Larry Nichter

University of California, Irvine | UCI · Department of Surgery

The unique dual-lumen and baffle design of the IDEAL IMPLANT Structured Saline breast implant gives it specific advantages over both silicone gel–filled and the original saline-filled implants. This internal baffle structure also gives it an appearance on various radiologic imaging studies that may be misinterpreted as a rupture because of similari...

Background: The IDEAL IMPLANT ® Structured Breast Implant utilizes different technology than unstructured saline or silicone gel implants, making it a third type of implant. FDA and Health Canada granted approval in November 2014. This saline-filled implant has an internal structure consisting of a series of nested shells that support the upper po...

The Ideal Implant Structured Breast Implant (Ideal Implant Incorporated, Dallas, TX), approved by the Food and Drug Administration in 2014, is a dual-lumen, saline-filled breast implant with a unique structured architecture of nested shells (Figure 1). The inner lumen has a posterior valve in the patch for inner lumen filling, and the outer lumen h...

We describe splenomegaly and bilateral grade 2 Baker breast capsular contracture in a woman who had undergone augmentation mammoplasty. This case represents the first documented instance of splenic marginal zone lymphoma, and is among the rare reports of B-cell lymphoma, arising in a patient with breast implants.

The IDEAL IMPLANT® Structured Breast Implant is a dual lumen saline-filled implant with capsular contracture and deflation/rupture rates much lower than single-lumen silicone gel-filled implants. To better understand the implant’s mechanical properties and to provide a potential explanation for these eight-year clinical results, a novel approach to...

Background: The structured breast implant utilizes different technology than saline or silicone gel implants, making it a third type of implant. FDA and Health Canada granted approval in November 2014.This implant is filled with saline, but has an internal structure consisting of a series of nested shells that support the upper pole when upright a...

Background-: High follow-up rates are critical for robust research with minimal bias and particularly important for breast implant Core Studies seeking FDA approval. The Core Study for IDEAL IMPLANT, the most recently FDA-approved breast implant, utilized a novel incentive payment model to achieve higher follow-up rates than in previous breast imp...

Purpose –To address the problems of current saline implants, a new implant design was developed. It is a double-lumen and contains an internal baffle structure that controls fluid movement to prevent bouncing, supports the upper pole to prevent collapse and supports the edges to minimize wrinkling. Two-year outcomes in 472 patients are reported her...

A double-lumen, saline-filled breast implant with a baffle structure (IDEAL IMPLANT Saline-Filled Breast Implant; Ideal Implant Incorporated, Irving, Texas) was developed to overcome the limitations of single-lumen saline implants by controlling saline movement and providing internal support to the implant edge and upper pole. The authors report 2-...

Goals/Purpose: In spite of the limitations of current single-lumen saline implants and the availability of silicone gel, ASAPS statistics for 2010 show that 38% of US women chose saline implants for breast augmentation. To correct some of the shortfalls of available saline implants, a new design saline breast implant was developed. It is a double...

On the basis of the extensive testing of the Sanitec Industries, Inc. waste management system by the North Carolina State University, the authors of this Editorial strongly recommend the immediate implementation of the Sanitec medical waste disinfection system throughout the United States to prevent the potential pandemic of the Avian Flu viral inf...

It is the purpose of this collective review to provide a detailed outline of a revolutionary medical waste disposal system that should be used in all medical centers in the world to prevent pollution of our planet from medical waste. The Sanitec medical waste disposal system consists of the following seven components: (1) an all-weather steel enclo...

People are exposed to ambient solar ultraviolet (UV) radiation throughout their daily routine, intentionally and unintentionally. Cumulative and excessive exposure to UV radiation is the behavioral cause to skin cancers, skin damage, premature skin aging, and sun-related eye disorders. More than one million new cases of skin cancer were diagnosed i...

