Island gluteus maximus myocutaneous flap.
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Humans↗
Biomedical subjects
D J Hurwitz
Publications and source records attributed to D J Hurwitz.
Is experimental muscle flap temperature a reliable indicator of its viability?
This study was designed to assess the effects of environmental factors on experimental muscle flap temperature and to critically evaluate temperature as a modality for assessing vascular patency. A brief overview of the physiology of tissue heat transfer is presented. The right vertebral head of the biceps femoris muscle was used in albino New Zealand rabbits for monitoring temperature. Temperature was recorded simultaneously by means of thermocouples placed into the tested muscle, the contralateral control biceps femoris muscle, the ipsilateral control thigh compartment, and rectally (core temperature). The muscle flap temperature was recorded as a function of time during the following flap manipulations: steady state, exposed muscle, muscle elevated and then replaced with pedicles intact, and pedicles ligated. In addition, the effects of environmental manipulations on muscle flap temperature were evaluated. The constant findings demonstrated that the dominant aspects of muscle temperature are the temperature of the surrounding tissue, as well as the prevailing environmental conditions. Vascular occlusion did not alter muscle temperature. In 3 patients who underwent successful free-flap transfer, muscle temperatures were monitored and found to be labile, and altered by environmental manipulations. We concluded that temperature is an unreliable, nonreproducible method of assessing the vascular status of a muscle flap, unless all environmental variables are meticulously monitored and controlled.
Animals↗
Repair of chronic radiation wounds of the pelvis.
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Debridement↗
Gluteal thigh flap repair of chronic perineal wounds.
Since the introduction of the gluteal thigh flap in 1979, we have had the opportunity to study and modify this reconstructive technique in over 40 patients. Our successful experience with the gluteal thigh flap in six consecutive patients with difficult, nonhealing perineal pelvic sinuses has increased our confidence with this modality and led to a modified technique. Bilateral deepithelialized and well-vascularized flaps are harvested from the posterior thighs and transferred to the perineal wounds on pliable musculofascial pedicles through the ischiorectal space. Proper filling of the pelvic space requires adequate debridement, which may include release of a bottleneck narrowing of the sacral promontory. Donor site morbidity is minimal and temporary. Follow-up periods of 8 months to 5 years have revealed no wound recurrence.
Adult↗
The cutaneous blood supply of the neck: relevance to incision planning and surgical reconstruction.
Previous descriptions of the blood supply of the neck have been contradictory. Neck dissections were performed on 17 adult cadavers after perfusion with radio-opaque microfil silicone rubber compound. In four cadavers cervical incisions were created and flaps elevated prior to perfusion to help demonstrate vascular pathways. In all cadavers myocutaneous perforators were seen passing from the sternocleidomastoid, strap muscles, and trapezius to supply the dermal-subdermal plexus. Also, there were consistently identifiable branches of the superior thyroid, posterior auricular, occipital, facial and transverse cervical arteries, which supply both the platysmal vascular plexus and the overlying dermal-subdermal plexus. The dermal-subdermal plexus is continuous across the midline and this contralateral pathway is supplied chiefly from branches of the superior thyroid artery, facial artery, and myocutaneous perforators of the strap muscles. This information may be useful in the planning of cervical incisions and the design of platysma myocutaneous flaps.
Adult↗
The salutary effects of the bed on the survival of experimental flaps.
The present study indicates that the distal, random segment of an axial pattern experimental flap can be partially salvaged by employing local pressure, which provides favorable contact with the bed. This portion of the flap could be considered as a composite skin graft. Serial India ink injections demonstrated that its physiological take resembles that of a split-thickness graft, dominantly depending on the blood vessels emerging from its bed, and to a lesser extent on those provided by its proximal segment and adjacent skin edges. Increasing the topical flap humidity hindered, rather than improved, its survival.
Animals↗
The microcirculatory pattern of the transverse-abdominal flap: a cross-sectional xerographic and CAT scanning study.
Following unilateral iliac artery injection of radiopaque Microfil in cadavers, coronal sections of the anterior abdominal wall at 1-cm intervals were obtained employing computerized axial tomography of the intact specimen as well as xerography of frozen slices. Because they avoid the distortion and disruption of the vasculature induced by anatomical dissection, these studies clearly indicate that the arterial supply to zones 3 and 4 of the transverse rectus abdominis musculocutaneous flap is derived through the following systems: the subdermal plexus, and the superficial subcutaneous tissue crossover system. This study substantiates previous anatomical assumptions.
Abdominal Muscles↗
Internal oblique muscle pedicle flap for coverage of a major soft tissue defect of the groin.
We describe a new muscle flap, using the internal oblique muscle as a transposition flap based on the ascending branch of the deep circumflex iliac artery, for coverage of a groin defect with exposed femoral vessels. This muscle also has potential usefulness as a pedicle flap for coverage of the anterior perineum and midline lower abdominal defects. It is a thin, flat muscle with excellent vascularity and is safe and reliable to use. The donor site scar is well concealed. The disadvantages are a possibly bloody and tedious dissection, and the long-term potential for abdominal wall weakness or herniation. In the case reported, no abdominal wall laxity or herniation were noted at eight and one-half months. We believe that the internal oblique muscle flap is a useful technique that complements the already popular methods of reconstruction for groin defects.
