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Biomedical subjects

R P Gruber

Publications and source records attributed to R P Gruber.

At least 19 recordsLinked to original sources
PubMed1988

A fresh look at the open rhinoplasty technique.

Use of the open rhinoplasty technique (ORT) in certain nasal and septal deformities has proven to be an invaluable asset in the rhinoplasty armamentarium of the authors. Primarily owing to the markedly increased exposure with this technique, more accurate assessment of the deformities is possible and additional or improved surgical maneuvers become available, particularly in the tip. Sculpting the entire cartilaginous and/or bony vault, as well as correcting difficult septal malalignments, can be carried out under better direct vision with greater precision, accuracy, and predictability. This has led to improved and more consistent final results. Previous criticisms of unsightly columellar scars have been virtually eliminated through the use of improved surgical techniques and simple magnification. Overall, open rhinoplasty technique can provide many distinct advantages in certain nasal deformities with no real disadvantages over conventional closed techniques.

Adolescent↗
PubMed1988

Open rhinoplasty.

Open rhinoplasty provides visualization, which for many is essential for the best sculpturing. The indications for its use include every primary and secondary rhinoplasty candidate unless tip grafts are going to be under tension or if the deformity is minor. The technique of opening the nose has been described. Emphasis is placed on (1) suturing the medial crura together, (2) suturing the medial crura to the septum, (3) resecting a portion of the lateral crus, and (4) leaving as much cartilage in the supratip and cephalic parts of the lateral crus as possible. The result is (1) greater tip projection with fewer tip grafts, (2) improved correction of tip convexity, (3) fewer supratip deformities, and (4) fewer Weir excisions. The columella scar is usually inconspicuous and has not been a significant problem in any case.

Adolescent↗
PubMed1981

Review of closed capsulotomy complications.

Seventy-five closed capsulotomies were reviewed and the degree of capsular contracture graded. The nutcracker technique was employed. In 35 cases, tonometric measurements before and after capsulotomy quantitated the improvement. Complications included inability to rupture the capsule, recurrence of contracture, distortion of breast shape, and in 1 patient, implant rupture. The degree of breast softness after capsulotomy correlated well with tonometry and was inversely proportional to the degree of preexisting capsular contracture. Softness was also proportional to the latency of onset of contracture. Analysis of the results suggests that capsulotomy is best performed in the patient with mild to moderate contracture and is containdicated in patients with severe contracture or breast distortion from previous capsulotomy. The nutcracker technique is advised, and reduction of pressure is urged once the capsular tear is heard. Closed capsulotomy usually, but not always improves breast firmness. It provides the physician with a nonoperative means of coping with an undesirable result.

Breast↗
PubMed1981

Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques.

An analysis of the benefits of submuscular versus subcutaneous implantation was made on mastectomy patients. Ninety-one breast were reconstructed following mastectomy. In 30 breasts, the implants were placed subcutaneously; in 19, subpectorally, and in 42, beneath both the pectoralis and the serratus. The follow-up averaged 2 to 3 years, and recent cases included postoperative tonometry measurements to quantitate the degree of capsular contraction. In addition, 12 cadaver dissections were done to delineate muscle insertion and origins. Results indicate that (1) submuscular implants are clearly superior to subcutaneous ones; (2) subpectoral implantation requires complete detachment of the muscular origin from the ribs; (3) subserratus implantation provides extra muscular coverage, but dissection is more difficult owing to its firm rib attachment; and (4) the subserratus technique provided the lowest incidence of capsular contracture, although the breast was slightly flatter initially, but improved with time.

Breast↗
PubMed1981

Periareolar subpectoral augmentation mammaplasty.

A modification of an established technique to augment the breast is described. Thirty patients underwent subpectoral augmentation though a periareolar incision with a follow-up period of 10 to 16 months. The purpose was to combine the benefit of subpectoral placement (to minimize capsular contracture) with an inconspicuous scar, which usually results from the periareolar approach. Under general anesthesia a periareolar incision was used. Dissection proceeded straight down to the pectoralis muscle, which was split between its fibers to enter the areolar subpectoral plane. The origin of the muscle from the ribs and part of the sternum was detached and the pocket was subcutaneously extended lateral to the muscle. Thus a larger than otherwise expected implant could be inserted without the problem of displacement by the muscle, Postoperative tonometry was done to quantitate the degree of breast softness. Initial results suggested that (1) the incidence of capsular contracture can be reduced by virtue of using th subpectoral plane; (2) breast tonometry measurements of brest softness or firmness correlate well with the clinical impression; (3) the periareolar scar is superior to the inframammary scar; and (4) the periareolar approach allows easy access to the subpectoral plane and allows for better visualization of the muscular detachment.

