Metachronous inflammatory pseudotumor ("myofibroblastoma").
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Female↗
Biomedical subjects
C D Tzarnas
Publications and source records attributed to C D Tzarnas.
The sternalis muscle: a normal finding encountered during breast surgery.
We report a case of mastectomy and immediate reconstruction in which the sternalis muscle, a normal anatomic variant, was encountered. Most surgeons we surveyed are not familiar with this variant.
Breast↗
Intraoperative intermittent lower-extremity massage for the surgeon with proven medical benefit.
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Counterpulsation↗
Management of vascular prosthetic infections: results of long-term follow-up.
An infected vascular prosthesis is a risk to life and limb, with many of the infections insidious in nature. A retrospective analysis with a minimum 49-month follow-up identified 18 patients (mean age, 61.3 years) with culture-positive infections and exposed prosthetic grafts in the infrainguinal region. All patients were managed with muscle flaps. Mean follow-up was 59 months, with a long-term salvage of infected prosthetic grafts in 16 of 18 patients; there was no loss of life or limb. Early, aggressive reconstruction of infected prosthetic grafts using a muscle flap technique saves graft, leg, and patient.
Adult↗
Simple sutureless skin graft fixation.
A simple method to enhance split-thickness skin graft immobilization without sutures is described. The method uses collodion to secure a mesh gauze to the adjacent skin preventing skin graft dislodgment. The technique is rapid and efficient.
Collodion↗
The effects of hyaluronidase on the efficacy and on the pain of administration of 1% lidocaine.
Despite current clinical practice, there is no objective evidence to demonstrate the efficacy or pain on injection when hyaluronidase is added to lidocaine as an anesthetic combination for local anesthesia. To evaluate the usefulness of hyaluronidase added to lidocaine in affecting pain on injection and effectiveness of local anesthesia, a prospective, randomized, double blind study comparing 1% lidocaine preparations with and without hyaluronidase (15 U/cc) was conducted. A paired experiment was done with each subject receiving both treatments. Solutions of these local anesthetics were prepared. A 0.5-cc intradermal injection of each was administered to the dorsum of the nondominant hand of 25 volunteers. After showing study participants a standard pain with a peripheral nerve stimulator, pain of anesthetic infiltration was rated by the subject using a visual analog scale. The amount of tissue deformation on injection was assessed. The area of anesthetized skin surrounding each injection was measured at 1/2, 1, 2 1/2, 4 1/2, 8, and 12 minutes after injection. The area of anesthesia achieved by 1% lidocaine infiltration can be significantly enhanced by the addition of hyaluronidase at a concentration of 15 U/cc (p = 0.0003). This raises the pH of the anesthetic to a slightly more physiologic level (6.33 versus 6.20) and makes the pH closer to the pK of the lidocaine. In addition, the hyaluronidase additive significantly decreases the amount of tissue distortion (p < 0.0001) without decreasing the efficacy of anesthetic action (p = 0.01). However, adding hyaluronidase to 1% lidocaine significantly increased the pain on injection (p = 0.0002). The injections of small amounts of hyaluronidase-containing solutions in this experiment did not produce any visible effects at 5 to 7 days after injection; however, the effect of hyaluronidase upon wound healing was not studied.
Adolescent↗
A unique fasciocutaneous flap for posterior urethral repair.
The anatomic restrictions produced by male to female gender reassignment surgery necessitated a new surgical solution to treat a traumatic posterior urethral stricture. Aesthetic considerations were of paramount importance to the patient. A unique use of the pudendal thigh fasciocutaneous flap is presented which satisfied the reconstructive needs of well-vascularized tissue for reconstruction of the posterior urethral segment, and addressed the patient's aesthetic concerns. Correction of the posterior urethral stricture was successful, and the flap donor site inconspicuous. This procedure has not been described previously for urethral reconstruction and is an additional regional source of vascularized tissue for urethral repair.
Adult↗
Uremic tumoral calcinosis: acute hand presentations mimicking infection.
Tumoral calcinosis is an uncommon condition of the hand characterized by deposition of calcium salts in the soft tissues of the extremities. The condition may be hereditary or acquired. Acquired tumoral calcinosis, also called tumoral calcification, is a rare manifestation of renal osteodystrophy due to derangement in divalent ion metabolism. Two chronic dialysis patients with tumoral calcification of the hand are presented. These cases are unusual in their rapid onset of presentation, mimicking acute infection. Prompt recognition of the condition may allow early nonsurgical intervention to preserve function.
Calcinosis↗
Carpal tunnel release without a tourniquet.
Release of the transverse carpal ligament can be performed safely under local anesthesia. The addition of epinephrine to the local anesthetic will cause sufficient vasoconstriction to maintain a dry field without the need of a tourniquet. This allows the procedure to be performed without regard to tourniquet pain. It has been our technique of choice in patients with functioning hemodialysis fistulae. The procedure was performed in 21 wrists to assess its safety. This approach was found to be a safe, effective, and efficient alternative to the standard tourniquet-dependent procedure.
Adult↗
Transverse rectus abdominis musculocutaneous flaps for lightweights: is a pinch enough?
Recent publicity concerning silicone breast implants has fostered patient interest in autogenous breast reconstruction after mastectomy. The transverse rectus abdominus musculocutaneous flap has become the standard for autogenous breast reconstruction. However, very thin patients have not been considered ideal candidates for this procedure due to the paucity of abdominal fat. The use of this procedure in these very thin patients has not been addressed. In patients whose abdominal skin fold thickness was 1 cm or less, we found the procedure to be reliable. However, maximizing the amount of transferred tissue to achieve symmetry necessitates a bipedicled flap. Abdominal fascial closure in these very thin patients is more difficult. Although these patients may not appear to be ideal candidates for the transverse rectus abdominis musculocutaneous flap at first glance, the results have been gratifying and this method of reconstruction is a reliable option.
Abdomen↗
Simultaneous carotid endarterectomy and excision of ipsilateral branchial cleft fistula--a case report.
Branchial cleft sinuses are congenital anomalies that usually present in childhood or early adulthood. It is uncommon that such a sinus will remain asymptomatic to the sixth decade of life. This case describes the presence of a second branchial cleft sinus in the setting of carotid artery disease, where both were treated surgically simultaneously without complication.
Branchioma↗