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Biomedical subjects

C L Puckett

Publications and source records attributed to C L Puckett.

At least 55 records · Page 3Linked to original sources
PubMed1989

Noninvasive assessment of microvessels with the duplex scanner.

This study was undertaken to determine if a duplex scanner equipped with a new 10 MHz probe could accurately evaluate microvascular anastomotic patency. The overall predictive accuracy of the duplex scanner was 90% (p less than 0.0001) with no difference noted among the three main anastomotic groups examined--acute artery, acute vein, and long-term artery. There was, however, a statistically significant difference (p less than 0.05) in the ability to interpret vessels that were patent (100%) versus those that were partially occluded (73%) or occluded (88%). It is believed that the duplex scanner has potential applications to preoperatively and intraoperatively study microvessels and postoperatively to supplement other techniques in monitoring acute and long-term anastomotic patency.

Anastomosis, Surgical↗
PubMed1989

Acute carpal tunnel syndrome in a patient taking coumadin.

This is a case report of a 66-year-old female who had been taking coumadin for 4 weeks for deep vein thrombosis. She developed acute carpal tunnel syndrome following minor trauma to her wrist. After conservative therapy failed to relieve her symptoms she underwent release of her carpal tunnel with resolution of her symptoms. While there are many patients taking coumadin, its association with acute carpal tunnel syndrome is quite rare: we were only able to find only one other reported case in the literature. While one is tempted to treat these patients conservatively, operative therapy may be indicated.

Acute Disease↗
PubMed1988

A comparison of irrigation solutions for microanastomoses.

A comparative study of irrigating solutions that contained various clot-active substances and/or vasodilating substances was done using a crush injury model of the rat's femoral artery. A routine microanastomosis was done with one of seven irrigation solutions employed in the study. The patency rate of lactated Ringer's solution (10%) (the control solution) was compared with solutions of heparin (35%) urokinase (50%), phentolamine (35%) tissue plasminogen activator (tPA) (15%), a combination of urokinase, heparin, and phentolamine (55%), and a combination of tPA, heparin, and phentolamine (42.5%). Statistically significant improvement in patency rates were obtained with heparin (p less than 0.0005), phentolamine (p less than 0.03), urokinase (p less than 0.001), the tPA, heparin and phentolamine combination (p less than 0.001), and the urokinase, heparin, and phentolamine combination (p less than 0.0001). There seems to be a benefit with the addition of either vasoactive agents or clot-active agents to the microvascular irrigating solution during construction of a compromised microanastomosis.

Anastomosis, Surgical↗
PubMed1987

A critical look at capsule contracture in subglandular versus subpectoral mammary augmentation.

A critical comparison of the contracture rate in subglandular versus subpectoral augmentations was done in a personal series (senior author's) of 100 consecutive augmentation patients, 50 with subglandular augmentation and 50 with subpectoral augmentation. The average followup for the series was 27 months. Baker's classification of capsule contracture was utilized. Overall contracture rate in the subglandular group was 58% (29 of 50 patients) while in the subpectoral group it was 22% (11 of 50 patients), p less than 0.0002. Considering only the more severe contractures (Baker III & IV), the subglandular patients had 48% (24/50) while the subpectoral patients had 14% (7/50), p less than 0.0002. Comparing the more severe contractures in individual breasts, the subglandular group had 41% and the subpectoral group had 8%, p less than 0.0001. We conclude that in this personal series of patients, subpectoral placement of the prosthesis has significantly reduced but not eliminated the occurrence of capsule contracture without sacrificing a normal breast appearance.

Adult↗
PubMed1987

Quantitative fluorometry as a monitor for microvascular surgery.

There is a clear need for effective methods of monitoring for postoperative occlusion of vessels in microvascular surgery. We have evaluated one technique, quantitative fluorometry, in the laboratory and clinically. Our laboratory study used rat abdominal flaps under conditions of controlled occlusion. We found accurate detection of vascular occlusion within 20 minutes, but we were unable to differentiate arterial from venous occlusion. Our clinical review of 34 microvascular cases (14 free flaps and 20 replantations) that employed fluorometry revealed corroboration of occlusion (indicated by another monitoring technique) in six cases and a diagnosis at variance with other monitoring methods in one case, thus preventing an operative exploration. We recommend the use of quantitative fluorometry as a primary or adjunctive method of monitoring when patency is in question and have outlined a protocol for clinical use.

Animals↗
PubMed1987

Salvage of infected expanded scalp without loss of flap length.

This case presents the dilemma of a scalp infection emerging at the conclusion of soft-tissue expansion. Basic principles of wound infection would dictate that the foreign body (the inflatable prosthesis) be removed and that the infection be treated before inset of the flap. The prevention of possible loss of flap length due to skin contraction during treatment of the infection was avoided by stretching the flap over the intact scalp temporarily, thus maintaining its expanded status.

Alopecia↗
PubMed1987

The gull wing incision in cleft lip rhinoplasty.

