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Biomedical subjects

Simon Withey

Publications and source records attributed to Simon Withey.

10 recordsLinked to original sources
PubMed2007

Vertical rectus abdominis flap reconstruction in patients with advanced penile squamous cell carcinoma.

OBJECTIVES: To evaluate the role of radical surgical debridement and excision with a vertical rectus abdominis myocutaneous (VRAM) flap reconstruction in patients with advanced penile cancer and subcutaneous metastatic disease, as the quality of life in such patients is extremely poor, multimodal treatments often fail and the outlook for the patient is limited with the development of uncontrollable disease. PATIENTS AND METHODS: Four patients with advanced penile cancer presenting with fungating, cutaneous tumour deposits received palliative surgical resections for abdominal and inguinal disease. A VRAM flap was used in all cases to achieve tissue coverage. RESULTS: All grafts were viable and the mean inpatient stay was 14 days. There were no immediate complications after surgery; patient satisfaction and symptom relief was excellent. CONCLUSIONS: Aggressive palliative resection with a VRAM can dramatically improve the patients' quality of life in advanced penile cancer, permitting disease control with satisfactory cosmesis. However, a multidisciplinary approach involving both the urological reconstructive and plastic surgeon is essential.

Adult↗
PubMed2006

Forehead flap method for total nasal reconstruction.

One of the very first recorded methods developed over the ages to correct the mutilating deformity of rhinectomy was the forehead flap. While many other techniques have also been devised, this surgical method has stood the test of time better than any other. Further refined during the 20th century, it has now become the gold standard for obtaining the best results in nasal reconstruction. We present an illustrative case of a young man who was assaulted outside a night club and who suffered a clean separation of the nasal pyramid from the facial plane. We highlight the novel use of osseous, as opposed to cartilaginous, reconstruction of the upper lateral cartilages, which has not previously been reported in the literature.

Adult↗
PubMed2006

Severe gynecomastia in an African boy with perinatally acquired human immunodeficiency virus infection receiving highly active antiretroviral therapy.

Highly active antiretroviral therapy (HAART) slows the progression of human immunodeficiency virus (HIV) disease and lowers mortality and morbidity in children. Coincident with these advances, an increasing number of side effects are being reported. We describe an adolescent boy with perinatally acquired HIV infection who developed significant bilateral breast enlargement as a result of HAART. He required bilateral mastectomies. Pediatricians need to be aware of less common side effects of HAART.

Adolescent↗
PubMed2006

Smoking and wound healing problems in reduction mammaplasty: is the introduction of urine nicotine testing justified?

We sought to prove a significant relationship between cigarette smoking and wound healing problems in reduction mammaplasty patients, to show the effect of stopping smoking before the procedure, and to justify the implementation of urine nicotine testing preoperatively. One hundred and seventy-three consecutive patients aged 16 to 67 years underwent bilateral reduction mammaplasty in our institution over 26 months. Patients were advised to stop smoking at least 4 weeks prior to surgery. Records were reviewed and smoking habits reconfirmed via telephone. Wound problems were registered when intervention was necessary. Smokers made up 38.5% of the cases. Wound healing problems showed statistical significance (P < 0.05) between smokers (55.4%) and nonsmokers (33.7%). More than 75% of smokers admitted denying smoking within 4 weeks of surgery. Trend analysis revealed a significant association of wound healing problems for those who stopped longer than 4 weeks (33.3%), those who stopped less than 4 weeks (52.6%), and those who persisted until the operation (67.7%). Smoking increased wound healing problems after bilateral reduction mammaplasty. The introduction of compulsory urine nicotine testing at the preadmission clinic and prior to the operation will provide objective verification of patients' smoking history, minimize morbidity, and enable healthcare cost savings.

Adolescent↗
PubMed2006

Facial atrophy in HIV-related fat redistribution syndrome: a plastic surgical perspective on treatment options and a look to the future.

Approximately 50% of patients on highly active antiretroviral therapy (HAART) develop lipodystrophy with central and visceral fat accumulation and/or facial and limb atrophy. Although the exact mechanisms of this are not fully understood, the facial atrophy encountered is secondary to atrophy of the subcutaneous fat, and not the deeper fat pads, as has been suggested. More recently, the above features in combination with hyperlipidaemia and insulin resistance have been described and are referred to as HIV-related fat redistribution syndrome. This review looks at treatment options available for this stigmatizing condition.

Atrophy↗
PubMedDate not supplied

Attitudes to face transplantation: results of a public engagement exercise at the Royal Society Summer Science Exhibition.

Hettiaratchy and Butler (Lancet 2002;360:5-6) framed face transplantation as the next logical step on the reconstructive ladder for severe facial injury, in particular, pan-facial burns. The procedure formed the basis for a Royal College of Surgeons of England working party report. Ethical, surgical, and psychological issues were identified as research priorities before face transplantation is attempted in the United Kingdom. Public engagement is a vital mechanism if people are to be informed about the risks and benefits of the technique and ultimately to be able to consent to either receiving or donating facial tissue. To sample public opinion about the procedure, 304 people attending the Royal Society Summer Science Exhibition were sampled by online questionnaire to determine their attitude toward face transplantation. Although people were more cautious about face transplantation when comparing this with solid-organ transplantation, most of the sample were in favor of the procedure, whether receiving a donor face or donating their own face after their death. Only 10% were against the idea in principle. Concerns about altered identity were not a barrier to face transplantation for 69% of the sample, with most people appropriately identifying the long-term problems of immunosuppression as the issue that most concerned them. There is a substantial population of people who, given the right circumstances, would contemplate face transplantation for themselves and would be willing to donate their own face for transplantation after their death.

Adolescent↗