Breast↗
PubMed1980

The "donut" mastopexy: indications and complications.

A previously described technique of mastopexy is employed whereby a donut-shaped portion of periareolar skin is deepithelized. The radius of the skin to be removed is usually 2 to 3 cm and includes a portion of the areola. The resulting wound is closed, leaving only a periareolar scar. The primary motivation for such a mastopexy was (1) minimizing scar to the periareolar area, (2) complete preservation of nipple sensation, and (3) ease and short duration of surgery. It is often used to correct a protuberant nipple-areolar complex ("Snoopy" deformity). Follow-up on 13 patients who underwent the procedure for ptosis indicated that surgery is brief and easy to perform, and nipple sensation is preserved. However, ptosis may recur even in small breasts; the periareolar scar often becomes hypertrophic; the breasts assume a more globular shape; and areolar spreading occurs to some extent in most cases. In view of the potential problems with the donut mastopexy it is suggested that (1) the procedure be reserved for very small breasts or those with only a protuberant nipple-areolar complex, where there is little weight to hasten areolar stretching and recurrent ptosis, and (2) the new areolar should be made smaller than desired in anticipation of post-operative stretching.

Breast↗
PubMed1979

Nipple-areola reconstruction: a review of techniques.

Various techniques of reconstruction of the nipple-areola complex are reviewed. An analysis of the criteria for an aesthetically pleasing nipple-areola complex is made. Symmetry appears to be the single most important factor in achieving the objective. More than color, texture, or the amount of projection, symmetry appears to provide the best overall result. Those techniques that treat areolae in identical fashion are more likely to produce symmetry. Reducing the normal nipple size not only provides donor tissue but reduces the problem of projection, which otherwise interferes with achievement of symmetry.

Breast↗
PubMed1977

Method to produce better areolae and nipples on reconstructed breasts.

A method to reconstruct the breast, nipple, and areola after mastectomy is described. The importance of symmetry is emphasized. A split-skin graft is used to reconstruct both (not one) areolae; this provides almost complete symmetry in terms of size, texture, and color. Ultraviolet light is used postoperatively to hyperpigment the skin-graft areolae, and the long-term appearance has been excellent. The method is quite simple, technically.

Breast↗
PubMed1975

Immunological enhancement of skin allografts in the rat. Role of vascular and lymphatic reconstitution.

Four skin graft models are created which vary in the rates of lymphatic and vascular reconstitution. Rat allografts (Brown Norway or (L times BN)F1 hybrid) transplanted to Lewis recipients by conventional (immediate lymphatic, delayed vascular), surgical anastomosis (immediate lymphatic, immediate vascular) or isolated anastomosis (delayed lymphatic, immediate vascular) techniques have similar mean survival times (7.8 days). Grafts placed on an isolated recipient pedicle (delayed lymphatic, delayed vascular) double the mean survival time to 15.6 days. Treatment with alloimmune serum, able to indefinitely prolong survival of similarly mismatched renal grafts, prolongs only isolated anastomosed grafts. In contrast, cyclophosphamide treatment prolongs survival of all groups. These results suggest, first, that both vascular and lymphatic routes of sensitization are equally effective and, second, that immunological enhancement requires either prompt vascular continuity or a persistent lack of lymphatic reconstitution.

Angiography↗
PubMed1975

The effect of commonly used antiseptics on wound healing.

Acetic acid, hydrogen peroxide, and povidone-iodine solutions were applied to experimental wounds in rats and to human donor sites to test their effects on wound healing. Control donor sites were treated with saline or dry Owens gauze. The acetic acid and povidone-iodine solutions had no significant gross or microscopic effect on the wounds. The hydrogen peroxide solution seemed to hasten the separation of the scab and to shorten the healing time, though characteristic bullae and ulceration appeared if the hydrogen peroxide treatment was applied after the crust had separated, when new epithelium was visible. We believe that the use of hydrogen peroxide should be avoided after crust separation. When only dry Owens gauze was used to treat split-skin graft donor areas, the result was a 3-day prolongation of the scab separation (compared to the saline controls) and greater subepidermal reactive and inflammatory changes.

Acetates↗