Biomedical subjects
N G Georgiade
Publications and source records attributed to N G Georgiade.
Reduction mammaplasty utilizing an inferior pedicle nipple-areolar flap.
A technique utilizing the inferiorly based dermal pedicle nipple-areolar flap is described. The advantages of this technique are:(1) predictable breast shape based on preoperative markings; (2) direct visibility of all areas for ease of resection and hemostasis; (3) retention of normal nipple duct connections; (4) no impairment of subjective sensation; and (5) adequate blood supply. This technique has particular application in younger women, in whom nipple sensation is quite important. The interruption of the intercostal nerve branches is usually limited because of the thickness and width of the inferior pedicles. Utilizing our modifications of the technique originally described, this versatile flap can now be used routinely in reduction mammaplasties requiring the removal of either small amounts (200 gm) or quite large amounts (2,500 gm) of tissue with consistently satisfactory aesthetic results and excellent patient satisfaction.
Is there a reduction mammaplasty for "all seasons?".
No technique will serve the needs of all patients requiring a reduction mammaplasty and mastopexy. However, the modified, inferiorly-based dermal flap technique appears to us to offer the most advantages and the greatest latitude for a predictable breast reduction in most of these patients.
Late development of hematoma around a breast implant, necessitating removal.
We present a patient who bled into the pocket around a breast implant 2 1/2 years after an augmentation mammaplasty. She had received inflatible silicone prostheses, each containing 40 mg of triamcinolone acetonide. Our belief is that this large dosage of corticosteroid was responsible for the late erosion of the medium-sized artery, which caused the hemorrhage. Exploration and evacuation of the hematoma was followed by an uneventful postoperative course.
Microsurgical composite tissue transplantation.
Since 1974, 69 patients with extensive defects have undergone reconstruction by microsurgical composite tissue transplantation. Using this method, donor composite tissue is isolated on its blood supply, removed to a distant recipient site, and the continuity of blood flow re-established by microvascular anastomoses. In this series, 56 patients (81%) were completely successful. There have been eight (12%) failures, primarily in the extremities. There have been five (7%) partial successes, (i.e., a microvascular flap in which a portion was lost requiring a secondary procedure such as a split thickness graft). In those patients with a severely injured lower extremity, the failure rate was the greatest. Most of these were arterial (six of seven). These failures occurred early in the series and were thought to be related to a severely damaged recipient vasculature. This problem has been circumvented by an autogenous interpositional vein graft, permitting more mobility of flap placement. In the upper extremity, all but one case were successful. Early motion was permitted, preventing joint capsular contractures and loss of function. Twenty-three cases in the head and neck region were successful (one partial success). This included two composite rib grafts to the mandible. Prolonged delays in reconstruction following extirpation of a malignancy were avoided. A rapid return to society following complete reconstruction was ensured. Nine patients presented for reconstruction of the breast and thorax following radical mastectomy. All were successfully reconstructed with this new technique except one patient. Its many advantages include immediate reconstruction without delayed procedures and no secondary deformity of the donor site. Healthy, well vascularized tissue can now be transferred to a previously irradiated area with no tissue loss. This new method offers many advantages to older methods of reconstruction. Length of hospital stay and immobilization are reduced. The total number of operative procedures required in achieving the desired result is also less, thus decreasing the cost of hospital care.
Use of the latissimus dorsi myocutaneous island flap for reconstruction in the head and neck area: case report.
Cadaver dissection indicated that a large amount of tissue could be transferred in one stage to the head and neck by a latissimus dorsi myocutaneous island flap tunneled beneath a pectoral skin bridge. A clinical trial of this flap (for one-stage reconstruction of a patient after excision of a recurrent mandibular carcinoma and a neck dissection) was successful. Previous investigators have found the myocutaneous latissimus dorsi flap to be dependable and adaptable in reconstructions of the chest wall, breast, and shoulder. It is evident now that the flap also has value in reconstructions of the head and neck.
