摘要:

The fasciocutaneous flap in the lower leg has been widely used since Pontén's 1981 report. The cutaneous artery running along the sural nerve—known as the superficial sural artery—has an important role in the blood supply of the fasciocutaneous flap in the lower leg as stated by Haertsch.The superficial sural artery has great variation with regard to its location and the origin of the vessel. The cutaneous artery is intimately connected to the sural nerve or the lateral sural nerve. It may run along the sural nerve or along the lateral sural nerve.We examined this vessel in 10 cadaver dissections and applied it in 17 clinical cases of pedicled, island, and free flaps. The island sural fasciocutaneous flap is particularly versatile for the reconstruction of the soft tissue defect around the knee joint. The operative procedure involving the island fasciocutaneous flap and the characteristics of this sural fasciocutaneous flap are described.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The addition of a second pedicle to the transverse rectus abdominis musculocutaneous flap has enlarged the pool of potential candidates for breast and chest wall reconstruction with that method to include patients who smoke, those with midline, abdominal scars, and others. Many surgeons are hesitant to try the double-pedicle technique, however, because of a concern about being able to close the fascial donor defect. Fortunately, what the flap requires for survival is blood supply, not fascia. This report describes two ways to preserve anterior rectus fascia in the donor area medial to the perforating vessels without compromising the blood supply to the flap. Consequently, primary closure of the donor defect in the fascia can generally be accomplished, making the use of synthetic mesh optional and encouraging wider use of the double-pedicle technique.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Deformity of the orbital region and contraction of the eye socket were encountered in 3 patients who in their infancy underwent exenteration of the orbit and postoperative irradiation for the treatment of retinoblastoma. These major problems were attributed to the less-vascularized cicatricial conjunctiva left in place. To solve these disadvantages, a microvascular technique using a free radial forearm flap was adopted. A large permanent eye socket was achieved and depression deformity of the orbital region was corrected in a one-stage operation. This is, to our knowledge, the first report on the use of a free vascularized skin flap for “malignant contracture” of an anophthalmic eye socket. The excellent cosmetic results of this method are demonstrated.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

There is a myriad of research in the pharmacological manipulation of skin flap survival. However, skepticism exists as to whether any of these drugs is clinically useful. We evaluated the efficacy of five categories of agents in improving skin flap survival in five different rat flap models. Diltiazem, isoxsuprine hydrochloride, nitroglycerin, prazosin hydrochloride (two doses), and methyldopa were compared in a double-blind, randomized fashion. Their benefits were assessed in a musculocutaneous flap, axial flap, and three types of random flaps. The “best” drug was determined to be nitroglycerin. Its efficacy was verified in a primate model.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Local vessels are occasionally unsatisfactory donor choices for vascularized tissue transfer in extremity reconstruction. Construction of a temporary arteriovenous loop facilitates not only tension-free anastomoses outside the zone of injury but also affords vascular distention at physiological pressures, an opportunity to verify vein graft patency before tissue transfer, and presumably a decrease in the ischemia time of the vein graft itself.We reviewed the cases of 25 consecutive patients who underwent upper and lower extremity reconstruction facilitated by temporary arteriovenous shunts. In single-stage procedures, greater or lesser saphenous veins were used; the venous end was left in situ in its bed in 17 patients and the entire vein harvested freely in 8. The most common destination was the leg (11), followed by the thigh (7), foot (2), sacrum (2), knee (1), arm (1), and forearm (1).There were three (12%) failures. We conclude that construction of temporary arteriovenous shunts using vein grafts is a productive adjunctive technique in vascularized tissue transfer where additional pedicle length is needed.