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Biomedical subjects

M W Marks

Publications and source records attributed to M W Marks.

At least 19 recordsLinked to original sources
PubMed1992

Surface area and tissue volume increases with differential expansion.

Increasing sophistication in generating soft tissue by tissue expansion has resulted in the evolution of differential expanders. These prostheses attempt to asymmetrically generate tissue for specific reconstruction, most commonly the breast. Using the pig model, differential expanders were placed in the rib area. A square grid was marked over the area, and the expander inflated. For each grid subunit, the surface area was calculated, the thickness measured, and the volume calculated. Subunits in the area of preferential expansion exhibited the greatest increase in surface area, however, these same subunits exhibited pronounced thinning of the tissue. The corresponding volume of these subunits was greater than that of nonexpanded subunits, but the increase was less than when comparing subunit surface area. All expanders were displaced superiorly during the course of inflation. These findings are of clinical significance in that the mastectomy scar and nipple reconstruction both are situated in the area of minimal thickness. Displacement of differential expanders must be anticipated so that the resultant inframammary fold will ultimately be symmetrical with the opposite side.

Animals↗
PubMed1992

Dentocutaneous fistula.

Chronic dental infection is the most common cause of draining sinus tracts of the face and neck. These lesions can be a diagnostic challenge to the clinician who is not familiar with dentocutaneous fistula. Diagnostic errors can result in multiple excisions, biopsies, and ineffective long-term antibiotic therapy. Patients may require excision of the fistula once the dental abscess has been successfully treated by root-canal therapy or extraction. Nine patients are reported.

Adolescent↗
PubMed1991

Management of the chest-wall deformity in male patients with Poland's syndrome.

The chest-wall deformity associated with Poland's syndrome was reconstructed in eight male patients 16 to 38 years old (average age 20 years). Follow-up ranged from 1 to 10 years. Two patients had custom silicone implants placed subcutaneously. In one of these patients, the edge of the implant could be seen. Three patients had transfer of an ipsilateral pedicled latissimus dorsi muscle flap with intact thoracodorsal nerve. All these patients had noticeable atrophy of the flap, and one underwent subsequent implantation of a custom silicone implant beneath the flap. Three other patients had a custom silicone implant covered immediately by a latissimus dorsi muscle flap. All four patients who had a combination of silicone implant and latissimus dorsi muscle flap had satisfactory correction of their deformity.

Adolescent↗
PubMed1990

Fibroblast-mediated contraction in actinically exposed and actinically protected aging skin.

The changes in skin morphology over time are a consequence of both chronologic aging and the accumulation of environmental exposure. Through observation, we know that actinic radiation intensifies the apparent aging of skin. We have investigated the effects of aging and actinic radiation on the ability of fibroblasts to contract collagen-fibroblast lattices. Preauricular and postauricular skin samples were obtained from eight patients aged 49 to 74 undergoing rhytidectomy. The samples were kept separate, and the fibroblasts were grown in culture. Lattices constructed with preauricular fibroblasts consistently contracted more than lattices containing postauricular fibroblasts. The difference in amount of contraction in 7 days between sites was greatest for the younger patients and decreased linearly as donor age increased (r = -0.96). This difference may be due to preauricular fibroblasts losing their ability to contract a lattice as aging skin is exposed to more actinic radiation.

Aged↗
PubMed1990

Early experience with high thoracic epidural anesthesia in outpatient submuscular breast augmentation.

High thoracic epidural anesthesia was administered by anesthetists in 20 patients undergoing submuscular breast augmentation. An average of 12 ml of 2% lidocaine was instilled after sedation with midazolam, 2-6 mg. The augmentation procedure averaged 90 minutes. In 3 patients, the block developed more rapidly on one side than the other, but soon became symmetrical in all; additional subcutaneous infiltration of lidocaine was necessary in 1 patient because of infraclavicular pain; ephedrine, 10 mg was needed in 2 patients to treat hypotension (greater than 20% decrease in blood pressure). Three patients felt infraclavicular pressure; 1 had a brief sensation of breathlessness; 3 had nasal stuffiness from Horner's syndrome associated with the block; none developed headache, back pain, or paresthesias; and 3 had postoperative nausea. The average time from the end of the procedure to patient discharge was 96 minutes. In this limited series, high thoracic epidural anesthesia for submuscular breast augmentation was extremely satisfactory.

