Face lift without preauricular scars.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to V Weisberg.
Explore the source record for details and available documents.
Despite improvements in our understanding of cutaneous vascular territories, clinical skin flap necrosis resulting from ischemic compromise is still a reality. Therapy with vasodilators has been generally unsuccessful, but replacement of high-energy phosphometabolites through the use of ATP-MgCl2 and fructose 1,6-diphosphate has been effective. Recently we reported that phosphocreatine is the major high-energy phosphometabolite in mammalian skin and that ATP levels and cellular well-being in skin flaps are dependent on adequate supply of this phosphometabolite. We report herein the successful augmentation of survival of ischemically compromised skin flaps through postoperative phosphocreatine infusion. This metabolite effectively circumvents the nonfunctioning mitochondrial creatine-phosphocreatine energy shuttle without disturbing the delicate [ATP]/[ADP] balance in the cytosol. In addition, phosphocreatine may favorably redistribute blood flow from muscle to the ischemically compromised skin.
The usual operative procedures (primary tracheal anastomosis, cricotracheal anastomosis, skin grafting and stenting, pedicle cartilage grafts, or free rib grafts) used to correct stenoses of great length involving the trachea or laryngotrachea have a high incidence of failure. An alternative method of reconstruction is the open technique, which requires three stages. The initial stage creates a trough after resection of the stenotic area, followed by subcutaneous embedding of a rigid material adjacent to the trough, and finally closure of the trough by reformation of the anterior wall. This staged procedure has been used in adult patients with tracheal stenoses greater than 4 cm, in patients with tracheal stenoses involving the cricoid, and in patients whose primary corrective operative procedures have failed. This paper critically assesses 30 patients who have had a staged reconstruction with a minimum follow-up of 12 months. The indications, number of procedures performed, time required for decannulation, complications, and analysis of failures are presented. The incidence of success in this series of patients is 76% (23/30).