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Biomedical subjects

D Buchbinder

Publications and source records attributed to D Buchbinder.

At least 37 records · Page 2Linked to original sources
PubMed1994

Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants.

OBJECTIVE: To identify donor sites from which vascularized bone may be harvested capable of accepting osseointegrated implants of the minimum dimensions required to ensure long-term implant stability. DESIGN: An anatomic study of the most commonly employed donor sites for vascularized bone in oromandibular reconstruction was conducted on 28 cadavers. SETTING: Academic tertiary referral center. PARTICIPANTS: Twenty-eight freshly embalmed, adult white cadavers (16 male, 12 female) were dissected. INTERVENTION: The ipsilateral fibula, iliac crest, radius, and lateral border of the scapula were harvested and multiply sectioned at predetermined sites. OUTCOME MEASURE: Implantability was determined for each section based on measurements of height, width, and cross-sectional area utilizing computer planimetry. RESULTS: The iliac crest was the most consistently implantable donor site, followed by the scapula, fibula, and radius (83%, 78%, 67%, and 21% of sections from each donor site satisfying the criteria for implantability). Consistent regional differences in implantability were encountered at each donor site except the scapula. CONCLUSIONS: Following ablation of oromandibular malignant neoplasms, restoration of stable retentive dentition is a prerequisite to a successful functional oral rehabilitation. This is best achieved with enosseous implants, capable of supporting a stable dental prosthesis, placed directly into vascularized bone flaps at the time of mandibular reconstruction. The implications of the results obtained in this study for gender, donor site selection, and orientation of the vascularized bone flap are discussed.

Aged↗
PubMed1994

Microvascular free flaps in head and neck reconstruction. Report of 200 cases and review of complications.

OBJECTIVE: Microvascular free-tissue transfer to the head and neck has become an accepted method of reconstruction owing to increased success rates and superior aesthetic and functional results. Although the large number of arteries and veins in the neck make free-flap revascularization easier than in other recipient sites of the body, there are also unique problems that pose significant risks to the success of the procedure. We report our experience with 200 microvascular free flaps performed between 1987 and 1992. SETTING: This study was conducted at a tertiary referral center. PATIENTS: The majority of patients in this series underwent surgery for squamous cell cancer. Approximately 75% of the reconstructions were performed for defects of the oral cavity. There were 120 vascularized bone-containing free flaps for mandibular and midface reconstruction. The remaining 80 soft-tissue flaps were used for a variety of defects ranging from the scalp to the pharyngoesophagus. RESULTS: An overall success rate of 93.5% for free-tissue transfers is reported. Greater experience with this technique has resulted in a reduction and a change in the nature of the complications encountered compared with those seen in the early part of our series. Donor and recipient site complications, including flap failures and anastomotic revisions, are analyzed in detail with respect to age, radiation status, donor site, and whether the ablative procedure was done for a primary or recurrent neoplasm.

Adolescent↗
PubMed1994

Outcome of carotid endarterectomy performed at a community medical center.

From 1990 to 1992 there was a 43% increase in the number of carotid endarterectomies (CEAs) performed at our institution. Not coincidentally the North American Symptomatic Carotid Endarterectomy Trial study was published in August 1991. To determine whether CEAs could be performed safely at community medical centers, records of 181 consecutive CEAs performed during a 30-month period at a suburban community medical center were reviewed. CEAs were performed by 14 surgeons: six vascular, three thoracic, and five general surgeons. Among all patients 87% had lesions with > or = 70% stenosis. Seventy percent of CEAs were performed on symptomatic patients, 84% of whom had stenoses > or = 70%. Among asymptomatic patients 96% had stenoses > or = 70%. There were five instances of neurologic complications in the perioperative period--two transient ischemic attacks, two reversible ischemic neurologic deficits, and one permanent neurologic deficit. One patient died. The mortality rate was 0.6%, the combined major stroke/mortality rate was 1.2%, and the any stroke/mortality rate was 2.2%. There were five patients with nonfatal major complications--one with myocardial infarction, one with pulmonary edema, one with congestive heart failure, and two with postoperative arrhythmia. Thirteen minor complications included eight cases of cranial nerve dysfunction. These data demonstrate that CEAs can be performed safely at community medical centers.

Aged↗
PubMed1994

Microanatomic analysis of the medial antebrachial nerve as a potential donor nerve in maxillofacial grafting.

