Biomedical subjects
C J Eaton
Publications and source records attributed to C J Eaton.
Treatment of skin and soft-tissue loss of the thumb.
Many options exist to provide soft-tissue cover of the thumb. The choice of cover should be dictated by the defect itself: the location, size, and requirements for sensibility and durability. Within these boundaries, the choice of cover should be in accordance with the goals of any extremity reconstruction, permitting primary wound healing and early active use.
Radial nerve compression.
Symptomatic radial nerve compression is relatively uncommon. A relatively high incidence of compressive neuropathy involves other major nerves in the same extremity. Because sensory complaints are minor, radial nerve compression may successfully masquerade as tendonitis or tendon rupture. The most common site of radial nerve compression is in the forearm, at the arcade of Frohse. Spontaneous onset of dense paralysis is often due to space-occupying lesions in the forearm. Trauma-related compression in the forearm is most often due to radial head dislocation and either humeral fracture or local external pressure in the upper arm. Compression resulting in weakness that does not improve with several months of splinting, anti-inflammatory medication, and activity changes should be treated surgically to reduce the extent of permanent deficit. After decompression, early active motion is instituted to encourage nerve gliding. Results after decompression are not as favorable as those for carpal or cubital tunnel release. The worst results of decompression are seen in patients who have work-related injuries, chronic pain, and poor localization of symptoms on physical examination.
Toe transfer for congenital hand defects.
Toe-to-hand transfer is a well-established reconstructive option for certain congenital hand anomalies. It is the only technique which can add growth potential to the immature skeleton. Toe transfer is best suited for constriction ring amputations, which have relatively normal proximal anatomy. Transfers should be performed early in life to avoid lack of cortical integration of the new part. Anatomic variations of both hand and foot are often encountered, which influence both operative approach and functional prognosis. Indications, techniques, and complications are reviewed.
Lymph node transfer for the treatment of obstructive lymphoedema in the canine model.
The efficacy of transferring vascularised lymph nodes into lymphoedematous limbs was investigated. Stable below-knee lymphoedema was established in one hind limb of 10 dogs. The superficial inguinal lymph node and perinodal tissue from the normal hind limb was moved to the popliteal region of the lymphoedematous leg as a free vascularised transfer. In five dogs lymphaticolymphatic anastomoses between lymphatics of the node and proximal recipient site lymphatics were also performed. Circumferential measurements of the foot, ankle and midleg were obtained preoperatively and postoperatively at 3 and 6 months. These measurements showed postoperative reduction of the lymphoedematous legs compared to controls, with no added benefit from lymphaticolymphatic anastomoses. Technetium 99 scans and lymphangiography demonstrated re-establishment of lymphatic continuity in all recipient legs at 3 and 6 months post-transfer. Histological examination at 3 and 6 months revealed normal architecture in 9 of 10 nodes, although areas of lymphocyte depletion were common. Vascularised lymph node transfer to a lymphoedematous leg re-established lymphatic continuity and resulted in partial reduction of limb size. The addition of lymphaticolymphatic anastomosis to vascularized node transfer is neither necessary nor beneficial.
Syndactyly.
Congenital syndactyly is associated with a wide spectrum of local anomalies that strongly influence the ultimate outcome of treatment. Surgical options, indications, timing, and prognosis are all determined by the preoperative degree of deformity. The surgeon must apply knowledge of anatomic variations and adhere to fundamental principles of technique, which are reviewed in detail.
The cytologic diagnosis of endometrial adenocarcinoma.
An outpatient diagnositc technique comparable to the Papanicolaou smear for carcinoma of the cervix is needed to permit early recognition of adenocarcinoma of the endometrium. Five different techniques of sampling the endometrial cavity were carried out on 1, 742 patients at the University of Michigan Medical Center. A total of 2,553 specimens were correlated with operating room curettings to assess the accuracy of each sampling technique. The methods of saline irrigation with an antrum cannula, endometrial brush sampling, high-vacuum aspiration, and the Gravlee jet washer proved not to be accurate enough to be used as a routine screeening test. There was excellent correlation (96 per cent) between endometrial biopsies and curettings. In our experience, endometrial biopsy with a suction or basket curette was the diagnostic technique short of curettage which permitted accurate diagnosis.