Biomedical subjects
Publications and source records attributed to B C Sommerlad.
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.
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We have undertaken the design and testing of a system for making measurements of velopharyngeal function from lateral videofluoroscopic images based upon standard equipment found in any cleft clinic. The uncertainties in the measurements have been found to be acceptably low and, in conjunction with other measurement techniques, the system has made a valuable contribution to the assessment of velopharyngeal function. Additional measurements using this system are presently being developed.
The results of clinical and radiographic assessment of palate re-repair (by a single operator) in 32 patients are presented. This has shown that radical muscle correction as a secondary procedure (following limited or no muscle correction in primary repair) has produced measurable improvement in velar function and should be considered as the first option in many patients with velopharyngeal incompetence. The results also support the concept of muscle dissection and retropositioning in primary cleft palate repair.
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This study examines the premise that, following severe injuries to the dorsum of the hand, reconstruction of the long extensor tendons of the fingers may not be necessary for many patients. The long-term hand function of nine patients who sustained such injuries and had operations to provide skin cover only, has been comprehensively assessed using objective tests and a detailed questionnaire. It is concluded that provision of skin cover followed by intensive early mobilisation may be an adequate management of these injuries.
A method for assessing hand function following loss of the long finger extensors in Zones 6 and 7 (Verdan, 1968) is described. It relies on a number of mechanical and functional tests combined with a detailed questionnaire.
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Free transfer of two undamaged fingers from a non-replantable left arm to a mutilated right hand in a 16-month-old boy is reported.
Two modifications to the classic design of the rhomboid flap are described. Firstly, no attempt is made to engineer a rhomboid defect and, secondly, the flap is made smaller than the defect to be reconstructed. The advantages of these modifications are discussed and their application in 175 reconstructions is reported.
A number of well-established pedicled flaps, including for example the delto-pectoral and pectoralis major flaps, are used in reconstructive work following excision of head and neck tumours. The most commonly encountered tumours of the head and neck spread predominantly via the lymphatic system and during the time between the insetting of a flap and the division of its pedicle some micro-lymphatic continuity of flow must develop from the site of insertion down the flap to its pedicle. This may form a route for spread of tumour when the primary lesion has been inadequately excised. A case report is presented.
To achieve the best results in cleft palate repair it is necessary to be aware of the normal anatomy. In a series of cadaver dissections, the levator palati muscle was found to occupy the intermediate 40% of the length of the soft palate. This normal distribution should be the aim at cleft palate repair. Observation of the oral surface of the palate during production of the sound "Ah" reveals palatal dimpling. This has been observed in many normal and cleft palate subjects. The dimpling has been reproduced in cadavers by levator palati traction and been found on dissection and serial histological section to correspond to the levator insertion.
The morphological relationship between the musculus uvulae and levator palati muscles and their importance in velopharyngeal closure was studied in cadavers by simulation of levator action, palate serial section and dissection, and in various subjects by nerve stimulation and blockade. These studies support the cardinal importance of the levator muscles in velopharyngeal closure. The significance of musculus uvulae activity is less clear. While lesser palatine nerve stimulation evoked a response from the musculus uvulae, a nerve block produced no detrimental effect on speech or nasendoscopic appearance in normal subjects.
A method of reconstruction of the zygoma, temporo-mandibular joint and hemi-mandible utilising a segment of the outer table of the sternum, sterno-costal joint and rib vascularised by an ipsilateral pectoralis major muscle flap is described. The mobility of an isolated sterno-coastal joint is compared with movements of the temporo-mandibular joint.
In the treatment of severely degloved hands, an innervated flap provides the best reconstruction in cases where revascularisation is impossible. An innervated flap using the cutaneous territory of the supraclavicular nerves in presented and an illustrative case presented. The anatomy is described and the flap compared with other distant flaps. The principal advantages of this flap are the large amount of available skin and the presence of three or more suitable donor nerves.
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A pilot study of perichondrial grafting in rheumatoid metacarpophalangeal joints is presented. Eighteen separate joints have been grafted with a mean follow-up time of eighteen months. Results and indications for this method of joint reconstruction in rheumatoid patients are discussed.