Faculty Bibliography

An objective method of assessing the healing potentials of skin ulcers would eliminate the long waiting period necessary for visual evidence of healing or nonhealing to appear. This would permit the continued conservative treatment for healing ulcers and prompt surgical interventions for those ulcers which are nonhealing. In this preliminary study, the cutaneous blood flow immediately around the ulcer site was studied using the photoplethysmograph. Vigorous cutaneous blood flow shown by good pulsatile wave forms on the photoplethysmograph is shown to be indicative of an ongoing healing process in which spontaneous healing of the ulcer can be predicted. Ulcers with nonpulsatile wave forms fail to heal with conservative management. One patient with nonpulsatile wave forms at the ulcer site showed improvement and eventual healing of the ulcer after undergoing a lumbar sympathectomy. Thus, nonpulsatile blood flow shown by poor wave forms on the photoplethysmograph would suggest early surgical intervention. This method may also aid in determining the extent of surgical excision of the ischemic scar tissue surrounding the chronic skin ulcer.

There are several basic techniques for obtaining acceptable closure of the orbital defect following exenteration. The approach to reconstructing a socket in the method chosen should be the one that gives the best cosmetic result while not compromising the surgical excision and the possibility of cure. Few surgeons have attempted to correct the deformity of orbital exenteration so that an artificial eye can be worn. We have found that approximately 20% of those patients undergoing radical ablation of the orbit quality for simultaneous reconstruction of the eye socket. The technique of a cheek-eyelid-conjunctiva flap allows for immediate reconsturction of the eye socket and the fitting of a prosthesis.

This case report illuminates the high possibility of catastrophic complications in the lateral neck, the vagaries associated with the preoperative therapeutic information, the technical effort to gain maximum surgical security, and the overwhelming complications associated with chemotherapy, irradiation, and surgical intervention.

Thread augmentation, a subsurface technique for correcting facial rhytides, is especially applicable to perioral wrinkles, melolabial furrows, and frown lines about the forehead. It is basically an augmentation technique which places a volume of well-tolerated, slowly absorbable or nonabsorbable sutures underneath the wrinkle. These threads produce augmentation by their volume and the mild local reaction of edema, lymphocytic infiltration, and fibrosis. This process gradually progresses to internal scar formation as the suture material is dissolved by slow hydrolysis in the presence of tissue fluid over a period of months; the nonabsorbable suture remains as a permanent implant. A high level of patient satisfaction with minimal complications has proved the value of this technique in over 100 cases.

It is axiomatic that nerve grafting be considered as an integral part of every ablative or traumatic injury involving the extratemporal main trunk and branches of the facial nerve. Our experience with 170 autogenous grafts has established the efficacy of the technique and has proved the high regenerative and adaptive capacities of the facial nerve system.

The most common cause of nasal obstruction is chronic enlargement of the inferior turbinate bones. The variety of medical and surgical treatments available for this condition bears testimony to their frequent ineffectiveness and the frustration of the physician or surgeon caring for these patients. Removal or destruction of the inferior turbinates has received strong criticism from rhinologists, although at present there is renewed interest in turbinectomy combined with rhinoplasty. A technique employing intranasal injections of long-acting corticosteroids has been used successfully for over twenty years in treating obstructing inferior turbinates secondary to allergic and vasomotor rhinitis. The indications, technique, and complications of this method are reviewed; the technique is presented as an alternative to destruction or resection of the inferior turbinates.

A review of thread augmentation has added helpful points to the technique and given an opportunity to assess the long-range results. It is obvious at this stage that there is no panacea for the wrinkling process. Each technique has advantages and disadvantages. The simplicity and low complication rate of thread augmentation supports this appeal. It is reasonable to state that the full application of the concept of this type of augmentation has not as yet been realized with this ongoing principle. This technique has been found of value when used as a single procedure or in combination with blepharoplasty or rhytidectomy.