Biomedical subjects
Publications and source records attributed to J Guerrerosantos.
This report describes the detailed construction, experimental basis, and clinical application of a reliable double microvascular clamp that can be built from inexpensive parts that are readily available. Twenty-five clinical free-tissue transfers were performed using this clamp with an acceptable free-flap survival rate.
The use of the frontalis musculocutaneous flap as a pedicle island flap offers some advantages in frontal reconstruction. It can be used for immediate reconstruction following the ablation of a small or moderate area, even after harvesting of the frontal flap for nasal reconstruction. Because of its intact lateral bundle, it has the potential to carry some sensory innervation, albeit minimal, to the reconstructed area. We have found the frontalis musculocutaneous flap, when used as a pedicle island flap, to be an adaptable and dependable alternative flap for repairs after small or moderate resections in the frontal region. This flap could be performed immediately and in one stage, have a low morbidity rate, and allow a rapid aesthetic restoration; and, it is easy to perform. In two cases, we have observed some degree of venous congestion in the island during the early postoperative period but with success in final healing. The experience demonstrates that this flap should be considered as another valuable tool in reconstructive efforts directed at the forehead. We propose a novel method for the forehead reconstruction using the frontalis musculocutaneous island flap. A case is presented that demonstrates the use of this flap for repair in a depressed frontal defect.
Fat grafts have become an important and necessary procedure in the field of plastic surgery. The author presents experiences with two types of patients: older people with thin facial soft tissues, in whom the combination of lifting and lipoinjection gives good results; and patients with progressive hemifacial atrophy caused by Parry-Romberg's syndrome in whom normal or almost normal facial contour can be achieved. The longterm survival of fat grafts is presented. This procedure has been used by the author for the past 16 years.
Cartilaginous autografts, either from the ribs, auricular concha, nasal septum, or even the alar cartilages, are some of the most widely used materials in nasal surgery. Nevertheless, no comparative study exists on these four cartilages in which their physicoelastic properties are analyzed based on their histological architecture and their function within the organism. The studies that do exist on structure and classification of cartilages differ widely. In this study, cartilage specimens obtained from the nasal septum, rib, auricular pavilion, and alar of 7 fresh cadavers were analyzed. They were subjected to special tincturing to be able to histologically observe their architecture, cellularity, intercellular substance, the relationship between cellularity and intercellular substance, the primary components of the matrix, and the distribution of fibers. Many similarities were found among the septal, costal, and alar cartilages. All three exhibit little cellularity and much intercellular substance. The intercellular substance is made up of homogeneously distributed collagen fibers. Auricular cartilage has many cells and little intercellular substance, being made up of irregularly distributed elastic fibers. On the basis of these findings, we propose a simpler classification and make recommendations for the use of these four cartilages in nasal surgery.
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Fat autografting is an accepted technique in the treatment of depressions or augmenting thin soft tissues. Aging soft tissues become thin, among them the subcutaneous fat layer, muscles, and fasciae, and these tissues in addition become flaccid. Therefore, to get better results in rejuvenation plastic surgery, a good alternative is the combination of lifting the flaccid tissues and thickening the thin soft tissues with a lack of contour and definition, which enhances the aspect of the entire face and neck. For 10 years in our practice, we have been combining rhytidoplasty (which includes systematizing superficial musculoaponeurotic system and platysma plication) with lipoinjection, placing thin rolls of autologous fat into the facial and cervical muscles, or at least under the fasciae. The results reveal a very high success rate with few minor complications. Proper diagnosis, patient selection, and adequate surgical technique produce predictable and favorable aesthetic results. A concurrent retrospective study of 357 consecutive patients who underwent simultaneous rhytidoplasty and lipoinjection was conducted over a 10-year period (1985 to 1995). The purpose of this article is to show our experience with this method, including long follow-up observations.
In trying to achieve symmetry and better contour of the back torso and middle third of the body, the combination of liposuction and lipoinjection is rapidly becoming the procedure of choice. Its versatility makes it suitable for most body contour deformities. The indications and operative and postoperative techniques are detailed in this article. Fat graft long-term survival is presented. This procedure has been used by the author during the past 12 years.
