Bryant Toth - Academia.edu (original) (raw)

Papers by Bryant Toth

World Journal of Surgery, 2008

Background The introduction of skin-sparing mastectomy has revolutionized both breast cancer surg... more Background The introduction of skin-sparing mastectomy has revolutionized both breast cancer surgery and breast reconstruction. Latissimus dorsi myocutaneous flap is a versatile flap that is gaining renewed popularity with the development of flap modifications and the continued recognition of its reliability and safety. We report our results with a new modification of the extended latissimus dorsi flap after skin-sparing mastectomy for breast cancer. patients of breast carcinoma had unilateral skin-sparing mastectomy and immediate breast reconstruction. A total of 132 cases of invasive duct carcinoma and eight cases of invasive lobular carcinoma are included. Age ranged from 27 to 53 (median, 40.5) years. Tumor stage was stage I in 22 cases, stage II in 100 cases, and stage III in 18 cases. We performed a new modification to the standard extended latissimus dorsi flap, which allowed us to obtain enough autologous tissue to reconstruct the relatively large breast of the Egyptian women without implant. The postoperative aesthetic results and donor side morbidity, including contour deformity and scaring, were examined. Results We applied both an objective and subjective aesthetic result monitoring. Aesthetic grading results of breast reconstruction were excellent in 85, good in 42, fair in ten and poor in three cases. Both flap and donor site complications were minor. Patients were followed for a median of 32.4 (range, 12-48) months. During this period of follow-up, no episode of local or distant failure was observed.

Plastic and Reconstructive Surgery, 1985

After 15 years of experience and 50 cases, we think that the axial frontonasal flap is of great v... more After 15 years of experience and 50 cases, we think that the axial frontonasal flap is of great value for the repair of large skin defects of the nose. This flap mobilizes all the skin cover of the nose located above the defect and the adjacent frontal skin and rotates it on a vascular pedicle existing at the level of the inner canthi. The excess of skin of the glabella is then transferred to the nose, and this large flap allows coverage of the defect without tension or distortion. The long-term results are very good, with a hardly visible repair in 26 of 50 patients, the long scar being very well hidden at the periphery of the nose.

Plastic and Reconstructive Surgery, 1999

The final appearance of the reconstructed breast is greatly dependent on the relative amounts of ... more The final appearance of the reconstructed breast is greatly dependent on the relative amounts of skin and breast tissue excised at the time of the mastectomy and on the exact location of the skin incision. A complete mastectomy may be performed using modified skin incisions to avoid the sacrifice of unnecessary breast skin. The type of skin-sparing incision used varies based on the exact location of the tumor and the size of the breast, but it always includes the nipple-areola complex and the biopsy site. The presence of local recurrence, distant disease, or death was determined in 50 consecutive patients who had skin-sparing mastectomies and immediate breast reconstruction between 1985 and 1991 to ascertain the safety of the procedure. The period of follow-up ranged from 23 to 121 months, with a mean of 57 months and a median of 51.5 months. There was no local recurrence, active distant disease was present in five patients, two patients died of distant disease, and there were two unrelated deaths.

Plastic & Reconstructive Surgery, 1999

Fourteen patients underwent Le Fort III midface advancement using distraction techniques. Six hav... more Fourteen patients underwent Le Fort III midface advancement using distraction techniques. Six have cephalometric documentation extending beyond 1 year postoperatively, and the positions of cephalometric points A and orbitale over time are reported here. Excellent stability of advancement at the occlusal level and some relapse at the level of orbitale are documented. Elimination or diminution of obstructive sleep apnea occurred in all patients so affected, and one of two patients with tracheostomy has been decannulated. Speech effects have been mild or transient. No untoward effects on extraocular muscle function have occurred.