Ambulatory Care↗
PubMed1989

Removing broken needles and other foreign objects.

A needle or other foreign body that has penetrated the skin superficially can be located and removed fairly easily. If it is too deeply embedded to be palpated, it should be located by use of an image intensifier and two venipuncture needles. If this is unsuccessful, exploration and removal must be done in the operating room.

Foreign Bodies↗
PubMed1989

Conchal cartilage and composite grafts for correction of lower lid retraction.

Lower eyelid retraction may be due to vertical deficiency of the anterior lamella, supporting cartilage, or posterior lamella. We have used autologous cartilage grafts from the conchal bowl for reconstruction of the central lamella, reestablishing and augmenting support of the lower lid. The positioning of the graft is dependent on the specific anatomic deficiency, and the etiology of the lid retraction must be carefully evaluated. In patients with posterior lamella deficiency, the contracted lower lid retractors and conjunctiva are released and the graft is placed facing the bulbar conjunctiva and is allowed to reepithelialize. In patients in whom there is an associated skin deficiency, composite auricular grafts are used. We present our experience in 33 patients with lower lid retraction. Twenty-three patients required placement of a cartilage graft only, while 10 patients had an associated skin deficiency requiring placement of composite cartilage. In nine patients the cartilage graft was seated against the bulbar conjunctiva and allowed to reepithelialize. Reepithelialization was complete within 3 1/2 weeks in all but two of these patients. This technique has provided stable lid support in all 33 patients.

Adolescent↗
PubMed1988

Studies on the endogenous flora of the human breast.

Identification of the endogenous microbiological flora of the human breast and its role in breast infections following subglandular augmentation or reduction mammaplasty was undertaken. A total of 231 cultures were performed on 59 breasts in 30 patients. Patients were followed for 12 months. No fungus was cultured from any specimen. Of the breasts cultured 53% were positive for coagulase-negative staphylococcus. Other aerobes found included diphtheroids, lactobacillus, D-enterococcus, micrococcus, and alpha-hemolytic streptococcus. Propionibacterium acne was the most frequent anaerobic bacteria cultured. Other anaerobes included peptococcus and clostridium sporogenes. There was no correlation with respect to the type of bacterium and the depth within the breast where the culture specimens were taken. Postoperative wound infections developed in 2 of 19 patients undergoing reduction mammaplasty. Bacteria identical to those cultured at the time of surgery were again cultured from the wound. Twenty subglandular augmentation mammaplasties were performed with a 25% capsular rate at one year. Two capsules were associated with no bacterial growth at the time of mammaplasty surgery, whereas three were associated with coagulase-negative staphylococcus, Propionibacterium acne, and diphtheroids, respectively. Of the 15 breasts with no capsular contracture after one year, operative culture revealed coagulase-negative staphylococcus in 8 and no bacterial growth in 7. Even breast tissue located deep within the gland away from the nipple contains a flora that is similar to that of normal skin. Cases of infection in which the endogenous bacteria were correlated with later infection was documented.

Bacteria↗
PubMed1988

Topical 5-fluorouracil in treatment of carcinoma of nasal floor and nasal alae.

Squamous cell carcinomas of the nasal floor present problems for surgical therapy. Similarly, basal cell carcinoma of the nasal floor and alae requires extensive reconstruction when cures are obtained. To improve the results, we have treated the squamous cell carcinomas with topical 5-fluorouracil to obtain sensitization and shrinkage of the tumor before resection. The same has been done with basal cell carcinomas, but in selected patients the topical 5-fluorouracil has been continued until biopsies are negative. Thus, the costs of resection and reconstruction have been avoided and excellent cosmetic results are possible. This treatment is lengthy and requires weekly supervision. It offers a different approach that gives surgeons further options in treating these difficult carcinomas in carefully selected and cooperative patients.

Administration, Topical↗
PubMed1988

Fasciocutaneous flap closure of a grade III lower third tibial fracture: an alternative to free flap coverage.