Skin cancer is the most common cancer diagnosed in the United States, and its incidence continues to rise. Epidemiological studies have documented that excessive sun exposure increases the risk of developing nonmelanoma skin cancer. Consequently, it is mandatory that the skin be protected from the damage that occurs from ultraviolet (UV) exposure....

Australia has developed a national health care policy that has made prevention of the occurrence of skin cancer a societal responsibility. Its strategies for skin cancer control have included careful documentation of the incidence of skin cancer over the last two decades. After realizing that the magnitude of sun exposure during childhood is a majo...

For many years, individuals around the world have relied on sunscreen alone as their primary form of protection against ultraviolet rays (UV-R). Australia has shown that a multitactic approach to skin cancer prevention, combining sun-protective clothing with sunscreen, can be both highly effective and widely accepted by the general public. In the U...

The World Health Organization was committed to eliminating neonatal tetanus by 1995. Three years after this date, the infection killed over 400,000 babies a year, even though a safe, effective vaccine had been available for most of this century. The frequency of tetanus in the developing world epitomizes the healthcare disparity between the develop...

Hydrocephalus is a common and potentially lethal condition in children that results from an imbalance between absorption and production of cerebral spinal fluid (CSF). Silastic shunts are inserted to drain excess CSF, but they are prone to a number of problems, and at times may be unreliable and ineffective. This study examines the physiological ba...

The first detailed description of congenital facial paralysis was reported by Moebius in 1888. It is characterized by either unilateral or bilateral paralysis of the facial muscles and an associated abducens palsy. The present report is of two patients with Moebius syndrome, who were also diagnosed with trismus at birth. Each patient also demonstra...

Excess scar formation secondary to traumatic or surgical injuries can have devastating consequences, ranging from body disfigurement to organ dysfunction. Hypertrophic scars and keloids are skin fibrotic conditions that can be caused by minor insults to skin, such as acne or ear piercing, or by severe injuries such as burns. Differences between kel...

Excessive scar contracture by wound fibroblasts can have devastating consequences, ranging from body disfigurement to joint immobility. The ability of fibroblasts isolated from lesions of hypertrophic scars, keloids, normal skin, or normal scars in contracting the provisional wound matrix (i.e., fibrin clot) was compared and analyzed. Hypertrophic...

Using a 3-dimensional fibrin gel model system simulating fibroplasia of wound repair, we investigated the interaction between keloid fibroblasts and fibrin matrix and compared it with that of normal fibroblasts. Normal skin fibroblasts caused fibrin gel degradation under serum-free conditions, whereas keloid fibroblasts did not cause microscopicall...

It is traditionally thought that the exchange of oxygen occurs only at the capillary level, with both arterial inflow and venous outflow required. However, as early as 1970, studies have indicated that significant arteriolar and venular diffusion of O2 and CO2 occurs. The precapillary and postcapillary diffusion of oxygen and carbon dioxide and the...

Debridement of contaminated wounds is an essential component of uncomplicated wound healing. Efficient techniques should be capable of removing bacteria as well as foreign matter because of the well-known ability of foreign bodies to potentiate infection. We have compared the ability of current debridement techniques with the relatively new ultraso...

Demineralized bone matrix (DBM) has been successfully used as a substitute for bone grafting. Autogenous bone grafts may cause site morbidity and undergo significant resorption. DBM may overcome these problems, but it has no mechanical stability until bone formation has occurred. We tested various alloplastic implants (i.e., Surgicel, polydioxanone...

Keloid and hypertrophic scars are fibrous growths characterized by overabundant collagen deposition. We examined the effect of transforming growth factor-[beta] (TGF-[beta]), a known stimulant for the production of connective tissue matrices, on the rate of collagen synthesis in keloid fibroblasts (KFs), hypertrophic scar fibroblasts (HSFs), and no...

We studied the efficacy of color Doppler sonography in the transcutaneous assessment of acute changes in microvascular flow. Arterial and venous occlusion studies were performed in rabbits after simple isolation of the common femoral artery and vein and after raising an epigastric island flap. Vessel diameters were measured through an operating mic...

