Bone Wax as a template for harvesting composite grafts.
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Drug Combinations↗
Biomedical subjects
A A Quaba
Publications and source records attributed to A A Quaba.
Skin grafts for the salvage of degloved below-knee amputation stumps.
We present a series of six patients in whom a traumatic below-knee amputation was associated with significant degloving, such that there was inadequate local skin to achieve primary stump closure. In each case, skin grafts were used to cover the stump muscle flaps. The patients ranged in age from 21 years to 73 years; the mean hospital stay was 72 days and the mean follow-up was 48 months. Despite an average of five procedures to achieve stump healing and an average of 118 days to first limb fitting, all patients have achieved independent mobility with their prosthesis. All have had minor stump problems necessitating periods of time off their prosthesis. Three patients have required minor stump-revision surgery. The advantages of a below-knee amputation over an above-knee amputation compensate for these problems. The forgiving nature of modern prostheses has contributed to acceptable results in these patients, who had what may previously have been considered insufficiently durable stump cover.
Adult↗
A family with hereditary port wine stain.
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Family Health↗
The soft tissue management of children's open tibial fractures.
A series of 49 children admitted with a diagnosis of open tibial fracture was reviewed with particular regard to soft tissue management. Injuries were grouped according to the Gustilo classification. Twenty-two patients had Grade I fractures, 11 Grade II and 16 Grade III (4 Grade IIIa, 11 Grade IIIb and one Grade IIIc). Patients were managed by early lavage and debridement under general anaesthesia, followed by immobilisation. Local transposition flaps were utilised in 10 patients and provided reliable soft tissue cover. A free tissue transfer was performed in only one patient. Complications appeared to be associated with delayed involvement by plastic surgeons.
Adolescent↗
Treatment of arborising telangiectasia with pulsed tunable dye laser (SPTL-1b).
Arborising telangiectasia is a rare but distinct progressive condition of unknown aetiology. The vessels are subepidermal and measure less than 0.2 mm in diameter. Twenty-three patients with this condition, involving the lower limbs and in extensive cases the upper limbs and trunk, have been treated with the flash lamp pulsed tunable dye laser (SPTL-1b, Candela Laser Corp.). Retrospective review of 17 of these patients, who have finished their treatment (average five sessions of therapy per patient, given at 3-4 monthly intervals), shows complete clearance of the telangiectasia in all cases. The mean follow-up time after the last session of treatment was 7 months. Temporary hyperpigmentation was seen in eight patients. Persistent pigmentary changes (one hyper- and one hypopigmentation) were noted in two patients. No evidence of scarring or change in skin texture was encountered. No progression or recurrence of telangiectasia was noted during the period of follow-up.
Adolescent↗
An investigation into the role of waterproofing in a two-stage hypospadias repair.
In our unit a two-stage procedure, using a full thickness preputial graft, has been adopted as the method of choice for the repair of hypospadias proximal to the coronal sulcus. In 1993 an audit was undertaken to establish our complication rate for this procedure. Twenty-two consecutive patients who completed a two-stage repair between January 1988 and December 1993 were studied. An unacceptably high fistula rate was identified (63%, 14/22 cases). Consequently our technique was modified by transposing a vascularised flap of preputial areolar tissue over the urethral suture line, at the time of urethroplasty. A second group of 22 consecutive patients, operated upon between January 1994 and July 1997, were subsequently investigated and a dramatic improvement in the fistula rate was demonstrated (4.5%, 1/22 cases). These cases represent a subgroup of almost 200 cases, which the senior author has managed over the last 10 years. The senior author undertook or supervised the surgery in all 44 cases, which were the focus of this study, and the introduction of a waterproofing layer represents the only change in technique.
Child, Preschool↗
The island posterior calf fasciocutaneous flap: an alternative to the gastrocnemius muscle for cover of knee and tibial defects.