Journal of Oral and Maxillofacial Surgery, 1998

The purpose of this report is to demonstrate a practical clinical method for advancement of the m... more The purpose of this report is to demonstrate a practical clinical method for advancement of the midface using a combination of Le Fort III osteotomy and gradual distraction. Use of internal, submergible distraction devices and modification of the Ilizarov distraction protocol are presented. Case reports show the effect of departing from the Ilizarov protocol by eliminating the latency period, initiating distraction intraoperatively, and rapidly distracting the segments postoperatively. A method of controlling fragment distraction rate by regulating pressures within the osteotomy site is described. The design and surgical application of internal distraction devices are shown. Nine patients with midface hypoplasia related to craniofacial anomalies underwent Le Fort III osteotomies assisted by gradual distraction. Ages ranged from 4 to 13 years. Custom internal distraction devices were employed to meet the unique requirements of each patient. Activation of the distraction device was accomplished by a percutaneous pin that remained in place for 3 to 5 days. The rate of transport was determined by regulating the forces within the distraction site. The internal devices remained in place for 6 months for fixation of the transported fragment. Midface advancement, measured as the anterior displacement of the infraorbital rim, ranged from 16 to 30 mm, with a mean of 20 mm. The typical force required to produce incremental movement of the Le Fort III osteotomy was found to be between 7 and 9 kg as transport exceeded 10 mm. Four patients with obstructive sleep apnea prior to surgery had resolution of the disorder. All the midface advancements remained clinically stable. Establishment of osseous continuity was verified by surgical examination in the four patients in whom the distraction devices have been removed. Combining intraoperative advancement of the Le Fort III osteotomy with gradual distraction consistently resulted in larger movements than could be achieved with conventional osteotomies and rigid fixation alone. The pediatric craniofacial skeleton responds differently to distraction than does the orthopedic skeleton. Eliminating the latency period, establishing a substantial bone gap intraoperatively, and rapidly distracting the fragment postoperatively did not adversely affect the osseous union in these patients. The internal, submergible feature of the device design offers advantages in patient acceptance, fixation stability, and wound management. This method of Le Fort III midface advancement has been shown to be clinically practical and effective.

Journal of Oral and Maxillofacial Surgery, 1996

The purpose of this report is to show the feasibility and potential advantages of using internal ... more The purpose of this report is to show the feasibility and potential advantages of using internal devices for distraction osteogenesis in the management of maxillofacial skeletal deficiencies. Distraction osteogenesis was used to correct a variety of maxillofacial skeletal deformities in five patients. One patient underwent bilateral Le Fort III advancement aided by distraction, three patients underwent mandibular ramus lengthening, and one patient underwent segmental alveolar reconstruction by distraction. The devices were activated by either a transcutaneous or transmucosal pin. After achievement of the desired skeletal transport, the activating pins were disengaged and removed from the distraction device. This allowed the distraction device to remain submerged and to stabilize the site of the consolidating bone. All patients achieved lengthening of their jaws. However, premature consolidation was noted in two patients, and one patient had significant relapse. Development of internal distraction devices is important to address the limitations of currently available biphasic systems. Potential benefits of internal devices include 1) elimination of skin scarring caused by translation of transcutaneous fixation pins, 2) improved patient compliance during the fixation or consolidation phase because there is no external component, and 3) improved stability of the attachment of the device to the bone.

Journal of Craniofacial Surgery, 1998

The purpose of this study was to demonstrate the potential advantages of applying distraction ost... more The purpose of this study was to demonstrate the potential advantages of applying distraction osteogenesis techniques to the correction of orbital and midfacial hypoplasia in craniosynostosis syndromes. Fifteen children with various craniosynostosis syndromes underwent Le Fort III advancement assisted by gradual distraction utilizing a pair of internal distraction devices custom-fabricated for each child. The surgical procedure consisted of a Le Fort III osteotomy, implantation of internal devices with initiation of distraction intraoperatively, and an accelerated rate of midfacial advancement over the next 3 to 5 days. Activation of the distraction hardware was accomplished by a percutaneous pin, which was removed at the end of the distraction protocol, allowing the internal devices to fixate the fragment for a minimum of 6 months during the period of consolidation. With follow-up ranging between 3 to 38 months, the average orbital and midfacial advancement was 19.7 mm (range, 12.0-30.0 mm). Proptosis was lessened and facial proportions significantly improved in all patients. Serious complications were not encountered. The modified distraction protocol utilized in this group of patients was aimed at addressing the unique requirements of pediatric craniofacial surgery, and resulted in almost twice the amount of correction previously reported for traditional rigid fixation techniques.

Aesthetic Plastic Surgery, 2006

The lateral fullness of the upper eyelid is its convex surface area from the eyebrow to the eyeli... more The lateral fullness of the upper eyelid is its convex surface area from the eyebrow to the eyelid crease. Rejuvenation of upper eyelids can be achieved by accenting their fullness. An S-shaped fusiform skin segment is removed from the upper eyelid, with care taken to spare the orbicularis occuli muscle. Approximately 1 ml of fat tissue is excised from the medial compartment by transmuscular incision. The fat is placed in the crease, and the orbicularis occuli muscle is stitched together over the transplanted fat tissue. Imbrication of the orbicularis occuli muscle and insertion of 1 ml of fat tissue into the muscle layers increase the lateral fullness and significantly emphasizes the aesthetic result of upper eyelid blepharoplasty.

TiTlE ModEl SuMMAry PrESEnTEd Comparative healing of surgical incisions created by standard elect... more TiTlE ModEl SuMMAry PrESEnTEd Comparative healing of surgical incisions created by standard electrosurgery, PEAK PlasmaBlade, and standard scalpel blade