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Biomedical subjects

M E Krugman

Publications and source records attributed to M E Krugman.

At least 19 recordsLinked to original sources
PubMed2001

Laser-assisted hair transplantation: histologic comparison between CO2 and Ho:YAG lasers.

BACKGROUND: Various laser wavelengths and devices have been advocated for use in the creation of recipient channels during hair transplant surgery, including flash-scanned CO2, Ho:YAG (lambda = 2.12 microm), and Er:YAG (lambda = 2.94 microm). OBJECTIVE: To determine the tissue injury caused by flash-scanned CO2 and pulsed Ho:YAG lasers during the creation of hair transplant recipient channels and to assess the efficacy of the Ho:YAG laser. METHODS: Recipient channels were created in vivo in human scalp tissue using both lasers, and were excised and prepared for histologic examination. Optical micrometry of tissue sections was used to assess thermal injury. RESULTS: The Ho:YAG laser created jagged, irregular-shaped channels with larger zones of thermal injury (superficial deepithelialization, thermal necrosis, and thermal damage). In contrast, the CO2 laser produced well-defined cylindrically shaped channels free of cellular debris with minimal epithelial disruption and significantly less lateral thermal injury. CONCLUSION: Given that the Ho:YAG produced larger regions of thermal injury and recipient channels that were unacceptable for graft, the CO2 laser remains the better choice for the creation of recipient channels during hair transplant surgery. However, ongoing research will be necessary to determine the optimal laser wavelength and/or devices for this procedure.

Carbon Dioxide↗
PubMed1999

Functional hemitongue reconstruction with the microvascular ulnar forearm flap.

Thirteen patients with squamous cell carcinoma of the tongue underwent full-thickness longitudinal resection of the hemitongue and immediate microvascular reconstruction using a large, contoured ulnar forearm flap. Six of the 13 patients had a composite resection for which an additional vascularized iliac crest graft was used to reconstruct the mandible and to provide support to the overlying contoured flap. To increase tongue mobility, the skin flap was designed for independent reconstruction of the hemitongue and the floor of mouth. Twelve patients were evaluated for swallowing and speech, including dietary assessment, cineradiography, and voice spectrographic analysis. Contrast cineradiography was performed to determine oral tongue mobility during the first phase of swallow. Nine patients with a narrow reconstructed tongue root and a large surface area in the floor of the mouth had good tongue mobility, allowing them to transfer food dynamically from the mouth into the pharynx for swallowing. The remaining three patients, who had a wide tongue root and an ill-defined floor of the mouth, had decreased tongue mobility and poor oral transport. The functional outcome of swallowing and speech strongly correlated with the shape of the root of the tongue, the proximity of the reconstructed tongue to the palate, and the surface area of the floor of the mouth.

Adult↗
PubMed1998

Pharyngoesophageal reconstruction with the ulnar forearm flap.

OBJECTIVE: To evaluate the use of a generous fasciocutaneous ulnar forearm free flap in pharyngoesophageal reconstruction. DESIGN: Tertiary referral center. SETTING: Private practice. PATIENTS: From September 1, 1991, to October 30, 1996, 20 ulnar forearm free flaps were used to reconstruct the pharyngoesophagus in 19 patients after surgery for squamous cell carcinoma. There were 13 circumferential defects and 7 near-circumferential defects (<2 cm of mucosa remaining). The reconstructions were performed primarily (at the time of tumor resection) in 16 cases and secondarily in 4 cases. INTERVENTION: A generous fasciocutaneous ulnar forearm flap with a minimum dimension of 9 x 22 cm was harvested to reconstruct the pharyngoesophagus. A 2-layer closure was performed in flap tailoring and proximal (pharynx to flap) and distal (flap to esophagus) anastomoses to minimize the risk of leakage. Also, portions of the flap were used to monitor flap viability, to cover cervical vessels, to obliterate dead space, and as skin coverage when the skin flaps were deficient. RESULTS: Nineteen of the 20 flaps transferred were successful. Swallow function was restored in 18 cases, and voice was rehabilitated in all the patients using either tracheoesophageal puncture and a voice device or an electrolarynx device. There was 1 perioperative mortality. Three fistulas occurred, all of which healed with nonsurgical treatment. One stricture developed that required intermittent dilatation. The donor site morbidity was minor. CONCLUSIONS: This versatile technique achieves excellent results with a decreased complication rate compared with other methods currently available in pharyngoesophageal reconstruction.

Adult↗
PubMed1997

Magnetic resonance angioplasty for prepharyngoplasty assessment in velocardiofacial syndrome.

OBJECTIVE: The assessment of the posterior pharyngeal vasculature in velocardiofacial syndrome has been traditionally based on endoscopic visualization of pulsations or conventional angiography. This case report describes the utility of presurgical imaging with magnetic resonance angiography (MRA) prior to performing pharyngoplasty. CONCLUSION: The use of the MRA data presurgically is an effective way to prevent bleeding complications during pharyngoplasty.

