Isaac Kaplan

The carbon dioxide laser in plastic surgery

Abstract A self-contained portable apparatus comprising a continuous single-mode carbon dioxide laser with an articulated arm and manipulator with interchangeable attachments designed for clinical surgery is described and illustrated. The application of this instrument to various plastic surgical procedures in the light of past experience is discussed.

A study of the ultrastructural features of the cut margin of skin and mucous membrane specimens excised by carbon dioxide laser

Abstract Electron microscopic examination was performed on the cut edge of three surgical specimens of skin and mucous membrane lesions to measure more precisely the depth of damage of the laser beams, appearing on light microscopy as “burn” rim. Serial sections of this material revealed that the “burn” rim extended to a depth of 200–250 μm, but damage was not equal for all tissue. Most sensitive to the laser beams are the epithelial cells and their organelles, which showed signs of necrosis to a distance of 250 μm from the cut edge. Desmosomes, cell nuclei collagen fibers, and erythrocytes are less sensitive to the laser beams and started showing some preservation of their structure on the ultrasections cut at a depth of 30–50 μm from the periphery. Capillaries revealed swollen endothelial cells with a marked narrowing of their lumen. The importance of these findings and the significance of the application of the laser in clinical surgery were discussed.

A rapid method for constructing a functional sensitive penis

Summary An operation for constructing a sensitive, functional penis in a few weeks by using a turned-in flap from the median raphe of the scrotum for the urethra and a thigh flap based on the femoral branches of the genito-femoral nerve for the penile shaft is described.

The Carbon Dioxide Laser in Clinical Surgery

Experimental work with the CO2 laser (Stellar et al., 1971a,b; Gonzalez et al., 1970; Goodale et al., 1970; Hall et al., 1971; Hall, 1971a,b; Kaplan and Ger, 1973) has led to the hypothesis that if the laser beam were to fulfill expectations it should be possible to excise or incise tissues without damage to adjacent tissue, while at the same time reducing bleeding to a minimum by sealing off at least all minor blood vessels. If this were so, then the following advantages would be immediately evident: 1. Blood loss would be reduced to a mimimum, thus reducing the requirement for blood replacement with its associated risks, such as incompatibility and virus infection. (The economic burden of acquiring and processing donor blood should not be underestimated.) 2. The operating time would be reduced by eliminating ligation of most bleeding points. 3. The reduction of the amount of necrotic tissue and hematoma formation in the wound would lead to a diminished infection rate. 4. In the event of existing sepsis, the laser beam would tend to sterilize the wound. 5. Wound healing would not be delayed, but might even be enhanced due to a combination of the above factors. 6. With the sealing off of vessels, the possible spread of malignant cells during extirpative surgery for malignant disease would be reduced to a minimum and, additionally, primary repair of the defect would not be precluded.

Current Laser Surgery

With the development of a suitable apparatus sufficient experience has been accumulated in clinical surgery to enable one to reach the conclusion that the CO2 laser has an application in all branches of surgery without exception, whereas it has a decided advantage over other modalities in (1) All operations where the anticipated blood loss is significant. (2) Operations performed on or through infected tissue. (3) Extirpation of malignant tumors. (4) Cavitational surgery involving the use of an endoscope or microscope.

Reconstruction of the columella

Summary The literature on reconstruction of the columella has been reviewed. The writer has described a simple method of reconstruction which gives satisfactory results with minimal scarring and disfigurement.

Prolonged retention of glutaraldehyde-treated skin homografts in humans

Treatment of cadaver skin homografts in vitro with glutaraldehyde significantly prolonged their average retention time from 10.9 to 21.8 days in 21 patients with burns and/or extensive soft tissue injuries. The glutaraldehyde-treated homografts serve as a useful non-viable wound cover. They remain adherent to the wound bed for prolonged periods and support the formation of granulation tissue favourable for the subsequent acceptance of autografts. Toxic symptoms or allergic reactions were not noticed in any of the recipients. Treatment of the skin with glutaraldehyde is simple to perform, requires minimal laboratory equipment, and is not time consuming.

BURNS OF THE DORSUM OF THE HAND: CONSERVATIVE TREATMENT WITH INTENSIVE PHYSIOTHERAPY VERSUS TANGENTIAL EXCISION AND GRAFTING

Abstract The treatment of burns of the dorsum of the hand by multiple daily dressings with physiotherapy at each dressing gives results favourably comparable with those of tangential excision and grafting.

Partial mastectomy and mammaplasty performed with a CO2 surgical laser: A Comparative Study

Abstract The practicality of performing mastectomy with a surgical CO 2 laser has been investigated. A comparative study shows that it is possible to carry out a simple mastectomy with the laser with less blood loss and with comparable healing to mastectomy with the scalpel.

The simultaneous repair of cleft lip and palate in early infancy

IN I year (196%1969) over 400 untreated cases of cleft lip and palate were seen at the Children’s Medical Relief International Plastic Surgery Unit in Saigon. Their ages ranged from infancy well into adulthood. Because of the workload and the difficulties of multiple-staged operations, simultaneous repair of the lip and palate was carried out on some of the older patients (Kaplan and Wesser, 1971). The operation was found to be so technically feasible that it soon became routine for infants too. In the light of this experience in Saigon, simultaneous repair of the lip and palate in infants has been introduced in this department as a controlled trial, and this is a report of the preliminary results.