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A Thoma

Publications and source records attributed to A Thoma.

At least 19 recordsLinked to original sources
PubMed2001

Decompression of the common peroneal nerve: experience with 20 consecutive cases.

A retrospective review of 20 patients with common peroneal nerve palsy treated with decompression between 1986 and 1997 was undertaken. Subjects were evaluated preoperatively and postoperatively by electromyography, nerve conduction, and clinical measures. The mean interval between the onset of symptoms to surgery (operative delay) was 15.9 months. The mean postoperative follow-up was 32.2 months with a minimum follow-up of 1 year. Decompression was performed at the level of the fibular neck and slightly distally at the tendinous origin of the peroneus longus using a standard approach to release tight fascial structures or scar tissue. External neurolysis was performed using the operating microscope in two cases for which scarring of the nerve was identified intraoperatively. Postoperatively, 19 of 20 patients showed improvement in ankle dorsiflexion as assessed by the Medical Research Council scale. Electromyographic examination was useful in the preoperative evaluation and selection of patients for decompression surgery. In conclusion, decompression even after a 1-year delay may offer benefit and suggest early intervention in patients with a severe lesion.

Decompression, Surgical↗
PubMed2001

Anterior intramuscular transposition with ulnar nerve decompression at the elbow.

The effectiveness of decompression and anterior intramuscular transposition of the ulnar nerve for treatment of severe cubital tunnel syndrome was evaluated. A consecutive series of 39 anterior intramuscular transpositions were reviewed. One surgeon performed the transpositions between 1993 and 1997 in 34 patients who presented with clinically severe cubital tunnel syndrome. Clinical outcome and satisfaction with surgery were assessed. The results showed early clinical improvement of 77% of patients (mean followup, 3.34 months). With repeated assessments later, the same group of patients had clinical improvement of 62% (mean followup, 30.9 months). Patients younger than 50 years, individuals who underwent external neurolysis, or patients who had a previously failed subcutaneous transposition had fewer satisfactory results.

Cubital Tunnel Syndrome↗
PubMed1999

Microsurgical reconstruction of the through-and-through defect in head and neck cancer: is it worth it?

As health resources diminish, there are compelling reasons to utilize health dollars in a fiscally responsible manner. The reconstruction of complex oromandibular defects involving mucosa, bone, and skin coverage poses one of the greatest challenges in microsurgery of the head and neck. The cancer patient who requires a through-and-through resection and microsurgical reconstruction usually has a poor prognosis. In this study, the authors examine whether this type of surgery is worthwhile in terms of cost, functional outcome, and patient satisfaction. Of 16 cases of through-and-through oromandibular reconstruction performed, the survival outcome of ten (n = 10) advanced cases requiring immediate oromandibular reconstruction (7 radial forearm flaps; 3 scapular flaps) is presented. Six cases were considered cured and required delayed reconstruction. Seven of the 10 patients died within 39 months postoperatively, while three survived up to 68 months postoperatively. The combined experience of these ten patients was examined using the Kaplan-Meier (product-limit) estimator of the survival curve. Results show that of the seven patients who died of disease, five did so within the first postoperative year. More important, among those five patients who survived for more than one postoperative year, three were still alive up to 68 months, representing a combined total of over 15 postoperative years. The probability of long-term survival is good in through-and-through oromandibular cancer patients who can survive to 1 year postoperatively, and it is proposed that microsurgical reconstruction, albeit costly, remains a worthwhile procedure,

Aged↗
PubMed1999

Oromandibular reconstruction with the radial-forearm osteocutaneous flap: experience with 60 consecutive cases.

One of the more difficult problems in reconstructive surgery of the head and neck is replacement of bone and soft tissue lost because of injury, osteomyelitis, or malignancy. The radial-forearm osteocutaneous flap is an accepted choice for oromandibular reconstruction. This study was undertaken to review one center's experience with 60 consecutive cases of oromandibular reconstruction with the radial-forearm osteocutaneous flap. Records of the 38 men and 22 women (mean age, 60 years; range, 26 to 86 years) were reviewed for tumor location, defect and bone length, flap failure rate, recipient- and donor-site complications, length of surgery, and hospital stay. Cancer resection was the reason for 97 percent of reconstructions; 33 percent of flaps were used to reconstruct a lateral defect of the mandible, 40 percent a lateral-central defect, and 27 percent a lateral-central-lateral defect. Mean skin flap size was 55 cm2 (range, 15 to 117 cm2) and mean bone length, 9.4 cm (range, 5 to 14 cm). The microvascular success rate was 98.3 percent. Complications included fracture of the donor radius (15 percent), nonunion of the mandible (5 percent), and hematoma (8.3 percent). These results are comparable to results reported in the literature with other radial forearm flaps. The free radial osteocutaneous flap is a safe and reliable choice for mandibular reconstruction. It offers sufficient bone to reconstruct large defects and can provide adequate pedicle length for vessel anastomosis to the contralateral side of the neck. The above attributes make the radial forearm osteocutaneous flap one of the "first line" flap choices for oromandibular reconstruction.

