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Biomedical subjects

B M O'Brien

Publications and source records attributed to B M O'Brien.

At least 145 records · Page 8Linked to original sources
PubMed1979

Microlymphatic surgery in management of lymphoedema of the upper limb.

Microlymphatic surgery is a recent addition to the range of surgical procedures for lymphoedema. Lymphaticovenous anastomosis is the most direct approach to the basic cause of obstructive lymphoedema bypassing the obstruction of the axilla or groin. With increased experience the overall results have improved and, in selective cases, segmental reduction is carried out either at the same operation or at a later date. Microlymphatic surgery in conjunction with segmental reduction of the upper arm is aesthetically and functionally most acceptable. The most significant effect of lymphaticovenous anastomosis in relieving the lymphoedema of the upper limb is over the dorsum of the hand and lower forearm. At least two, or more if possible, lymphaticovenous anastomoses are required for effectiveness of the procedure. Besides subjective and objective improvement in the lymphoedema there is significant reduction in frequency of cellulitis following lymphaticovenous anastomoses. The technique, along with the results and follow-up over 5 years is presented.

Arm↗
PubMed1978

Microvascular surgery in degloving injuries: an experimental study.

Using an experimental model in the rabbit, the importance of direct cutaneous vessels for skin flap survival in skin avulsion injuries with, and without, a crushing injury has been investigated. The results are presented and possible application to the human situation discussed.

Animals↗
PubMed1978

Microvascular great toe transfer for congenital absence of the thumb.

Two cases of microvascular great toe transfer for congenital absence of the thumb in children are reported. A rationale and operative details are discussed. A long term follow up is needed, but at this stage the results are most encouraging. There has been no interference with gait.

Child, Preschool↗
PubMed1978

Simultaneous double toe transfer for severely disabled hands.

Two cases are presented in which a severely damaged hand was reconstructed by the simultaneous transfer of two toes using microvascular techniques. A two year evaluation of the functional result is made in both cases. Conventional reconstructive methods have little place in the reconstruction of these severe disabilities.

Adult↗
PubMed1978

Neurovascular free flaps from the foot for innervation of the hand.

Microneurovascular flaps from the first web space of the foot offer a solution to upgrade sensibility of the denervated hand. Based on the dorsalis pedis artery, it allows simple dissection and a large vessel for easy and safe anastomosis. Seven cases are presented in which combinations of the first web anatomy for a variety of denervation injuries were used. The technique is ideally suited in those cases where no areas of island flap tissue are available for transfer.

Adolescent↗
PubMed1978

The no-reflow phenomenon in experimental free flaps.

The no-reflow phenomenon was studied following reconstitution of blood flow by microvascular anastomosis in an ischemic and denervated free epigastric flap in the rabbit. Microscopic, histological, angiographic, and hematological studies demonstrated the progressive nature of this obstruction to the peripheral blood flow after increasing periods of ischemia. This obstruction reached a point of irreversibility after 12 hours of ischemia, leading to ultimate death of these flaps. These results are consistent with the hypothesis that an ischemia-induced no-reflow phenomenon is caused by cellular swelling, intravascular aggregation, and the leakage of intravascular fluid into the interstitial space. Similarities between these experimental findings and human observations are made. The clinical importance of early diagnosis and treatment of ischemic tissues is emphasized.

Animals↗
PubMed1978

The effects of the perfusion of various solutions on the no-reflow phenomenon in experimental free flaps.

The effects of solution perfusion in the free epigastric flap of the rabbit, after normothermic ischemic periods of 8 hours or 12 hours, have been examined by operative microscopic and histological methods. A smaller group of animals was also studied in which the perfusion was done before the ischemic insult. An ischemia-related obstruction to the peripheral blood flow occurred in the absence of stagnant ischemic blood in this model. Although the 3 perfusion fluids studied were shown to penetrate to all levels of a flap after such an ischemic period, none of them had a beneficial effect on skin survival. However, the solution containing mannitol did have a protective effect on fat survival. Analogies between these experimental findings and the clinical situation are made, and the importance of the early diagnosis and treatment of ischemia in a flap is emphasized.

Abdominal Muscles↗
PubMed1978

Experimental replacement of the cervical oesophagus with a free transverse colon autograft using microvascular anastomoses.

Microsurgical revascularization in the neck has improved the survival rate of free small-bowel grafts used to replace the cervical oesophagus. Colon vessels are larger than those in the jejunum, and even with naked-eye technique good results have been reported following free colon grafting of the oesophagus. The authors thought it might be possible to achieve even better results using microvascular anastomoses in the neck, and in this way replaced the cervical oesophagus in each of 15 dogs with a free transverse colon autotransplant. Four dogs died during operation and four within three days, two of the latter with graft necrosis. The next seven dogs survived eight days or more, and all their colon grafts were viable. Where patent arteries were demonstrated (three cases) the mucosa and myenteric plexuses of the graft survived. In all four dogs where the arteries were thrombosed or not demonstrated, the mucosa was absent, myenteric plexuses were absent in three, and one graft was grossly stenosed. Among these seven dogs there were three fistulae, one where graft arteries were patent and two where they were not; immediate anastomotic healing was not guaranteed by graft survival or arterial patency.

Animals↗
PubMed1978

The microsurgical revascularisation of resected segments of tibia in the dog.

A segment of tibia 4.5 centimetres long was removed from one hind limb of fifteen dogs. It was then replaced and the main vasculature was restored by a microsurgical technique. In eight controls the segment was replaced without such restoration. In two-thirds of the former cases the microvascular reconstruction was successful; the rate of infection was found to be reduced, bone union was guaranteed and the rate of union accelerated. Success or failure of the reconstruction was clearly demonstrated in five cases by early bone scanning using technetium-labelled polyphosphate.

Animals↗
PubMed1978

Clinical experiences in free flap transfer.

In this series of 62 free flap transfers, 48 (80%) have been successful. There have been a significant number of vascular complications, 39% of which the majority were arterial thrombosis. Fifty per cent of those which thrombosed were salvaged on exploration and revision of the vessels. The frequency of complications has diminished with experience but they remain significantly high. Free flap surgery demands considerable expertise in both donor site dissection and microvascular technique. Two surgeons with microvascular experience, each with adequate assistance, are preferred and ready availability of operating room is essential. Close postoperative observation and readiness to revise anastomoses are equally important. About 50% of failed free flap sites have been repaired by application of split skin grafts.

Adolescent↗