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Biomedical subjects

B M Achauer

Publications and source records attributed to B M Achauer.

At least 91 records · Page 5Linked to original sources
PubMed1984

Immediate vaginal reconstruction following resection for malignancy using the gluteal thigh flap.

Immediate flap closure of perineal defects following extirpative procedures for gynecologic malignancies is highly desirable. Advantages include more rapid healing, reduced infection rate, decreased nutritional demands, early rehabilitation, greater safety in radiated fields, and more functional results. The posterior thigh flap, deriving its blood supply from the inferior gluteal artery, was used in 7 patients (9 flaps) with excellent results. The flap has proven reliable and quite feasible at the time of resection. While most partial pelvic or vaginal defects can be reconstructed with a single flap, bilateral flaps are recommended for more extensive defects. The major postoperative problem has been discomfort while sitting and paresthesias along the distribution of the posterior cutaneous nerve. To avoid these problems, the flap should be rotated distal to the ischium and, in subtotal reconstruction, the nerve excluded.

Adult↗
PubMed1984

Lateral cervical advancement flaps for the correction of webbed-neck deformity.

In the webbed-neck deformity, a horizontal excess of cervical skin creates bilateral and often asymmetrical skin webs from the mastoid to the acromion. Hair extends laterally to the free edge on the posterior web surface, creating a wide nuchal hairline. A technique of correction is presented. Through an incision along or within the hairline, the glabrous anterior web surface is undermined with the platysma muscle into the anterior cervical triangle until posterosuperior traction will obliterate the web. The posterior hair-bearing web surface is also elevated, and an excess of scalp is excised anterior to the new hairline position determined by the surgeon. The anterior glabrous flap is advanced posteriorly to resurface the scalp defect and recreate a normal neck contour and symmetrical hairline. A Szymanowski triangle of scalp is excised to equalize wound margins creating two "lazy" Y incisions that join in the scalp midline on completion of the opposite neck web. All scars lie within or along the hairline or extend onto the posterolateral shoulder. The method allows precise control of bilateral neck contour and hairline position without intraoperative repositioning and avoids scars on the exposed anterolateral cervical surface. There has been no recurrence of the neck deformity after 2 years.

Child↗
PubMed1984

Augmentation of the atrophic mandible with a vascularized rib graft.

A patient with a 29-year history of denture wearing had her mandible augmented with a vascularized rib graft. The rib was contoured to fit the arch of the mandible and vascularized by means of the facial arteries to the intercostal vessels. The nutrient artery was not included in the vascularized bone graft. Cortical cancellous bone chips were packed around the rib to augment the buccal surface of the rib graft. Periosteal perfusion and vascularity of the transferred rib were well documented at 1 week, 1 month, and 6 months postoperatively by radionuclide scintigraphy. It is now 24 months after surgery and the patient began wearing a denture 2 months after the rib transfer. She underwent a split-thickness skin graft vestibuloplasty and floor-of-the-mouth lowering 12 months following the rib transfer with improvement in her denture-wearing capabilities, which has remained constant for 10 months. Vertical resorption of the graft at 3 months was 10 percent, at 6 months 15 percent, and it has stabilized at 25 percent.

Atrophy↗
PubMed1983

Gluteal thigh flap in reconstruction of complex pelvic wounds.

Nine flaps for reconstructing pelvic wounds were centered on the posterior portion of the thigh over the inferior gluteal artery and posterior cutaneous nerve of the thighs of seven patients. No flap necrosis occurred and all wounds healed (one hematoma and one partial wound separation). Three patients had radiation wounds and three had immediate reconstruction following tumor resection. This flap represents an important advance in pelvic reconstruction and should be considered the flap of choice for this area. Contributions to the procedure from this series include (1) use in vaginal reconstruction, (2) length of flap extended to the popliteal fossa, and (3) use of an air-fluidized bed for postoperative management.

Aged↗
PubMed1983

Microsurgical transfer of the great toe to the radius to provide prehension after partial avulsion of the hand.

Transfer of the great toe to the radius proved to be an effective means of gaining the function of grasp in a patient with an incomplete amputation of the hand in which all the digital flexor tendons had been avulsed. The remaining stump consisted of the carpal bones and fragments of the second, third, and fourth metacarpals. A long, oblique osteotomy of the first metatarsal was designed so that it would abut with the palmar face of the radius. Power was supplied to the great toe by the flexor carpi radialis and the brachioradialis tendons. Sensibility was supplied by the median nerve and circulation was furnished by the radial artery and the cephalic vein.

Adult↗
PubMed1983

A serious complication following medical-grade silicone injection of the face.

A serious complication following MDX4-4011 Dow-Corning silicone for injection to the face is reported. The patient developed inflammatory lesions 11 years after her last silicone injection for what was felt to be Weber-Christian disease. The patient also had a diagnosis of rheumatoid arthritis and a questionable history of mycoplasm infection. She eventually required excision of the right facial area with flap reconstruction. There is at least one other investigator who has had inflammatory complications following silicone injection to a patient with Weber-Christian disease. For these reasons, caution in using liquid silicone in patients who might have Weber-Christian disease is recommended.

