Biomedical subjects
Publications and source records attributed to C R Rayner.
Experience in the use of oral mucosal flaps in 18 patients shows that their viability is good if drying is prevented and the blood supply enhanced either by muscle inclusion in the pedicle or by insertion into a vascular bed. A number of potential uses remain to be evaluated.
A robust, arterially based, innervated island flap of thin skin has been successfully used in nine patients to repair defects around the ankle and heel. Based on the lateral calcaneal artery, the flap gives excellent, well-bedded cover in a short operation with insignificant donor site problems.
General supportive measures, the ability to avoid infection, the natural tendency to improvement and the feasibility of major reconstructive procedures later suggest that neonatal limb ischaemia should be managed conservatively at first, despite an alarming appearance. The number of infants at risk, especially due to prematurity and effective resuscitation, is theoretically increasing.
Deep dermal burns can be induced to epithelialize rapidly, and, therefore, heal by abrasion at about day 14 after injury. Hypertrophic scarring does not occur after such healing. If necessary, meshed skin graft can be applied at operation. Reduced blood loss, safe graft-take, smaller donor areas and avoidance of unnecessary surgery are all advantages of the method and make it a feasible alternative to early tangential excision and grafting.
The transposed sternomastoid muscle split longitudinally, provided a good bed for free nerve grafts in a brachial plexus repair.
Deep dermal burns heal by a combination of new connective tissue formation (granulation) and epithelialization. In deep dermal wounds, which are unhealed after 14 days of conservative treatment, epithelialization can be enhanced by abrasion either alone or combined with provision of a skin graft. Some 42 burn wounds in 25 patients treated by this method have healed quickly and with good results. This method represents a move away from the current trend of early tangential excision and grafting of burn wounds and raises the possibility of developing a regime with the advantages but not the disadvantages of early tangential excision and grafting.
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Patients with malignant melanoma who require a block dissection for clinically enlarged lymph nodes have a relatively good prognosis if only one node is involved histologically and the primary is on the lower limb. Sixty per cent of these patients with single nodes show a 10 year disease-free survival rate, compared with 9% for those with multiple node involvement. The local recurrence rate at the resection site of hyperplastic nodes was 26% but fell to 10% when only a single node was involved. The disease-free interval and the survival time are a useful measure of the effectiveness of node resection.
Squamous carcinoma of the hand behaves more aggressively, and is more difficult to cure by non-surgical means, when it arises in the interdigital clefts or adjacent skin over the metacarpo phalangeal joints.
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A simple method to correct inverted nipples is described. The method is suitable only when the patient has no desire or ability to breast feed.
A series of 37 patients with Gorlin's syndrome is described; 23 had the typical naevi, 19 had jaw cysts and only 10 had both. A wide range of associated deformities was noted. The need for early identification of patients at risk is stressed; follow-up is essential for 2 reasons: The naevi although indistinguishable histologically from basal cell carcinomas only rarely require radical removal. The jaw cysts are locally invasive and should be radically removed when small. In 8 patients examined there was a low level of alpha-globulins in the plasma. Spontaneous involution of the naevi may occur in un-irradiated skin.
The pseudo-synovium appearing around Silastic rods is a labile layer made up of a range of cells from undifferentiated fibroblast precursors through to mature fibrocytes. Various factors influencing their behaviour are discussed. The optimum time for grafting into a rod-induced sheath would seem to be in excess of four months.
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A simple, accurate method for demonstrating very small areas of endothelium is described. Some possible fields for further investigation are suggested. An outline of the possible normal mechanism of endothelial regeneration is described.