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Biomedical subjects

W Gubisch

Publications and source records attributed to W Gubisch.

At least 19 recordsLinked to original sources
PubMed1999

[The value of various techniques for esthetic correction of the lower eyelid].

Blepharoplasties are amongst the most commonly performed aesthetic procedures. Various lower blepharoplasty techniques have been described in the literature. Often, value and appropriate indication for each individual technique have not been sufficiently delineated. The recent renaissance of the transconjunctival blepharoplasty allowed the evolution of new and safe procedures for correction of the lower lid. Additionally, the technique of resection of the herniated orbital fat underwent certain improvements. The aim of this article is to describe the currently utilized surgical techniques and to discuss their indications.

Adipose Tissue↗
PubMed1999

[Clinical aspects and therapy of benign symmetrical lipomatosis--Madelung disease].

The clinical picture, diagnosis, therapy, and theories on the etiology of benign symmetric lipomatosis (Madelung disease) are outlined. Personal experience from 62 operations on 28 patients is compared to the literature. Up to now, there is only palliative surgical treatment for this sporadically appearing disease of unknown etiology. Liposuction--a less traumatic treatment--has considerably facilitated the treatment of the circumscribed fatty hyperplasias. The surgical characteristics of different anatomical regions are pointed out.

Adult↗
PubMed1999

[Orthotopic cartilage transplantation. Morphologic, angiography and histochemical studies of the vitality of free septum transplants].

Orthotopic cartilage transplantation is a technique frequently used in modern septal surgery. The prerequisite for a stable long-term result is viability of the transplanted cartilage. Therefore, we studied the healing process histologically, angiographically, and histochemically. We found a characteristic picture. Due to chondronal structure of the cartilage, the healing process varied in time and location. Reintegration took place by chondroneogenesis, commencing at the inner perichondrium. Reintegration depended directly on the distance of the cartilage cells to the surrounding vessels. Histochemically, we found an intact respiratory chain in the mitochondria and thus, we were able to demonstrate the preservation of viability in orthotopic transplanted cartilage.

Angiography↗
PubMed1999

[Tripier bridge flap technique for lower eyelid reconstruction].

Defects of the lower lid are more common than defects of the upper lid. Various methods for reconstruction of the lower lid have been published; we prefer the method of Tripier. The inner lining is reconstructed using a composite graft from the nose, and the outer defect is covered by a myocutaneous bridge flap from the upper lid. We have used this technique for defects of different sizes and have obtained good functional and aesthetic results.

Aged↗
PubMed1999

Refinements in extracorporal septoplasty.

Septal deviations interfere with nasal airflow and contribute to deformities in the external appearance of the nose. An aesthetically and functionally satisfactory correction of severe septal deformities or "crippled" septal plates often requires a temporary intraoperative removal of the septal cartilage for appropriate remodeling. This article describes refinements to the previously described technique of extracorporal septoplasty; these refinements have proven useful and have made the procedure safer in the hands of less experienced surgeons. The refinements simplify the straightening methods for the explanted septal plate, achieving a stable and median fixation of the replanted septum while maintaining a satisfactory contour of the nasal dorsum. A milling cutter is used to straighten the irregularities of the explanted septal plate and to thin broadly based anterior nasal spines. When necessary, microplates are added to stabilize the osteotomized and medialized anterior nasal spine. The final positioning of the replanted septal plate is greatly enhanced by a rein stitch, transosseous sutures, and multiple quilt stitches. Additionally, direct fixation of the replanted septum to the edges of the upper lateral cartilages further improves the stability of the reconstruction. Finally, particular care should be taken to avoid residual irregularities of the nasal dorsum; it they occur, these irregularities can be covered with a thin cartilaginous splint or a layer of dehydrated fascia lata or autologous temporal fascia. A total of 436 patients who underwent rhinoseptoplasties at the authors' department during a 1-year period were reviewed. Of these patients, 108 presented with severe septal deviations and underwent an extracorporal septoplasty using the refined techniques described herein. Despite the complexity of the procedure, the patients' satisfaction rates were high, independent of the operating surgeon.

