Biomedical subjects

D N Hing

Publications and source records attributed to D N Hing.

9 recordsLinked to original sources

PubMed1991

Sequential multiple free flap transfers for reconstruction of devastating hand injuries.

Restoring function to a severely damaged hand can require complex reconstructions using multiple tissue transfers to replace skeletal, soft tissue, and nerve components. We present 2 patients with severe hand trauma treated with serial multiple flap transfers, an operative sequence not previously reported in detail. One patient underwent five flap transfers in three operations, whereas the second patient underwent four flap transfers in two operations. All the flaps survived. Total anesthesia time for these patients was 43.5 and 34.5 hours, respectively. Both patients obtained measurable functional restoration, and suffered no significant perioperative morbidity. These patients illustrate the clinical feasibility of serial multiple microvascular transplantations for complicated reconstructions.

Adult↗

PubMed1990

Serratus anterior muscle transplantation for treatment of soft tissue defects in the hand.

The inferior three slips of the serratus anterior muscle have been used as a free tissue transfer in 18 patients for the reconstruction of dorsal and palmar defects in the hand. Mean follow-up was 2.8 years. There were 12/18 flaps for palmar coverage and 6/18 for dorsal coverage. All flaps survived. On the basis of this experience we conclude that this flap has three attributes making it suitable for palmar and dorsal metacarpal resurfacing: (1) low donor site morbidity, (2) the three separate slips are easily divisible for contouring, and (3) durability and adhesion provide a stable resurfacing for grasp.

Adolescent↗

PubMed1988

Cefotaxime-sensitive Aeromonas hydrophila infection in a revascularized foot.

Three days following revascularization of a foot injured in a boating accident, Aeromonas hydrophila cellulitis developed in the victim's foot and leg. The infection resolved with debridement and 10 days of cefotaxime therapy. A. hydrophila infection has not previously been reported in a revascularized extremity. Clinical response of an A. hydrophila cellulitis to cefotaxime is likewise undescribed. Our findings of a cefotaxime-sensitive Aeromonas infection and its successful treatment suggests that the organism should undergo further evaluation of cefotaxime sensitivity and that cefotaxime and other third-generation cephalosporins may have a role as broad-spectrum antibiotic agents in fresh-water trauma.

Adult↗

PubMed1988

Massive doses of midazolam infusion for delirium tremens without respiratory depression.

After undergoing replantation and revascularization surgery for a complex hand injury, a 25-yr-old male developed florid delirium tremens. Over a 5-day period, he received 2850 mg of midazolam as a constant infusion of varying rates. The midazolam controlled his severe agitation without respiratory depression and the hand reconstruction survived undamaged.

Adult↗

PubMed1988

Use of the temporoparietal free fascial flap in the upper extremity.

Reconstruction of hand coverage has been limited to flaps with the drawbacks of bulkiness and donor-site morbidity. In contrast, the temporoparietal fascia is a thin, pliable, well-vascularized sheet of tissue available in abundant quantity. It leaves an inconspicuous donor site within the hair-bearing scalp. In addition, microvascular transfer is facilitated by the consistent, reliable, and large-caliber axial superficial temporal vascular supply. The branches of the superficial temporal system provide flexibility in designing axial-pattern flaps. Secondary reconstructive surgery can be safely performed beneath the flap. The intrinsic vascularity of the flap may be useful in revascularizing scarred or irradiated areas. There is also the potential to transfer cranial bone as a composite temporoparietal osteofascial free flap to the hand. There has been partial flap necrosis and permanent alopecia at the donor site in only 1 of 12 patients. We recommend this flap based on our experience in these 12 patients.

Adolescent↗

PubMed1987

Applications of the extensor digitorum brevis muscle for soft tissue coverage.

The extensor digitorum brevis muscle flap is valuable in covering defects of the distal tibia and both malleoli as an island muscle flap. It can also be used as a free vascularized muscle transfer for more distant problems. Case reports illustrating these applications are described, demonstrating the advantages of consistent anatomy, large vessel size, flap thinness, arc of rotation, and an inconspicuous donor site.

Adolescent↗

PubMed1985

Free flap coverage of the hand.

The microvascular cutaneous transplant, or "free flap", suitable for hand resurfacing is described in detail. Anatomic and clinical indications are stressed, and the operative steps involved in the preparation and transfer of each flap are outlined.

Amputation Stumps↗

PubMed1983

Frostbite injuries: a rational approach based on the pathophysiology.

The breakdown products of arachidonic acid have been implicated as mediators of progressive dermal ischemia in both cold and thermal injuries. Increased tissue survival can be demonstrated experimentally with the preservation of the dermal microcirculation by using antiprostaglandin agents and thromboxane inhibitors. Thirty-eight consecutive patients (28 males and 10 females aged 2 mo to 46 yr) with frostbite injuries were treated at the University of Chicago's Burn Center in January 1982 with a protocol designed to decrease the production of thromboxane locally and prostaglandins systemically. All patients recovered without significant tissue loss. The average hospital stay was 5.6 days for acute injuries and 6.9 days for subacute injuries.

Adolescent↗

PubMedDate not supplied

The contributions of microvascular surgery to emergency hand surgery.

Microvascular surgery has revolutionized the field of emergency hand surgery in the areas of replantation and microvascular transplantation. Amputated parts from as small as a distal phalanx to the entire extremity can now be successfully replanted and unreplanted, or missing parts can be restored and reconstructed with immediate microvascular transplants (MVTs). MVTs can be used to cover exposed vital structures and replace missing complex parts. Part or whole digits can be reconstructed, with up to 4 toe transplants. Joints, bones, and muscles can be replaced with osteocutaneous and neuromyovascular transplants. Using the same approach for multiple replants, teams of 4 to 6 surgeons operating simulatneously and sequentially around the clock can accomplish multiple microvascular transplants in the acute setting. The classical principle of hand surgery, "preserve length and function", can now be modified to "restore length and function."

Amputation, Traumatic↗