OBJECTIVE: To determine autoantibody profiles of patients with Parry-Romberg syndrome (PRS). METHODS: Antinuclear antibodies (ANA) in 14 patients with PRS were studied by indirect immunofluorescence (IIF), immunodiffusion and immunoblotting. Antinative DNA antibodies and rheumatoid factor (RF) were also analyzed. RESULTS: ANA were positive in 8 patients (57%). The patterns of staining included nucleolar, nuclear speckled and homogeneous. Anticentromere antibodies were observed in 2 and antihistone antibodies in 3 sera. Rheumatoid factor was found in 5 (36%) sera. Antinative DNA or antibodies that precipitated rabbit thymus extract were not found in any patients. CONCLUSION: The serologic abnormalities observed in this study suggests that autoimmunity could play a pathogenic role in PRS.
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The up-to-date plastic surgeon should consider using augmentation rhinoplasty with relative frequency. In selected cases, for improving the face integrally, it is desirable to augment the paranasal area. In the author's hands, grafts of cartilage and fascia are the preferred tissues, based on the experience of many years. Fascia can be used alone or combined, and in the last few years we have used it alone quite often. A temporoparietal fascia graft has great versatility in the correction of a number of nasal deformities. A depressed nasal dorsum can be augmented by utilizing fascia grafts. A depressed nasal radix can be corrected successfully by utilizing fascia grafts. Submucosal placement of strips of fascia has proved to be an effective method of reconstructing the roof of the middle cartilaginous vault. For augmenting the nasal dorsum when it is a case of primary rhinoplasty, the author prefers the use of fascia alone, but if the patient is having a secondary rhinoplasty, then the graft of fascia and cartilage combined is preferred.
For the last 4 years, the author has been using the open lower cartilaginous vault rhinoplasty, making an external cutaneous incision on the columella. After observing the improved results in patients with nasal tip, lateral crura, and medial crura difficulties, the author widely recommends the use of this procedure in selected patients. In addition to multiple advantages which have been reported useful in open-tip rhinoplasty in the past, the author has contributed two additional advantages: that it avoids scarring columella skin and that it can be extended to cope with defects of the entire lower cartilaginous vault. Disadvantages are some residual edema in some patients over a 6-months period and prolongation of operating time.
A combined procedure removing the buccal fat pad by excision and the subcutaneous fat of the cheek and neck by lipoplasty is described; this results in an improved contour in both the cheeks and neck. The technique has been applied in 28 patients of various ages without complications and with satisfactory results. Both the immediate results of the operation and the results noted 1 year or more after the operation are very satisfactory. Excellent results have been noted for nine young patients, and good results were obtained in 19 older patients. A review is given of the findings previously reported in the literature. At present, we are inclined to believe that removal of the buccal fat pad and lipoplasty of the subcutaneous fat of the cheeks and neck offers more improvement than either procedure alone. It is hoped that this combined procedure will give a solution to the troublesome problem of chubby cheeks and lead to a method of safely recontouring the cheek to a more youthful and beautiful appearance.
A retrospective study was performed analyzing 521 consecutive patients who had either lower eyelid, malar region, or cheek reconstruction performed from January 1960 through December 1985. Of the group, 285 patients had basal cell carcinoma (BCC) of the cheek and malar regions, and 236 had BCC of the lower eyelid. In this paper we reevaluate and illustrate the repair of different-sized lower eyelid, malar, and cheek defects at various locations by interpolated sliding skin flaps from the cheek and neck. Very satisfactory aesthetic results have been obtained and have been evaluated with follow-up observations and treatment discussed. In the reconstruction of soft-tissue defects in these areas, large cheek (or cheek and neck) flaps are preferred in 26 cases. This report shows three examples of the surgery.
The onlay fascia-cartilage graft technique for malar or maxillary projections can be used for recontouring the middle third of the face. Covering onlay grafts with fascia achieves a smoother contour, concealing the edges in addition to obtaining a more natural anatomical look for the face. The technique has provided a predictable and permanent method of augmenting malar or maxillary projections, and it has produced good aesthetic results.
The purpose of this paper is to report a modification of the commonly used incisions for obtaining a composite earlobe graft. A procedure is described to reconstruct a skin fold between the earlobe and the cheek after excision of the graft. The presence of a definitive skin fold, the avoidance of scar and notching in the lobule border, and the maintenance of a normal lobule contour under a reconstructed earlobe after the excision of a composite graft do much to enhance its appearance. Two demonstrative patients are illustrated.
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