PURPOSE: To histologically compare the anterior branch of the medial antebrachial cutaneous nerve (MACN) with the sural nerve using biometric techniques. PATIENTS AND METHODS: Twenty-centimeter segments of the right and left (MACN) and sural nerves from three cadavers were analyzed. The number of fascicles within the nerves were counted and the neural to connective tissue ratio was estimated. RESULTS: Sural nerves consistently showed greater amounts of connective tissue between the fascicles than the MACN. Fascicle diameter varied less throughout the length of the MACN. Fascicle diameter varied less throughout the length of the MACN and it showed fewer and larger fascicles, more closely approximating the anatomy of the inferior alveolar nerve. CONCLUSION: These preliminary data suggest that the MACN, on anatomic grounds, is theoretically more suited for grafting to the alveolar and lingual nerves than the sural nerve.

Forearm↗
PubMed1993

Patients evaluated for venous disease may have other pathologic conditions contributing to symptomatology.

Of the more than 200 patients recently evaluated for venous disease, 8 were diagnosed with lower extremity masses. Three patients were referred for superficial phlebitis and four for deep venous obstructive disease. The eighth mass was found during work-up for varicose veins. Five masses were identified by palpation, and three were identified by duplex scan. All were confirmed by magnetic resonance imaging (MRI) or computed tomography (CT). Of the eight masses, three were malignant: a metastatic melanoma, a histiocytoma, and a myxoid liposarcoma. Nonmalignant masses included a hematoma, an inflammatory lesion, a hemangioma, and an intramuscular lipoma. One patient presented with deep venous thrombosis secondary to an occluded popliteal artery aneurysm compressing the popliteal vein. Thus, patients presenting with ostensible venous disease may have other pathologic conditions responsible for symptomatology. Careful physical examination will reveal a mass in a majority of patients who have one. Duplex scanning will identify masses that should be confirmed by MRI or CT. Definitive diagnosis should be made by biopsy, due to the high possibility of malignancy.

Adult↗
PubMed1993

Mobilization regimens for the prevention of jaw hypomobility in the radiated patient: a comparison of three techniques.

This study evaluated and compared the Therabite Jaw Motion Rehabilitation System (Therabite Corporation, Bryn Mawr, PA) to tongue blades as a technique for maintaining and/or improving mandibular range of motion in post-irradiated patients. Three groups of patients were evaluated and compared: 1) unassisted exercise, 2) mechanically assisted mandibular mobilization with stacked tongue depressors combined with unassisted exercise, and 3) the Therabite System combined with unassisted exercise. The initial average maximum incisal opening (MIO) for the study population was 21.6 mm, and did not vary significantly among the groups. Measurements were recorded at 2-week intervals for 10 weeks. At week 6 and thereafter, the net increase in MIO of group 3 (13.6 mm [+/- 1.6 mm]) was significantly greater than group 1 (6.0 mm [+/- 1.8 mm]) and group 2 (4.4 mm [+/- 2.1 mm]) (P < .05). The rate of improvement leveled after 4 week in group 1 and group 2. However, the rate of gain in MIO in the Therabite group (group 3) remained constant at 10 weeks. There was no statistical difference between groups 1 and 2.

Adult↗
PubMed1992

The combined sensate radical forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects.

The loss of motor and sensory function of the tongue following ablative surgery has a devastating effect on oral function. At the present time, there is no way to restore lost tongue musculature following partial glossectomy. The use of sensate cutaneous flaps has been shown to restore sensory feedback to reconstructed areas of the oral cavity. No single composite flap supplies a sensate soft-tissue component together with an osseous component of sufficient bone stock for functional mastication. In this article, the combination of the radial forearm free flap with the iliac crest osteocutaneous or osteomyocutaneous free flap is reported. The radial forearm free flap was used to resurface the resected portion of the tongue to provide maximum mobility and sensation. The lingual nerve was the recipient nerve for anastomosis to the antebrachial cutaneous nerves in all but one case. The iliac bone was used to reconstruct the mandible, with the iliac skin paddle or the internal oblique muscle used to reconstruct the neoridge. This combination of flaps was used in 10 patients. There was one flap failure due to vascular kinking from "piggybacking" the iliac crest to the distal end of the radial forearm flap. As a result, the use of two separate sets of recipient vessels is now advocated. Although a single composite free flap offers an excellent form of oromandibular reconstruction in most cases, it has been shown that oral function deteriorates when large areas of anesthesia are present in the oral cavity. We believe that this combination of two free flaps offers an opportunity for superior function in select patients with significant glossectomy and/or large mucosal defects.

Anastomosis, Surgical↗
PubMed1991

Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects.

We describe 71 cases of oromandibular reconstruction using microvascular composite free flaps. There was an overall flap success rate of 94%, while 97% of the patients in this series had their mandibles reconstructed with free vascularized bone flaps. Fifteen patients were rehabilitated with implant-borne dental prostheses. Primary repair of discontinuity defects of the inferior-alveolar nerve using a variety of nerve grafts was performed in 16 patients. A new classification scheme for composite defects of the oral cavity involving bone, soft tissue, and neurologic defects is proposed and applied in the description of each of the patients in this series.

