Biomedical subjects
Publications and source records attributed to D E Tolhurst.
Twenty-seven consecutive fasciocutaneous flaps comprising skin, fat, and deep fascia have been successfully used to close a variety of defects on the lower leg and trunk. The advantages of these flaps are enumerated, and the blood supply of the deep fascia and its relationship to the tissues deep and superficial to it are described.
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A case report is presented of a circumscribed neurofibroma in the external genitalia of a young girl which gave the impression of a phallus and a labioscrotal gonad. There was a large care-au-lait spot on the lower abdomen. An acute anxiety state developed which, together with the genital abnormality was corrected by clitoral and labial reduction.
A case report is given of a girl who, at the age of 17 years, lost her total posterior part of her perineum in a traffic accident. She was left with out an anal sphincter mechanism and a diverting sigmoidostomy was performed. Two years after the accident a new anal sphincter was constructed using bilateral transposition flaps of the gluteus maximus muscles. After 6 months of active training of this new "reanastomosed". The patient thereafter regained complete fecal continence by the natural route.
In place of the multi-staged skin flap procedures often required to cover exposed bone in the lower leg, muscle flaps offer a bonus in that the repair can be completed in one operation and at the same time the blood supply to the unhealthy area is vastly improved. Elsewhere muscle flaps bestow the same advantages and in addition provide a cushioning layer between prominent bone and the skin in the repair of decubitus ulcers. As an extension of the muscle flap technique, myocutaneous flaps have proved a useful adjunct to conventional skin flaps in the repair of many complicated trunk and lower limb defects.
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In an attempt to restore more normal voluntary and involuntary movement to the paralysed face, free revascularised muscle grafts were inserted in 7 patients, all of whom had a non-functioning perioral and lower cheek musculature on one side. This procedure was preceded by a cross facial nerve graft in order to supply the nerve fibres to the graft as soon after its insertion as possible. The clinical and electromyographical results are discussed and together have provided sufficient evidence to indicate that the technique works effectively.
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One hundred and two cases of hypospadias without chordee which were corrected by van der Meulen's operation were reviewed. There were no fistulas and only 10 complications. The functional result was good in 90 per cent.
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