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Biomedical subjects

R O Gregory

Publications and source records attributed to R O Gregory.

17 recordsLinked to original sources
PubMed1999

The risks of laser surgery.

The science and art of laser surgery are changing rapidly, secondary to a variety of socioeconomic and technological forces. Thus, the risks and complications continue to be defined. Frequently, it is difficult to determine if an event is a side effect, a complication, or an exaggerated or temporary state that occurs prior to the desired outcome. Knowledge of the dynamic development of laser-induced changes and their outcomes can lead to prompt intervention which can prevent and/or minimize untoward results.

Humans↗
PubMed1998

Laser physics and physiology.

Laser light is a controlled, disciplined energy source that can rejuvenate skin efficiently. The carbon dioxide laser is the standard of skin rejuvenation because of its selective effect on water and skin. Understanding laser physics and tissue interaction allows the operator to use the laser effectively and safely to ablate actinic damage, wrinkles, and scars from the skin.

Humans↗
PubMed1996

Lasers in aesthetic surgery.

Lasers are now in their third decade of medical application. The use for aesthetic surgery is relative new. Multiple attempts to use lasers in cosmetic surgery, in the past, resulted in less than desirable results. The current generation of lasers now has multiple applications in aesthetic surgery, with much success in tattoo removal, skin resurfacing, and cosmetic procedures. The plastic surgeon, with an augmented armamentarium, is now able to solve old problems and face new challenges. Careful attention to the fine details will allow the surgeon to avoid problems and complications when using the laser for aesthetic surgery. The ease of using the laser, speed of the procedure, patient satisfaction, and the minimal amount of potential complications all encourage the plastic surgeon to utilize the laser for aesthetic surgery.

Adult↗
PubMed1989

Applications of lasers in plastic surgery.

Laser application for treatment of vascular lesions continues to be refined as newer techniques and lasers become available. Capillary cavernous hemangiomas can be treated by shrinking or excision with the laser; however, early treatment in the neonatal period is indicated in many instances to prevent growth of the lesion and complications. Treatment of port wine stain and telangiectasia lesions continues to improve with the advent of newer laser instruments.

Child↗
PubMed1986

Application of photodynamic therapy in plastic surgery.

Photodynamic therapy is a technique for administering a sensitizer, hematoporphyrin derivative, which is selectively retained in malignant tissue. This is then activated by light, usually of 630 nm resulting in selective deterioration of the malignant tissue. This technique has been used for detecting and treating a variety of cancers in experimental animals and human beings. In plastic surgery, it has been applied to both basal and squamous cell carcinomas as well as to other skin lesions. Metastatic deposits will also respond to this treatment. Advantages include ease of treatment, sometimes requiring little or no anesthesia, low incidence of reactions, ability to repeat the treatment any number of times, and sparing of normal tissue. Photodynamic therapy has been used as a salvage operation, to clear tissue of suspected or probable remaining malignant disease, and to alleviate the need for a radical operation, allowing a more conservative one. Photodynamic therapy continues to be an investigational tool, and it should be used only as an adjunct to commonly accepted techniques, and then only when needed. Common disadvantages include a severe photosensitivity of the patient for several weeks following administration of the drug as well as inability to treat adequately bulky tumors. New techniques of administration and methods of activation will make this an increasingly common and useful tool in the practice of plastic surgery.

Aged↗
PubMed1985

Preliminary investigative studies with PDT in dermatologic and plastic surgery.

PDT has been shown to be of value in inoperable basal and squamous skin cancers and in cutaneous metastases. Azone, a new investigative vehicle for HpD, is of value more for intralesional injections than for topical applications in tumors, except perhaps for superficial mucous membrane lesions. The more flexible gold head vapor is of definite value in the PDT program. For test models for PDT studies in dermatology and plastic surgery with HpD and other fluorochromes, single thickened resistant plaques of psoriasis and the common baso squamous acanthoma (seborrheic warty growth) have been used. In all these studies, adequate controls are necessary.

Adenocarcinoma↗
PubMed1985

Management of perioral burn scarring in the child and adolescent.

The experience gained in the treatment of 116 patients with perioral burn scarring is presented. Important considerations are the choice of unit release or simple release, the choice of donor site to match the prevailing skin of the remainder of the face, and the timing of the reconstruction. Delaying the reconstructive procedure with the routine use of pressure appliances until the scar was mature produced a more pleasing final result. In addition, we found that modifying the traditional aesthetic unit excised to include darts when there was severe burning of the surrounding facial cheek skin with loss of natural nasolabial folds improved the final result and reduced the need for secondary revision.

Adolescent↗
PubMed1985

Use of i.v. fentanyl in the outpatient treatment of pediatric facial trauma.

Fentanyl, a synthetic analgesic narcotic, was used in 2,000 cases of pediatric facial trauma between 1981 and 1984. A dose of 2 to 3 micrograms per kilogram of body weight was administered slowly intravenously to provide sedation and analgesia to facilitate the repair. The drug has advantages ideal for outpatient use, namely rapid onset, brief duration, and short recovery time. The major possible complication is that of apnea, which requires that resuscitation equipment be available. Three apneic episodes occurred in this series and all were successfully reversed with naloxone with no untoward effects.