A backward look into the future.
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Transfer of free flaps to provide well-vascularized, thick cover for breast reconstructions after radical mastectomy.
The use of a free flap to bring in well-vascularized cover for a breast reconstruction (following radical mastectomy) is presented. Eleven of 12 such transfers were successful. (One free groin glap failed, and that reconstruction was abandoned.) Patients for breast reconstruction who have a marked deficiency of healthy, well-vascularized skin and subcutaneous tissue in the area are suitable candidates for this operative procedure. When a free groin flap is transferred, the donor defect is minimal.
Microsurgical composite tissue transplantation: a new method of immediate reconstruction of extensive defects.
Of thirty-five cases of microsurgical composite tissue transplantation, twenty-five (71 per cent) were completely successful, four (11 per cent), were partially successful, and six (17 per cent) failed. If a microvascular flap should fail, older but more lengthy methods of reconstruction may be employed with a reasonable chance for success. The advantages of the donor groin flap are discussed. Operative technic and management are outlined.
A rib-containing free flap to reconstruct mandibular defects.
A composite free flap based on intercostal vessels may be used to reconstruct in one stage defects around the mandible in which skin, soft tissue and bone are missing. A delay procedure is recommended one week prior to transfer.
The vascularization of free flaps: a clinical and experimental correlation.
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A prototype articulator for planning orthognathic and craniofacial surgery.
Current techniques and hinge-type articulators do not provide sufficient information and versatility for the planning of orthognathic and craniofacial surgery. Dental articulators either require plaster of paris for mounting or they do not accommodate movement of both casts in all directions of space. A prototype articulator that satisfies movement of both casts in all directions of space is successfully being used as an adjunct in planning orthognathic and craniofacial surgery. There is a need for future development of sophisticated and accurate armamentarium that can be used as an aid in planning and designing surgical procedures.
Ankylosis of the temporomandibular joint anatomy, etiology and a case presentation.
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Comparison of free flaps with pedicled flaps for coverage of defects of the leg or foot.
The use of free flaps to repair defects of the leg or foot is a viable alternative to cross-leg flaps because (1) the total time of immobilization and hospitalization is less, (2) the total number of general anesthetics is less, and (3) the morbidity and cost are less. Increased experience will enhance the survival statistics for free flaps, making their use the method of choice for the reconstruction of defects in the distal part of the lower extremity.
Congenital giant nevi: clinical and pathological considerations.
A clinical and pathological review of 67 cases of congenital giant nevi and of 5 cases of malignant transformation in congenital giant nevi brings out the following. 1. The lesions should be regarded as premalignant. 2. An aggressive approach is advocated to remove the lesion before school age. 3. Staged excisions, combined with skin grafting and/or local rotation flaps, are advocated. 4. Any nodularity or ulceration developing within a congenital giant nevus should be regarded as an ominous sign. 5. A long-term follow-up is necessary in those patients having subtotal excisions.
Microsurgical composite tissue transplantation: a new horizon in plastic and reconstructive surgery.
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An extraorally activated expansion appliance for cleft palate infants.
A new lever-action expansion appliance is described which is designed specifically for use in infants with cleft lip and palate. An extraoral control knob allows for easy activation, while the important anterior cleft areas are left clear for premaxillary repositioning and clinical assessment. Activation is registered by a positive clicking sound. Rapid expansion is made possible by the design of the appliance which is retained by stainless steel pins.
Microsurgical composite tissue transplantation: a method of immediate reconstruction of the head and neck.
A new approach utilizing microsurgical composite tissue transplantation is advocated for the management of difficult reconstructive problems in the region of the head and neck. This method is especially useful when local flap coverage may be inadequate. Morbidity and hospitalization is reduced and reconstruction is complete upon discharge from the hospital. Extirpative surgery for a malignancy can now have the defect reconstructed immediately with less disfigurement and psychological insult to the patient and family.