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Biomedical subjects

S S Greenbaum

Publications and source records attributed to S S Greenbaum.

At least 19 recordsLinked to original sources
PubMed2001

Iontophoresis as a tool for anesthesia in dermatologic surgery: an overview.

One of the biggest challenges of performing dermatologic surgery procedures is to minimize pain. Not only will the experience of each patient be enhanced by increased comfort, but the medical and aesthetic results achieved by the physician will be facilitated as well. Iontophoresis is the use of electrical impulses to drive molecules into the skin. Anesthetic agents are one type of medicine that can be delivered in such a way. There is a tremendous potential for the applications of iontophoresis to be expanded. As our understanding of the technique increases we will be able to modify the skin's surface as well as the individual agents we wish to transport.

Anesthetics, Local↗
PubMed2000

Modified Burow's wedge flap for upper lateral lip defects.

BACKGROUND: There are fundamental concepts we use in managing surgical defects. Whether planning a primary closure or a local flap, we frequently modify the basic design to maximize aesthetic outcomes, taking into consideration a number of factors including the location of the defect and tissue availability. OBJECTIVE: We describe a modified Burow's wedge flap for upper lateral lip defects. METHOD: Report of an illustrated case. RESULT: A patient with an upper lip defect was successfully reconstructed using the modified Burow's wedge flap, where the Burrow's wedge is placed on the mucocutaneous lip. CONCLUSION: Certain modifications of commonly used reconstructive techniques can be utilized in specific situations to enhance cosmesis. For the Burow's wedge flap, the dermatologic surgeon has several options in placing the Burow's triangle. This is an example of how alternatives in a closure can be used depending on the laxity of the skin and the size of the defect. Advantages and disadvantages of this alternative placement of the Burow's triangle are discussed.

Aged↗
PubMed2000

Stellate purse-string closure.

BACKGROUND: There are fundamental concepts we use in managing surgical defects. Whether planning a primary closure or a local flap, we frequently modify the basic design to maximize aesthetic outcomes, taking into consideration a number of factors including the location of the defect and tissue availability. OBJECTIVE: We describe the stellate modified purse-string closure, a novel flap modification. METHOD: Report of an illustrated case. RESULT: A patient with vertex scalp defect was reconstructed using the stellate purse-string flap. CONCLUSION: Certain modifications of commonly used reconstructive techniques can be utilized in specific situations to enhance cosmesis. Advantages of this modification are discussed.

Aged↗
PubMed1999

Modified purse-string closure for reconstruction of moderate/large surgical defects of the face.

BACKGROUND: Large surgical defects of the face can often be difficult to repair. Extensive adjacent tissue transfer may be necessary and may result in significant scars and possible flap compromise. Often there may be less donor tissue available than is necessary to achieve closure. The alternative is a split-thickness skin graft, which often has a poor cosmetic outcome with poor color match and contour irregularities. OBJECTIVE. A novel approach to closing large surgical defects of the face is described. This relies on a combination of side-to-side bilateral advancement and circumferential tissue recruitment utilizing the purse-string suture. METHODS: Report of illustrated cases. RESULTS: A 3.5 x 5.5 cm preauricular cheek defect, which could not be closed primarily side-to-side, was successfully completely closed in a curvilinear fashion by implementing both side-to-side bilateral advancement and circumferential tissue recruitment. A 3.8 x 5.5 cm cheek defect and a 6.0 x 8.0 cm temple defect were significantly decreased by using the modified purse-string closure. Healing by second intention in these two cases provided an excellent cosmetic result. CONCLUSION: The use of the purse-string closure utilizing circumferential tissue recruitment in combination with side-to-side bilateral adjacent tissue transfer allows seemingly large facial defects to be closed or significantly reduced in size. Such closure is evident even in cases where poor skin laxity and size of the defect would not appear to allow this. The modified purse string closure can result in an excellent cosmetic outcome.

Aged↗
PubMed1998

Intraoperative tissue expansion in eyelid reconstruction.