Tissues threatened by venous congestion often can be saved by timely leech therapy. Methods to restimulate sated leeches, particularly emergently, are only poorly described in the nineteenth-century literature. Sated leeches were purged of their blood meals by (1) posterior crop incision, (2) hypertonic saline (3 percent) immersion, (3) gentle fing...

Given the plethora of techniques available for debridement of contaminated bone, no single method can be considered ideal. Ultrasound has been shown to be less traumatic and more effective for debridement of contaminated soft tissue than either abrasive scrubbing or high-pressure jet irrigation. Using the distal femur and condyle of 23 freshly sacr...

: Given the plethora of techniques available for debridement of contaminated bone, no single method can be considered ideal. Ultrasound has been shown to be less traumatic and more effective for debridement of contaminated soft tissue than either abrasive scrubbing or high-pressure jet irrigation. Using the distal femur and condyle of 23 freshly sa...

On the dorsum of adult Sprague-Dawley rats, 3 × 7 cm pedicle flaps were raised and a temporary arteriovenous shunt (AVS) from anastomosis of the tail artery and vein was placed beneath. Fourteen, 21 and 28 days later, the pedicle flaps were converted to island flaps leaving only the AVS attachment. The degree of subsequent flap viability was direct...

A child with respiratory insufficiency due to a lethal syndrome known as spondylocostal dysostosis is described. Severe chest-wall deformities with resultant paradoxical chest-wall motion were successfully corrected by surgical reconstruction of the right thorax. We conclude that patients with the severe lethal form of the syndrome may benefit from...

Tumors in the musculoskeletal system are generally treated surgically, although radiation therapy and chemotherapy have greatly improved survival statistics of patients with high-grade sarcomas of the musculoskeletal system. The mainstay in treatment of nearly every primary tumor of the musculoskeletal system is surgical resection for cure. Radiati...

Large soft-tissue defects of the lower extremity can present a challenging reconstructive problem. The extended deep inferior epigastric pedicle flap is a versatile and reliable flap that can be used for the coverage of complex lower extremity soft-tissue defects as far distal as the knee. We reviewed our 5-year experience with 20 consecutive exten...

Use of the fracture table for patient positioning instead of the standard operating room table is advantageous in many nonorthopedic surgical situations. Benefits include circumferential accessibility of bilateral lower extremities, permitting two or more surgical teams to work simultaneously on different anatomical sites. Burns and multiple acute...

A new oscillating drill, designed for insertional ease and safety, was biomechanically tested using an MTS 812 servohydraulic material testing machine (Instrom). Holding strength and drilling force were compared against a traditional rotary drill using rabbit tibias to approximate the diameter and cortical thickness of human metacarpals. Three diff...

Demineralized bone matrix (DBM) has been successfully used as a substitute for bone grafting. Autogenous bone grafts (ABG) may cause donor site morbidity and undergo significant resorption. DBM may overcome these problems but is mechanically unstable when originally placed. We explored using a slowly resorbable template, polydioxanone (PDS), in com...

Replantation of amputated rat feet utilizing an efferent arteriovenous shunt constructed between the distal posterior tibial artery and the proximal posterior tibial vein, in the absence of all other venous drainage, provides an alternative pathway to the normal venous drainage in a replanted rat foot. However, this substitute venous drainage was i...

A successful nose replantation assisted by hyperbaric oxygen therapy is presented, with a brief discussion of the possible mechanisms and a brief literature review of the use of hyperbaric oxygen in tissue preservation and replantation. Although it is not certain that the hyperbaric oxygenation ensured the survival of the replanted nose in this 2-y...

Venous congestion is a constant threat in the survival of free flaps, pedicled flaps, tissue replantations and traumatized tissue. Leech therapy has proved effective in salvaging much of these compromised tissues. To be effective, leeches must be both readily available and hungry, requirements not always easily met. Our investigation seeks to estab...