Abdominal Muscles↗
Life response to Crouzon's disease.
This paper describes the life responses of two adult patients with facial deformities associated with untreated Crouzon's disease. Each patient has normal intelligence, and each has two children and close family relatives who exhibit variable degrees of Crouzon's disease. The impact of untreated facial deformity is considered, and recommendations are made for psychosocial management of these patients and their families.
Adaptation, Psychological↗
The foliage leaf in microvascular surgery.
A lacerated fresh leaf is introduced as a model for developing and refining microvascular skills. Being friable, this plant tissue exaggerates damage due to technical errors, therefore improving a trainee's skills.
Animals↗
The effect of topical hyperalimentation on wound healing rate and granulation tissue formation of experimental deep second degree burns in guinea-pigs.
Revital , a product containing 19 amino acids, was applied to experimental deep second degree burns in guinea-pigs for 24 days, in order to assess the effect of this form of hyperalimentation on the healing process. Silver sulphadiazine cream served as the contralateral control standard. Epithelialization was faster in the silver sulphadiazine treated burn wounds, while contraction of both tested wounds proceeded at a similar rate. Revital significantly enhanced the formation of granulation and scar tissue in this burn wound model. These observations indicate that topical wound hyperalimentation promotes granulation tissue formation of experimental deep second degree burns in guinea-pigs.
Administration, Topical↗
The coat burn wound dressing.
A simple and reliable technique to protect experimental burn wounds in guinea pigs is described. This method significantly reduced the accidental removal of dressings, as well as autocannibalism and contamination.
Animals↗
The india ink injection technique to assess the depth of experimental burn wounds.
A detailed description of the India ink injection technique for assessment of experimental burn wound depth is presented with emphasis upon special technical manipulations. Assessment of the burn depth is mandatory for the establishment of a burn wound model as well as to reproduce consistent data among different investigators.
Animals↗
Osseous interference of soft tissue healing.
Bone may interfere with soft tissue wound contracture by osteomyelitis or unyielding rigidity. Chronic osteomyelitis and nonhealing cavities are being successfully treated by debridement, coverage or fill by permanently pedicled flaps, and appropriate antibiotics.
Adult↗
The sonic digitizer: a rapid and accurate method to assess the size of experimental flaps.
Two methods for measuring area, the sonic digitizer and the polar-planimeter, were compared for speed, accuracy, and efficiency. The sonic digitizer was significantly (p less than 0.001) faster than the planimeter (97.2 +/- 9.5 versus 206.3 +/- 14.8 seconds per flap) and more efficient. The accuracy of both methods in measuring areas of 5 to 30 cm2 was comparable; however, for areas of 5 to 13 cm2 the sonic digitizer gave more reproducible results (p less than 0.001). These differences were not reflected in the computed rate of necrosis of the present flap model.
Animals↗
Tobacco smoking: impairment of experimental flap survival.
The survival rate of experimental flaps as affected by exposure to inhaled tobacco smoke has been investigated in rats subjected to different smoking regimens. A distally based dorsal flap was raised and reattached in each animal. Evaluation of the flaps on postoperative day 8 showed a mean rate of necrosis of 28.5% in 25 control animals, 32.2% in 21 rats postoperatively smoking for 7 days, 41.3% in 18 rats preoperatively smoking for 7 days, and 45.7% in 21 rats smoking for 7 days both before and after the surgical procedure. Histological sections from the lungs of the smoking animals revealed a pattern compatible with mild smoke inhalation injury. Arterial oxygen tensions were lower in the tobacco smoking animals. It is assumed that the multiple effects of tobacco smoking contributed to the impairment of experimental flap survival.
Animals↗
The disc dressing for local irrigation of experimental burn wounds.
The newly designed disc dressing permits the surface of experimental burn wounds to be irrigated with liquid therapeutic agents without the need for frequent dressing changes. This approach is simple to handle, reduces the risk of trauma or contamination of the wound, and is not time consuming.
Animals↗
The internal oblique muscle flap: an anatomic and clinical study.
A new muscle flap based on the ascending branch of the deep circumflex iliac artery is described. Twenty internal oblique muscle flaps have been dissected and studied in 10 fresh cadavers. This muscle flap has been used successfully as a free-tissue transfer in seven lower extremity defects. There was one loss of flap due to venous thrombosis. Other complications included a local wound abscess (one case), partial loss of skin graft (two cases), and arterial thrombosis (one case). There has been no donor-site morbidity. The donor scars are well concealed and no hernias have been observed, the longest follow-up being 9 months. The additional advantages of this flap include its thin, flat shape, excellent vascularity, and ease of application to areas about the ankle, with good aesthetic results. The disadvantages are (1) bloody and tedious dissection and (2) potential for abdominal weakness or hernia in the long run. This muscle flap appears to be excellent as a free flap for coverage of small- to moderate-sized defects of the distal lower extremity and as a pedicle flap for coverage of soft-tissue defects of the groin and anterior perineum.
Abdominal Muscles↗