PubMed Health⌕ Search

Biomedical subjects

D G Dibbell

Publications and source records attributed to D G Dibbell.

At least 37 records · Page 2Linked to original sources
PubMed1984

Reconstruction after median sternotomy infection.

Reconstruction after median sternotomy infections is a difficult problem. We have presented ten consecutive patients with a wide variety of underlying cardiac illnesses who have had this dreaded complication develop. All of these patients have undergone successful reconstruction after adequate debridement and elimination of the mediastinal dead space using a combination of well vascularized omentum and pectoralis major muscle flaps. Stability of the chest wall has been accomplished primarily with pectoralis major muscle flaps. Complications have been few, morbidity has been significantly reduced and mortality, thus far, has been eliminated, although we certainly have no expectations that it will remain so.

Adult↗
PubMed1983

Diamond burr otoplasty.

We present a technique for the treatment of prominent ears using a diamond burr to produce a very natural and stable antihelical fold. Our experience in the treatment of over 43 ears over a ten-year period has been very satisfactory for both patient and surgeon. This procedure overcomes many of the shortcomings of more traditional techniques of otoplasty, including suture pull-through, widened antihelical fold, and an unpredictable, unstable result.

Ear, External↗
PubMed1983

Clinical experience with polydioxanone monofilament absorbable sutures in plastic surgery.

Various sizes of undyed monofilament polydioxanone surgical suture were assessed in 52 surgical patients who underwent plastic surgery. With a single exception, follow-up observations were carried out for at least 40 days. Clinical results were judged satisfactory in 13 patients and excellent in 39 patients. The suture was found significantly better than gut in terms of pliability, ease of passage through tissue, ease of tying, strength, fray resistance, and overall handling properties. The undyed suture material tested in this study was rated as having inferior visibility when compared with surgical gut. This new suture material, the first synthetic absorbable available as a monofilament, would appear to be particularly useful in situations requiring extended wound support, in potentially infected wounds in which a monofilament suture would have lessened tendency to harbor pathogenic bacteria, and in cases where ease of passage through tissue, smooth tie-down, and precise knot placement are important.

Absorption↗
PubMed1983

The magnum procedure: surgical salvage of end-stage velopharyngeal incompetence.

One of the most difficult problems in cleft palate surgery is the patient who remains velopharyngeally incompetent after previous attempts at surgical correction. The magnum procedure was employed as a method of surgically salvaging these problem patients. The magnum flap is a procedure involving the use of a single or double hemipalatal flap based on the greater palatine vessels and inserted posterior to the hard palate to provide a maximum pushback in these patients. Eleven cases of severe and persistent velopharyngeal incompetence secondary to cleft palate after prior palatoplasty and secondary procedures are presented. All these patients had had at least two previous palatal procedures and were not considered good candidates for significant improvement by further speech therapy, based on evaluation in the Speech Pathology Department. All patients had preoperative and postoperative speech evaluations, including nasal airway studies and cineradiography. Postoperative follow-up was between 12 and 66 months. Speech evaluations and results and operative details and complications were investigated. All patients had mild to marked improvement in their velopharyngeal function, articulation, and resonant voice quality. There were two perioperative complications, one of which was a delayed bleeding episode requiring no treatment and the other of which was a case of cellulitis of the cheek requiring additional antibiotics. Based on this initial series of patients, we feel that the magnum procedure offers considerable promise in the salvage of those patients previously falling into the category of end-stage velopharyngeal incompetence.

Adolescent↗
PubMed1981

Hypoplasia of the latissimus dorsi muscle complicating breast reconstruction in Poland's syndrome.

Poland's syndrome includes anomalies of the breast, thorax, and upper extremity. Unilateral hypoplasia of the breast and pectoral muscle are seen most frequently, and the resulting problem of breast reconstruction must be addressed. The latissimus dorsi myocutaneous flap is one of the most useful reconstructive tools in this situation. A case is presented of Poland's syndrome with hypoplasia of the latissimus dorsi muscle-an abnormality not generally associated with Poland's syndrome. The latissimus dorsi muscle should be carefully evaluated preoperatively in such patients, to make sure it is adequate for reconstructing the absent breast and pectoral muscle.

Adult↗
PubMed1981

Usefulness of the innervated tensor fascia lata flap in paraplegic patients.

Pressure sores in paraplegic patients are a well-known problem. Such patients can develop pressure necrosis and skin breakdown in spite of preventive measures and adequate surgical management. The occurrence and recurrence of these problems is due in large part to the patient's inability to perceive pressure discomfort in the insensible sitting area. Use of the innervated tensor fascia lata flap has great value in selected patients. A series of 9 patients is presented. In all patients, postoperative sensibility in the flap was maintained as in the preoperative stage. Follow-up of these patients shows that all flaps have remained healed and functioning The neuroanatomical features of the innervated tensor fascia lata flap make it a promising method for covering pressure sores and avoiding subsequent complications.