Arthritis, Rheumatoid↗
PubMed1982

Face flambé.

Explore the source record for details and available documents.

Accidents↗
PubMed1982

Efforts to enhance survival of limb allografts by prior administration of whole blood in rats using a new survival end-point.

Injecting whole blood into the recipient before surgery can significantly prolong renal transplant survival in rats. Therefore, experiments were performed in rats to study the effects of prior administration of whole blood on the survival of limb allografts. Tests to quantitate survival of the allografts included monitoring the internal temperature of the leg, assaying serum creatine kinase levels, and testing for alloantibodies. Lewis recipients of (BN x LEW)F1 limb transplants that received 1 ml of BN or (BN x LEW)F1 whole blood before surgery had mean survival times that were longer compared with controls as measured by a 10 F change in temperature. In a test-retest experiment, decline of temperature proved to be a reliable quantitative determination of limb allograft survival since a difference of only 5.6% was observed in the mean number of days of graft survival between two separate groups of control Lewis recipients. Moreover, combined data demonstrated that control Lewis recipients of (BN x LEW)F1 limb allografts averaged 24.0 days of graft survival based on a 10 F decline in temperature with a 95% confidence interval of +/- 6.3 days. It is concluded that prior administration of whole blood can produce significant prolongation of survival in organ transplantation, but it is not as effective in enhancing survival of limb allografts. It is also concluded that internal temperature measurement of limb allografts is an easy, effective, and quantitative method of monitoring rejection.

Animals↗
PubMed1982

A comparison of hemostatic agents in microvascular surgery.

The hemostatic abilities of oxidized cellulose, gelatin powder, microfibrillar collagen, and expanded polytetrafluoroethylene cuffs were compared on anastomoses of the femoral vessels in rats. The intraoperative hemostatic time and patency were recorded. Vessels that were patent intraoperatively were examined at various intervals postoperatively to determine patency and to detect the development of abnormalities, and specimens for examination under a scanning electron microscope were obtained. Microfibrillar collagen was found to be superior in maintaining patency and in ease of use. The PTFE cuffs demonstrated the shortest hemostatic times, but they produced distortion of the vessels several weeks after surgery. The authors conclude that microfibrillar collagen is the best overall hemostatic agent and have continued to use it experimentally and clinically with no complications.

Animals↗
PubMed1981

Two cases of orbital dystopia: Tessier III cleft and craniofacial osteomas.

Two cases of orbital dystopia are reported. One was caused by a Tessier III cleft and was treated by cranio-facial osteotomies of three walls of the orbit, allowing the left to be moved upward. The second involved multiple craniofacial osteomas and was treated by extractional osteotomies of four walls of the orbit including a transverse split of the roof. These osteotomies were entirely extramucosal.

Adolescent↗
PubMed1980

Microvascular reconstruction of the mandible.

Five microvascular reconstructions of the mandible were performed in the past 2 years. One dorsalis pedis osteocutaneous flap was used to reconstruct the alveolar ridge and four groin osteocutaneous flaps were used for various defects of the mandible. Free microvascular bone grafts were found useful in previously irradiated fields, in anterior arch reconstruction, and in patients with massive soft tissue and bone loss.

Adult↗
PubMed1980

The myocutaneous flap: a versatile approach to major reconstructive problems.

Our experience with 50 myocutaneous flaps shows that the remarkable flexibility in design and execution of these flaps has opened up a new frontier in plastic and reconstructive surgery. The complication rate was 20 percent. Only one complication, partial flap necrosis, caused serious compromise of the reconstruction. Not only could the flaps be transposed in any direction locally, but they could be transferred to distant sites with microvascular anastomoses, and muscle function could be restored by incorporating nerve repairs into the reconstruction. Myocutaneous flaps permit us now to solve reconstructive problems that were heretofore unsolvable.

Adult↗
PubMed1980

Reconstruction of the burned nose.

Nasal reconstruction is one of the most important elements in rehabilitation of the patient suffering from the devastating deformities of full-thickness facial burns. When possible we use a single pedicle for complete nasal reconstruction. The forehead furnishes the best donor area. More distant donor sites are used if the forehead is not available. In lesser deformities, resurfacing with composite grafts or full-thickness skin grafts gives satisfactory results.

Aged↗
PubMed1979

Free microvascular flaps for defects of limbs, head, and neck.

Twenty-three free microvascular flaps were transferred during the period September 1975 to December 1978. These included skin flaps, osteocutaneous flaps, and flaps of omentum and jejunum. These flaps were used for a variety of conditions ranging from life-threatening bleeding from a tumor to facial contouring in congenital deformities. In selected patients a microvascular free flap has significant advantages over multi-staged conventional flaps.

Adult↗