Microsurgery. Nerve Repair

Microsurgical nerve repair and use of the operating microscope is a particular area of interest for me and has become a significant part of my practice. I enjoy the optics of the Carl Zeiss Pentero microscope. The Pentero provides adequate resolution for nerve repair on the magnitude of 2mm and even less.

Peripheral nerve injuries in the upper and lower extremity are common with the frequent physical activity in southern California. Activities such as biking, surfing, motorcycles, climbing, as well as occupational hazards can cause peripheral nerve injury.

In the photograph above, the blue background contains a grid with 1 mm squares, allowing the surgeon to assess the dimensions of the injured nerve.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Revision Augmentation Mastopexy Surgery

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I have found an increasing number of women who present to my office in consultation who had saline breast implants placed ten years ago and who are now requesting removal and replacement of their mammary implants for highly cohesive silicone gel mammary prosthesis.

Often these women underwent reduction mammoplasty with an implant to maintain upper pole fullness, but now want to change to an implant with a slightly higher profile to deliver more breast projection.

We are seeing more women present from out of state who come to Newport Beach and Beverly Hills who have capsular contracture and who now want to have their breast implant capsules removed, saline implants replaced for silicone gel implants, and a simultaneous breast lift.

These operations are challenging to preserve the blood supply to the nipple areola complex as previous operations contribute to scarring and necessitate experience with these cases to deliver consistent results.

Bilateral capsulectomies, implant exchange, and mastopexy are commonly performed operations in Newport Beach and Beverly Hills.

Brian P. Dickinson, M.D.
www.drbriandickinson.com

Deep Inferior Epigastric Perforator Flap Publications

Reconstruction of Total Laryngopharyngectomy Defects with Deep Inferior Epigastric Perforator Flaps:

Otway Louie, Brian Dickinson, Jay Granzow, J. Brian Boyd

Journal of Reconstructive Microsurgery. 25(9):555-558, November 2009

It is truly a great honor and distinct pleasure to publish in the Journal of Reconstructive Microsurgery with Dr. Otway Louie, Dr. Jay Granzow, and Dr. J. Brian Boyd. I received outstanding microsurgical training from them during my time training at Harbor-UCLA.

Brian P. Dickinson, M.D.

Hand & Microsurgery: Flexor Tedon Injuries

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While I enjoy all aspects of plastic and reconstructive surgery, hand and microsurgery are particularly enjoyable as the anatomical dissections closely resemble the diagrams in the text books. In fact, surgery of the hand is what stimulated my interest in plastic & reconstructive surgery. I find that I use mostly the techniques taught to me by Dr. Miachael Hausman, Dr. Prosper Benhaim, and Dr. Neil F. Jones.

I find that studying and performing surgery of the hand, improves techniques for microsurgical breast reconstruction and vice versa.

It is important when repairing flexor tendons in zone II of the hand, to preserve the A2 and A4 pulleys. After fenestrations have been made in the synovium between the pulley system of the hand the injured flexor tendon can be easily identified. Occasionally I have found that the cruciate pulleys often need to be partially excised so that adequate purchase can be made on the flexor tendons to ensure a strong and durable repair.

Immediate post-operative mobilization with the Duran protocol is important to ensure adequate flexor tendon gliding.

Brian P. Dickinson, M.D.
http://www.drbriandickinson.com/