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The traditional teaching that “nerve fibers are lost at the suture line” after a nerve repair was investigated by asking the question, “Can the number of nerve fibers distal to a nerve repair site be increased by increasing the number of nerve fibers proximally?” Ratios of proximal to distal nerve fibers were increased from 1:1 to 2.5:1 to 3.5:1 by suturing peroneal or posterior tibial or sciatic nerve proximally to peroneal nerve distally. At one year following the repair, distal nerve fiber numbers increased to twice normal as the ratio increased to 2.5:1, and then nerve fiber numbers plateaued. Nerve function, as judged by walking track analysis, was best in the peroneal:peroneal group (1:1 ratio), suggesting that appropriateness rather than number of proximal fibers was more critical in this nerve repair model.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Microneurovascular techniques make transfer of innervated soft tissue a reality. The present study investigated the sensory potential of four such donor sites: volar wrist, dorsal hand, dorsal foot, and great toe. Normal moving and static two-point discrimination values for these areas are reported. A sensory reeducation protocol demonstrated that even these normal values may be improved with training. This suggests that the full potential of transferred innervated soft tissue may best be achieved by incorporating sensory reeducation routinely in the postoperative rehabilitation program.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Data from six cases of penoscrotal Paget's disease were collected. Erythematous, indurated, and pruritic skin lesions that failed to respond to the topical therapy were the main complaints. Symptoms had been observed for three to seven years before correct diagnosis. Extensive diagnostic studies revealed negative findings of subjacent adenocarcinoma, but 1 patient had concurrent skin cancer of nasal ala. In treating penoscrotal Paget's disease, our policy is to (1) resect 3 cm or more skin beyond the margin of the cutaneous lesion, (2) resect deeply to the subcutaneous fat, (3) use intraoperative frozen sections to confirm the free margin and (4) reconstruct the wound with the local iliac flap. No local recurrence was noted during the follow-up period of two to seven years. The iliac flap is thin and pliable; it precluded scar contracture and painful penile erection, which are the common sequelae of free skin graft in the penoscrotal area. Patients enjoyed normal sexual activity after surgery.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This study examines the usefulness and reliability of bone scintigraphy in correlation with radiological and clinical evidence of bone healing in 15 patients who underwent microvascular transfer of the fibula. All patients were followed for a minimum of 18 months postoperatively. Technetium-99 methylene diphosphonate bone scans and the most recent radiographs were blindly rereviewed. Bone scintigraphic results were characterized as (1) clearly positive (i.e., excellent visualization of the fibula), (2) clearly negative (i.e., no evidence of tracer uptake in the fibula), or (3) indeterminate (i.e., artifact present as a result of metallic or soft tissue interference). Bone radiographs were classified into three typical patterns: (1) complete bony union and graft hypertrophy, (2) incomplete union (either distal or proximal) requiring a second procedure), and (3) nonunion, with increased proximal and distal lucency (with or without pathological fracture) and loss of graft definition. Eleven patients had positive scintigraphic scans postoperatively. In 8 no subsequent procedure was necessary; 2 patients required additional bone grafts to augment the osseous reconstruction; viable fibulas were seen at reoperation. One patient with a positive scan showed decreased graft definition at four months followed by autograft fracture. Three patients had indeterminate scans, 2 of whom evidenced uncomplicated clinical and radiological union. One patient had a clearly negative scan and ultimately tibia-fibula synostosis was required to attain stability. Bone scintigraphy appears to correlate with survival, but not necessarily union, of a vascularized fibula autograft. Additional monitoring techniques should be used in combination with a one-time bone scan to both monitor the patency of the microanastomoses and to prioritize the orthopedic management of the patient.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The perichondrium adhering to mature cartilage is not active, but that separated from cartilage is highly chondrogenic. Cartilage formation from isolated perichondrium does not last forever, and perichondrium soon becomes inactive. What activates or inactivates the perichondrium? The authors investigated the effect of mature cartilage on the cartilage formation from perichondrial graft material. The results showed that mature cartilage attached to the perichondrium inhibited neochondrogenesis. The phenomenon that cartilage—a product of chondrogenesis—inhibits neochondrogenesis of perichondrium can be called negative feedback.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID