Biomedical subjects

E H Rose

Publications and source records attributed to E H Rose.

At least 19 recordsLinked to original sources

PubMed1992

Slip-knot suspension technique: a fail-safe microanastomosis for small-caliber vessels.

The most common technical error associated with microvascular anastomotic failure is accidentally snagging the opposite wall and including it in the stitch, thereby reducing the vessel lumen diameter or occluding it altogether. A simple, safe microsuturing technique is described that combines the use of the slip-knot and the suspension technique in a procedure that allows direct visual inspection of suture placement from first to last stitch. This technique is applicable to end-to-end and end-to-side microvascular anastomoses, for thick-walled ducts such as the vas deferens and the fallopian tube, and in laparoscopic suturing.

Anastomosis, Surgical↗

PubMed1991

Nasal spray desmopressin (DDAVP) for mild hemophilia A and von Willebrand disease.

OBJECTIVE: To evaluate the effect of a nasal spray preparation of desmopressin (DDAVP) on levels of factor VIII activity, ristocetin cofactor activity, and von Willebrand antigen as well as the length of bleeding time in patients with mild hemophilia A and von Willebrand disease; to determine whether effective hemostatic levels can be attained; and to compare the effect of this spray with that of standard intravenous desmopressin treatment. DESIGN: Before-and-after trial in patients known to respond to intravenous desmopressin. SETTING: Regional, comprehensive, hemophilia diagnosis and treatment center. PATIENTS: A total of 22 patients, including 11 patients with von Willebrand disease, 8 patients with mild hemophilia A, and 3 symptomatic hemophilia carriers. INTERVENTIONS: Patients were infused with desmopressin, 0.3 micrograms/kg body weight. At least 1 week later, they were taught to self-administer desmopressin nasal spray, 150 micrograms to each nostril. MEASUREMENTS: In patients with hemophilia, the level of factor VIII activity was measured; in patients with von Willebrand disease, levels of factor VIII activity, ristocetin cofactor activity, and von Willebrand antigen as well as bleeding time were measured before and after each administration of desmopressin. MAIN RESULTS: Desmopressin, when administered intravenously or intranasally, elevated levels of factor VIII, ristocetin cofactor, and von Willebrand antigen in both mildly hemophiliac patients and patients with von Willebrand disease when compared with baseline measures (P less than 0.05). Factor VIII levels adequate for hemostasis were achieved by 82% of the hemophiliac patients. An abnormal bleeding time was corrected in the majority (62%) of patients with von Willebrand disease. CONCLUSION: A nasal spray preparation of desmopressin apparently was effective both in treating bleeding episodes and when used prophylactically for minor surgical procedures in several patients.

Administration, Intranasal↗

PubMed1991

Palmaris brevis turnover flap as an adjunct to internal neurolysis of the chronically scarred median nerve in recurrent carpal tunnel syndrome.

Thirteen hands in 11 patients with previous carpal tunnel releases were treated by microscopic internal neurolysis and palmaris brevis "turnover" flaps. All patients in the series had positive electrodiagnostic testing, dysesthetic wrist pain, and numbness in the median nerve distribution before operation. Average age was 41.9 years (range, 27 to 62 years). Ten were male and 3 were female. Range of follow-up after the procedure was from 1 to 1 1/2 years. All hands with abnormal preoperative two-point discriminations or Semmes-Weinstein measurements showed numerical improvement in their sensory parameters. Thenar strength and bulk improved at least one grade in all six cases of thenar atrophy. Mean grip strength was 15.2% greater than before operation. Key pinch increased 5.5% and pulp pinch 31.9%. Subjective assessment of improvement ranged from 25% to 100%. All patients returned to their former jobs or to vocational retaining except the oldest patient who is semiretired.

Adult↗

PubMed1990

Massive foreign body impalement of the shoulder and chest wall.

Impalement injuries to the upper extremity are rare. A case is described of penetration of a 10 x 3.5-inch fence post into the left shoulder of a 16-year-old boy, pinning the shoulder to the chest wall. Sequelae of potential serious brachioplexus, vascular, and intrathoracic injuries are reviewed. The author presents a systematic treatment approach to the assessment, extrication, and microneurovascular repair of damaged structures, and to soft tissue reconstruction following massive foreign body injuries.

Adolescent↗

PubMed1990

The versatile temporoparietal fascial flap: adaptability to a variety of composite defects.

The unique properties of the temporoparietal fascial flap (TPFF) offer adaptability in reconstruction of a variety of composite defects. The broad, thin sheet of vascularized tissue may be transferred alone or as a carrier of subjacent bone or overlying skin and scalp. As a pedicled flap, it is ideal for defects of the orbital, malar, mandibular, and mastoid regions. As a free-tissue transfer, the large vessels and lack of bulk find broad utility in reconstruction of the extremities. This flap is our choice for reconstruction of the dorsal hand and non-weight-bearing surfaces of the foot. A viscous gliding surface decreases friction for tendon excursion. The thin contour is aesthetically superior to thicker flaps, allowing unmodified footwear or gloves. The pliable fascia convolutes into surface defects (e.g., bone craters) or drapes over skeletal frameworks (e.g., ear cartilage). The rich capillary network offers nutrition to saucerized bone, cartilage or tendon grafts, and overlying skin grafts. The geometry of the skull lends to fabrication of membranous bone for complex facial puzzles. The donor site is well disguised by hair growth. Twelve cases performed over a 2-year period demonstrate the versatility of this flap. These include complex foot reconstruction, ear and scalp avulsion, shotgun wound of the cheek and orbit, posttraumatic jaw recontouring, chronic osteomyelitis of the hand and foot, and acute resurfacing of dorsal hand with tendon reconstruction.

Adult↗

PubMed1989

The "cap" technique: nonmicrosurgical reattachment of fingertip amputations.

With the exception of children, amputations at the level of the lunula survive poorly by direct reattachment. Microsurgical replantation is costly and often fails because of poor venous drainage. In a series of seven adult patients the severed tip was filleted and replaced as a "cap" over the skeletonized distal phalanx of the stump. A 2 mm remnant of germinal matrix was preserved for nail regrowth. The reconstructed digits, although shortened by an average of 6 mm, give the "illusion" of a normal finger. All were successful with small areas of tip necrosis in two, healing by secondary reepithelialization. Mean static two-point discrimination was 6.5 mm (range, 3 to 10 mm) and pulp pinch was 67% of normal. The "cap" technique of nonmicrosurgical reattachment is a simple, reliable method of functional preservation of pulp tissue, as well as normal esthetic appearance of the nail complex.

Adolescent↗

PubMed1989

The reversed venous arterialized nerve graft in digital nerve reconstruction across scarred beds.

Conventional nerve grafts in complex digital injuries often yield poor results, particularly when placed in traumatized or avascular beds. Vascularized nerve grafts offer an option; experimental evidence suggests superior axonal regeneration across scarred beds with vascularized nerve grafts. We previously described a vascularized graft based on the dorsalis pedis artery--deep peroneal nerve "system." Reluctance to sacrifice this major artery, combined with the recent description by Townsend and Taylor and Gu, et al, of "reversed venous" arterialized nerve grafts, spurred us on to investigate the deep peroneal nerve--dorsalis pedis venae comitantes system. Fourteen neurovenous grafts were used in scarred or poorly vascularized beds for digital nerve reconstruction in 10 patients over a 4-year period. Graft length averaged 4.4 cm; interval from injury was 1 to 17 months. Sensory parameters of return included average static two-point discrimination of 8.3 mm, moving two-point discrimination of 5.8 mm, and median Semmes-Weinstein monofilament appreciation of 2.83. Two patients received three vascularized grafts and three conventional grafts for adjacent nerve injuries in the same digit, serving as internal controls. In these patients, the vascularized nerve grafts returned mean static two-point discrimination values of 9.3 mm and moving two-point discrimination values of 6.7 mm. The conventional nerve grafts averaged static two-point discrimination of 14.3 mm and moving two-point discrimination values of 10.3 mm. These differences imply enhanced axonal regeneration through vascularized nerve grafts. These data suggest that the reversed neurovenous graft may be the procedure of choice in secondary reconstruction of digital nerves across scarred beds or following injuries with poor soft-tissue vascularity, especially in those patients with cold intolerance.

Adolescent↗

PubMed1989

Small flap coverage of hand and digit defects.

Small defects of the hand and digits challenge the surgeon to use innovative methods of composite reconstruction for retention of digital length; aesthetic nail appearance; coverage of joint, implants, and tendons; release of scar contractures; and restoration of sensation in critical tactile surfaces. This article is by no means totally encompassing but an attempt to provide the reader with an insight into the author's select flap choices applying some of the newer microvascular methods. Descriptions include the volar advancement flap, free microvascular pulp transfer from the toe, "kite flap," onycho-osteocutaneous transfer, arterialized toe transposition, wrap-around flap, arterialized island pedicle, venous flow-through flap, and the free temporoparietal fascial flap. Options are influenced by morphological and physiological considerations, specifically in the fingertip, nail complex, volar surface of the digit, and dorsum of the hand.

Adult↗

PubMed1988

Microsurgical management of complex fingertip injuries: comparison to conventional skin grafting.

In selected cases of severe fingertip injuries, an aggressive approach using microvascular and microneural techniques can yield functional results equal or superior to conventional methods of treatment in less severe injuries. A series of 20 patients were treated microsurgically from 1983 to 1986 for severe acute distal finger injuries or their early sequelae--five distal replantations, eight neurovascular free tissue transfers, and nine distal neurorrhaphies/nerve grafts with or without vascular conduit. Concurrently, 33 simpler tip avulsions were treated with full-thickness skin grafts for comparison. In the microsurgical series, one replant and the distal 1 cm of a free toe flap necrosed. Replants averaged two-point discrimination of 9.8 mm and pulp pinch 65 percent of normal; free toe transfers, two-point of 6 mm, pulp pinch 58 percent; distal nerve reconstruction, two-point 6 mm. Operating time per digit averaged 5.0 hours for replants, 4.3 hours for toe flaps, and 1.5 hours for nerve repair/grafts. All patients returned to full pre-injury employment within six months. None required revisional surgery for dysesthetic fingertips. In the conventional skin graft series, greater than six months follow-up is available in 17 patients. Average two-point was 7 mm (range: 3 to greater than 15 mm) and pulp pinch 83 percent of normal. There were seven poor results with cold intolerance, numbness, and paresthesias, three of which required revisional surgery. The data suggest that microsurgical management of fingertip injuries achieves results comparable to skin grafts, despite the greater complexity of the initial injury. This approach has resulted in fewer secondary tip revisions. Operative times are acceptable. Parameters of sensory return are similar, although pulp pinch is slightly less. Disability times are comparable to the average in major pulp losses. Of importance, final permanent partial factors of disability are diminished in rating, due to retained digital length, improved esthetic appearance, and less dysesthesia/cold intolerance.

Adult↗

PubMed1987

Unilateral invasive xanthelasma palpebrarum.

We describe an unusual case of an aggressively invasive, recurrent xanthelasma palpebrarum which was unilateral in its occurrence. Despite characteristics that appeared malignantly invasive clinically, the lesion was benign. The surgical treatment consisted of wide excision and resurfacing of the eyelids with full-thickness skin grafts.

Eyelid Diseases↗

PubMed1986

The high-tech hand surgery interface.

We have reviewed a potpourri of high-tech advances of interest to the hand surgeon: electronically controlled prostheses, functional neuromuscular stimulation, computer graphics, data base computer programs, 3-D imaging, magnetic resonance imaging, and lasers--fields that point toward new directions in medicine, in general, and in our specialty, in particular, as we enter the twenty-first century. With clearer understanding of the basics, we can overcome the natural tendencies of negativism fostered by the complexities of the new ideas and proceed with optimism and curiosity.

Animals↗

PubMed1985

Restoration of sensibility to anesthetic scarred digits with free vascularized nerve grafts from the dorsum of the foot.

Five cases of segmental vascularized nerve grafts that bridge scarred beds for digital sensory nerve reconstruction where previous nonvascularized nerve grafts have failed are reported. Average follow-up in this study was 27 4/5 months. Three patients were men and two were women. Average age was 35 1/2 years. The thumb was the recipient digit in one patient; the index finger in two patients; and the long finger in two patients (primary opposing digit). Three digits had suffered amputation and two had crush lacerations. Average graft length was 6.6 mm. Pin prick, touch, and vibratory sensation were restored in all patients (slightly impaired in one). Average moving two-point discrimination was 7.2 mm; average static two-point discrimination was 9.5 mm. Von Frey monofilament cutaneous pressure averaged 4.03 gm. Donor morbidity was negligible except for a neuroma in one patient and slight superficial skin loss in another.

Adult↗

PubMed1985

Nipple reconstruction with four-lobe composite auricular graft.

