Biomedical subjects
M S Fayman
Publications and source records attributed to M S Fayman.
Abdominal wall reconstruction after open management of the septic abdomen.
The increasing popularity of open management of the septic abdomen has generated a challenge that the surgeon is forced to face more frequently. The typical presentation is that of a patient with a full-thickness abdominal wall defect occurring after a protracted, severe illness. The various methods of reconstruction of the abdominal wall are reviewed and evaluated. The reconstruction should only be attempted once intra-abdominal sepsis is controlled, re-exploration of the peritoneal cavity is no longer necessary and organ support is discontinued. Although various methods of reconstruction are described, the recommended technique consists of either medial advancement of the rectus abdominis muscle or direct application of split-thickness skin grafts. Mid-line abdominal defects may also be repaired with tensor fasciae latae or rectus femoris flaps.
A modified frontalis sling in the treatment of combined blepharoptosis and facial nerve paresis.
A surgical method is proposed to treat patients with combined severe blepharoptosis and peripheral facial nerve paresis. The operation involves construction of a sling from the contralateral active frontalis muscle to the affected eyelid tarsal plate. The method has been applied in one patient, with satisfactory results. Re-education of the patient was relatively easy to achieve.
Reconstruction of the alar groove.
The obliteration of a well-defined alar groove is common after nasal alar reconstruction. A method is described that can be used at the time of reconstruction to ensure the continued definition of the groove or to restore it in cases where it has been obliterated. The technique is based on the natural tendency of the skin to tube itself. Cheek skin is advanced beneath the posterior free edge of the reconstructed ala so that this edge now comes into contact with an epidermal surface. As this edge now tends to tube itself, a natural alar groove is produced. This method has been used successfully in six cases.
Verapamil improves survival of rat hyperemic island skin flaps.
Inability to maintain cellular calcium homeostasis is a critical factor in the pathogenesis of cellular ischemic injury and may mediate oxygen radical release in the reperfusion period. We assessed the effect of the selective calcium channel blocker verapamil on the performance of rat hyperemic island skin flaps. Pretreatment with verapamil markedly improved survival of skin flaps after 6 hours of venous cross-clamping compared with animals receiving placebo only (99% vs 53.3%; p less than 0.01). Verapamil also prevented the formation of lipid peroxidation products and the depletion of the endogenous antioxidant glutathione, suggesting that the beneficial effect of verapamil is the result of protection against oxygen radical injury. After 12 hours of venous cross-clamping, verapamil did not improve survival of skin flaps despite protection against lipid peroxidation. Oxygen radical release is therefore a crucial event in the pathogenesis of skin flap necrosis after short-term ischemia but is of less significance in long-term ischemia.
Multiple myeloma presenting as localized expansile jaw tumour.
Myelomatous involvement of the maxilla is an exceptionally rare occurrence, and the presentation of the lesion as an expansile jaw bone tumour has not been reported. 2 cases, one with a maxillary lesion, the other with a mandibular lesion are presented, both of which illustrate gross bone expansions. Additionally, 1 case presented with a rare biclonal IgG kappa and IgG lambda light chain secreting myeloma. Relevant clinical, immunological, histological, biochemical and histochemical features are presented and discussed, and suggestions pertaining to surgical management made.
Treatment of postreconstructive collapsed nasal ala with a costal cartilage graft.
A technique to restore the skeletal support of the postreconstruction collapsed ala is proposed. This makes use of the elastic characteristic of costal cartilage to provide a natural spring to elevate the ala and thereby enlarge the nostril. Three illustrative cases are described.
The pectoralis major flap for reconstruction of septic wounds.
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The distally based split soleus muscle flap.
A refinement of the previously described distally based soleus muscle flap is proposed. The essential features of the flap are mobilisation of the tibial origin, splitting the muscle longitudinally, partially along a distinct anatomical plane, and preservation of anatomical continuity of the muscle. We suggest that improved blood supply to this flap derives from the intact major lateral proximal pedicles via the intact lateral portion into the flap. We also think that minimal damage to intramuscular vasculature integrity contributes to the improved circulation. The flap has been designed and studied using ten fresh cadaver leg dissections. Angiographic studies proved adequate blood supply to the flap. The flap has been tested eight times on seven patients with favourable results.
Monitoring the completely "buried" muscle flap by temporary conversion to a myocutaneous unit.
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The "Zulu" tissue expansion in construction of the helix and ear lobe.
A traditional custom has been employed in a design of a new technique to expand a rudimentary auricle. The technique involves a full thickness incision of the blob of tissue and positioning of a spacer which is gradually expanded by means of a conical obturator. The technique provides a large amount of local tissue that can be used in helix and ear lobe reconstruction. An illustrative case is reported.
A subpectoral pocket in the management of a patient with impending extrusion of a pulse generator.
A new method of management of the extruding cardiac pacemaker is proposed. The technique involves placement of the pacemaker and its leads in a subpectoral pocket. The technique has been studied in 13 patients with a success rate of 84.6 percent, perioperative complication rate of 7.7 percent, and late extrusion rate of 7.7 percent.
Two unusual complications related to fibre-optic endoscopy. Case reports.
Two unusual complications related to fibre-optic endoscopy are described. In one case a pneumomediastinum occurred during gastroscopy with no evidence of perforation. The patient was treated conservatively and made an uneventful recovery. The suggested mechanism is that of alveolar leakage resulting from raised intrathoracic pressure. The other is a case of temporomandibular joint dislocation, a complication not previously described.
Short scar mastopexy with flap transposition.
A personalized technique using a vertical scar mastopexy is described. The breast tissue is utilized as a transposition flap behind the nipple-areolar complex to increase its projection. The inferior pole of the breast can be developed either as a superiorly pedicled or inferiorly pedicled flap for that purpose and the indication for each version is described. The technique has been successfully utilized in 80 patients with pleasing results. Illustrative cases are presented.