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Biomedical subjects

M E Manstein

Publications and source records attributed to M E Manstein.

10 recordsLinked to original sources
PubMed1998

Paraspinous muscle flaps.

Coverage of midline posterior wounds presents a challenge to the reconstructive surgeon, especially when spinal stabilization hardware has been present and exposed in the wound. Most commonly those wounds that involve the mid to upper thoracic spine have been covered by latissimus dorsi muscle or musculocutaneous flaps. Lower midline wounds, especially in the thoracolumbar region, have needed more complex means of coverage. These have included reversed latissimus dorsi flaps, free flaps, extended intercostal flaps, or fasciocutaneous rotation flaps. We have utilized a far simpler and effective muscle flap: the paraspinous muscle flap. We have raised paraspinous muscle flaps bilaterally and have been able to cover a number of difficult wounds. The wounds were presented by 8 patients with exposed Harrington rods, 3 patients with cerebrospinal fluid leaks, and 1 patient with exposed spinous processes. The wounds in 5 of these 12 patients were in the upper thoracic region, where a latissimus flap was utilized as an additional layer of muscle coverage. The other seven patients had wounds in the lower midline region below the potential reach of the latissimus dorsi. In the latter patients the only flaps employed were paraspinous muscle flaps. We had only one failure in all patients, which involved a recurrent cerebrospinal fluid leak in which there was no decompression of the cerebrospinal fluid pressure utilized in the immediate postoperative period to protect the dural repair. In that instance, a leak recurred. This paper presents the method of flap elevation and the results of our series.

Aged↗
PubMed1997

Obtaining projection in the amputation free nipple/areolar graft breast reduction without a vertical scar: using breast parenchyma to create a new mound.

Multiple techniques for breast reduction in the giant breast have been used. The amputation technique with the free nipple/areolar graft has been the mainstay for severe macromastia since 1921. Traditional methods for amputation of the inferior pole of the breast have created fairly flat breast mounds. Projection of the mound was enhanced by an inferior pleat with a resulting vertical scar. A new technique employing a superiorly based dermal fat flap folded back behind the residual breast to improve projection and roundness has been developed. It has not only eliminated the vertical scar but improved the shape of the mound. It has also given patients who were not previously good candidates for reduction with other techniques an option for surgery despite the presence of old scars or the need for lumpectomy in the lower third of the breast. A clinical series is presented.

Cicatrix↗
PubMed1989

Creating a curvilinear scar.

A technique is presented by which predictable curvilinear scars can be produced by using asymmetrical lenticular excisions. This is particularly useful for the excision of skin tumors of the cheeks and lateral to the commissures of the lips. It must be remembered not to compromise the surgical resection margins in order to achieve the optimal aesthetic result.

Cicatrix↗
PubMed1988

Varix of the facial vein.

The differential diagnosis for a mass overlying the angle of the mandible but not attached to it includes lymphatic masses, benign and malignant parotid lesions, cysts, and vascular malformations. Thrombosis of the facial vein is a rare entity that now must be added to the list. This article details the first English-language description of such a thrombosis presenting as a mass. The possible causes are antecedent trauma, infection, or thrombosis of contiguous venous structures. While the diagnosis could be made preoperatively by selective venography or ultrasonography, it most likely will be made by surgical excisions. The preoperative diagnosis may be suggested by the "turkey wattle sign" (i.e., fluctuation in the size of the mass with bending the head downward). In this article the entity and differential diagnosis are reviewed and discussed.

Humans↗
PubMed1987

Increased hair growth and density following controlled expansion of guinea pig skin and soft tissue.

The goal of this study was to investigate the effect of controlled tissue expansion on hair growth and density using the guinea pig model. Thirty white guinea pigs were randomly divided into three groups: a group to undergo expansion (EXP), an operated control group (OC), and a nonoperated control group (NOC). All groups were shaved to create a 1 cm X 2 cm tuft of dorsal hair, which was subsequently dyed. Only the EXP and OC group members underwent construction of a pocket beneath the tuft. Only the EXP group was implanted and expanded over four weeks. The EXP group revealed a significant increase (p less than 0.005) over the controls in both the number of new white hairs produced (W) and density proportion (W/A). The OC group exhibited a significant increase (p less than 0.005) over the NOC group in both W and W/A. Mechanisms to explain the results are postulated. These include the possible roles of increased follicular mitotic activity (hair follicle transformation and cycle dynamics) and improved perifollicular vascularity (capsule formation and the delay phenomenon of skin pocket construction). Clinical implications are discussed.

Animals↗
PubMed1981

Granular cell tumor of the common bile duct.

Granular cell tumor most commonly appears in the tongue and skin, but has been found in varied locations (10). There are now 14 reported cases of the lesion occurring in the common bile duct. In most of these 14 cases, it has affected black females in their thirties. The lesion is most often benign. It should be considered in the differential diagnosis of obstructive jaundice secondary to bile duct tumors, especially if other granular cell tumors are present. This is the first reported case of pancreaticoduodenectomy for granular cell tumor of the common bile duct.

Adult↗
PubMedDate not supplied

An alternative treatment for the split skin-graft donor site.

There are a variety of methods employed in the postoperative management of the partial thickness donor site created during harvest of a split thickness skin graft. Each technique may be associated with potential complications of fluid loss, excessive pain, prolonged period for healing and delayed mobility, hypertrophic scarring, undesirable pigment aesthetics, and thin skin poorly resistant to everyday trauma. Thompson, and Converse and Robb-Smith have previously shown improved donor site outcome with the application of thin split skin grafts. Based on these studies, we present a technique that involves 1.5:1 meshing of a split skin graft and dividing it into equal halves so that one half is used to cover the defect and the other half is immediately returned to the donor site. Patients who are elderly, debilitated, or who have thin, poor-quality skin can expect less discomfort, reduction of fluid loss, improved durability and elasticity, and lower incidence of hypertrophic scarring with the proposed donor site regrafting.

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