Humans↗
PubMed1998

[Effect of anesthesia technique on blood loss in breast reduction-plasty. A study of 56 patients operated on by one surgeon].

Since we had the impression that there was an increase in blood loss during mammaplasties after a change in the anesthesiology department responsible, we conducted a study to compare 28 cases from each anesthesiology department. All operations were carried out by the first author in succession using the same operative technique. The two groups did not differ in age, BMI, operative time, weight of resected tissue or preoperative laboratory. Blood loss was calculated from the perioperative drop in hemoglobin and patient's blood volume. Blood pressure, heart rate, medication and intravenous fluid supply were obtained from the anesthetic protocols. RESULTS (MEANS AND STANDARD DEVIATIONS): Group I (n = 28) and [Group II (n = 28)]: total resected tissue 1862 +/- 928 g [1912 +/- 791 g]; Hb-preop. 13.6 +/- 0.9 g/dl [13.8 +/- 0.8 g/dl]; Hb-postop. 10.8 +/- 1.3 g/dl [9.7 +/- 1.3 g/dl] P = 0.006; Blood loss 970 +/- 339 ml [1443 +/- 456 ml] P < 0.001. After exclusion of surgical or biological causes hemodynamic effects of the anesthetic techniques were suspected as the reason for the significant difference in blood loss. MAP was elevated only initially, while the heart rate was considerably elevated throughout the procedures in group II. During anesthesia with nitrous oxide and enflurane, the dose of enflurane in group I could be limited to 0.3-0.5% after initial i.v. administration of 60 to 100 micrograms sufentanil, while in group II without opioids doses of 0.5-2% were required. The well-known dose-dependent effect of enflurane on the peripheral vascular tone was not masked by vasoconstrictors at the operative site. CONCLUSIONS: Blood loss during mammaplasties can be affected considerably by the anaesthetic technique--even without deliberate hypotension. Sufentanil can indirectly reduce the blood loss by lowering the necessary dose of enflurane. Blood transfusions can be avoided at mammaplasties.

Adult↗
PubMed1998

The relevance of extracorporeal septoplasty in cleft nose correction.

The aim of this paper is to delineate the importance of the correction of the nasal septum when attempting to improve the nasal shape and function in patients with cleft lip and palate (CLP) deformity. The particular problems of the nasal shape in CLP patients are assessed. Various approaches for adequate correction are reviewed and discussed. The method of extracorporeal septoplasty is presented in detail. This method was used between 1982 and 1997 in 141 out of 332 CLP patients who required septoplasties and appears particularly suited for this purpose since it offers the possibility of reconstructing an almost normal septum. This is necessary in order to achieve both a functionally and an aesthetically good result. Our experience over the past 16 years confirms the advantages of this approach.

Adult↗
PubMed1998

The triple swing flap technique to correct the asymmetry of unilateral cleft lip nose deformities.

The correction of a nasal deformity is a decisive step in the secondary treatment of patients with cleft lip and palate. The complex nasal deformity in these patients is caused partly by the anormaly itself and is partly a result of previous corrective surgery. Correcting the nasal deformity involves solving four complex problems: the septal deformity; the malposition of the exterior nose; the deformity of the nasal tip; and the deviation of the ala on the cleft side. The stigma of the patients with a cleft is sustained mainly by the asymmetry of the nasal entrances. Many operations, some of which cause extensive additional scarring, have been suggested for removing this typical feature in patients with clefts. We developed a triple swinging flap technique which has proved successful when used with an open as well as a closed approach. This also enables us to achieve symmetry of the nostrils.

Adolescent↗
PubMed1997

[Principles of cleft nose correction].

