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Biomedical subjects

T D Wang

Publications and source records attributed to T D Wang.

17 recordsLinked to original sources
PubMed1992

The effect of tissue expansion on previously irradiated skin.

Opinion remains divided over the advisability of tissue expansion in previously irradiated skin. We examined the properties of, and complications associated with, tissue expansion in previously irradiated rabbit scalps. Irradiation injury was produced using fractionated roentgen rays, with a total dose of 5000 cGy over a 5-week interval. Following a 20-week convalescence interval, expansion was incrementally conducted over 4 weeks. Monitored parameters included cutaneous perfusion as indicated by fiberoptic dermofluorometry, intraluminal pressure, linear surface gain, and area of surface necrosis. The incidence and severity of complications, including surface necrosis, were significantly higher among irradiated animals. Furthermore, the overlying skin of irradiated animals demonstrated a significantly decreased compliance and measurable area gain. Given the inferior expansibility and higher tendency toward complications with contemporary expansion techniques in previously irradiated skin, alternate reconstructive options are preferable in this setting.

Animals↗
PubMed1991

Cervical rotation flaps for midface resurfacing.

The midface has long served as a focus for creativity in surgical reconstruction. Full-thickness skin grafts, split-thickness grafts, and distal flaps have long been used to attempt to reduplicate existing anatomy in this area. Recent reconstruction efforts have focused on the creative use of microvascular free flaps for this purpose. This article reports on the use of extensively developed regional rotation flaps as an excellent reconstructive modality for use in this area of the face. The details of surgical incisional planning are given. The nuances of surgical creation of these flaps and their rotation and suspension into place are given. The cases we have done using this technique for the past 3 years are reviewed. Our present indications for use of these flaps and their limitations are given.

Adult↗
PubMed1991

Steroids and rhinoplasty. A double-blind study.

Many facial plastic surgeons use perioperative steroids to reduce postoperative edema and morbidity. This use of steroids is based more on theory and anecdotal experience than on controlled studies. We studied 49 patients undergoing rhinoplasty in a randomized, double-blind fashion to evaluate the effects of perioperative and postoperative steroid use. We found significantly less postoperative eyelid and paranasal edema in those patients receiving steroids. In addition, trends toward less ecchymosis, less intranasal edema, and less discomfort in the patients receiving steroids were noted.

Adolescent↗
PubMed1991

Experimental study on microvascular anastomosis using a dissolvable stent support in the lumen.

A new method for microvascular anastomosis was developed and compared with conventional techniques, using the rabbit femoral artery. A dissolvable stent biomaterial was placed in the lumen to expose the vessel walls clearly, so that the quality of anastomosis could be improved. The results showed no significant difference in immediate and late patency rates between the methods, but the use of the stent resulted in faster repair, less dilation at the anastomosis, and less narrowing of the distal segments, causing apparently minor hemodynamic disturbance, with increased blood flow distally. Minor damage to the vessel walls and rapid healing of the wound were verified by histologic evaluation.

Anastomosis, Surgical↗
PubMed1991

Spectrum of results after treatment of rhinophyma with the carbon dioxide laser.

Between 1986 and 1989, 30 patients with rhinophyma were treated with the carbon dioxide (CO2) laser at our institution. The duration of disease ranged from 1 to 20 years, and the duration of follow-up ranged from 1 to 4 years. All the patients were men, and all had fair skin (predominantly type I skin); their mean age was 63 years. Patients with minor and moderate rhinophyma were treated with CO2 laser vaporization only, whereas patients with major rhinophyma were treated sequentially with CO2 laser excision and then vaporization. A spectrum of long-term results is presented. Although dilated pores developed in many patients, no re-treatment with the CO2 laser was necessary. In one patient each, leukoderma, unilateral alar lift, and mild hypertrophic scarring developed. In general, use of the CO2 laser is effective for precise decortication of rhinophyma in an office-outpatient setting.

Adult↗
PubMed1990

Significant premaxillary augmentation.

