Paul Silverstein

AlloDerm for Dorsal Nasal Irregularities.

After nasal surgery, thinning of the nasal skin, bony irregularities, or adhesions of dorsal skin to underlying bone can all occur. These problems can be solved by using either alloplastic materials or various autogenous tissues. In this study, AlloDerm, a dermal replacement derived from cadaveric skin, has been used to cover the osseocartilaginous framework of the nose in an attempt to achieve a smooth contour and a natural feel in secondary rhinoplasties. Fifteen patients were treated and observed for a minimum of 24 months. Clinically palpable or visible bony irregularities were successfully covered, and adhesions of dorsal skin to nasal bones were diminished. Prolonged but not socially unacceptable dorsal nasal swelling, which resolved during the first 4 months, seemed to be the only problem related to its use. With this limited experience, AlloDerm was found to be useful in secondary nasal surgery to cover osseocartilaginous irregularities, to eliminate the adhesions between nasal bones and overlying skin, and to create a smooth nasal dorsum.

Subcutaneous mastectomy by extended periareolar incisions

Abstract A technic is described wherein a transverse incision starting in the inferior periareolar area provides exposure of the breast to allow nearly complete mastectomy. Submuscular mammary reconstruction is facilitated by this approach.

Subcutaneous tissue infiltration as an adjunct to split-thickness skin grafting

Abstract Subcutaneous infiltration of warm Ringers lactate solution has been used to facilitate the harvesting of split-thickness skin grafts from ordinarily irregular donor sites in over 400 patients. The technic is simple, relatively inexpensive, and safe when utilized with care and judgment. The quality of skin obtained from donor sites on the chest, back, buttocks, or extremities is superior to that obtained without the use of this technic.