A new method of nipple reconstruction using a four-lobe free composite graft from the inferior pole of the earlobe in the shape of a clover leaf is described. Invagination of the flaps achieves long-term nipple projection without flattening. Donor deformity has been negligible and ear piercing has been preserved when desired. The transposed grafts have retained the pinkish appearance of the vascular donor sites. Color has blended well with the pigmented areolar grafts.

Breast↗

PubMed1979

Free toe-to-fingertip neurovascular flaps.

Six cases of free toe-to-fingertip neurovascular flaps are presented. The principal advantages of this procedure over rotation island flaps are (1) achievement of better two-point discrimination, (2) an acceptable donor defect, (3) no cortical reorientation is necessary, and (4) there is minimal tension on the nerve.

Adolescent↗

PubMed1978

A microarchitectural model of regional variations in hypodermal mobility in porcine and human skin.

In this paper, we focus on the hypodermal component of the integument and its functional contribution to properties of skin mobility. A specially designed mechanical apparatus was used to measure hypodermal extensibility in vivo of 6-mm "island" punches at selected anatomical sites in anesthetized pigs. Representative regional hypodermal force displacement curves were found to differ statistically in magnitude of acceleration, slope, and extensions at breaking point. A vertically oriented "lattice network" of hypodermal fibrous elements arranged in geometric subunits is consistently seen in sample specimens. Microarchitectural differences in network configuration, geometric unit size, fat infiltration, and intrinsic collagen fiber length can be correlated directly to the biomechanical data. These findings are corroborated by light microscopy, scanning electron microscopy, and quantitative hydroxyproline concentrations. A similar network is confirmed in human cadaver biopsies. Clinically, our data suggest that skin mobility is at least partially allowed by unfolding and stretching of the hypodermal vertical collagen network, and that regional variations in fibrous network architecture satisfy specific functional requisites (e.g., joint mobility, skin stabilization), as well as serving as an expansile retractile reservoir for the deposition and absorption of fat.

Adipose Tissue↗

PubMed1978

Successful replantation of two avulsed scalps by microvascular anastomoses.

Two cases of immediate replantation of avulsed scalps by microvascular anastomosis are presented. This method of treatment seems to offer significant economic, social, and psychological advantages over split-skin grafting of the calvarium, or other presently used treatments. The need for secondary reconstructive procedures after a successful replantation is minimal, or nil. The mechanism of scalping is reviewed, and it is related anatomically to the structure of the galea aponeurotica. Specific recommendations are made regarding the immediate care of the avulsed scalp and the denuded calvarium, the value of a team approach in replantation, and various technical aspects of the procedure and postoperative management. The more frequent use of interpositional vein grafts is urged.

Adolescent↗

PubMed1977

The panniculus carnosus in the domestic pig.

The panniculus carnosus arises from the superficial fascia of the midlateral back, inserts into the medial skin of the forelimb, and fuses ventrally with the contralateral cutaneous muscle. In the midback, forelimb, thigh, and groin the panniculus carnosus is lacking; there, superficial fascia alone is present. Both the panniculus carnosus and the superficial fascia divide the panniculus adiposus into a superficial compact layer and a less compact deep layer. The firm attachment of the dermis to the panniculus carnosus, and of the panniculus carnosus to the deep fascia, makes pigskin a more suitable model for comparison with human integument than the usual laboratory animals with loosely draped skin. When using the pigskin model, however, care must be exercised to define the level of incisions and the location of flaps or grafts, with respect to the panniculus carnosus.

Animals↗

PubMed1977

Excisional wound biomechanics, skin tension lines, and elastic contraction.

Confusion surrounding the concept of Langer's lines can be reduced by careful distinction among the operational definitions of the phenomenon, the empirical descriptions, and the theoretical explanations. An experimental analysis of the mechanical parameters of excisional wounds in pigskin shows that the marginal retraction, the elastic modulus at the wound midline, and the closing tension are higher for wounds oriented at right angles to tension lines--but the elastic modulus of the terminal segment of the force displacement curve is independent of orientation. The regional distribution of these values shows two patterns. The modulus parameters and the closing tension share a common distribution related to the steepness of regional force-displacement curves, while retraction has a qualitatively different distribution. On the basis of similarities in the behavior of retracting wound margins and in the distortion of punch holes which define tension lines, we hypothesize that the same mechanism may be responsible in both cases.

Animals↗