PubMed Health⌕ Search

Biomedical subjects

C M Avery

Publications and source records attributed to C M Avery.

At least 19 recordsLinked to original sources
PubMed2001

Suprafascial dissection of the radial forearm flap and donor site morbidity.

A cutaneous free radial forearm flap was harvested from 25 patients using a suprafascial dissection technique. The donor site was managed with either a full or split thickness skin graft and a negative pressure wound dressing. The incidence of initial complete graft take was 96% at day 5 and 100% by 1 month. There was 100% early and complete graft take in the full thickness group but one area of partial loss in the split thickness group. This area of graft loss represented less than 0.5% of the total grafted area in this series. The mean time to wound healing was 14 days. There were no cases of tendon exposure or delayed healing. The suprafascial dissection creates a superior graft recipient bed. When combined with the negative pressure wound dressing technique it ensured early and complete graft take.

Adult↗
PubMed2000

Precautions against cross-infection during operations for maxillofacial trauma.

One hundred oral and maxillofacial units in the UK were sent a postal questionnaire. Surgical staff of all grades were asked which infection-control measures were taken during the treatment of maxillofacial fractures. Two hundred and ninety-four questionnaires were completed, a response rate of 49%. If the patient was known to be infected by a blood-borne viral disease, significantly more surgeons used standard barrier precautions such as eye protection, fluid-resistant gowns, drapes, ball-ended clips, adhesive tapes and intermediate trays (P<0.0001). Bone-plating techniques were used in preference to wire osteosynthesis (P<0.0001). Only 31 (10.5%) of surgeons routinely used double gloves but 250 (85%) did so if the patient was an infection risk (P<0.0001). Universal precautions were not applied equally to all patients.

Blood-Borne Pathogens↗
PubMed2000

Surgical management of chronic parotid disease.

This is a retrospective review of a single surgeon's experience over a 20-year period, and covers the presentation, investigation, histology, management and complications of the surgical treatment of chronic parotid disease. There were 46 superficial parotidectomies (23 with ductal ligation); 3 required removal of calculi and there was one ductoplasty and one total parotidectomy. There were 28 cases of temporary palsy of the VIIth cranial nerve (55%, mean duration 4 months) and this was predominantly panfacial (79%). There were no cases of permanent palsy. Five patients who initially had a superficial parotidectomy required subsequent total parotidectomy for recurrent disease (11%). We have now adopted a policy of near total parotidectomy for the surgical treatment of chronic parotid disease.

Adolescent↗
PubMed2000

Combined treatment of adenoid cystic carcinoma of the salivary glands.

A retrospective review of the experience of a single surgeon over a 20-year period is presented. Fifteen patients with primary adenoid cystic carcinoma of the major (6) or minor (9) salivary glands underwent combined treatment with wide local excision and radical postoperative radiotherapy. The actuarial survival is 100% at 5 years and 62% at 10 and 15 years. The disease-specific survival is 100% at 5 years and 86% at 10 and 15 years. There were no loco-regional recurrences. Wide local excision and radical postoperative radiotherapy seems to be an effective treatment for adenoid cystic carcinoma of the salivary glands.

Adult↗
PubMed1999

Double gloving and a glove perforation indication system during the dental treatment of HIV-positive patients: are they necessary?

AIM: The aim of this study was to compare the incidence of glove perforation when double gloved or single gloved during the routine treatment of HIV-positive patients. In addition, a glove perforation indication system based on a double gloving technique was assessed. DESIGN: Prospective, randomised and open study of glove perforation. METHODS: 138 consecutive HIV-positive patients underwent routine dental treatment by senior dental staff and dental hygienists in a teaching hospital. Staff wore either single gloves (Regent Biogel D or standard surgical gloves) or double gloves (Regent 'Reveal' perforation indication system or standard surgical gloves). A subjective assessment of glove comfort, sensitivity and ease of donning was made using a visual analogue scale. RESULTS: The incidence of glove perforation/procedure was low, 2.9%. There were no skin penetrating injuries, visible exposure to body fluids or unnoticed perforations. Double gloving was subjectively less comfortable and sensitive than single gloving (P < 0.0001). The glove perforation indication system did not increase the detection of intra-operative perforations. CONCLUSIONS: There is unlikely to be any significant benefit from the use of a double gloving technique or perforation indication system during the routine dental treatment of HIV-positive patients.

Dental Care for Chronically Ill↗
PubMed1999

Management of Jehovah's Witness patients undergoing major head and neck surgery.

