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Biomedical subjects

B Schlechter

Publications and source records attributed to B Schlechter.

7 recordsLinked to original sources
PubMed1997

Lower-limb salvage in a patient with recalcitrant venous ulcerations.

The authors report the salvage of a lower limb with recalcitrant venous stasis ulcers by "sequential" free flaps in a patient with co-existing chronic venous insufficiency and arterial occlusive disease. This presentation is interesting for inclusion of the following: (1) treatment of a recalcitrant venous ulcer by the combination of free-tissue transfer and valvular transplantation; (2) thrombosis of the free flap pedicle at an indeterminate time postoperatively without flap loss or leg ischemia; and (3) performance of a second free flap to the peroneal artery-only, to a one-vessel leg with an excellent clinical outcome at long-term follow-up.

Abdominal Muscles↗
PubMed1995

Reconstruction of posterior trunk defects.

A high rate of success can be expected in the management of posterior trunk defects with muscle flaps. The surgeon has to adhere closely to the basic reconstructive principles of adequate debridement of all necrotic or devitalized tissues; management of infection with local wound care and appropriate antibiotic therapy; and coverage with well-vascularized tissue to obliterate any residual dead space and to cover bone grafts, orthopedic hardware, and vital structures such as the dura and spinal cord. Flap selection is also of paramount importance for success, and only muscles with appropriate arc of rotation, vascularity (vascular pedicles outside the field of radiation injury, or intact vascularity following previous procedures) and bulk should be used. Adequate flap mobilization to obtain a tension-free closure and judicious use of drains and perioperative antibiotic agents are essential. Occasionally, microvascular free-tissue transfer may be necessary if local flaps are unavailable. The complications of flap reconstruction include partial flap loss, persistent dead space for lack of adequate muscle bulk, and persistent infection. Debridement and re-advancement of the flap is adequate in most cases. If there is significant or total flap loss, however, a second flap reconstruction is often necessary to obliterate the dead space and protect vital structures.

Back↗
PubMed1994

Intraabdominal mesh prosthesis in a canine model.

Laparoscopic inguinal hernia repair is still at an investigational stage, and varying methods have been described in the literature. These include the transabdominal preperitoneal approach, the intraperitoneal onlay mesh procedure, and the extraperitoneal approach. This study evaluates the differences in macroscopic adhesion formation between transabdominal preperitoneal mesh placement, intraperitoneal onlay mesh procedures, and extraperitoneal mesh placement in a canine model. The determination of microscopic tissue ingrowth and mesh incorporation was not a goal of this study. Operative sites utilizing mesh in a reperitonealized fashion resulted in less adhesion formation than did those sites where mesh was placed in an intraperitoneal manner using the onlay technique. Mesh placed in the extraperitoneal space without entering the peritoneal cavity did not exhibit any adhesion formation. Results favor the reperitonealization of intraabdominal mesh or mesh placement by an extraperitoneal approach.

Animals↗
PubMed1994

A comparison of different suture techniques for microvascular anastomosis.

Of the various techniques known, simple interrupted sutures remain the gold standard in the microanastomosis of vessels. Tying many knots, however, is time consuming. This may be of more significance with tissue such as the jejunum, which is significantly effected by ischemia time, or when several vessels are to be anastomosed. In this study, 60 femoral arteries of rabbits were divided into three equal groups. The arteries were then divided and repaired using simple interrupted, simple continuous, and continuous locked sutures. Application of the Bonferroni t-test revealed that both groups of arteries repaired using continuous sutures exhibited a statistically significant (p < 0.02) reduction in anastomosis time (50%) compared with interrupted suture techniques. However, there also was a 45% incidence of reduction in flow (9 of 21 anastomoses) when the simple running suture technique was utilized, giving the running locked suture unquestionable superiority.

Anastomosis, Surgical↗
PubMed1991

Tract formation following percutaneous endoscopic gastrostomy in an animal model.

Complications of percutaneous endoscopic gastrostomy (PEG) have often been related to the application of excessive traction to the gastrostomy tube in an attempt to achieve immediate juxtaposition of the gastric and abdominal walls. Recent clinical reviews have suggested that complication rates can be reduced by avoiding such traction and leaving a longer tract between these structures. Laboratory evaluation of tract development has been lacking. The present study was designed to evaluate tract formation in an animal model. Eight mongrel dogs underwent PEG placement using silastic (n = 4) or latex (n = 4) catheters. Two animals from each group were subsequently sacrificed at 1 week and the remaining animals, at 2 weeks. In each animal, 6 cm catheter length was left between the gastric and the abdominal walls. This distance was assured by crossbar and suture fixation of the catheter at the skin entry site. Complete tract formation was evident in all animals at the time they were sacrificed, with no significant gross or histologic differences being noted between the silastic and the latex groups. Increased collagen deposition was noted at 2 weeks in comparison with that observed at 1 week. In an additional three animals, the same procedure was performed, but the catheter was not secured to the abdominal wall at the site of skin penetration. In these animals, tract formation was incomplete as late as at 2 weeks, but there were no associated complications. We conclude that early PEG tract formation is not dependent on the immediate proximity of the gastric and abdominal walls. The type of catheter used does not dictate the time course of early tract development.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed1990

Pseudomeningocele as a complication of teratoma resection and aseptic meningitis following craniofacial reconstruction: a case report.

This is a report of two extremely unusual complications of craniofacial surgery on a single patient. A 14-year-old female underwent resection of a recurrent teratoma four times within the first 9 years of life. This left her with two large cranial cavities in the left temple and posterior to the orbit communicating with the subarachnoid space constituting a pseudomeningocele and pulsatile mass in the left temple--an unusual complication. Following resection of the pseudoepithelial cavity linings, the spaces were filled with a split temporalis muscle. Two weeks following surgery, she developed signs and symptoms of meningitis with negative cultures from the drain sites and lumbar puncture. Six days following an unsuccessful attempt to treat her with wide spectrum antibiotics, she was treated with dexamethasone. As a result, there was a dramatic disappearance of signs and symptoms in less than 36 hours; she has not experienced any recurrence since. We feel that this aseptic meningitis was the result of cerebrospinal fluid exposure to muscle--a rare, yet, previously reported complication. The details of the case history and discussion of complications and the way in which they can be avoided, are subjects of this report.

Adolescent↗