Carcinoma, Squamous Cell↗
PubMed1997

Preservation of denervated muscle by sensory protection in rats.

The goal of this study was to determine whether sensory motor nerve crossover could alter post-denervation atrophy of skeletal muscle. Sixty adult Lewis rats were divided into three groups: 1) unilateral transection of the tibial nerve alone; 2) unilateral transection of the tibial nerve with immediate repair; and 3) unilateral tibial and sural nerve transections with repair of the proximal sural nerve (sensory) to the distal tibial nerve (motor). The unoperated hind legs acted as positive controls. At 1 and 2 months postoperatively, posterior compartment musculature was harvested, weighed, then fixed and stained for histologic analysis. One month postoperatively, mean muscle weight in Group 1 animals (transection alone) was 23.0 +/- 2.6 percent of the control side; for Group 2 animals (motor-motor repair) was 40.9 +/- 42 percent; and for the sensory-protected Group 3 animals (sensory-motor repair) was 26.7 +/- 2.8 percent of controls (n = 15 per group). Two months postoperatively, the mean weights were 14.5 +/- 0.9 percent, 58.8 +/- 7.3 percent, and 21.1 +/- 3.1 percent of controls for Groups 1, 2, and 3, respectively (n = 5 per group). Differences between groups were statistically significant. Histologic analysis of Group 1 specimens revealed generalized atrophy of all muscle fibers. In Group 2, specimens showed evidence of reinnervation and less atrophy. Group 3 specimens demonstrated an atrophic pattern with islands of non-atrophic fibers scattered throughout. Sensory protection was thus shown to have significant effect on post-denervation atrophy in rat skeletal muscle.

Animals↗
PubMed1995

The fate of the osteotomized free radial forearm osteocutaneous flap in mandible reconstruction.

The radial forearm osteocutaneous free flap has become a standard method of mandible reconstruction. In order to improve the contour of the reconstructed jaw in large resections, especially the anterior defect, the radial forearm bone graft needs to be osteotomized. The bone graft is nourished by small branches of the radial artery via the fascial connections between the skin flap and bone. The effect of the osteotomy, fixation devices, and the angulation of the bone segment on bone viability and eventual bone healing is not known. Forty-two radial forearm osteocutaneous flaps were used for composite mandible reconstruction. In 25 patients, the bone graft required osteotomy to achieve contour, of which 16 required single osteotomy and nine required double osteotomy. In a remaining 17 cases, no osteotomy was performed. Only those patients who had at least a 1-year follow-up were included in this study. The proportion of patients who achieved bone union was similar for both groups (i.e. osteotomy vs. nonosteotomy). Performing osteotomies on the segment of the radius in free osteocutaneous transfers is safe, and it allows for more flexibility in reconstruction, to achieve a natural-appearing jaw.

Adult↗
PubMed1994

Surgical patterns of venous drainage of the free forearm flap in head and neck reconstruction.

A retrospective review of 40 consecutive free forearm flaps used in head and neck reconstruction in our Head and Neck Service identified five different patterns of venous drainage. In type 1, the cephalic vein and two venae comitantes join into a larger median cubital vein, which itself splits into two sizable branches (n = 8, two anastomoses). In type 2, a median cubital vein drains both the cephalic vein and the two venae comitantes (n = 17, single anastomosis). In type 3, the cephalic vein and the confluence of two venae comitantes are drained separately (n = 7, two anastomoses). In type 4, the cephalic vein and each of two venae comitantes are anastomosed separately (n = 2, three separate anastomoses). In type 5, the cephalic vein and the larger of the two venae comitantes are drained separately (n = 6, two anastomoses). Understanding these possible venous drainage patterns substantially expedites the raising of the free forearm flap. The selection of patterns 1 and 2, when possible, with the large-caliber veins ensures the safety of the flap. Long vascular pedicles permit anastomoses to contralateral neck recipient vessels, obviating vein grafts, and permit safe full head and neck mobility.