Substantial premaxillary augmentation is necessary as an adjunctive treatment in most cleft rhinoplasties and in those patients exhibiting an acute nasolabial angle due to retrusion of the premaxila. We describe our technique of evaluation and treatment of this condition using a custom-carved piece of material made from a woven combination of Teflon and organic fibers (Proplast). Detailed technical illustrations as well as patient results are demonstrated. We have found this technique in our hands to be a simple, safe, and effective means of correction of significant premaxillary retrusion.

Adult↗
PubMed1990

Histopathologic evaluation of adipose autografts in a rabbit ear model.

Injection of autologous adipose tissue removed via liposuction has been used clinically for facial contouring, the aging face, furrows, facial atrophy, acne scars, nasolabial folds, chin, and various other surgical defects. Survival rates for autografts of fat have been quoted anywhere from 30% to 80%. Our study uses a reproducible rabbit animal model for autotransplantation of adipose tissue and examines the histopathologic changes that occur to the graft over time. Autogenous subcutaneous fat was removed from a dorsal scapular donor site, treated to stimulate cannula damage as in liposuction, then reinjected at the base of the ear. Histologic examination of the grafts were made at 5, 10, 15, 20, 40, and 100 days after transplantation. Hematoxylin-eosin sections were graded on degree of fibrosis present (0 to 4+), viable fat (1 to 10), degree of inflammation (0 to 4+), and neovascularization (+ or -). Viability of fat decreased from 8.5 to 10 at 5 days to 2 viability at 40 days. Acute inflammation peaked at 10 days, followed by the chronic inflammatory response with macrophages and multinucleated giant cells scavenging the dying fat graft. Neovascularization began at 5 days, peaked at 10 days, and remained constant thereafter only at the edge of the graft. Microcysts appeared at 15 days and increased in number in proportion to the decrease in viable fat. In summary, the temporal histologic events are progressive fibrosis; decreased amount of viable fat; inflammation beginning with a neutrophilic response, later a macrophage and giant cell response; and neovascularization at the periphery of the graft insufficient to maintain graft viability.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1990

Vertical frontal subtotal laryngectomy and immediate reconstruction of larynx with cervical skin flap.

Vertical frontal subtotal laryngectomy, a procedure that can remove as much as 90% of the larynx, was used to produce a functionally acceptable neolarynx with adjacent cervical skin flaps. Thirty-four patients with laryngeal carcinoma underwent this operation. All patients were staged according to their physical findings before operation. Of these patients, 1 was lost to follow-up and 2 died from other causes 6 months and 4 years after operation respectively. The remainder are living and well without recurrence. The longest follow-up was 8 years and the shortest 14 months. Laryngeal functions were restored completely in 27 patients and partially in 7. We conclude that the procedure is best suited for the removal of anterior commissure tumor extending from both vocal cords to the anterior 1/3 or the entire length of the true cords and that if the tumor extends to the supraglottis or subglottis, this procedure is adequate as long as the posterior part of the larynx is not involved, leaving a sufficient safety margin.

Humans↗
PubMed1989

The versatile midforehead browlift.

Ptosis of the brow is a significant and often unrecognized portion of aging of the upper face. It contributes to both cosmetic and functional aging. Correction is often mandatory prior to blepharoplasty in that functional problems may be worsened without elevating the brow. Direct and coronal browlifts are the most common approach to the problem. Midforehead browlifts have been reserved for men with receding hairlines. We have, for the past three years, performed midforehead browlifts on all our patients needing ptotic brow correction. Our review of 72 patients treated in this way, including 52 women, shows excellent and long-lasting cosmetic and functional improvement. There have been few complications, and the resultant incisional scars have been very well accepted. Therefore, we feel that the midforehead browlift, performed as we describe, is the ideal surgical correction for the ptotic brow.

Adult↗
PubMed1989

Rhytidectomy for treatment of the aging face.

Rhytidectomy or face-lift is an operation designed to remove facial wrinkles. Most often, it is performed in conjunction with other facial procedures, such as brow-lifts, blepharoplasty, and submental liposuction, for complete rejuvenation of the aging face. The recent surge of interest in cosmetic surgery has prompted more patients to inquire about and undergo a face-lift operation. Careful preoperative selection of patients is extremely important in achieving a successful outcome. At the Mayo Clinic, most facial cosmetic surgical procedures performed by the Department of Otorhinolaryngology are done on an outpatient basis. A combination of local anesthesia and intravenous sedation provides excellent patient tolerance and comfort both intraoperatively and postoperatively. Treatment involving the superficial musculoaponeurotic system is used for those patients who require additional underlying support and definition of the facial contour. Postoperative recovery is routinely uneventful. Complications of face-lift surgery are rarely encountered. Case reports are presented to illustrate the representative postoperative results.