The gastrocnemius muscle remains the workhorse for providing soft tissue over the knee and upper tibia. Nevertheless, we have found the island posterior calf fasciocutaneous flap to be a valuable alternative. We describe 10 cases in which an island posterior calf fasciocutaneous flap was used to cover defects over the knee and tibia. Three cases were after knee arthroplasty wound dehiscence, three cases were of traumatic soft-tissue loss, three cases involved replacement of unstable skin, and one case required closing a synovial fistula. This series is compared with 10 contemporaneous consecutive cases of soft-tissue loss around the knee that were reconstructed with a gastrocnemius muscle flap. Nine posterior calf fasciocutaneous flaps survived completely, and one flap had to be replaced because of poor flow. Although this flap is technically more demanding, we have found that it offers some advantages over the gastrocnemius. These include a greater flexibility of size and shape, a longer arc of rotation to reach suprapatellar defects, the provision of sensate skin with protective though crude sensation, less bulk, and the avoidance of a twitch. The flap is also easy to re-elevate from the recipient site for subsequent orthopedic work.
Adolescent↗
A five year review of islanded distally based fasciocutaneous flaps on the lower limb.
The use of the distally based islanded fasciocutaneous flap is described in 61 patients with lower limb defects and its application in coverage of compound fractures of the tibia is highlighted. A total of 66 flaps were raised from the posteromedial border of the leg, based on a single perforator off the posterior tibial artery. Flap coverage extended to include defects of the lower one third of the leg (n = 47) as well as the ankle, heel and foot (n = 4). Bony stabilisation was performed with a tibial intramedullary locking nail in 30 out of 53 fractures; mean time to bony union was 5.9 months. Mean operating time was 1.7 hours and mean hospital stay was 25 days (range 8-98 days). Mean follow-up time was 13 months (maximum 5 years). Twenty-five flaps were used to cover Gustilo IIIb fractures primarily, with a 20% complication rate in this group. The flaps were used preferentially in males and in older females. The overall flap failure rate was 7.6%, with a further 10.6% of flaps suffering from tip necrosis and haematoma formation. Contributory factors to suboptimal healing included the presence of peripheral vascular disease and heavy smoking.
Adolescent↗
The distally based islanded dorsal foot flap.
A modification of the distally based first web space flap on the dorsum of the foot is described. This flap, originally described by Earley and Milner, has been completely islanded on its blood supply and used to resurface defects following release of post-burn hyperextension contractures of the toes. Our experience with 14 consecutive flaps is presented. Partial necrosis occurred in three flaps, one leading to slight residual contracture. We have found this flap reliable and easy to raise, and the donor site morbidity is minimal.
Burns↗
The pulsed tuneable dye laser as an aid in the management of postburn scarring.
Permanent erythematous scarring following burns is a common problem which may be disfiguring and distressing for the patient. In this case the pulsed tuneable dye laser (585 nm) was used to treat the areas of scarring and also used prophylactically on an active scar.
Adult↗
Epithelioid sarcoma masquerading as Dupuytren's disease.
Epithelioid sarcoma is a rare and deceptive lesion, often confused both clinically and on histopathological examination with other malignant processes. The surgical course of two patients with initial diagnoses of Dupuytren's disease is described. Early biopsy of all unusual fibrotic lesions on the palm is recommended. An aggressive surgical approach to confirmed malignancy is mandatory.
Adult↗
An adipofascial turnover flap for soft tissue cover around the clavicle.
Skin defects overlying a clavicular fracture are uncommon. Soft tissue cover is essential to avoid osteomyelitis and non-union. We present two cases of exposed fractures of the middle third of clavicle following osteosynthesis. Soft tissue cover was provided by an adipofascial turnover flap based on the inferior edge of the defect. The flap was raised with considerable ease and its vascular supply was reliable. There was minimal donor site morbidity and the aesthetic outcome of the reconstructions was excellent.
Adult↗
Treatment of nevi aranei with the pulsed tunable dye laser at 585 nm.
One hundred children aged < or = 12 years with spider nevi of the face have been treated with the SPTL-1 laser. The laser emits pulsed light at a wavelength of 585 nm, with a pulse duration of 450 microseconds. The series included 37 boys and 63 girls. Patients whose spider nevi were previously treated with other methods were excluded. In 97 cases the lesions were completely removed, but 29% of them required more than one treatment session. Six months later, two patients had mild recurrence of the nevi, which required further treatment. No signs of scarring or of textural or permanent pigmentary changes have been noted.