BACKGROUND: Cleft lips are very common malformation and all patients present a typical feature of the nose. The correction of a cleft nose is the most important step in secondary rehabilitation of CLP patients. Adequate correction of the septum is a must for the functional as well as the aesthetic result. In many cases it will become necessary to take out the whole septum, to build up a straight septum plate and to replant it. To keep the replanted septum in the midline it is necessary to bring the dislocated anterior nasal spine into the correct position. After closure of the lip, the deformity of the nasal tip and the nostrils preserve the stigma of the CLP patient. To achieve symmetry of the cartilagenous structures and the deformed soft tissue, a triple swing flap technique is recommended, which we have up to now used in 261 patients.

Cleft Lip↗
PubMed1997

Mucous cyst--a postrhinoplasty complication: outcome and prevention.

We present three cases of mucous cyst as a rare postrhinoplasty complication that were seen in our clinic during the last 16 years. They were located in three different positions of the nose: bony and cartilaginous part of the dorsum of the nose as well as over the alar cartilage part of the nose. We were able to treat all three patients successfully by excision of the cyst through intranasal or open approaches. In reviewing the literature and from our own experience we come to the conclusion that postoperative clearing of all tissue remnants, especially mucous parts, and a careful, atraumatic operation by forming an intact mucoperichondrial tube for intransal osteotomy as well as for hump removal are the best prevention of postrhinoplasty complications such as mucous cysts.

Adult↗
PubMed1997

[Improving the contour and preserving the profile of the lower third of the face].

Aesthetic surgery of the lower third of the face is divided up into five clinically relevant problem regions: nasolabial folds, lips, chin, mandibular angle including horizontal ramus and neck. Surgical correction is be described in the international literature. The pathophysiological conditions that lead to aesthetic problems in the lower third of the face are explained. Based on this, the indications for different methods of correction, which include soft and bony tissue of the face, are explained. The results of our own clinical experience, dependent on alloplastic material, are presented with all the advantages and disadvantages.

Cephalometry↗
PubMed1996

[What becomes of free septum cartilage transplants? Experimental studies of orthotopic cartilage transplantation].

BACKGROUND. Orthotopic septal cartilage transplants are grafted in numerous rhinosurgical operations. To ensure long-lasting success of surgery, preservation of the vitality of the grafted cartilage is imperative. Although many studies have been conducted on heterotopic cartilage transplants, no studies have been published on a follow-up of the course of orthotopic grafts. METHODS. We performed submucous septal resection in 33 rabbits and then regrafted the cartilage between the laminae of the mucous membrane. Microangiography was performed one, two, six and twelve weeks later and the cartilage was then examined histologically. Cartilage biopsies were performed on humans and compared with the experimental results. RESULTS. Integration of the cartilage presented a characteristic pattern: In the rabbit, the grafted cartilage had healed completely and had been stably integrated in three months' time. Reintegration with the orthotopic cartilage occurred by means of appositional reorganisation of cartilage originating from the inner perichondrium. Microangiography revealed that reintegration took place the faster, the shorter the distance between the cartilage cells and the vessels. We confirmed these experimental results also clinically by means of the cartilage biopsies in man.

Angiography↗
PubMed1996

[Diagnosis and therapy of vascular malformations in the head-neck area and their differentiation form hemangiomas].

The classification of vascular anomalies is controversial since the same terms are applied for different lesions. The biological classification according to Mulliken and Glowacki is based on the correlation of cellular features of vascular lesions during infancy and childhood with the physical examination and natural history. On this basis, two main categories of vascular anomalies can be distinguished: 1. Hemangiomas with endothelial proliferation and clinical course of rapid postnatal growth followed by slow involution. 2. Vascular malformations as developmental anomalies with normal endothelial cell cycles. These are subdivided according to the part of the vascular system involved.

Adult↗
PubMed1995

Functional and aesthetic nasal reconstruction in unilateral CLP-deformity.

The correction of nasal deformities in cleft patients presents a challenge in the secondary treatment of this malformation. The complexity of the nasal deformity in cleft patients partly depends on the congenital anomaly itself and partly on the surgical procedures which were previously carried out. The nasal deformities in unilateral CLP patients are typical. The nasal floor and the nostril sill are mainly constructed during primary lip repair. While the ala on the cleft side is repositioned, the septum deformity and the anterior spine dislocation are not touched. If large circular incisions are used at the time of primary operation to achieve symmetry, the situation usually deteriorates. One of the main characteristics of a classic cleft lip nose is the deviation of the external nose to the non-cleft side due to the typical septal deformity, where the anterior part of the septum and the caudal edge of the septum are subluxated to the non-cleft side (Fig. 1). Furthermore, there is a typical asymmetry of the nasal tip and the ala (Figs. 5 to 7). The columella is slanted and shortened on the cleft side. The ala cartilage on the cleft side is distorted and displaced. There are two important points in the concept of surgical rehabilitation: First, straightening the deviated nose, which often needs extracorporeal septum correction. This seems to be the prerequisite for correction of the external deviation. Second, rehabilitation includes the correction of the asymmetry of the tip and the nostril. A number of techniques have been suggested for this problem, which indicates that there is no ideal procedure. In our hands the triple-flap repair produced good and reliable results. There was no difference in the results, whether an open approach or an endonasal one was used.

Cleft Lip↗
PubMed1995

Experimental and clinical study on the vitality of orthotopic cartilage transplants.

Orthotopic cartilage transplants are performed in the course of numerous rhinosurgical operations. Precondition of a permanent success of the operation is preservation of vitality of the transplanted cartilage. Although numerous study results of heterotopic cartilage transplants exist, corresponding examinations in orthotopic transplants have not been done so far. Therefore, in 33 rabbits we did a partial submucous septumresection and put the cartilage back between the mucosal wall. After 1, 2, 3, 6, and 12 weeks, the animals were killed and the cartilage histologically proved. These results were compared to analogous human biopsies. Cartilage reintegration showed a characteristic picture. In the rabbit, the replanted cartilage was healed and stable after 3 months in each case. During reintegration, appositional growth started from the inner perichondrium. With microangiographical examinations, we were able to demonstrate that the speed of reintegration increased with decreasing distance of the cartilage cell from the blood vessels. We managed to confirm the experimental results in human cartilage biopsies.

Animals↗
PubMed1995

The extracorporeal septum plasty: a technique to correct difficult nasal deformities.

The severely deformed septum remains a problem. We recommend removing the whole septum and reconstructing a new, straight, septum plane that will be replanted (i.e., extracorporeal correction). Until April 1993 we had used this technique in 1012 patients with functionally as well as aesthetically encouraging results. All septal replants healed primarily. A problem may occur with this technique in reconstructing the dorsum and in stabilizing the replant. The exact technique is explained in detail, and the results are compared with those reported in the literature. Even with this radical procedure, the rate of complication was only 2.2 percent. Biopsies provided the histologic proof of cartilage survival.

Adolescent↗
PubMed1995

Comparative immunohistochemical distribution of amylin-like and calcitonin gene related peptide like immunoreactivity in the rat central nervous system.

Using the indirect immunofluorescence method with a polyclonal antiserum raised in rabbits and directed against amylin (AMY), we have investigated the distribution of AMY-like immunoreactivity (-ir) throughout the central nervous system of the rat. The widespread distribution of AMY-ir was much more abundant than that previously reported for calcitonin gene related peptide (CGRP) immunoreactivity. In most brain areas there was no overlap between AMY- and CGRP-ir cell body groupings, with the exception of the motor nuclei of the hindbrain and spinal cord, which were found to contain large numbers of AMY- and CGRP-immunoreactive cell bodies. Areas with a moderate to dense appearance of AMY-ir were the rhinencephalon, the nucleus of the diagonal band, the magnocellular, dorso- and ventro-medial and mammillary nuclei of the hypothalamus, the habenula, the compact part of the substantia nigra, the ruber and pontine nuclei, and the inferior olive and the cerebellar nuclei. The widespread immunohistochemical distribution of AMY-ir in the rat brain is in partial agreement with the distribution of AMY-binding sites.

Amyloid↗