Anastomosis, Surgical↗
PubMed1993

Microvascular treatment of impotence.

Occlusion and/or stenosis of arteries supplying the penis was the cause of erectile impotence in 11 patients. They were chosen from 124 patients who were assessed by a multidisciplinary team for impotence. Indirect revascularization of the corpora cavernosa was performed by anastomosing the inferior epigastric artery to the deep dorsal penile vein. This arterialized vein was, in turn, anastomosed side to side to one of the corpora cavernosa. In seven patients the anastomosis remained patent. There was one documented thrombosis. Three patients were unavailable for Doppler examination but are known to have achieved erection. The indirect revascularization of the corpora cavernosa appears to be an acceptable surgical treatment of vasculogenic impotence.

Adult↗
PubMed1993

Perichondrial arthroplasty in a canine elbow model: comparison of vascularized and nonvascularized techniques.

The purpose of this study was to use a canine model to compare the ability of vascularized and nonvascularized perichondrial grafts to resurface an experimental joint defect. In five adult mongrel dogs, a 3 x 2 cm segment of perichondrium, subtended by the intercostal-internal mammary vessels, was harvested and transplanted to a surgically created defect on the ulnar condyle of the humerus. A similar defect in the opposite elbow was repaired with a 3 x 2 cm standard perichondrial graft. Five untreated dogs acted as normal controls. The dogs were allowed to mobilize freely for a period of 6 months. At that time, angiography demonstrated that all microvascular anastomoses were patent. There was no statistical difference in the range of motion of the two elbows, in the radiographic appearance, or in bone density of the two groups of joints. Histologic assessment demonstrated that the vascularized perichondrium formed an articular cartilage with an average thickness of 21.8 microns as compared with 38.5 microns for the nonvascularized perichondrium (p < 0.05). The cartilage in both grafts was morphologically hyaline in type. There were degenerative changes in the grafts with partial separation of the graft from the underlying bone and formation of surface clefts or pits, villous projections, and synovial proliferation. Degenerative changes also were observed on the articular surface opposite the grafted humeral condyle. In two animals the grafts displaced from the recipient condyle, which instead became resurfaced by greater amounts of hyaline-type cartilage with lesser degrees of degeneration and subarticular fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1992

The superficial ulnar artery "trap" and the free forearm flap.

A superficial ulnar artery identified during the elevation of a free forearm flap is reported. This is the second case appearing in the English literature. The free forearm flap is increasingly popular among plastic surgeons, and it is therefore imperative that this anomaly be well recognized because inadvertent injury of this anomalous artery may devascularize the hand. In cadaver dissections, the incidence of this anomaly has been reported to be 3.1%. This variation is probably encountered in clinical practice more commonly, but it is not recognized. Identification of this anomalous artery is facilitated by elevating but not exsanguinating the forearm prior to harvesting the flap.

Arteries↗
PubMed1992

[Vascular complications in reconstructive surgery of the foot].

Even when we assess accurately the preoperative vascular damage of the blood vessel we intend to use for reconstruction, difficulties may arise during operation which cannot be resolved by routine methods. Microvascular surgery is an important part of many modern reconstruction procedures which can be used during reconstruction of the extremity. As an example the authors describe injuries of the left foot involving loos in a 41-year-old patient who was knocked down by a taxi. The defect denuded the bone and loss of soft tissues of the heel called for free transfer of a vascularized flap. During operation venous thrombosis and subsequently arterial thrombosis developed. The use of an interposed vein helped to ensure a sufficient blood supply to the transferred tissue. The left foot healed well.

Foot↗
PubMed1991

The free medial scapular osteofasciocutaneous flap for head and neck reconstruction.

A modification of the scapular free flap has been developed using the medial ridge of the scapula. This variation preserves the advantages of the previously described lateral scapular flap, providing abundant hairless skin and soft tissue, adequate bone for mandibular reconstruction, and a primarily closed asymptomatic and inconspicuous donor site. It adds the advantage of a longer vascular pedicle and enhanced versatility because it is independent of the parascapular artery. Furthermore, it eliminates the disadvantage of rotator cuff muscle weakness associated with the lateral scapular flap. Multiple skin paddles subtended by the common circumflex cutaneous scapular artery and the interconnecting dorsal thoracic fascia were used in 4 of the 9 patients in our series. The ability of this somewhat thinner bone to incorporate biointegrable implants is unproven.

Adult↗