Aging↗
PubMed1989

Preservation of laryngeal function after removal of carcinoma of the pyriform sinus.

Since March 1978, conservative laryngopharyngeal surgery has been used in the treatment of carcinoma of the pyriform sinus at this hospital. For pharyngeal reconstruction, cervical skin flap, deltopectoral flap, free microvascular bowel transfer, and pectoralis major myocutaneous flap and gastric pull-up transfer were used. The remaining part of the larynx was repaired with cervical skin flap, sternohyoid myofascia, epiglottis or remnant of epiglottis for complete rehabilitation (phonation, deglutition protection and respiration) or partial rehabilitation (phonation and deglutition protection) of laryngeal functions. 47 patients with carcinoma of the pyriform sinus were treated, and fairly good results were obtained. The 5-year survival rate was 41.7%, and the 3-year survival rate 50%. The laryngeal function restored completely in 31 patients and partially in 16. It is suggested that preservation of the unaffected part of the larynx is feasible both for eradication of tumor and preservation of laryngeal function.

Adult↗
PubMed1985

Hypoparathyroidism following total laryngopharyngectomy and gastric pull-up.

We have used the gastric pull-up technique for closure of large pharyngoesophageal defects after radical oncological surgery since 1979. The management of severe hypocalcemia and hypovitaminosis D seemed more difficult in patients undergoing pull-up reconstruction than in patients undergoing the same extirpative surgery, but reconstructed with more traditional methods. To determine if hypocalcemia and hypovitaminosis D were more common in gastric pull-up patients, and if postoperative management of these conditions is more problematic in this group, we retrospectively compared three groups of head and neck surgery patients. Group 1 consisted of 17 patients undergoing total laryngectomy with thyroid complex preservation. Group 2 consisted of 7 patients undergoing mediastinal dissection with total laryngectomy-thyroidectomy previously or concurrently. Group 3 consisted of 30 patients undergoing total laryngopharyngoesophagectomy-thyroidectomy and gastric pull-up reconstruction. The incidences of hypocalcemia requiring therapy were 12%, 50%, and 73%, respectively, with an overall incidence of 51%. The average amounts of supplemental calcium and vitamin D in the three groups were compared. A significant between the three groups was noted. Finally, the dietary calcium and vitamin D requirements for one problematic patient were prospectively recorded and summarized graphically. We conclude that any patient should be carefully monitored for the signs and symptoms of hypocalcemia after major head and neck surgery. In the special instance of the gastric pull-up patient, calcium requirements and the range of serum calcium fluctuation are greatly increased compared to patients undergoing more traditional methods of reconstruction.

Esophagus↗
PubMedDate not supplied

Free jejunal grafts for reconstruction of pharynx and cervical esophagus.

Reconstruction of the pharynx and cervical esophagus continues to pose a challenge to the surgeon. Over the last 2 years the free jejunal graft with microvascular anastomosis has been used to reconstruct pharyngoesophageal defects in ten consecutive cases with failure in only one case, because of a malfunctioning microscope and a temporary pharyngocutaneous fistula. Eight procedures were performed for reconstruction of a pharyngoesophageal defect after an extensive excision of hypopharyngeal carcinoma, one for pharyngoesophageal defect due to cervical trauma in an accident, and another for corrosive atresia. In seven of these cases the unaffected larynx or normal part of the larynx was simultaneously preserved and reconstructed with laryngeal function restored totally in four cases and partially in three cases. The techniques of both pharyngoesophageal and laryngeal reconstruction are presented. In our experience this is a relatively safe and reliable single-staged procedure that provides easier and earlier rehabilitation compared to other methods of reconstruction. Furthermore, the majority of patients may have their larynges rehabilitated simultaneously.

Esophagus↗