The relative efficacy of local lidocaine anesthesia administered by subcutaneous injection and by iontophoresis was studied in 13 pediatric renal dialysis patients (ages 11-19 years: mean age 15.8 years). Each patient served as his own control at 3 assessment periods. Each type of anesthetic delivery method was administered to either of 2 fistula s...

Venous congestion is a constant threat in the survival of free flaps, pedicled flaps, tissue replantations and traumatized tissue. Leech therapy has proved effective in salvaging much of these compromised tissues. To be effective, leeches must be both readily available and hungry, requirements not always easily met. Our investigation seeks to estab...

To help clarify many of the controversial issues affecting early microvascular graft patency, a series of experiments was performed comparing the relative importance of graft material used alone and in conjunction with antiplatelet agents. Using a rat carotid model employing 1 cm micrografts with 1 mm luminal diameter, this study demonstrated that...

A case of coccidioidal meningitis following an open-head injury is presented. A 6-year-old boy was ejected from a motor vehicle as it was driven over a cliff, resulting in a severe open-skull fracture with grossly contaminated wounds. The accident occurred in an area in which coccidioidomycosis is endemic, and the causative agent, Coccidioides immi...

Twelve head and neck cancer patients scheduled to undergo an operation contaminated by entrance into the upper aerodigestive tract were enrolled in a prospective, randomized, double-blinded study to evaluate the efficacy of a preoperative antibiotic mouthwash in reducing oral cavity quantitative bacterial counts and the incidence of postoperative w...

Proper management of highly contaminated traumatic wounds frequently requires delayed primary closure of healing by secondary intention to prevent subsequent infection. This animal study compares the efficacy of various wound debridement methodologies to prevent infection following primary closure of treated contaminated wounds. Forty-four Sprague-...

Intralesional corticosteroid injections were performed in 31 hemangiomas in 30 infants aged 1 to 10 months at first injection. One to five injections were given, spaced 6 weeks apart. Lesions were located throughout the head and neck region, except one that was on the buttock. A mixture of betamethasone acetate and triamcinolone acetonide was used....

Subgaleal hematomas following minimal trauma, haircombing, and hair pulling by playground swings have been described. Recently a case was reported that progressed to otic hemorrhage and upper facial edema. We present a case (of a previously unreported nature) of a subgaleal hematoma that resulted in airway obstruction, massive edema of the entire f...

We have witnessed six cases of the hair-thread tourniquet syndrome, an entity characterized by strangulation of an appendage (toes, fingers, or external genitalia) by hair or hair-like fibers in the pediatric population. All six of our cases were in infants, 12 days to 5 months of age. The offending fibers were hair in three of the four patients wi...

Vascular malformations, particularly in the absence of cutaneous changes, can be difficult to distinguish from other soft tissue masses in children. We have used technetium-99m-labeled red blood cell scintigraphy to study 47 lesions in 43 children. Thirty-nine lesions showed increased flow and were, therefore, diagnosed as vascular malformations. S...

Verapamil is a calcium channel blocker that inhibits mast cell degranulation, platelet aggregation, and neutrophil function and is a potent vasodilator. The efficacy of verapamil (20 mg/kg/day) to salvage a standard failing random skin flap in the rat was studied. In this study verapamil failed to benefit skin flap survival. The results are analyze...

In this article we describe the use of an electrosurgical cautery tip scratch pad for the treatment of traumatic (adventitious) tattoos. This inexpensive item is available in most surgical operating rooms. The pad is flexible yet firm and obviates the need for power equipment. Most important, the technique is simple, easy to learn, and highly effec...

Hospital wall suction, standard tubing, and liposuction cannulas have been used successfully for liposuction. Benefits include convenience, simplicity, cost effectiveness, and reduction of effluent dispersion. Our experiences indicates that hospital wall suction can be used as an efficacious lipoaspirator.

