages over conventional surgery. A well-demarcated lipoma 15 cm in diameter and deep to muscle was treated by liposuction. Biopsy showed an atypical lipoma. Because the entire tumor was removed by liposuction, we feel that the prognosis is excellent. The cosmesis and morbidity results were far superior to those anticipated with conventional excisional surgery. Small superficial lipomas may be treated by suction lipectomy and the surrounding area can be contoured symmetrically at the same time, whereas large ones can be liposuctioned completely without extensive surgical extirpation and morbidity. Because such big lesions may represent atypical lipomas or liposarcomas, care must be taken to remove the entire tumor.

Adult↗
PubMed1986

Treatment of recurrent earlobe keloids.

The use of complete surgical excision and postoperative pressure with steroid-impregnated tape has been evaluated in fifty-seven patients with recurrent earlobe keloids. All patients underwent conventional treatment previously, which was not curative. In a four-year follow-up of the method described here, four recurrences occurred. Patients' failure to use the recommended pressure earring and alteration in endocrine balance were noted in three of the four patients with recurrent keloids.

Adolescent↗
PubMed1981

Surgical treatment of fiber-implanted scalps.

The treatment of synthetic fiber-implanted scalp has not been standardized. Eleven cases are reviewed to present our experience in the treatment of this problem. Technical consideration and recent findings are discussed.

Acrylic Resins↗