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Biomedical subjects

H S Byrd

Publications and source records attributed to H S Byrd.

33 records · Page 2Linked to original sources
PubMed1993

Rhinoplasty: a practical guide for surgical planning.

A method for determining the aesthetically proportioned nasal length, tip projection, and radix projection in any given face is described. The proportioned nasal length is two-thirds (0.67) the midfacial height and exactly equal to chin vertical. Tip projection is two-thirds (0.67) the surgically planned or ideal nasal length. Radix projection, measured from the junction of the nasal bones with the orbit, is one-third (0.33) the ideal nasal length. The preferred clinical reference for measuring radix projection is the plane of the corneal surface; the radix projects 0.28 times the ideal nasal length from this surface (range: 9-14 mm). These-dimensional relationships were confirmed from direct clinical measurements taken from 87 models and subsequently applied in 126 consecutive rhinoplasties. The significance of this dimensional approach to rhinoplasty lies in the fact that planned nasal dimensions are based on facial measurements that allow the nose to vary in size directly with the face. Furthermore, it removes the dorsum as the primary focus in dimensional assessment. Rather, the dorsal prominence may be consistently described relative to a plane connecting the "ideal" radix and tip.

Adult↗
PubMed1990

Optimal timing of cleft palate closure. Speech, facial growth, and hearing considerations.

We have presented an updated overview of the controversy surrounding the timing of cleft palate closure based upon the goals of cleft palate surgery: attainment of normal speech, maxillofacial growth, and hearing. From a critical analysis of the conflicting literature in these areas, we have developed our own philosophy of the cleft palate closure over the past decade that incorporates these three primary goals in the multidisciplinary care of the cleft palate patient. We feel that only through an objective, long-term, goal-oriented, prospective study of our patients will we be able to obtain realistic data in this controversial area. To date, there are no long-term, prospective, double-blind studies available in the area of cleft palate surgery. In the interim, we must objectively assess our results and, above all, adhere to the primary principle of medicine of doing no harm in the multidisciplinary management of the cleft palate patient.

Age Factors↗
PubMed1989

Abdominal wall expansion in congenital defects.

A method for expanding the skin, fascia, muscle, and peritoneal layers of the abdominal wall is described, and clinical application is demonstrated in two children with cloacal exstrophy and congenital absence of the lower half of the abdominal wall. This technique provides an innervated composite reconstruction of defects in excess of 50 percent of the abdominal surface and is recommended in large secondary defects where peritonealization has been achieved and in congenital defects that do not lend themselves to standard methods of closure. Cadaver dissection confirms that tissue expanders may be placed with preservation of innervation and blood supply to the abdominal wall.

Abdominal Muscles↗
PubMed1985

Management of open tibial fractures.

A prospective study was undertaken to accurately classify open tibial fractures and to evaluate the benefit of muscle flaps in the management of these injuries. From 191 open tibial fractures, 59 type III and 14 type IV open fractures were identified and managed prospectively. Fractures managed with open-wound techniques have a much higher complication rate than those closed with flaps. Results with flap coverage are affected by the biologic phase of the wound. The best results are seen in the acute flap coverage group and are thought to be secondary to removal of devitalized tissue with provision of a vascularized soft-tissue envelope prior to wound colonization. Flap coverage of the colonized subacute wound is subject to invasive infection with additional tissue loss. The subacute wound should be managed with open-wound technique until the parameters of a chronic localized wound are established, at which time flap coverage is again indicated. Microvascular free flaps are the preferred cover for type IV wounds because the local tissues are too ischemic and devitalized for transfer. With meticulous wound care and adherence to the enumerated surgical procedures, limb salvage may be achieved in most injuries.

Adolescent↗
PubMed1984

Poland's syndrome: improved surgical management.

Single-stage reconstruction of the chest wall combined with simultaneous augmentation mammoplasty and transfer of an island pedicle myocutaneous flap of latissimus dorsi muscle are major improvements over previous multiple-stage procedures that provide less satisfactory cosmetic results in management of patients with Poland's syndrome. Utilization of the single-stage technique in 2 patients demonstrated its efficacy as proven by excellent cosmetic results. In 1 patient with absent second, third, and fourth costal cartilages and ribs, Marlex mesh covered with a synthetic dura mater graft was employed to stabilize the chest wall. Simultaneously, an island pedicle myocutaneous flap of latissimus dorsi with its neurovascular bundle preserved was transferred to cover the prosthesis. The other patient had a coexistent pectus carinatum defect, which was repaired by resection of the costal cartilages and osteotomy of the sternum without use of Marlex. The breast implant was covered concomitantly with the myocutaneous flap of latissimus dorsi. No morbidity or mortality occurred. The cosmetic and functional results are superior to those obtained with standard techniques.

Abnormalities, Multiple↗
PubMed1983

Head and neck reconstruction with the latissimus dorsi myocutaneous flap: anatomic observations and report of 60 cases.

