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Biomedical subjects

G P Reece

Publications and source records attributed to G P Reece.

68 records · Page 4Linked to original sources
PubMed1993

Osseous free flaps for orbit and midface reconstruction.

Osseous free flaps were used for reconstruction of the orbit and midface in 10 patients. The reconstruction was done at the time of tumor resection in two patients (20%) and secondarily in eight patients (80%). Nine patients (90%) had previously received radiotherapy. The flaps used were fibula (four), radial forearm (two), scapula (two), and split iliac crest (two). Flap loss occurred in one patient. Complications occurred in 2 of 10 (20%) patients. The results were classified as good in seven patients, fair in two, and poor in one. The patient classified as having a poor result was the one who sustained the flap loss; he refused further surgery. Reconstruction was directed to the maxilla in five patients, the orbit in two, and both in three. The radial forearm flap was best used for orbit-only reconstruction because of the small amount of bone required. The fibula, iliac crest, and scapula were best used for larger defects involving the maxilla. Osseointegrated dental implants were used successfully in three patients. Osseous free flaps are indicated for midface reconstruction when bony support is needed and previous irradiation prevents the use of nonvascularized grafts.

Adolescent↗
PubMed1993

Interposition vein grafting in head and neck reconstructive microsurgery.

To characterize the role of interposition vein grafts, and to determine whether their use significantly influences the success of free tissue transfers in head and neck cancer reconstruction, we reviewed 191 consecutive cases with defects involving the aero-digestive tract soft tissues (80), the mandible (75), craniofacial resections (25), or cutaneous coverage (11). One hundred twenty patients had received prior loco-regional therapy, including 63 patients with recurrent lesions. Interposition vein grafts were used for the artery (11), vein (3), or both (3) in a total of 17 cases. The overall technical success rate was 93.2 percent (178/191). Cases in which vein grafts were used had a significantly (p < 0.001) lower success rate, 70.6 percent (12/17), than those without vein grafts, 95 percent (166/175). Grafts were most often used in patients who had received prior therapy (13/17). The use of vein grafts was associated with a significantly higher incidence of flap failure in head and neck cancer reconstruction; however, a causal relationship is not suggested.

Adult↗
PubMed1993

Mandible fragment fixation during reconstruction: the splint-and-plate technique.

One of the most popular methods of mandible fragment fixation is the precontoured reconstruction plate technique. Unfortunately, this method is not a reliable option when tumor distorts the mandibular contour or extends through the buccal cortex of the mandible. An alternative to the precontoured reconstruction plate is the splint-and-plate technique of mandible fragment fixation. An application of this appliance and method in 10 patients revealed the technique's advantages. The splint can be applied quickly and does not obstruct the ablative or reconstructive procedure. Further, the splint accurately keys the dentition and reliably maintains temporomandibular joint relationships. Finally, this technique provides a reference point to the exact position of the symphysis and angle when these landmarks have been resected.

Adult↗
PubMed1993

Incidence of autoimmune disease in patients after breast reconstruction with silicone gel implants versus autogenous tissue: a preliminary report.

OBJECTIVE: To test the hypothesis that there is a higher incidence of autoimmune disorders in patients who have undergone breast reconstruction with silicone gel implants rather than autogenous tissue. DESIGN: Prospective study. SETTING: Tertiary referral center dealing exclusively with cancer. PATIENTS: All female breast cancer patients who underwent breast reconstruction between January 1986 and March 1992. Patients were nonrandomly assigned to breast reconstruction with one of the following four methods: (1) silicone gel implant only, (2) latissimus dorsi flap with implant, (3) latissimus dorsi flap without implant, and (4) transverse rectus abdominis flap. The first two groups made up the implant cohort and the last two groups the autogenous tissue cohort. Selection of reconstructive method was made on clinical grounds and was based on both physician and patient preference. MAIN OUTCOME MEASURES: Documented diagnosis of autoimmune disorder by Board-certified rheumatologist. RESULTS: Three hundred eight implants were used in 250 patients, and 408 reconstructions with tissue were performed on 353 patients. The two groups were similar in age and tumor stage. The two groups contributed 615.8 and 663.4 person-years of follow-up, respectively. One patient from each group (< 0.5%) had a documented occurrence of an autoimmune syndrome requiring therapy. Both cases were considered mild, and after initial low-dose steroid therapy, both patients are now off steroids. CONCLUSION: The incidence of autoimmune disease in mastectomy patients receiving silicone gel implants is not different than in patients who had reconstruction with autogenous tissue.

