Paralytic lagophthalmos: gold-weight implantation.
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Eyelid Diseases↗
Biomedical subjects
J David Kriet
Publications and source records attributed to J David Kriet.
Comparison of radial forearm with fibula and scapula osteocutaneous free flaps for oromandibular reconstruction.
OBJECTIVE: To compare our experience with the osteocutaneous radial forearm free flap (group 1) (n = 108) with other commonly used osteocutaneous free flaps (group 2) (n = 56) such as the fibula and scapula in single-stage oromandibular reconstruction. DESIGN: Retrospective case review. SETTING: Tertiary-care academic medical center. PATIENTS: One hundred sixty-three consecutive patients who underwent 164 mandibular reconstructions with osteocutaneous free flaps. MAIN OUTCOME MEASURES: Assessment of preoperative and intraoperative variables for both groups. We compared recipient-site complication rate, intensive care unit stay, total hospital stay, and postoperative function. RESULTS: The most common donor site used was the radius (n = 108 [66%]), followed by the fibula (n = 36 [22%]) and scapula (n = 20 [12%]). Mean follow-up was 29 months (range, 1-116 months). Group 2 patients had larger soft tissue and/or bony defects. Surgical and medical complication rates and major donor site morbidity in group 1 were similar or better when compared with those in group 2. The lengths of the intensive care unit (4 vs 7 days; P = .009) and hospital stays (13 vs 15 days; P = .06) were shorter in group 1. Although the microvascular success rate was similar in both groups, the local wound complication rate was significantly better for group 1. The difference for the length of intensive care unit stay was statistically significant and potentially amounts to more than 6000 dollars of savings. Functional outcomes, including the ability to tolerate oral diet, tracheostomy presence, and dental rehabilitation, were similar between the groups. CONCLUSIONS: The primary site long-term morbidity, donor site morbidity, and postoperative function of osteocutaneous radial forearm free flaps are comparable to those of other commonly used osteocutaneous free flaps such as the fibula and scapula when used in single-stage oromandibular reconstruction.
Adolescent↗
Complex nasal defects: structure and internal lining.
The development of nasal reconstruction concepts such as the three-layered (lining, structure, and covering) repair has led to remarkable esthetic and functional improvements. The authors present a variety of techniques for providing nasal structure and internal lining and discuss the application of these methods to specific nasal defects.
Bone Transplantation↗
The role of the osteocutaneous radial forearm free flap in the treatment of mandibular osteoradionecrosis.
OBJECTIVE: To evaluate the role of the osteocutaneous radial forearm free flap (OCRFFF) in the treatment of mandibular osteoradionecrosis (ORN). STUDY DESIGN AND SETTING: Retrospective case review of patients who underwent OCRFFF oromandibular reconstruction after resection of nonviable tissue at an academic tertiary care center because of ORN. Patients with reconstructions other than OCRFFF were excluded from this study. RESULTS: Nine patients underwent a composite oromandibular resection for ORN with a reconstruction using an OCRFFF between April 1998 and February 2003. All patients had failed previous less aggressive surgical and medical management of the ORN. Mean follow-up was 36 months (range, 14-67 months). There were no flap failures or significant immediate postoperative or long-term complications observed. All patients had successful restoration of mandibular integrity and continuity, with 100% success rate of stabilization of ORN. All patients were able to tolerate PO diet, with only one third having to supplement their diet with gastrostomy feedings, compared with 89% gastrostomy dependence preoperatively. CONCLUSIONS: Primary or adjuvant radiotherapy for head and neck malignancies can result in ORN of the mandible. This difficult problem often requires surgical intervention. In our experience, the OCRFFF can be successfully used for oromandibular reconstruction, even in the setting of the heavily radiated tissue with excellent postoperative outcomes. SIGNIFICANCE: This is the first study that demonstrates the efficacy of the OCRFFF as a treatment of mandibular ORN.
Aged↗
Self-inflicted submental and transoral gunshot wounds that produce nonfatal brain injuries: management and prognosis.
OBJECT: Penetrating brain injuries caused by self-inflicted gunshot wounds are very often fatal and survivors suffer serious disabilities. Recognition of a possibly more favorable prognosis for a specific type of injury, the submental or transoral handgun or low-energy rifle wound, prompted the authors to review their experience with patients who had attempted suicide in this manner. METHODS: The records of 11 consecutive patients seen over a 10-year period (1992-2001) were retrospectively reviewed. Handguns were used by eight patients and .22 caliber rifles by the others. The patients presented with predominantly unilateral frontal brain injuries that required urgent attention. One elderly patient who had made an advance directive concerning care died. All other patients underwent craniotomy and repair of associated ophthalmological and maxillofacial injuries. Follow-up review ranged from 9 months to 3 years, during which time there were no repeated suicide attempts. All but one patient expressed satisfaction with their appearance and returned to a self-sufficient lifestyle. CONCLUSIONS: Self-inflicted submental and transoral handgun and low-energy rifle wounds may produce serious but survivable brain injuries if the path of the bullet is limited to the frontal area. Early aggressive management of brain, dural, and craniomaxillofacial injuries should return the patient to a highly functional neurological status and restore an acceptable outward appearance. Outcomes, therefore, appear to be much better for these patients than for most patients with a penetrating brain injury due to a self-inflicted gunshot wound.
Adult↗
Use of the 2.0-mm locking reconstruction plate in primary oromandibular reconstruction after composite resection.