An efficient and simple method for collection of bone dust during surgical procedures is presented.

Purpura fulminans is a rare manifestation of meningococcemia that in its full-blown form has a predictive death value of 61%. Those patients who survive usually develop gangrenous lesions that involve skin and underlying structures, mostly of the extremities and sometimes of the cheeks. Experience with early excision and skin grafting of these lesi...

Current management of major acute burns is as much art as science even in the best of hands, in part because of the physician's inability to estimate accurately even the most basic patient requirements. The use of computer assistance in burn care management has the potential both to optimize and to standardize care. The computer is a tireless worke...

Survival following traumatic hemipelvectomy in the child with subsequent local flap coverage of wounds has been previously described. The use of axial skin flaps and thigh and rectus abdominis musculocutaneous flaps for coverage of hemipelvectomy defects following tumor extirpation has also been noted in the literature. The use of muscle flaps to s...

We compared the hospital costs of 94 patients undergoing femoropopliteal bypass grafts with those of 53 patients undergoing primary amputation. The total cost of uncomplicated bypass surgery averaged +20,300, compared with +14,000 for uncomplicated below-knee amputation. However, including the cost of prosthesis and rehabilitation, the total cost o...

Current management of hand injuries includes debridement by abrasive scrubbing with anti-bacterial detergents, surgical excision, or pressure irrigation. A rat model with a contaminated laceration was used to study the efficacy of ultrasonic debridement to diminish bacterial counts and particulate matter in open wounds. Ultrasonic debridement of ha...

Treatment of tinea capitis consists of a 5-week course of griseofulvin. A 1-week course of a systemic corticosteroid may be considered in addition to griseofulvin therapy to accelerate the subsidence of inflammation in kerion lesions. Kerion is an inflammatory form of tinea capitis which may progress rapidly into a fulminant infection if untreated....

The use of the omentum as a source for vessel grafts is recommended when long or multiple vessel conduits are needed and when a combination of vessel grafts and soft tissue are needed. It is particularly suitable in reconstructing the superficial palmar arch but may also provide an immense graft reserve for the imaginative and careful surgeon.

A small segment of universally available and inexpensive rubber catheter can be easily fitted to insulate electrocautery tips. This technique can prevent numerous thermal injuries and potential litigation arising from accidently burning adjacent tissues. The routine use of this modification in the operating room can save time, anxiety, and potentia...

New guidelines on tetanus prophylaxis in wound management have been prepared by the American College of Surgeons and are available in a poster format or in bulletins. The purpose of this study was to determine the impact of these educational brochures on tetanus prophylaxis in a hospital setting. The results of this study indicate that these inform...

Many congenital cranial vault deformities are only incompletely corrected by currently available surgical techniques. The supplementary use of external cranial vault molding devices after these surgical techniques, however, has resulted in consistently improved cranial vault from over what could be achieved by operation alone. These devices are ine...

This article is a collective review of all the prospective clinical studies that assessed the therapeutic value of antibiotics in minor soft tissue lacerations. This review critically evaluates each study that tests the hypothesis that antibiotic treatment reduces the incidence of infection. Even though the design of each of the studies was scienti...

Toxic epidermal necrolysis (TEN) is a symptom complex characterized by a devastating skin disorder, erosive involvement of two or more mucous membranes, and severe constitutional symptoms. The disorder shares features with erythema multiforme and is thought to be an expression of the syndrome. Although a wide range of etiologic factors have been in...

Much research effort has attempted to identify pharmacological agents that will augment random skin flap survival. Unfortunately, the vast majority of these agents have been administered preoperatively, and as such their routine use is not often justified. Ibuprofen administered in the postoperative period significantly augments random skin flap su...

Selective external cranial vault remodeling has been practiced since antiquity. The variations, methods, and desired results of external cranioplasty are as pervasive as the practice is old.