Adult↗
PubMed1992

Comparison of the rectus abdominis free flap with the pectoralis major myocutaneous flap for reconstructions in the head and neck.

The pectoralis major myocutaneous flap (PMMF) is often used in the reconstruction of large head and neck defects. Unfortunately, its use is associated with a high incidence of minor complications, can distort the contour of the neck, and may cause significant donor site deformity, especially in women. This study compared 30 patients with major head and neck cancer-related defects who underwent reconstruction with a rectus abdominis free flap (RAFF) with 39 patients with similar defects who underwent reconstruction with the PMMF. The complication rate found in the RAFF group (13%) was significantly lower than that found in the PMMF group (44%; p = 0.0145). Flap necrosis was found in 10% of the PMMF group, whereas none was found in the RAFF group. The aesthetic outcome was also better in patients who had reconstructions with the RAFF. We conclude that, for most major head and neck defects, reconstruction methods that utilize the RAFF and other free tissue transfer techniques are preferable when the requisite equipment and expertise are available.

Abdominal Muscles↗
PubMed1992

Costs and complications in mandibular reconstruction.

Because of increasing concerns about the high cost of complex medical care, we compared the combined cost of ablation and reconstruction incurred using five different management strategies for patients undergoing mandibular resection. We also compared the rates of complication and failure for the methods used. The records of 69 patients undergoing segmental or total mandibulectomy between January 1, 1986, and June 30, 1990, were reviewed. Of these, 15 had reconstruction with soft tissue only (average cost, $36,137; complication rate, 33%), whereas 20 had immediate reconstruction with vascularized bone (average cost, $46,894; complication rate, 50%), and 15 had reconstruction with only a metal plate (average cost, $47,678; complication rate, 73%). Nine patients had plate reconstructions initially but subsequently underwent reconstructions with bone (average cost, $54,346; complication rate, 78%), whereas 10 patients had no initial reconstruction but subsequently underwent delayed reconstruction with bone (average cost, $52,486; complication rate, 70%). If reconstruction was performed with bone, immediate reconstruction was more cost effective than delayed reconstruction and had a lower complication rate as well.

Adult↗
PubMed1992

The osteocutaneous free fibula flap: is the skin paddle reliable?

This clinical and anatomic study was undertaken to see if the skin paddle of the osteocutaneous fibula flap could be made more reliable. Eighty cadaver limbs were dissected to evaluate the type, number, and location of the cutaneous perforators supplying the lateral leg. Three types of perforators were identified: septocutaneous, musculocutaneous, and a type we termed septomuscular, which does not actually run within the muscle substance but is adherent to the muscle. Although not a true musculocutaneous perforator, it should be treated as such clinically. Musculocutaneous perforators were found to be more numerous and more proximal than the septocutaneous perforators. Eighteen clinical cases demonstrate a 33 percent skin paddle survival when dissected as a septocutaneous flap and a 93 percent skin paddle survival when dissected as a septomusculocutaneous flap. In using the osteocutaneous fibula flap, it is recommended that a cuff of soleus and flexor hallucis longus be incorporated into the flap to help ensure flap viability.

Bone Transplantation↗
PubMed1992

Mandibular restoration in the cancer patient: microvascular surgery and implant prostheses.