Adult↗
PubMed1991

The combined latissimus dorsi-scapular free flap in head and neck reconstruction.

Microvascular free tissue transfer techniques offer great versatility in the selection of tissue for reconstruction of head and neck defects. The system of flaps based on the subscapular artery and vein provides the widest array of composite free flaps. The possible flaps that can be harvested based on this single vascular pedicle include the scapular and parascapular skin flaps, the serratus anterior and latissimus dorsi muscle flaps, and the lateral scapular bone flap. In addition, a segment of vascularized rib can be transferred with the serratus anterior and latissimus dorsi muscles. Large cutaneous defects can be resurfaced by combining the latissimus dorsi and scapular flaps. Another advantage of this combined flap is the independent vascular pedicles of its components, which allow freedom in orientation of the various tissue segments. Thus, the combined flap can be helpful in reconstructing complex three-dimensional composite defects of the head and neck. In addition, by reinnervating the muscle portions of this flap, bulk can be preserved and an improved functional reconstruction of the oral cavity achieved. A review of the literature shows three previous reports utilizing this combination of flaps in five patients. We report the use of the combined latissimus dorsi-scapular free flap in six patients to reconstruct massive composite defects of the oral cavity, midface, and scalp. There was one flap failure, which was successfully reconstructed with the contralateral latissimus dorsi-scapular flap. The anatomy of this flap is reviewed, and the indications for its application are discussed.

Adult↗
PubMed1991

The internal oblique-iliac crest free flap in composite defects of the oral cavity involving bone, skin, and mucosa.

The reconstruction of oromandibular defects following ablative surgery is a challenging undertaking. When the defect involves skin as well as mucosa, the challenge becomes even greater. The internal oblique iliac crest osteomyocutaneous free flap is particularly useful for reconstruction of through-and-through composite defects due to the inclusion of two separate soft-tissue flaps on the same vascular pedicle. We report our experience with this flap in the reconstruction of 10 patients with such defects. The utility, and the limitations of this form of reconstruction are discussed in detail.

Aged↗
PubMed1991

Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients.

Over the past decade, the use of free flap transfers in head and neck surgery has led to remarkable advances in the reliability and the ultimate results of oromandibular reconstruction. Stable and retentive dental restorations have been achieved using enosseous implants placed directly into the vascularized bone flaps. However, the functional assessment of patients who underwent primary mandibular reconstruction with these techniques has not been previously reported. A group of 10 reconstructed and 10 nonreconstructed segmental hemimandibulectomy patients were compared using a battery of tests to assess their overall well-being, cosmesis, deglutition, oral competence, speech, length of hospitalization, and dental rehabilitation. In addition, objective measures of the masticatory apparatus (interincisal opening, bite force, chewing performance, and chewing stroke) were used to compare these two groups as well as normal healthy subjects and edentulous patients restored with conventional and implant-borne dentures. The results show a clear advantage for the reconstructed patients in almost all categories. Persistent problems and future directions in oromandibular reconstruction are discussed.

Adult↗
PubMed1991

A comparative review of in situ versus reversed vein grafts in the 1980s.

In patients requiring an infrainguinal bypass who have an ipsilateral intact GSV, the choice between the reversed and in situ vein graft should be determined by the operative findings and the site of the distal anastomosis. When the ipsilateral GSV has either been removed or is of poor quality, ectopic autologous vein should be used in most circumstances and certainly for bypass to the infrapopliteal arteries. In reviewing the results of the two types of vein bypass to the popliteal artery, the results of two prospective, randomized studies and recent retrospective, nonrandomized reports suggest that there is no difference in patency rates between the two techniques. When performing a bypass to this level, the surgeon should not routinely use one method, but tailor the operative management to the individual patient. However, when the two bypass procedures to the infrapopliteal arteries were compared, the results of a prospective, randomized study and recent retrospective, nonrandomized reports furnish strong evidence that ISVGs provide better long term patency rates than RVGs. These results favoring use of distal ISVGs in nonrandomized reports are even more impressive, since the in situ technique was often preferentially chosen over the reversed vein method when only small diameter GSVs were available and when the bypass was performed to the distal tibial or pedal arteries. Many vascular surgeons agree with the conclusion that the ISVG is the bypass of choice for infrapopliteal bypass when an intact GSV is available. Although both the in situ and reversed vein techniques provide excellent long term patency rates for infrainguinal bypasses, and the vascular surgeon should be able to adapt this technique and approach for the individual patient, further randomized, prospective studies with extensive follow-up evaluation and a large number of patients are necessary to definitively resolve which technique provides optimal patency rates for arterial reconstruction of the lower extremity.

Anastomosis, Surgical↗