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Biomedical subjects

D A Hudson

Publications and source records attributed to D A Hudson.

At least 37 records · Page 2Linked to original sources
PubMed2000

The use of the prepuce for reconstruction of an intraoral burn.

Intraoral and commissural burns present a complex challenge for the reconstructive surgeon, with contractures being the main sequela encountered. Various reconstructive techniques have been described, none of which offers an ideal solution. A case of a severe intraoral contracture due to a caustic burn, and the modality of treatment is described. Once the contractures were released, a full-thickness preputial graft was used to cover the resultant buccal mucosal defect, with a satisfactory result. Due to its unique properties, the prepuce should be included as an additional tool in the reconstructive surgeon's armamentarium.

Burns, Chemical↗
PubMed2000

Combined pedicled flaps for grade IIIB tibial fractures in children: a report of two patients.

Severe open tibial fractures in children are associated with notable morbidity and require early aggressive management to ensure a successful outcome. Free flaps are currently the gold standard in distal extremity reconstruction in which large soft-tissue defects exist, as is often the case with grade IIIB fractures. In severe lower limb trauma, however, free flaps are associated with a relatively high risk of failure, particularly when definitive soft-tissue coverage is delayed. Alternative methods of soft-tissue reconstruction may, therefore, occasionally require consideration. The authors describe the combined use of three pedicled flaps to attain soft-tissue coverage in 2 children with grade IIIB tibial fractures. These three flaps are individually in common use for lower limb soft-tissue coverage, are simple to raise, and in combination can cover extensive soft-tissue defects of the lower extremity. The major vascular axes of the limb are not sacrificed; however, the aesthetic result is modest.

Child↗
PubMed2000

Aesthetic correction of a contour deformity of the neck with buried expanded flaps.

This case report describes the use of two tissue expanders to correct a contour deformity of the neck, secondary to radical block dissection and radiotherapy for a recurrent parotid tumor. One flap was deepithelialized and then buried under the other to create the necessary bulk. This technique provided tissue similar in texture and color to the adjacent skin, and there is minimal donor site morbidity. It is, however, a staged procedure.

Adult↗
PubMed2000

The use of pedicled expanded flaps for aesthetic resurfacing of the burned face.

Reconstruction of extensive, deep burns of the face is a challenging problem in plastic surgery. The authors report the use of tissue expanders placed in the upper chest for facial resurfacing after burn injuries in 4 patients. The expanders are hyperinflated. The flap is then advanced upward to resurface an aesthetic unit of the face with the pedicle intact. The pedicle is divided 2 weeks later. The method of reconstruction allows a large area of facial resurfacing to be performed without fear of flap loss or flap retraction impairing the cosmetic result. This technique has the disadvantage of being a staged procedure and cannot be performed in those with burns of the upper chest.

Burns↗
PubMed2000

Long-term results of tendon transfers for radial nerve palsy in patients with limited rehabilitation.

The authors reviewed the long-term functional results of 22 patients who underwent tendon transfer for isolated radial nerve palsy. The average number of postoperative visits was eight (range of postoperative visits, 3-16), and the mean follow-up was 6.3 years. All but 1 patient had improved function after the tendon transfers, and could cope with the activities of daily living. Radial deviation of the wrist at rest was present in 10 of the 15 patients with flexor carpi ulnaris transfer and in 2 of 7 patients with flexor carpi radialis transfer, with a mean of 14.5 deg (range of radial deviation, 5-30 deg). Although a global decrease in wrist power and power grip was noted, 13 of 17 previously employed patients were able to work after transfer; however, only 1 of 7 heavy manual laborers was able to return to his previous employment. Despite the poor clinic attendance, the overall functional results compared favorably with other published series. It appears that tendon transfer for radial nerve palsy is a viable option, even in patients with limited rehabilitation.

Adult↗
PubMed2000

One-stage immediate breast and nipple-areolar reconstruction with autologous tissue I: a preliminary report.

