Biomedical subjects
Publications and source records attributed to C L Puckett.
Radiation wounds caused by newer high-voltage radiotherapy techniques are very difficult to manage. Recent developments in flap design and transfer aid the surgeon in successfully treating these difficult problems.
Since 1972, the groin flap has been used as an excellent source of skin coverage for the hand. This flap can incorporate the underlying iliac crest to provide both soft tissue and vascularized bone for the reconstruction of complex hand injuries. Three patients who sustained gunshot wounds of the hand with loss of the thumb metacarpal and extensive soft tissue were treated with a groin flap that included the iliac crest. Bony union was rapid and thumb stability was excellent in all patients 3 months after initial reconstruction. The advantages of the osteocutaneous flap include the ability to: (1) supply vascularized bone to what is frequently a poor recipient bed for a bone graft, (2) reconstruct both soft tissue and bony defects simultaneously, and (3) be used in facilities without capability for microvascular surgery.
Prolonged ischemic periods may inhibit success in microsurgical procedures. Impairment of fibrinolytic activity could be a factor contributing to this problem. Ischemic epigastric flaps in the rat were used as a model to measure the potential of streptokinase to improve blood flow and tissue survival. A moderate but statistically significant improvement in flap survival was observed and is felt to be due to the enhancement of fibrinolytic activity previously impaired by ischemia. Saline irrigation alone in control animals was found to be detrimental to flap survival. Streptokinase might prove beneficial when dealing with an ischemic replant or free flap.
A precise and safe method for passing percutaneous circumzygomatic and circummandibular wires is presented. The advantage of this double-wire technique is that important soft-tissue structures are protected and oral contamination is minimized.
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Obstructive sleep apnea is an insidious and potentially life-threatening disorder that is probably more prevalent than has been previously diagnosed. Since there is generally some mechanism for relief of the respiratory obstruction, this is a very successfully treatable disorder. A strong index of suspicion should be held in cases of oronasal or pharyngeal abnormalities with a potential for respiratory obstruction. Loud snoring (particularly a recent change) and daytime hypersomnolence should alert us. In-hospital sleep monitoring and arterial gas measurements can provide a definitive diagnosis.
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Direct lymphovenous anastomoses were constructed in dogs with chronic obstructit on the course of the lymphedema. Early patency rates of the lymphovenous anastomoses of 100 percent related to a 32 percent decrease in the lymphedema. However, by 3 weeks, all lymphovenous anastomoses became occluded and the edema level returned to the original state or was somewhat worse. Patent lymphovenous anastomoses seem clearly capable of improving the lymphedema state. However, long-time patency was not maintained in this series. We postulate that effective decompression of the lymphedematous leg by the patent lymphovenous anastomoses results in decreased flow through the anastomoses with subsequent occlusion.
The transnasal-transsphenoidal approach for pituitary surgery is an effective procedure that benefits nicely from a team concept utilizing the expertise of both the neurosurgeon and the plastic surgeon. Experience with eleven cases is presented along with a review of historical information and a description of the surgical technique.
The absence of muscle in the prolabial segment and the failure to identify and join the fibers of the orbicularis muscle from the lateral lip segments at the time of initial lip repair frequently result in a characteristic bulge above the vermilion laterally. This bulge is caused by the bunching of the orbicularis oris as the result of its discontinuity in the prolabial segment. Late repair of this deformity is possible. In a series of fifteen patients with previously repaired bilateral cleft lips, lateral mobilization and midline suturing of the separated segments of the orbicularis oris muscle have been employed to correct the orbicularis bulge. Significant improvement in oral animation and in facial aesthetics have been noted in these patients.
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Three groups of dogs were studied to compare the bone formation obtained with traditional bone grafting techniques, and that obtained with revascularized periosteum or revascularized bone grafts--all in unstressed bone. Revascularized periosteum did not produce a significant amount of bone in this unstressed model. At 4 months the revascularized rib grafts had a slightly greater tolerance to stress at the callus site than traditional bone grafts, but the incidence of non-union was the same. We conclude that the use of revascularized bone grafts should be reserved for situations in which traditional bone grafting techniques are unlikely to be successful.