Fascia↗
PubMed1980

A technique for temporary obturation of fistulae.

We devised a simple technique to differentiate the contribution of the oronasal fistula from that of the velopharyngeal port when abnormal nasal air flow is present. Temporary obturators were constructed from a thin sheet of dental wax and retained by a dental adhesive. Speech samples collected for aerodynamic analysis, both with and without the appliance, included both fricatives and plosives in single words and connected speech. Our results indicate that this temporary obturator, used in conjunction with aerodynamic studies, can be used to determine the etiology of abnormal nasal flows in speakers with oronasal fistulae.

Child↗
PubMed1980

The gastrocnemius myocutaneous flap.

Medial and lateral gastrocnemius flaps are large flaps that can be taken in the lower extremity with no delay. They have a wide arc of rotation from above the patella in the thigh to the upper portion of the lower tibia. Both flaps can be taken simultaneously. They can cover extremely large defects of the anterior leg or knee. The use of these flaps with their ready availability, excellent blood supply, and wide range of coverage has tremendously facilitated immediate correction of severe injuries of the knee and lower leg.

Humans↗
PubMed1979

The breast reconstruction patient and her health insurance carrier.

To determine policies of health insurance companies regarding payment for breast reconstruction following mastectomy, we polled 50 companies selected at random, as well as every Blue Cross-Blue Shield company. To verify that insurance carriers' replies represented their practices, we polled 96 plastic and reconstructive surgeons in 47 states. Although most health insurance carriers claim to fully cover breast reconstruction following mastectomy for cancer, practices vary widely; many postmastectomy patients receive incomplete or no coverage for reconstruction. Two major reasons for discrepancies appear to be (1) inadequate coverage prompted by unrealistic conception of reconstruction on the part of carriers and (2) specific contractual exclusion. We suggest (1) educating lay and professional persons about breast reconstruction, (2) encouraging more realistic coverage from insurance companies, and (3) if necessary, legislative protection for the postmastectomy patient.

Breast↗
PubMed1979

A quantitative examination of the use of fluorescein in predicting viability of skin flaps.

The use of fluorescein as a predictor of skin viability in the rat flap model of avascular skin necrosis is well known in the field of plastic surgery. Inherent in this model are several faults that must be corrected if it is to become a valid standard. Fluorescence readings are one of the main variables in flap models. By carefully shaving rat backs with a double-edged razor, taking fluorescence readings in a uniformly darkened space, carefully tattooing the exact extent of both the bright and the mottled areas of fluorescence on the flap, and placing a plastic barrier between the flap and the body to prevent any part of the flap from acting as a graft, we were able to quantitatively predict which portions of a flap would survive and which would die after fourteen days. The bright fluorescent area (mean = 11.99 cm2, SEM +/- 0.53 cm2) is equal to the amount of tissue that will survive (mean = 11.91 cm2, SEM +/- 0.50 cm2; NS), while the sum of the nonfluorescent area and the mottled fluorescent area (mean = 27.69(2), SEM +/- 0.52 cm2) is equal to the amount of tissue that will die (mean = 27.99 cm2, SEM +/- 0.52 cm2; NS).

Animals↗
PubMed1979

Immediate reconstruction of gunshot injuries to the face.

In the past, severe traumatic injuries to the face resulting from shotgun injuries have been managed by primary wound healing followed by little or late reconstruction. This would involve a long period of convalescence by the patient, followed by years of living with his deformity. With recent demands to minimize the patient's suffering and disabilities and to lessen hospitalization costs, a method of immediate reconstruction of such crippling facial injuries using a partially de-epithelialized skin flap has been devised and successfully applied to the patient presented here.

Adult↗
PubMed1979

Providing useful and protective sensibility to the sitting area in patients with meningomyelocele.

About 62 percent of the patients with meningomyeloceles will have essentially normal sensation in the area supplied by the lateral femoral cutaneous nerve (which is also the territory of the extended tensor fasciae latae flap), despite the fact that they may have complete anesthesia in their sitting area. In these, pressure sores can be healed and future ones prevented by transposing a sensation-bearing tensor fasciae latae flap to provide virtually normal sensibility in the sitting area.

Buttocks↗
PubMed1979

Successful correction of velopharyngeal stress incompetence in musicians playing wind instruments.

Two professional musicians who played wind instruments developed velopharyngeal stress incompetence which prevented them from generating the high intraoral pressures required to play their instruments. In both cases, we did a V-Y pushback with a superiorly-based pharyngeal flap. At 1 1/2 and two years postoperatively, both patients remain free of velopharyngeal incompetence and are actively engaged in their musical careers.

Adult↗