OBJECTIVE: Chronic tissue expansion is a well-accepted modality for increasing available tissue for reconstructive surgery. In rapid intraoperative tissue expansion (RITE), a tissue expander is used intraoperatively to increase the available tissue area for defect closure. The use of the ubiquitous and inexpensive Foley catheter has previously been reported as a tissue expander in RITE. In this paper, the authors examine the application of the Foley catheter for RITE in oculoplastic surgery. DESIGN: Case series. PARTICIPANTS: Twenty-six patients (ages 50 to 87) with eyelid defects from various causes underwent reconstruction using RITE. INTERVENTION: Using this technique, the tip of a #14 French Foley catheter is trimmed, keeping the balloon intact. The balloon is inserted under a skin-muscle flap. Counter traction is applied, and the balloon is filled with saline until the flap blanches. The balloon is inflated twice for 5 minutes with a 1- to 2-minute rest period between expansions. This provides increased tissue area for reconstruction of periocular defects. MAIN OUTCOME MEASURES: The linear extent of the eyelid defect was measured prior to and after expansion with RITE. A comparison was made between the two measurements. RESULTS: The linear extent of the eyelid margin defect decreased by 36% after RITE. CONCLUSIONS: Rapid intraoperative tissue expansion with a Foley catheter is a means of providing increased tissue area for reconstructive surgery of the eyelids and periorbital region. This technique provides excellent tissue match for color, texture, and thickness. The technique decreases the size of the incised and undermined skin-muscle flap and the tension needed for wound closure.

Aged↗
PubMed1998

Carbon dioxide laser resurfacing of peri-oral rhytids in scleroderma patients.

BACKGROUND: The short pulse duration high-energy carbon dioxide (CO2) lasers have been used in the past for treating cutaneous pathology and more recently for cosmetic improvements of rhytids, photo-aging, and acne. OBJECTIVE: This study was undertaken to determine the benefits of CO2 laser resurfacing on the severe peri-oral rhytidosis commonly seen in patients with systemic scleroderma. METHODS: Three patients were studied and evaluated for satisfactory wound healing, improved cosmetic result, and lack of complications. RESULTS: All three patients experienced significant improvement following laser resurfacing. CONCLUSION: The study demonstrated the safe and effective treatment for peri-oral rhytidosis in patients with generalized scleroderma utilizing CO2 laser resurfacing.

Aged↗
PubMed1994

Comparison of iontophoresis of lidocaine with a eutectic mixture of lidocaine and prilocaine (EMLA) for topically administered local anesthesia.

BACKGROUND: Almost all dermatologic surgery is accomplished using local anesthesia. To make our patients more comfortable, there is a constant search for less painful methods of administering anesthetic agents. Topical EMLA as well as iontophoresis are both useful in this regard. OBJECTIVE: In this study we compared topical EMLA with lidocaine delivered by iontophoresis in a double-blind placebo-controlled trial. Our goal was to assess the degree of anesthesia obtained as well as the relative rapidity of onset. METHODS: A double-blind controlled study was performed on 10 healthy volunteers between 26 and 37 years of age. Three test sites were placed on each forearm. EMLA or a moisturizer control was placed on two of the three test sites on each arm. Each site was wiped free of cream and tested for sensitivity to pinprick 30 and 60 minutes after cream placement. One iontophoretic unit was placed on each forearm. Both units were saturated with anesthesia with the control unit being turned off. Sensitivity to pinprick was evaluated at the iontophoretic sites and one of the EMLA sites 30 minutes after site placement on the subject. The additional EMLA-treated site was tested in the same manner 60 minutes after placement. RESULTS: Both EMLA cream and the iontophoretic unit delivered topical anesthesia greater than the control. Significantly more anesthesia was acquired 1 hour after application of EMLA than was seen 30 minutes earlier. The iontophoretic patch-treated area provided greater anesthesia than the EMLA-treated sites evaluated 30 and 60 minutes after placement. Both modalities provided significant anesthesia when left in place for 60 minutes. CONCLUSION: Both iontophoresis of lidocaine and topical EMLA delivered significant, and sometimes complete, local anesthesia. A greater degree of anesthesia is delivered via iontophoresis after 30 minutes as compared with EMLA left on the skin for 30 or 60 minutes. Both modalities have important and unique advantages and disadvantages. Topical EMLA and iontophoretically delivered lidocaine are both valuable tools for the dermatologic surgeon.