The latissimus dorsi myocutaneous flap can be employed successfully in head and neck reconstruction when the size or nature of the defect precludes the use of local or regional flaps. Generous amounts of hairless skin and muscle may be transferred in one operative procedure while producing an acceptable donor defect. Certain measures may be taken to enhance dependability of the flap and minimize complications, and these are discussed. The Doppler flowmeter is helpful in ascertaining patency of the main-flap vessels preoperatively as well as in identifying specific cutaneous perforators for accurate placement of the island. Locating the paddle two-thirds of the way down the muscle ensures adequate blood supply and sufficient pedicle length for most defects between the thoracic outlet and the roof of the orbits.

Adult↗
PubMed1983

Secondary ear reconstruction with cartilage grafts covered by axial, random, and free flaps of temporoparietal fascia.

Secondary ear reconstructions due to either previous surgical failures or severe traumatic injuries present a significant reconstructive challenge. In this paper we introduce an aggressive reconstructive approach in which radical scar excision is followed by immediate coverage of a newly sculpted cartilage framework with a temporoparietal fascial flap and skin graft. This approach evolved through experience with 40 patients who required secondary reconstructions due to either previous surgeries or trauma.

Adolescent↗
PubMed1983

Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results.

Thirty-six Types III and IIIa open fractures of the tibial shaft are presented with a treatment protocol based on early, aggressive wound management and fracture coverage utilizing muscle, myocutaneous, or free flap techniques. There were five amputations, seven deep infections, three nonunions, and no cases of chronic osteomyelitis in the series. The criteria for inclusion in the series were definitive wound coverage by 30 days after injury and end-result records including time of union. Wound coverage was classified as early (0-7 days) or late (8-30 days). Major and minor wound healing disturbances were found in 20.8% of the early and 83.3% of the late groups, with mean union times of 4.0 months and 6.4 months, respectively. Extensive and serial debridements, coverage within five to seven days, and early bone grafting produce a viable soft tissue envelope and a favorable mesenchymal milieu for the healing of complex open fractures. This significantly improves end results with respect to union, tissue loss from infection, healing time, and cost of hospitalization and rehabilitation.

Debridement↗
PubMed1982

Some observations relative to the levator veli palatini muscles in the cleft palate.

Three observations relative to the levator veli palatini muscles in the cleft palate patient are emphasized. They are: 1) the fascia of the levator muscle is readily identifiable and should be preserved intact during the dissection and retrodisplacement of the muscles during palatoplasty; 2) the levators are attached to the palatine bone via a tendon-like condenstation of muscle fibers; and 3) adequate release of the band-like attachment of soft tissue to the anteriolateral aspect of the levator is essential for optimal retrodisplacement of the muscle unit.

Cleft Palate↗
PubMed1981

The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage.

Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft-tissue loss, and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well-vascularized soft tissue is presented. Eighteen patients with 20 type III and type IIIa wounds were treated in a prospective fashion employing a combined orthopedic and plastic surgical scheme based on the tenets of early radical debridement, a "second look" operation, muscle or muscle-skin flap cover within 5 days of injury, external pin fixation, and ambulation within the first 3 weeks of injury. All fractures united in a mean time of 4.0 months. The mean hospitalization was 4.2 weeks. There have been no chronic infection, osteomyelitis, nonunion, shortening, or tissue breakdown.

Adult↗
PubMed1980

Forehead and scalp reconstruction after wide-field resection of skin carcinoma.

Full-thickness defects of the forehead and scalp after excision of extensive skin carcinomas are a reconstructive challenge. With loss of periosteum, bone can be covered by skin grafts after altering the outer table of the skull or by flaps. Axial subcutaneous fascial flaps and crane tissue methods are alternative techniques; clinical experience has elucidated their indications, benefits, and limitations.

Basal Cell Carcinoma↗
PubMed1980

The use of subcutaneous axial fascial flaps in reconstruction of the head.

Problem wounds of the forehead and face are reconstructed using an axial fascial flap. The flap is developed by subdermal dissection that allows a subcutaneous fascial paddle to be elevated over one of the five primary arteries of the scalp. Accordingly, a vascularized local flap is obtained that can be transferred in one stage with minimum bulk and allows one to select the desired tissue covering for one or both surfaces. The flap avoids altering the scalp hairline and generally causes no donor surface irregularity.

Child, Preschool↗
PubMed1975

Effects of parenteral alimentation on postoperative gastric function.

The effects of parenteral hyperalimentation on postoperative gastric function were studied in eleven patients undergoing abdominal aortic surgery. Positive nitrogen balance was achieved in hyperalimented patients. Hyperalimentation was found to augment gastric mucosal regeneration, allowing for more physiologic secretory patterns and the maintenance of the protective gastric mucosal mechanism.

Aorta, Abdominal↗