The deficient anatomy of the cleft lip-nasal deformity has been fairly well described and a number of surgical procedures have been offered for its correction. Access to the nasal cartilages and precise correction have remained elusive. While a number of internal and external approaches have been proposed, we feel that the gull wing incision gives us excellent exposure for simultaneous visualization of both lower lateral cartilages and places the scar at the base of the columella which seems its best hiding place. With better visualization of the lower lateral cartilages and the employment of Dibbell's cartilage strut technique, we have been able to overcorrect accurately and ultimately achieve better symmetry and more lasting improvement. We have used this approach in the unilateral and bilateral cleft lip-nasal deformity in 15 patients. Principles that have become apparent by virtue of this better exposure include: full dissection of the lateral wings of the lower lateral cartilages and overcorrection using nonabsorbable mattress sutures for cartilage positioning. Pre- and postoperative cases are presented.

Adolescent↗
PubMed1986

Resolution of experimental microvascular spasm and improvement in anastomotic patency by direct topical agent application.

This two-part study investigated the topical treatment of vasospasm in the tail arteries of rats. In part A, an epinephrine-induced model of vasospasm was used to study a variety of vasodilating agents with actions on at least five different sites in the contractile mechanism of the vascular smooth-muscle cell. The most effective commercially available agents evaluated in this part of the study appeared to be 20% lidocaine and Thorazine (25 mg/ml). In part B, a model was established in which epinephrine-induced vasoconstriction was found to significantly impair anastomotic patency. Thorazine was shown to improve the patency rate of vessels in this setting, and it was found to be superior to 20% lidocaine in improving anastomotic patency.

Administration, Topical↗
PubMed1985

Studies of pathologic vasoconstriction (vasospasm) in microvascular surgery.

Characterization and resolution of microvascular spasm were investigated in 170 studies with the use of tail or femoral arteries of the rat. Topical epinephrine reliably produced vasospasm and topical vasodilators which included 2% and 20% lidocaine (Xylocaine) and 0.75% bupivacaine (Marcaine) were applied to resolve the vasoconstriction. Extensive vessel dissection was necessary to obtain significant resolution of vasospasm, and adventitial stripping was associated with even more impressive results. Local anesthetics appear to have a concentration dependent ability to resolve vasospasm, and 20% Xylocaine is the most effective agent yet studied.

Anesthetics, Local↗
PubMed1985

Crescent mastopexy and augmentation.

We have defined a group of patients with a lesser degree of moderate breast ptosis whose ptosis correction is not adequately improved by augmentation alone but requires some elevation of the nipple-areola complex. We have selected the crescent excision mastopexy to provide this additional needed lift. Experience with 26 patients employing this technique has helped to define the indications and limitations for this approach. It seems to adequately provide the additional needed lift when nipple descent has been no more than 1.5 to 2 cm below the inframammary crease. Complications such as scar widening (46 percent) were reviewed, but seemed to be well tolerated by the patients.

Breast↗
PubMed1985

Results of treatment of extensive volar wrist lacerations: the spaghetti wrist.

A series of 38 volar wrist lacerations is reviewed with regard to epidemiologic aspects and results. In general, return of tendon function was quite good, and return of nerve function in this series was also satisfying. We attribute the generally good results to immediate repair of all structures, microscopic repair of significant arterial injuries, microscopic grouped fascicular nerve repair, early mobilization (dynamic splinting and intensive occupational therapy), and a generally youthful group of patients. Review of this series has strengthened our opinion that aggressive primary repair of all injured structures is appropriate for these extensive lacerations.

Adolescent↗
PubMed1985

Genetic analysis in families with van der Woude syndrome.

We have brought together information on 864 affected individuals in 164 families (including three new pedigrees) reported in the 137 year period since 1845 when Demarquay first described a family with what was later called van der Woude syndrome (VWS). Both types of oral cleft, cleft palate (CP) and cleft lip with or without CP (CLP), segregate in these families together with lower lip pits or fistulae in an autosomal dominant mode with high penetrance estimated to be K = .89 and .99 by different methods. Cleft types (CLP and CP) occur in VWS in the same proportions as in the general non-VWS population, ie, about twice as many cleft-bearing individuals have CLP as have CP. On the other hand, we do not find the usually observed excess of females with CP and excess of males with CLP; in VWS the sex ratios are more nearly equal. Lip pits also are equally distributed between the sexes. Affected males and females are equally likely to transmit VWS. However, there is an excess of less severely affected individuals among transmitters and a deficiency of more severely affected, brought about by a proband bias and differential fecundity. The expression of VWS is significantly modified by the genetic background: More extreme phenotypes in parents tend to produce more extreme expression in their children. For a VWS gene carrier the relative risk of transmitting a cleft is 26.45%; that of transmitting lower lip pits is 23.55%. Three pedigrees of lip pits in the literature show no clefts among a significant number of affected individuals. Control of gene expression in VWS in the three target tissues appears to be independent and separately designated. Mutation rate of the VWS gene is calculated to be 1.8 X 10(-5).

Cleft Lip↗
PubMed1984

Pelvic abscess following preoperative radiation and abdominoperineal resection: management with a free flap.

The case of a woman treated for a large rectal cancer with high-dose radiation therapy and abdominoperineal resection followed by a large pelvic abscess is presented. Wound healing, reconstruction, and rehabilitation were achieved with a free latissimus dorsi myocutaneous flap. The importance of providing well-vascularized tissue for wound healing in the infected irradiated wound is emphasized.

Abscess↗