Biomedical subjects
Publications and source records attributed to N H Schulman.
A detailed description of a simple technique to minimize scarring and hairline elevation following rhytidectomy is provided. The technique is illustrated with a step-by-step account of planning and performance.
The concepts and techniques describing a geometric breast reduction were first reported by Dr Gustrave Aufricht almost 50 years ago. In his presentations of 1948 and 1949 he described in detail his concept of breast reduction markings. Less obvious in these papers was his description of a central- and inferior-based pedicle preserving nipple viability. The author has used this technique for 25 years and has passed on this knowledge to 21 generations of residents. This paper represents 25 years of experience with this technique, carefully analyzing its components and noting the few modifications necessary to ensure its uniform application and consistent, good results. It is a technique that does not require precut templates and is custom applied easily to the individual patient. Skin incisions almost never require operating room adjustment, and correct nipple positioning is achieved easily, without the need for intraoperative change in patient position. Consistent, excellent results and efficient operating room time are hallmarks of this technique.
This program enhances residency training in aesthetic surgery. It provides hands-on operating experience in a supervised hospital setting. Concerns of financial support and liability are addressed. Four chief residents from two university programs each spend 3 months conducting a "private" practice in a service population. A separate resident operative consent form unambiguously specifies the resident as the operating surgeon. Patients are derived from an advertised, free screening clinic every 3 months. The hospital has a special aesthetic surgical fee schedule for the residents. A resident operative fee is collected in support of resident salaries and insurance. An additional fee is collected on behalf of our anesthesiologists. During their 3 months the residents perform 30 to 40 operations as primary surgeon and 50 to 60 as the first assistant. Patient discontent, though rare, is resolved in conference with the patient, the resident, the attending surgeon, and the chief of section. Didactic training consists of monthly surgical conferences, journal club, and guest speaker presentations. Residents experience a practice setting by overseeing appointments to their clinic, booking operating room cases, and providing all paperwork for preadmission testing and certification, as well as fulfilling utilization and quality assurance requirements. They are responsible for their operative patients 24 hours a day, 7 days a week. The program is in its seventh year and its success is noted by continued full certification of the two participating university programs and absence of litigation.
An unusual recurring mass presented in the parotid region in a young woman. The presentation of the mass was unusual in that it varied with the positioning of the patient's head and with exertional and emotional activity. Prior surgical attempts at cure were unsuccessful. Biplanar subtraction radiographic techniques were used to pinpoint the anatomical problems. This lesion is a vascular anomaly, which requires specific attention to its morphology in order to effect a permanent cure. This case of parotid venous ectasia with its unusual symptom complex was successfully treated, and more than four years have passed without recurrence.
A surgical procedure is described for the definitive treatment of trochanteric decubitus ulcers. It combines the advantages of the bipedicle skin flap and the musculocutaneous flap; that is, a large area of skin is provided with a thick protective padding consisting of fat, fascia, and muscle richly vascularized by the musculocutaneous perforating circulation. The disadvantages of either flap alone (i.e., dependence on dermal blood supply and skin grafting of the donor bed) are avoided. In patients who are traditionally the most difficult nursing problems, this one-stage reconstructive procedure results in shorter operating room time, easier postoperative care, shorter hospital convalescence, and an enduring protection against recurrent trochanteric pressure problems.
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