BACKGROUND: Several diverse strategies have been recommended to manage Jehovah's Witness patients undergoing surgery when significant blood loss is expected. However, many of the proposed management strategies cannot be used when the urgent nature of the disease precludes adequate preoperative preparation of the patient. We present our experience of the management of two Jehovah's Witnesses with oral carcinoma requiring extensive resection, neck dissection, and reconstruction with free tissue transfer. METHODS: Hypervolemic hemodilution, hypotensive anesthesia, meticulous surgical hemostasis, and antifibrinolytic therapy were used as an alternative to blood products or transfusion. RESULTS: Radical surgical ablation and state-of-the-art reconstruction were possible, as a single-stage procedure, even though blood transfusion or blood product replacement therapy was refused. CONCLUSION: Radical surgical ablation of oral carcinoma, with free tissue transfer reconstruction, is possible in this group of patients without the use of blood products or transfusion. There would have been no advantage in raising the red cell mass preoperatively, as the packed cell volume was ideal for free tissue transfer.

Adult↗
PubMed1999

Double gloving and a system for identifying glove perforations in maxillofacial trauma surgery.

The treatment of some maxillofacial fractures has an incidence of glove perforation as high as 50%, with over 80% going unnoticed at the time of operation. We investigated double gloving and a glove perforation indication system to ascertain whether the latter offered any additional protection. 1061 gloves used for 113 patients were examined. The outer glove perforation rate was significantly higher than the inner glove (0.48 compared with 0.10, P < 0.0001). There were fewer unnoticed perforations in the glove perforation indication group than the standard surgical glove group (19% compared with 79%, P < 0.0001). The indication system was most effective in wet operating fields. The perforation rate varied with the type of fracture and treatment. Mandibular fractures that were 'hand-held', while bone-plated had a lower mean number of outer glove perforations/operation than fractures treated with temporary intermaxillary fixation (0.43 compared with 4.62, P < 0.0001).

Chi-Square Distribution↗
PubMed1999

A comparison of one hundred and fifty consecutive parotidectomies for tumours and inflammatory disease.

The demographic profile and complications are compared and contrasted for 150 consecutive parotidectomies. All patients were under the care of one surgeon (JDL) over a twenty-year period (1977-1997). The case records and contemporaneous database were analysed retrospectively. 111 (74%) procedures were performed for tumours and 39 (26%) for inflammatory disease. The incidence of unexpected permanent facial nerve palsy was 1.8% in the tumour group and zero in the inflammatory group. The overall unexpected palsy rate was 1.3%. Transient paralysis was more common in the inflammatory group than the tumour group (61.5% compared with 33.3%, P<0.02) and was more likely to be panfacial (48.7% compared with 17.1%, P<0.0002). The overall incidence of Frey's syndrome was less than 20% and both salivary fistulae and sialocoeles were infrequent.

Adolescent↗
PubMed1998

Dermoid cyst of the parotid gland.

A dermoid cyst occurring within the parotid gland of a 37-year-old Chinese man is reported. The diagnostic difficulties, histopathological features and pathogenesis are considered.

Adult↗
PubMed1998

Glove perforation during surgical extraction of wisdom teeth.

OBJECTIVE: This study investigated the incidence of sterile surgical glove perforation during hospital-based surgical extractions of wisdom teeth performed with patients under general anesthesia. STUDY DESIGN: A total of 104 consecutive patients (420 gloves) were studied prospectively. A standardized water inflation technique was used. RESULTS: The operative perforation rate was 8.6%, or 4.3% per surgeon per operative side. The individual glove perforation rate was 2.1% per operation. Over 55% of perforations were not noticed at the time of surgery. There were no skin-penetrating injuries or visible contamination with body fluids. The perforation rate was the same with drill and chisel. CONCLUSIONS: The incidence of glove perforation is lower than previously reported. The surgical extraction of wisdom teeth carries a relatively low yet still significant risk with regard to exposure to bloodborne cross-infection. We recommend that high-quality surgical gloves be used and that universal precautions be adhered to.

Anesthesia, Dental↗
PubMed1997

Reconstruction techniques in oral carcinoma.

Resection of oral carcinoma can cause serious problems with speech, mastication and swallowing. Several methods of reconstruction of the defects caused by tumour resection are available to the modern oral and maxillofacial/head and neck surgeon, some of which are more effective and aesthetically pleasing than others. This article discusses the methods available, their advantages and disadvantages, and gives guidelines on the circumstances in which each is ideally used.

Female↗
PubMed1995

Effective administration of heparin and antibiotic prophylaxis.

A prospective audit was performed to determine whether new departmental procedures had improved the administration of heparin and antibiotic prophylaxis in patients undergoing major surgery who were at risk of deep vein thrombosis, pulmonary embolism and postoperative wound infection. The results are compared with a previous retrospective audit of the same 'at-risk' groups. A significant improvement in prophylaxis administration is demonstrated.

Adult↗