This preliminary report discusses 7 patients with early breast cancer (mean age, 48 years) who underwent one-stage breast reconstruction. Reconstruction was achieved using a deepithelialized transverse rectus abdominis musculocutaneous (TRAM) flap placed in a pocket created by a skin-sparing mastectomy. Areolar reconstruction is performed by harvesting the areola as a full-thickness graft from the mastectomy specimen, and nipple reconstruction is achieved with a CV flap (in zone II of the TRAM flap), which is deepithelialized and covered with a full-thickness graft from the areola. In all patients a contralateral reduction or mastopexy was performed. Recent evidence suggests that not all patients with early breast cancer have areolar involvement, and that certain prognostic factors can be used to predict the likelihood of tumor involvement. A number of large studies have shown that in patients with early breast cancer, when the tumor is situated more than 5 cm from the nipple-areolar complex, tumor involvement of the nipple-areolar complex is most unlikely. No patients in this study had histological evidence of nipple involvement by cancer. The aesthetic results were very satisfactory in 5 of 7 patients. One patient who developed sepsis of the TRAM flap had an unsatisfactory result. The other complications that occurred were minor and self-limiting. The advantages of single-stage breast reconstruction are financial and psychological. In addition, the patient attains homogenous nipple-areolar reconstruction. Areolar reconstruction is achieved with the best possible option--areola. This preliminary report suggests that in a select group of patients with early breast cancer, when the tumor is more than 5 cm from the nipple-areolar complex, the areola may be preserved. The aesthetic results in these patients was considered satisfactory. However, long-term studies are required to confirm the oncological safety of this technique.

Adult↗
PubMed2000

The use of serial tissue expansion in pediatric plastic surgery.

There are clinical situations in which even despite the use of simultaneous multiple tissue expanders, complete coverage of a defect cannot be achieved. In this situation, serial, repeated tissue expansion may be indicated. There are few studies that have reported repeated tissue expansion in pediatric plastic surgery. Twelve children (6 girls, 6 boys) with a mean age of 7 years underwent serial tissue expansion for giant hairy nevus (N = 3) or burn reconstruction (N = 9). A total of 63 tissue expanders were used. Serial expansion of the expanded flap was performed a second time in 12 children, a third time in 6 children, and a fourth time in 2 children. The major complication rate was 4% for the first expansion, and 20%, 18%, and 0% for the second, third, and fourth expansions respectively. Clinically, at the time of expander reinsertion, there was no evidence of capsule from the previous expander in any patient. This was confirmed on histological examination of 12 biopsy specimens. Repeated tissue expansion is a safe and effective procedure for use in pediatric plastic surgery.

Burns↗
PubMed2000

Another method to prevent venous thrombosis in microsurgery: an in situ venous catheter.

Free-flap failure is in the order of 4 to 10 percent. Heparin is more effective at preventing venous thrombosis than arterial thrombosis. This study was undertaken to investigate the efficacy of delivering heparin at a high dose locally but low dose systemically (heparin infusion via a catheter placed proximal to the venous anastomosis) to prevent venous thrombosis in microsurgery. A model of venous thrombosis was first established by a venous inversion graft in the rat femoral vein (this was performed in seven animals and resulted in 100 percent thrombosis). Saline and heparin were delivered proximal to the inverted vein graft to assess the effect of each in preventing venous thrombosis. Flow/patency distal to the inverted vein graft was assessed by observation under the microscope, the milk test, and rate of flow (flowmeter). Saline infused via a catheter proximal to the venous inversion graft resulted in 100 percent thrombosis in 10 animals. Heparin (100 U/ml at 2 to 3 ml/hour) infused through a catheter for 2 hours proximal to the anastomosis resulted in flow in all 10 animals during the infusion. Blood was also taken before beginning the procedure (control) and after the heparin infusion distal to the anastomosis (local partial thromboplastin time) as well as in the contralateral femoral vein (systemic). The control for all animals that received heparin was <3 minutes. The systemic partial thromboplastin time after heparin infusion was <3 minutes in seven animals, 3.3 minutes in two animals, and >7 minutes in one animal. The local partial thromboplastin time distal to the inverted vein graft was >10 minutes in nine animals and 3.7 minutes in one animal. The study also had a clinical component, in which a catheter was placed in a vein of the free flap, and heparin was infused over 5 days. This technique has been used in 83 consecutive free flaps. In three recent free flaps performed on the limbs, the local partial thromboplastin time (close to the anastomosis) was raised but the systemic time was normal. This technique offers a method in preventing venous thrombosis in microsurgery. It is simple to implement and is not associated with the systemic complications of heparin.

Adult↗
PubMed2000

Mirror foot.

Mirror image polydactyly is a rare congenital abnormality that may occur in isolation, or in association with multiple congenital anomalies. A case of unilateral mirror foot with an ipsilateral short, broad tibia is described. The clinical, radiologic, and operative findings are presented, and current theories of embryo-pathogenesis are reviewed.

Female↗
PubMed2000

Some thoughts on choosing a Z-plasty: the Z made simple.

The Z-plasty and its variations are techniques commonly performed in plastic surgery. However, there are few descriptions and comparisons of the various types of Z-plasty. This article examines the mechanics of the Z-plasty and its variations. Understanding the geometry of the different variations will allow selection of the most appropriate Z-plasty for contracture release.