OBJECTIVE: To review our experience with 2.0-mm locking reconstruction plate (LRP) system for patients requiring oromandibular reconstruction. STUDY DESIGN: Retrospective case review of 43 consecutive patients who underwent mandibular composite resection with immediate reconstruction. SETTING: Tertiary care center. RESULTS: Forty-three patients underwent oromandibular reconstruction with the 2.0-mm mandibular LRP system and free flaps containing vascularized bone. Mean follow-up was 11 months. There were no intraoperative difficulties utilizing this system. Two (5%) patients had partial fasciocutaneous flap loss resulting in plate exposure. There were no instances of plate fracture or complications requiring plate removal to date. CONCLUSION: 2.0-mm LRP mandibular system is reliable even in the setting of previous or adjuvant radiation therapy. Its technical ease of application, contouring malleability, and very low profile have proven to be advantageous in oromandibular reconstruction. SIGNIFICANCE: No previous descriptions of use of the 2.0-mm LRP in combination with osteocutaneous free flaps for mandibular reconstruction are found in the literature. EBM RATING: C.
Adult↗
Evaluation of pericranial skull adherence during healing in the rabbit model.
BACKGROUND: The endoscopic brow-lift is a popular technique for rejuvenation of the aging brow and forehead. Long-lasting results depend on readherence of the pericranium to the underlying skull in the newly elevated position. Determination of the time required for pericranial readherence to occur is important when considering optimal brow fixation time postoperatively; however, few studies of pericranial healing exist in the literature. OBJECTIVE: To quantify the time required for pericranial adherence after pericranial elevation in a rabbit model. DESIGN: Anesthetized New Zealand white rabbits underwent elevation of a pericranial flap on day 0. The flap was then repositioned and the skin sutured. One unoperated-on group served as a control. A tensiometer was used to measure the force required to separate the pericranial flap from the skull of the control animals and of test animals killed on postoperative days 3, 5, 8, 10, 13, 17, 20, 25, and 28. Statistical analysis was performed to determine the effect of healing time on the strength of pericranial readherence. RESULTS: There was a statistically significant decrease in the force required for pericranial separation at 3 and 5 days after surgery compared with the control group. By 8 days postoperatively and throughout the subsequent times examined, no statistically significant differences from the control group were observed. CONCLUSION: In this rabbit model, pericranial adherence (as measured by tensile strength) is decreased postoperatively and does not return to baseline levels until postoperative day 8.
Animals↗
Self-induced nasal ulceration.
BACKGROUND: Nasal ulcerations have many causes. Ulcerations that are self-induced are difficult to diagnose and treat. Two rare conditions with self-induced nasal ulceration are trigeminal trophic syndrome (TTS) and factitious disorder (FD). Trigeminal trophic syndrome is characterized by trigeminal anesthesia, nasal alar ulceration, and facial paresthesia. Appearance of the nasal ulcer after trigeminal ablation for neuralgia is diagnostic. Self-induced nasal lesions that occur in FD are primarily distinguished from those in TTS by the presence of normal trigeminal nerve function and frequent patient denial of lesion manipulation. OBJECTIVES: To increase physician awareness of the disorders leading to self-induced nasal ulceration and to discuss management issues in our patient series. DESIGN: A retrospective review of 7 cases in which the patients presented for reconstructive consultation between March 1985 and October 1997 and were found to have self-induced nasal ulcerations. SETTING: Tertiary university medical center. RESULTS: Five patients were identified with TTS and underwent nasal reconstruction an average of 43 months (range, 4-72 months) after nasal ulcer presentation. Four of the 5 patients developed ulcer recurrence between 1 and 58 months after reconstruction; secondary reconstruction resulted in recurrence in 2 of these patients. Two patients were identified with FD and self-induced nasal ulceration. One of these 2 patients underwent total nasal reconstruction 15 months after ulcer occurrence and developed recurrence 2 weeks after surgery. CONCLUSIONS: Self-induced nasal ulceration remains a difficult condition to diagnose and treat. Readily treatable conditions should be excluded, and diagnostic workup should include tissue biopsy and laboratory studies. Patients with TTS may have associated ocular findings, and those who do should be referred for ophthalmologic consultation. Surgical reconstruction can be considered in the highly motivated patient with TTS; however, delayed ulcer recurrence is common. Patients with FD should be treated primarily with local wound care and referred for psychiatric intervention. We strongly recommend nasal prosthetic devices as the primary means of aesthetic correction and discourage surgical repair in the patient with FD.
Adolescent↗
Biomechanical properties of materials used in static facial suspension.
OBJECTIVE: To compare the biomechanical properties of the superficial (human acellular dermis); (AlloDerm; LefeCell Corp, Branchburg, NJ) and deep layers of cadaveric dermis and expanded polytetrafluoroethylene (ePTFE); (Gore-Tex; W. L. Gore & Associates, Flagstaff, Ariz). METHODS: Sixteen samples of superficial dermis (AlloDerm), 12 samples of deep dermis, and 12 samples of ePTFE were axial loaded on a materials testing machine. Maximum load to failure and stiffness were calculated and statistical analysis was performed to compare the materials. RESULTS: Dermis samples had statistically greater mean stiffness compared with ePTFE samples. There was no statistical difference of maximum load to failure comparing ePTFE with superficial dermis. There was a statistical difference in maximum load to failure between ePTFE and deep dermis. There was no statistical difference between the superficial and deep layers of the dermis with respect to stiffness or maximum load to failure. CONCLUSIONS: Cadaveric dermis has some biomechanical properties to be a superior material for static facial suspension. There was larger than expected variability in both parameters (stiffness and maximum load to failure) tested in dermis samples, which may correlate with occasional clinical failure.
Biocompatible Materials↗