Edward A. Pechter

Maggot therapy: a review of the therapeutic applications of fly larvae in human medicine, especially for treating osteomyelitis

ABSTRACT. In traditional medical practice, the larvae of some Diptera: Calliphoridae, notably Lucilia illustris (Meigen), L. sericata (Meigen) and Phormia regina (Meigen), have been employed for maggot therapy, i.e. to help clean lesions antiseptically, especially for treatment of chronic osteomyelitis. This mode of treatment remains appropriate for cases where antibiotics are ineffective and surgery impracticable.

Listeria infection of silicone breast implant

A case of breast implant infection with L. monocytogenes is presented. The nature of this organism, its usual mode of transmission, and factors predisposing to the development of listeriosis are reviewed. We speculate that, in this case, the organism was acquired during a natural period of depressed immunity due to pregnancy, and it initiated a low-grade infection around the breast prosthesis. Possible implications of this scenario are discussed.

Instant Identification of Redundant Tissue in Abdominoplasty With a Marking Grid

BACKGROUND It is generally believed that continuous or discontinuous undermining of an abdominoplasty flap is necessary for its advancement, but it is also recognized that such undermining may increase the risk of ischemic complications. OBJECTIVE The author describes a grid-marking system to quickly identify the redundant tissue in abdominoplasty, making the procedure simpler, safer, and more consistent. METHODS A standardized grid was preoperatively marked on 35 consecutive female abdominoplasty patients to determine the exact pattern and extent of skin resection at the beginning of the procedure. This allowed resection of redundant tissue while confining proximal flap undermining to the minimum amount necessary for diastasis repair and umbilical repositioning. RESULTS The 35 patients who underwent abdominoplasty with the authors technique were followed from three months to 2.5 years. Of these, 12 underwent simultaneous liposuction. All procedures were performed on an outpatient basis under general anesthesia in an accredited office operating facility. Overall results were excellent, with no flap ischemia or other complications directly related to wound tension or to limited undermining. CONCLUSIONS A standardized grid system allows identification of redundant abdominoplasty tissue before any incisions are made, which limits undermining to the area over the medial rectus abdominis muscles, the minimum amount necessary for diastasis repair and umbilical repositioning. Simultaneous liposuction can be performed with relative safety, although it is not required for flap advancement.

The Grid/staple Adjunct to Abdominoplasty

Background: A variety of designs have been described for skin resection in abdominoplasty, but all have in common the need for intraoperative modification. Comparison of the different techniques is problematic because the actual skin resection may differ from the preoperative design. In addition, it may be difficult to achieve a symmetrical result, given the shifting bulk of the skin and soft tissue and the differences between the upright and supine patient. Methods: This article describes a standardized grid pattern drawn on the abdomen preoperatively that promotes symmetry and allows postoperative determination of the exact extent of skin resection. Preliminary stapling fundamentally changes the sequence of the procedure by eliminating the conventional first step of flap elevation. Results: The technique was used on 31 patients from January of 2004 through May of 2005. Body mass index ranged from 19.1 to 33.1, with an average of 24.4. All procedures were performed under general anesthesia in an accredited office operating facility on an outpatient basis. Details of the technique and representative cases are shown. Conclusions: Use of the grid pattern allows more meaningful comparison of different techniques and gives the surgeon more insight into his or her own technique. When combined with temporary intraoperative skin stapling, it maximizes symmetry of the results, facilitates precise scar placement, and minimizes the need for modifications such as chasing dog-ears. Stapling also allows identification of the proper amount of safe tissue resection at the beginning of the procedure, allowing the redundant tissue to be removed without first being elevated as a cumbersome flap.