Humans↗
PubMed1999

Primary epineural repair of the ulnar nerve in children.

Transectional nerve injuries are uncommon in children. We report the outcome of 19 children aged < or = 13 years with acute transectional injuries to the ulnar nerves who were treated by primary epineural repair. There were 13 boys and 6 girls with a mean age at the time of injury of 6.7 years (range, 2-12 years). The site of injury was the palm in 4 children, wrist in 10, forearm in 4, and above the elbow in 1. Associated injuries to other structures occurred in 13 children. The mean recovery (Medical Research Council scale) of the first dorsal interosseous muscle was grade 4.0 (range, grade 3-5) and the mean outcome for the abductor digiti minimi was grade 3.9 (range, grade 2-5). The mean static 2-point discrimination was 6 mm (range, 2-20 mm). The mean follow-up period was 50 months (range, 12-103 months). Although proximal injuries (at or above the elbow) had a poorer outcome, satisfactory function of the intrinsic hand muscles still occurred; this finding contrasts to results reported in adults. Similarly, associated injuries to adjacent structures had no impact on ulnar nerve recovery. Primary epineural repair of the acutely transected ulnar nerve leads to a satisfactory recovery in both motor and sensory function in children younger than 13 years.

Arm Injuries↗
PubMed1999

Measurement of c-myc oncogene expression provides an accurate prognostic marker for acral lentiginous melanoma.

Acral lentiginous melanoma is a particularly aggressive tumour with a worse prognosis than other varieties of primary cutaneous melanoma. In order to study the biology of this disease, the activity of the c-myc oncogene was studied in tumours from 45 patients using flow cytometry. High levels of oncoprotein were found in all tumours and exceeded that documented in other varieties of cutaneous melanoma. Survival analysis with stratification of patients according to oncogene activity provided a useful prognostic marker with shorter disease free interval (Log-Rank test, chi 2 = 16.7, P < 0.0001) and overall survival (Log-Rank test, chi 2 = 8.9, P = 0.002) in tumours with high oncoprotein levels. Multivariate analysis revealed c-myc oncogene expression to be more accurate in predicting clinical outcome than all existing clinicopathological parameters including the Breslow depth (Cox's proportional hazards model, P = 0.0011). This study provides biological evidence to explain the aggressive behaviour of acral melanoma and supports the application of oncogene measurement as an accurate prognostic marker.

Adult↗
PubMed1999

Septic arthritis of the metacarpophalangeal and interphalangeal joints of the hand.

Septic arthritis of the small joints of the hand is not reported frequently. Twenty-eight patients were treated during a 15-month period, from November 1992 to January 1994. Prompt surgical drainage, antibiotics, and early postoperative mobilization (within 24 hours) were the cornerstones of management. Nineteen patients were available for a median follow-up of 10 months. Patients who presented after 10 days all had a poor result. Patients who presented earlier achieved a good result unless they defaulted from treatment or had sustained an associated severe traumatic joint injury. Ten of the 19 patients obtained a good result. Good functional results can be obtained with early postoperative mobilization.

Adolescent↗
PubMed1999

Tuberculosis of the upper extremity.

Twelve cases of tuberculosis of the upper extremity over a 5-year period are presented. The average time to diagnosis was 5 months. All patients were treated with a regimen of combination antituberculous chemotherapy for a minimum of 6 months, initial splinting, and intensive physiotherapy. The indications for surgery were limited, with biopsy being the most common procedure. Patients with tenosynovitis underwent tenosynovectomy, and nerve decompression was performed when indicated clinically. Large abscesses were drained. No patient had bony debridement or early arthrodesis to control the infection. The pre- and posttreatment range of motion was recorded, with a mean follow up of 25.4 months. Employing this regimen resulted in resolution of infection and an improved range of motion in 11 patients.

Adult↗
PubMed1999

A novel surgical method of repair for Stahl's ear: a case report and review of current treatment modalities.

Stahl's ear is a congenital malformation of the auricle, which is uncommon in non-Oriental societies. A number of different treatment modalities have been suggested, many of which yield unpredictable results. We review current treatment modalities from the English literature and describe a novel, simple surgical method of repair. First, a helical rim incision is made to expose the abnormal third crus and upper pole of the ear. The third crus is excised as a narrow wedge of cartilage and posterior skin, and the defect is closed primarily. The free third crus cartilage is then grafted onto the scaphal cartilage in an anatomically correct position to form a superior crus. The anterior skin flap is redraped and bolstered over this graft. Only a very small scar on the helical rim remains visible anteriorly.

Child↗