Administration, Cutaneous↗
PubMed1993

Intraoperative tissue expansion with the Foley catheter.

BACKGROUND: As surgeons face larger and more complex surgical defects, there is the continual search for more practical, successful, and cosmetically elegant methods for repair. Intraoperative tissue expansion is a relatively new technique built upon the fundamentals of traditional chronic tissue expansion. The Foley catheter is an inexpensive, readily available device that can be used for intraoperative tissue expansion. OBJECTIVE: The purpose of this article is to explain and demonstrate some of the uses for intraoperative tissue expansion with the Foley catheter. METHODS: A series of cycles of inflation and deflation of the Foley catheter balloon allows for gradual stretching of the skin over a period of 15 to 20 minutes. RESULTS AND CONCLUSION: The "tissue gain" achieved via this technique often facilitates wound repair. The Foley catheter is a useful device and a significant addition to the dermatologic surgeon's armamentarium.

Catheterization↗
PubMed1993

Acidic and basic fibroblast growth factors down-regulate collagen gene expression in keloid fibroblasts.

The effects of acidic and basic fibroblast growth factors (FGFs) on collagen expression by keloid fibroblasts were examined in the absence and presence of heparin. Collagen biosynthesis and gene expression of type I collagen were down-regulated by the FGFs in the presence of heparin. Acidic FGF, in a concentration range of 0.4 to 50 ng/ml, had little or no effect on collagen synthesis after a 4-day incubation. However, in the presence of heparin (100 micrograms/ml) acidic FGF, in concentrations ranging from 2 to 50 ng/ml, decreased [3H]hydroxyproline synthesis by 44 to 68%, compared with untreated control cultures. Total [3H]hydroxyproline synthesis was similar between control and heparin-treated cultures. Basic FGF (2.0 to 50 ng/ml) was effective in suppressing [3H]hydroxyproline synthesis by 50 to 90% after a 4-day incubation without heparin in keloid and normal fibroblast cultures. The steady-state levels of type I collagen messenger RNA were significantly decreased by acidic FGF in the presence of heparin, as well as by basic FGF without heparin. The data suggest that the FGFs are effective in down-regulating excess collagen production by keloid fibroblasts and that this inhibitory effect is apparently associated with pretranslational events. Moreover, acidic FGF is apparently dependent on heparin, whereas basic FGF is not, for potentiation of the down-regulatory effects of the FGFs.

Collagen↗
PubMed1992

Intraoperative tissue expansion: a review.

Tissue expansion is used to facilitate reconstruction procedures following trauma and cosmetic breast augmentation. This article describes tissue expansion, reviews intraoperative expansion techniques, and discusses the nurse's role in the procedure.

Humans↗
PubMed1991

The treatment of chondrodermatitis nodularis chronica helicis with injectable collagen.

Chondrodermatitis nodularis chronica helicis (CNCH) consists of a painful, erythematous, often crusted, papule most commonly found on the helical rim of the ear of white men over the age of 40 years old. It is seen less commonly in women and younger individuals, where the anatomic locations may vary to include the antihelix, antitragus, and other areas on the external ear. Over the years there have been many treatments for this disorder. We present the use of injectable collagen implants as a conservative, effective, and practical method for treatment of this disorder.

Chronic Disease↗
PubMed1991

An alternative for nasal tip reconstruction: the bilateral rotation flap.

A large percentage of the skin tumors that dermatologic surgeons treat are located on the nose. Of these, a significant percentage are located on the nasal tip. The nasal tip is notoriously difficult to reconstruct and we present a bilateral rotation flap that may be useful in some instances for reconstruction of this area.

Basal Cell Carcinoma↗