Pseudofolliculitis barbae is a common cutaneous infection occurring in the bearded area of the face of black men. The infection is caused by ingrown hairs that produce an inflammatory foreign body reaction characterized by papules and pustules at the point of hair penetration that may result in permanent scarring, usually in grooved patterns, and o...

Power lawnmower accidents are one of the most frequent causes of mutilating injuries in pediatric patients. Guidelines for the optimal surgical management of children differ from adult patients by several key anatomic, physiologic, and rehabilitative features. Small blood vessels in children less than 2 years old may prohibit microvascular surgery....

Power lawnmower accidents are one of the most frequent causes of mutilating injuries in pediatric patients. Guidelines for the optimal surgical management of children differ from adult patients by several key anatomic, physiologic, and rehabilitative features. Small blood vessels in children less than 2 years old may prohibit microvascular surgery....

A user-friendly computer-assisted method of calculating total body surface area burned (TBSAB) has been developed. This method is more accurate, faster, and subject to less error than conventional methods. For comparison, the ability of 30 physicians to estimate TBSAB was tested. Parameters studied included the effect of prior burn care experience,...

The results of our experiment prove that arterialized venous perfusion is a viable means of nourishing complex composite tissue without using the arterial tree. Previous laboratory findings [36], coupled with the results of this experiment, demonstrate that as long as proximal arterial inflow is ensured, both the arterial and venous trees need not...

An accurate estimation of burn surface area is needed to correctly calculate initial fluid resuscitation, nutritional requirements, prognosis, and comparisons of treatment protocols among burn centers. The following experiment was conducted to test the accuracy of physicians compared to a computer-assisted method. Twenty-seven physicians were asked...

Calcification and ossification of tissue other than bone may occur in burn patients. This article is a collective review of the literature and highlights the diagnosis, treatment, and prevention of this complication of burn injury.

The efficacy of topical nitroglycerin in the augmentation of random-pattern skin-flap survival was studied. Our model consisted of a standardized cranially based random skin flap on the dorsum of Sprague-Dawley rats. Nitroglycerin was delivered transdermally through a semipermeable membrane from a constant delivery system. The four study groups inc...

Calcification and ossification of tissue other than bone may occur in burn patients. This article is a collective review of the literature and highlights the diagnosis, treatment, and prevention of this complication of burn injury. (C)1985The American Burn Association

Inadequate venous outflow is the factor most responsible in digital replantation failure and is a common cause of tissue loss in general. An experimental replantation model utilizing the rabbit ear was used to study the extreme example of venous congestion: absent venous drainage in the replanted part. Results of this study support the use of singl...

Low-voltage electric burns are the leading cause of electric burn injury in childhood and can result in an injury to the oral cavity that can heal with a noticeable deformity. The mechanisms of burn injuries to the oral cavity are either due to the electric arc or current or both. Electric burns of the oral cavity can involve the lip, tongue, mucou...

Coagulase-positive staphylococci of phage group II produce an epidermolytic toxin that results in a spectrum of diseases that include localized bullous impetigo, generalized scarlatiniform syndrome without exfoliation, and staphylococcal scalded-skin syndrome (SSSS). The mechanism of action of the toxin occurs at the level of the lower stratum gran...

Entrapment neuropathies occur in a number of different but predictable locations in the upper extremity. These neuropathies can produce a spectrum of sensory and motor deficits in the hand and upper extremity. A careful clinical examination in conjunction with electromyography and nerve conduction velocity studies can usually delineate peripheral n...

A simple, inexpensive, reproducible, and reliable model for digital replantation is described utilizing the rabbit ear. When compared to the human digit, it provides benefits over previous models. It is of similar tissue type and characteristics. The vessels closely approximate the digit in size and number. Results are easily quantified and the opp...

Treatment of burn injuries of the head and neck can be divided into acute and chronic stages. The acute phase consists of physiologic resuscitation of the patient and early care of the burn wound. The chronic stage begins from completion of wound coverage until the wound has matured. A major advance in the care of the patient with head and neck bur...