Child↗
Does the pulsed tunable dye laser have a role in the management of infantile hemangiomas? Observations based on 3 years' experience.
Over a 3-year period, 50 patients with strawberry hemangiomas and 7 patients with postinvolutional redness or telangiectasia were treated with the SPTL-1 laser (Candela Corporation, Wayland, Mass.). The SPTL-1 laser emits pulsed light at a wavelength of 585 nm with a pulse duration of 450 ms. Lesions with a superficial red component were treated even if they had a significant subcutaneous component; however, wholly subcutaneous lesions were excluded. The series included 42 female patients aged between 1 and 72 months (mean 14 months) and 8 male patients aged between 3 and 12 months (mean 7 months). The mean number of treatments administered was 3.8 (range 1 to 8), and the average number of pulses per patient was 55 (range 2 to 350). This series also included 7 patients (6 female and 1 male) with postinvolutional redness or telangiectasia with a mean age of 12 years (range 2 to 23 years). They received an average of 3.4 treatments per patient (range 2 to 8) with an average of 35 pulses per treatment session (range 3 to 150). In this study group, life-threatening complications secondary to the hemangioma were rare in that only one patient suffered from an airway obstruction requiring a tracheostomy and three patients suffered from complete visual occlusion. A significant improvement in color was achieved in 30 patients (53 percent), but there was no appreciable reduction in bulk in any of the lesions despite repeated exposure to laser light.
Child, Preschool↗
Clinical experience in the treatment of the "red nose" using the flashlamp-pumped pulsed dye laser (585 nm).
The first 30 patients with telangiectasia of the nose that presented to our unit were treated with the SPTL-1 laser. The SPTL-1 laser emits pulsed light at a wavelength of 585 nm with a pulse duration of 450 microseconds. Patients with telangiectasia and diffuse spider nevi were included; patients with small spider nevi were excluded. The series included 23 females between 23 and 56 years (mean 37 years) and 7 male patients between 21 and 54 years (mean 42 years). A significant improvement was achieved in 24 patients (80%) and, on the whole, patient satisfaction was high, but more than one treatment session was required (mean of three treatment sessions per patient). At the 6-month follow-up there was some recurrence in two patients for which they required more treatment. No sign of scarring was noted in any patient, but some hypopigmentation occurred over the bridge of the nose of one patient.
Adult↗
A two-year review of pain control during laser therapy using the flashlamp pulsed dye laser.
Laser therapy is now accepted as the treatment of choice for port wine stains. Patient reaction to laser light exposure and methods used to control pain during 1357 treatment sessions for 350 medium to large port wine stains using the SPTL-1 laser (Candela Laser Corporation) are reported. In the majority of cases (86%) it was necessary to use either general anaesthesia or some other form of local pain control.
Adolescent↗
Experience with the adipofascial turn-over flap.
Use of the adipofascial turn-over flap has been extended to cover such complex wounds of the extremities as defects over exposed joints and fracture sites. Experience with 10 consecutive cases and long-term follow-up confirmed that this flap is easy to plan and quick to raise, with minimum donor site morbidity and high success rate.
Adipose Tissue↗
Clinical experience with the PLDL-1 (Pigmented Lesion Dye Laser) in the treatment of pigmented birthmarks: a preliminary report.
Twenty patients aged between 2 years and 17 years (mean 9 years) with pigmented birthmarks, mainly of the head and neck, were treated with the PLDL-1 laser (Pigmented Lesion Dye Laser--Candela Corporation, Wayland, Massachusetts, USA) which emits light with a wavelength of 510 nanometers and a pulse duration of 300 +/- 50 nano-seconds. Nine patients (45%) showed excellent results after a test-patch was performed. Two patients (10%) showed some lightening of colour after initial test-patch. Six patients (30%) showed no improvement and 3 patients (15%) showed some hyperpigmentation at the test-patch sites which had not disappeared at 6 months follow-up. There was no change in the clinical behaviour at 6 months follow-up and no evidence of scarring was encountered.
Adolescent↗