Ambulatory Surgical Procedures↗
PubMed1983

Research and development of additional aids for dermatologic and plastic surgery.

Increasing numbers of accessories continue to be found to make laser surgery more effective for dermatologic and plastic surgery. Argon laser surgery aids are available to increase the dilatation of the superficial vessels and to localize increasing numbers of red cell masses. Laser probes for intravascular thrombogenesis and thrombolysis have now been adapted for intradermal and deep dermal tissues and for cardiology. Studies on laser effects on platelets and heat transmission and thromboembolic phenomena are lacking. Investigative studies are developing for laser fiber optic probes for laser-induced fluorescence, not only for oncology, but also for studies of metabolism of tissues and also for spectroscopy. The use of different wavelengths and shorter pulses, more flexible fiber-optics transmission for all laser systems, combinations of laser systems into a single operating probe, as well as the increased use of lasers for diagnosis and treatment will all stimulate the development of new aids for laser surgery. Cooperative programs developed jointly by dermatologic and plastic surgeons will make for great progress in skin and soft-tissue laser surgery.

Dermatologic Surgical Procedures↗
PubMed1983

Complications of muscle-flap transposition for traumatic defects of the leg.

A careful study of 95 consecutive muscle-flap procedures performed on 71 patients with traumatic soft-tissue defects of the leg was carried out. Although there were only 5 cases of total muscle-flap necrosis, major and minor complications were found in 31 patients, requiring additional surgery for coverage. Technical errors resulted in partial split-thickness skin-graft loss or hematoma and were responsible for the 10 minor complications. Inadequate debridement of necrotic soft tissue and bone, the use of diseased or traumatized muscle, and unrealistic objectives for the muscle-flap coverage were the source of 21 major complications. We feel fewer complications would result with more careful preoperative evaluation and surgical planning, adequate debridement of bone and soft tissue, and the transfer of healthy, nontraumatized muscle.

Adult↗
PubMed1983

Functional reconstruction of an extremity by free tissue transfer of the latissimus dorsi.

Fifteen lower extremities with large traumatic defects in the soft tissues were resurfaced by free microvascular transfer of the latissimus dorsi muscle and overlying skin. This procedure was particularly useful in four patients in whom a portion of the extremity had been acutely denuded of its soft-tissue sleeve, leaving exposed bone, joint, or tendon. It was also effective in eleven patients with chronic lesions who required additional reconstructive procedures (arthrodesis, internal fixation, bone-grafting, or tendon-grafting), and in the treatment of chronic osteomyelitis when infected bone and soft tissue had to be liberally debrided. In the eleven patients who had chronic osteomyelitis at the time of the transfer (five with infected, unstable tibial fractures), no subsequent drainage was evident at an average of twenty-two months' follow-up.

Adult↗
PubMed1982

Latissimus dorsi musculocutaneous flap for elbow flexion.

A technique is described for the simultaneous restoration of traumatic loss of elbow flexors and overlying skin by transferring the latissimus dorsi muscle on its neurovascular pedicle with an island of overlying soft tissue. The procedure is safe and is performed in a single stage, thereby accelerating rehabilitation time. It provides bulk, contour, and coverage for the vital structures in the brachium and results in minimal donor morbidity.

Adult↗
PubMed1982

Breast reconstruction in the burned adolescent female (an 11-year, 157 patient experience).

The experience accumulated after reconstruction of 157 burned breast patients has led to the development of surgical principles and techniques tailored to this problem. Most important among these principles is that the surgeon recognize and preserve viable breast bud tissue in the debridement phase of the acute burn. Reconstruction should begin when the burned breast envelope is insufficient and restricts normal growth. Best results are obtained if contracture release is complete, if defects are covered by thick split-thickness skin grafts, and if nipple-areola reconstruction is obtained from a normal opposite breast if present. Postoperative management should continue until wounds are mature and should include techniques to prevent contracture recurrence.

Adolescent↗
PubMed1981

Complete sternectomy for chronic osteomyelitis with reconstruction using a rectus abdominis myocutaneous island flap.

We believe the rectus abdominis myocutaneous island flap offers a reliable alternative method of midchest reconstruction in selected cases of chronic osteomyelitis of the sternum, in conjunction with complete resection of injected sternal bone and cartilage. This single-stage procedure provides an en bloc unit of muscle with overlying skin and soft tissue, reaching from the xiphoid to the sternal notch. Three successful cases demonstrating the method are presented, with follow-up ranging from two months to two years.

Aged↗
PubMed1978

Characteristics of malignant phenotypes in familial polyposis.

Numerous clinical syndromes associated with multiple polypoid lesions of the gastrointestinal tract have been described. These syndromes generally have two striking characteristics: 1) Most of them are familial with the disease being inherited as a mendelian autosomal dominant trait, and 2) most of the affected patients have moderate to marked propensity to develop gastrointestinal carcinoma, usually of the large bowel. Whereas previously many of these syndromes were thought to be well-defined entities, it now appears that there is overlap between certain of them such that they appear more similar than different. The clinical and pathologic characteristics of the various gastrointestinal polyposis syndromes and the methods of diagnosis and treatment are reviewed in this manuscript.

Adolescent↗