We present a patient who sustained a close-range shotgun wound resulting in a grade III fracture of the lower tibia. The wound was debrided on several occasions and, on day 4, was closed with a flexor digitorum muscle and pedicled fasciocutaneous flap. Grades III and IV lower one-third tibial fractures generally require a free flap to accomplish stable soft-tissue coverage. Free-tissue transfer, however, remains a tedious and lengthy procedure. Occasionally a fasciocutaneous flap may be available to facilitate wound closure and spare the patient a lengthy procedure and distant donor site. The established principles of compound tibial coverage must be adhered to when choosing a local fasciocutaneous flap.

Adult↗
PubMed1988

The temporal island scalp flap for management of facial burn scars.

Facial burn scars are difficult to conceal and often preclude an aesthetic rehabilitation of the patient. Multistaged scalp and neck flaps have been described to provide hair-bearing skin to resurface burn scars in men. We have been resurfacing the upper lip and cheek in a one-stage procedure using a temporal artery island scalp flap. The temporoparietal fascia has been well described in recent years, and the understanding of this anatomy has facilitated the use of the island scalp flap for more distal transfers.

Adult↗
PubMed1988

Heterotopic brain presenting as a lip lesion.

Heterotopic brain tissue in the upper lip of a newborn child is presented and discussed. This rare developmental anomaly is usually present at birth and may simulate hemangioma. Before any surgical procedure can be performed, thorough radiographic and neurosurgical examination is essential to rule out eventual communication of the tumor with intracranial space.

Brain↗
PubMed1987

Squamous cell carcinoma of the parotid gland.

Squamous cell carcinoma involving the parotid gland is an aggressive and rapidly advancing lesion which if not recognized and treated early will result in a high morbidity and mortality. We reviewed 30 patients with squamous cell carcinoma involving the parotid gland. Twenty-four patients had had previous epidermoid skin lesions in an area known to drain to the parotid gland and three resulted from direct extension into the gland from an overlying skin carcinoma, whereas only three were primary lesions of the gland. Patients who presented with involvement of the gland more than 4 months after excision of the skin lesion had a poor prognosis. Patients with epidermoid skin cancer in areas with a propensity to secondarily involve the parotid gland must be closely followed after treatment of the primary skin lesion.

Adult↗
PubMed1987

Rapid expansion: experimental and clinical experience.

One of the drawbacks of clinical expansion is delay of the final reconstruction and patient inconvenience. The authors have explored the physiologic response to rapid expansion in an animal model and present initial clinical experiences with three patients.

Adolescent↗
PubMed1987

Expanded myocutaneous flaps: their clinical use.

In particularly large defects the best available flap may not provide sufficient tissue for satisfactory correction. Pre-expansion of an overlying musculocutaneous flap allows transposition of a larger flap to reconstruct such defects. The authors present their experience in four patients to illustrate the efficacy of this modality in select patients.

Adult↗
PubMed1987

Burn management: the role of tissue expansion.

Tissue expansion has facilitated reconstruction in selected burn patients. For the past 5 years the authors have used this modality in 45 patients, reconstructing the head and neck, trunk, and extremities.

Breast↗
PubMed1986

Enhanced capillary blood flow in rapidly expanded random pattern flaps.

We have quantitatively examined the effect of rapid sequential skin expansion on capillary blood flow in the porcine random flap model in order to determine the relation between the increased survivability of expanded random flaps and capillary blood flow. Three 6 X 20 cm random flaps were tattooed on the backs of six small (20-kg) pigs. One flap was not manipulated (control). A 450-ml expander was inserted at the base of the second flap and left in place (sham). At the base of the third flap a 450-ml expander was inserted and each day for 5 days sequentially filled to the limits of skin viability as determined by vital dye staining (expanded). Capillary blood flow was measured on day 8 by measurement of radioactivity after injection of 15-microns radiolabeled microspheres. Samples were taken at 4-cm intervals from the base of each flap. Rapid expansion led to significant increases in capillary blood flow in expanded skin and to enhanced preservation of capillary flow after elevation of random pattern flaps based on expanded skin compared to sham and to control tissues. This correlates with and explains at least in part our previous observation of improved length of survival of flaps raised on expanded skin.

Animals↗