Blood Loss, Surgical↗
PubMed1995

Reconstruction of the base of the tongue with the microvascular ulnar forearm flap: a functional assessment.

Ten patients with infiltrating carcinomas of the base of the tongue/tonsillar region underwent 30 to 100 percent resection of the base of the tongue and lateral pharyngeal wall. The surgical defect was reconstructed (9 primary, 1 secondary) with a large microvascular ulnar forearm flap that was selectively contoured to provide bulk for the base of the tongue and a thin lining for the pharyngeal wall. Seven patients were evaluated for swallowing and speech 6 weeks to 2 years following the reconstruction. Cineradiographic studies showed excellent base of the tongue and flap mobility allowing glossopharyngeal closure in all patients and complete pharyngeal evacuation in four patients. Four patients who were in good health preoperatively were able to eat a regular diet postoperatively, and the remaining three patients were able to handle soft food. Functional recovery after major tongue base surgery is contingent upon a three-dimensional microvascular reconstruction using a thin forearm flap.

Aged↗
PubMed1990

Parotid salivary fistula following rhytidectomy.

With the advent of suction-assisted lipectomy and superficial muscular aponeurotic system procedure for face-lift, the risk of parotid injury increases. A case of parotid salivary fistula is presented and its management discussed.

Aged↗
PubMed1990

Pilomatrical carcinoma.

Pilomatricoma is a common benign skin-appendage tumor. Surgeons should be on the alert for pilomatrical carcinoma, an aggressive variation of a usually benign skin neoplasm.

Adult↗
PubMed1990

Nurse executive role socialization and occupational image.

In this research, Krugman explores the effects of educational and experimental variables on the occupational image of the nurse executive. Early socialization as a nurse seems to remain a constant, and institutional management climate is another important variable.

Humans↗
PubMed1990

Total and subtotal glossectomy: function after microvascular reconstruction.

Twelve patients with advanced carcinoma of the floor of the mouth and tongue were treated with total (five patients) or subtotal (seven patients) glossectomy, partial mandibulectomy, and immediate reconstruction with the microvascular composite groin flap. The osteomusculocutaneous groin flap was used in eleven patients, and the osteomuscular flap was used in one patient. The groin musculocutaneous or muscle flap was designed to resemble the shape of the tongue for dynamic food transport, improved swallowing, and acceptable speech. Eight of the 12 patients who survived more than 1 year were evaluated for speech and swallowing. Eight patients were able to speak intelligibly, six patients could tolerate a soft/pureed diet, and two patients were limited to fluids. Cinefluorographic swallow studies using semisolid contrast material showed voluntary active intraoral transport and propulsive pharyngeal emptying without aspiration in six patients with complete flap to palate contact; the remaining two patients were unable to move the intraoral contrast material effectively for swallowing because of poor palatal contact.

Adult↗
PubMed1987

Adaptive mechanisms of speech and swallowing after combined jaw and tongue reconstruction in long-term survivors.

Twelve patients have been studied for speech and swallowing function after major combined jaw and tongue reconstruction with the microvascular iliac bone and groin skin composite flap. Cinegraphic barium swallows demonstrated that for bolus propulsion, it is important to be able to occlude the palate with the flap. Glottic competence prevents aspiration. Speech studies show that although there is loss of certain speech sounds, approximate sounds are substituted. Speech is intelligible when soft-tissue contact to the palate can be accomplished. The adaptive mechanisms in these patients have been compared with the mechanisms used by a patient with uncorrected congenital aglossia and hypomandibulosis who developed excellent speech and swallowing. The mobility of this patient's mouth and pharynx was similar to that in the reconstructed cancer patients who were able to swallow and speak. This procedure has become our reconstruction method of choice for these major defects.

Adult↗
PubMed1986

Tissue expansion in the treatment of alopecia.

Tissue expanders have been used in multiple body sites. We successfully used the Radovan tissue expander in the scalp of patients with cicatricial alopecia and in hair replacement surgery for male pattern alopecia. The expander is placed in the subgaleal plane beneath a hairbearing area and is inflated over a six- to eight-week period. In a second procedure, the device is removed and the bald area is excised. Closure of the defect is accomplished, with the stretched hairbearing scalp replacing the area of alopecia. Scalp reduction and pedicle scalp flap procedures have benefited by preliminary scalp expansion.

Adolescent↗
PubMed1985

White, exophytic lesion of the left lateral surface of the tongue.

Verrucous carcinoma is an unusual variant of squamous cell carcinoma; it comprises approximately 5% of all oral malignancies. The buccal mucosa, gingiva, and tongue are the most commonly involved areas within the oral cavity. Histologically, verrucous carcinoma can present a diagnostic dilemma. The basement membrane is often intact, which may cause the pathologist to misinterpret these carcinomas as hyperkeratosis and severe dysplasia. The preferred treatment for this lesion is wide local excision. Regional lymph node dissection is usually not necessary and radiation therapy appears to be contraindicated. Close follow-up is recommended.

Carcinoma, Papillary↗