This article deals with state of the art reconstruction and rehabilitation of the head and neck cancer patient who requires mandibular resection. The mandible can be reconstructed by microvascular free tissue transfer of bone and soft tissue from distant body sites. The dental units and missing soft tissue contours can be supported by osseointegrated implants placed in the grafted bone. This article discusses the rationale for patient selection and sequencing of this complex and rewarding rehabilitation.

Dental Implants↗
PubMed1991

Use of the AO plate for immediate mandibular reconstruction in cancer patients.

Free vascularized bone grafts have revolutionized mandibular reconstruction, yet their use in all mandibulectomy patients is not always necessary. A recently developed alternative to bony reconstruction has been the use of the AO reconstruction plate. We compared the use of the AO reconstruction plate with immediate free bone graft mandibular reconstruction in 31 patients. Reconstruction plates were used in 20 and immediate free bone grafts were used in 11 patients. The overall success rate for use of the plate was 15 of 20 (75 percent). There were 6 anterior reconstructions, of which only 2 (33 percent) were successful. This is opposed to 13 of 14 (93 percent) lateral reconstructions that were successful in lateral plate placements. There were 11 immediate composite free flaps: 4 iliac crest, 4 scapula, 2 fibula, and 1 composite radial forearm flaps. Six repairs were for anterior defects, and there were 5 full-thickness defects, 3 of which were in the anterior position. All 11 flaps were successful. In conclusion, we believe the reconstruction plates are a useful adjunct for mandibular replacement in the head and neck cancer patient but should be reserved for lateral defects. For anterior reconstructions, even in patients with locally advanced disease, free-tissue transfer of composite osteocutaneous flaps is the reconstructive method of choice.

Bone Plates↗
PubMed1988

Blunt injuries of the cervical trachea: review of 51 patients.

The low incidence of blunt trauma to the cervical portion of the trachea limits management experience in most centers. Hence, we combined our patients with those in published reports containing essential information on injury, treatment, and results. Among 51 patients (93% male), ages ranged from 3 to 65 years. There were 32 complete transections, 15 partial transections, and four tears. There were associated injuries of the recurrent laryngeal nerve (49%), esophagus (21%), larynx (14%), and cervical spine (9%). Presenting signs and symptoms included subcutaneous emphysema in 84%, respiratory distress in 76%, hoarseness/dysphonia in 46%, and hemoptysis in 21%. Tracheostomy was the best means of airway control; 13 of 17 (76%) attempted oral/nasotracheal intubations failed, necessitating emergency tracheostomy. Five patients with no respiratory distress and minimal tissue injury were successfully managed without tracheal repair. Ten patients had tracheal repair without tracheostomy. The only poor result occurred in a patient with a treatment delay of several days. Tracheal repair with tracheostomy was used in 27 patients, with good results in 19. Two patients died of other injuries, and six patients (four with delayed repair) required subsequent tracheal reconstruction. Repair over a stent was used in seven patients, four of whom had satisfactory results. From this review we conclude that (1) the diagnosis of blunt trauma to the cervical trachea requires a high index of suspicion, since this injury can easily be overlooked; (2) tracheostomy (vs intubation or cricothyroidotomy) is the preferred means of airway control; (3) preoperative laryngoscopy/bronchoscopy should be done to assess vocal cord function, possible laryngeal damage, and level of tracheal injury; (4) good long-term results, measured by voice and airway quality, are best obtained by immediate repair of significant injuries.

Accidents, Traffic↗
PubMedDate not supplied

Rehabilitation of a midface defect with reconstructive surgery and facial prosthetics: a case report.

This paper reports a case in which reconstruction of a midface defect was accomplished by using microvascular surgery with free tissue transfer of the fibula for a 55-year-old man with squamous cell carcinoma in the nasal vestibule and nasal wall. This technique was developed and first used to reconstruct mandibular defects. Using a surgical template during the midface reconstruction can help the surgeon place the graft in a position that will complement the definitive facial prosthesis, as illustrated in this report.

Carcinoma, Squamous Cell↗