PubMed Health⌕ Search

Biomedical subjects

Eduardo D Rodriguez

Publications and source records attributed to Eduardo D Rodriguez.

10 recordsLinked to original sources
PubMed2007

The anterolateral thigh flap is highly effective for reconstruction of complex lower extremity trauma.

BACKGROUND: Trauma patients with high-energy injuries often present with severe tissue damage that extends beyond the immediate zone of injury and requires recruitment of vascularized tissues from distant sites. The objective of this study was to evaluate the utility of the anterolateral thigh (ALT) flap for reconstruction of the traumatically injured lower extremity. METHODS: Prospective data were collected on all patients who underwent lower extremity reconstruction with an ALT flap during a 3.5-year period at a primary adult resource center (PARC). Demographics captured included age, gender, Injury Severity Score, mechanism of injury, and size of defect and complications. RESULTS: Fifty-six patients underwent a total of 59 ALT flap harvests during the study period. The majority of patients were male (75%) and sustained blunt injury (95%). The mean age was 37 +/- 14 years with a mean Injury Severity Score of 17.9 +/- 8. The mean flap size was 20.7 x 8.4 cm, with 64% harvested from the injured limb. Total flap success rate was 91.5%, with four total (6.7%) and one partial flap failure (1.7%). CONCLUSION: The ALT flap is a useful tool for trauma reconstruction in lower extremity salvage. We have shown that the ALT flap can be performed successfully in the traumatically injured patient even when harvested from the ipsilateral lower extremity.

Adult↗
PubMed2006

Nipple reduction using the modified top hat flap.

BACKGROUND: Large nipples, disproportionate to the small areola and breast size, are an ethnic characteristic frequently encountered among Asian female patients. Patients seek correction to improve cosmesis and alleviate psychological and physical discomfort. The authors present a new technique of nipple reduction and describe its potential advantages over other techniques. METHODS: Between March of 2003 and April of 2005, 34 nipple reductions were performed in 19 female patients (mean age, 40.5 +/- 5.6 years) using the modified top hat flap. The neonipple is designed to reduce the nipple diameter at the superior pole of the nipple while preserving the subdermal plexus. A crescent-shaped section of nipple skin below the proposed neonipple is excised, maintaining the integrity of the neonipple and the central nipple core. Two lateral wing flaps are elevated and trimmed to reduce both nipple height and diameter at the lateral walls of the nipple. The flaps of the neonipple are then sutured to the areola. RESULTS: Postoperative recovery was rapid and uneventful and no complications were encountered. The mean diameter of the hypertrophic nipple was 16.3 +/- 2.6 mm (range, 16 to 30 mm). The mean diameter of the neonipple was 7.9 +/- 1.7 mm (range, 5 to 11 mm), with an average reduction of 8.4 +/- 1.6 mm (range, 5 to 20 mm). At 17.2 +/- 2.9 months of follow-up, the neonipple had a natural appearance, with less projection and an inconspicuous scar. There was no statistically significant difference on monofilament sensation testing (p = 0.5829) between reduction nipple and areola in 11 nipples of seven patients. CONCLUSIONS: The modified top hat flap requires minimal preoperative planning, is easy to perform, and yields reproducible results. This technique decreases both the diameter and height of any size nipple and can be modified to meet patient preferences. Because the continuity of the neonipple with the subdermal arterial plexus is maintained and the majority of the parenchymal elements are preserved, nipple sensation and circulation remain largely unaffected.

Adult↗
PubMed2006

Multiplanar distraction osteogenesis of fibula free flaps used for secondary reconstruction of traumatic maxillary defects.

Traumatic maxillary bone loss, if not treated acutely, is accompanied by contracture of the overlying soft tissue envelope and loss of facial projection in three dimensions. Reconstruction aimed at replacing the bony architecture, expanding the soft tissue envelope and establishing a platform for dental rehabilitation can be accomplished in a staged approach. We present two patients who underwent replacement of missing maxillary segments with a free fibula flap, followed by distraction of the free fibula in three dimensions and eventual dental rehabilitation with osseo-integrated implants.

Adult↗
PubMed2006

Long term impact of damage control surgery: a preliminary prospective study.

BACKGROUND: To evaluate the impact of damage control laparotomy on long term morbidity and survival. METHODS: Prospective data were collected on 56 consecutive trauma patients over a 20-month period (May 2000-January 2002). Patients were stratified by mechanism of injury, age, Injury Severity Score, and type of injury, temperature at admission, initial blood transfusion volume and pH. Initial outcome data included major complications, intensive care unit and hospital length of stay, and mortality. Readmission data including number of admissions, surgical procedures, and hospital length of stay were then analyzed over the subsequent follow-up years (2001-2003). RESULTS: The mean age of the study group was 31 +/- 11 years with a mean Injury Severity Score of 33 +/- 13. The majority of the patients were male (73%) with a relatively equal number of blunt (n = 30) and penetrating injuries (n = 26). Liver injuries (34 [61%]) were the most common solid organ injury followed by 22 bowel (39%), 19 spleen (34%), 11 major vessel (20%), and 7 pancreas (13%) injuries. The mean number of initial abdominal surgical procedures was 4.4 +/- 2.2 per patient. The overall mortality during the first admission was 27%. Time spent in the intensive care unit and hospital length of stay was 17 +/- 13 and 30 +/- 19 days, respectively. There were a total of 74 readmissions and 58 subsequent surgical procedures in the 41 patients who were readmitted. Thirty-one (76%) patients were re-admitted at least one time. Infection (n = 19) was the most common reason for readmission followed by ventral hernia repair (n = 17) and fistula management (n = 14). There was 0% mortality for patients who survived the preliminary hospitalization but required readmission. CONCLUSION: Although damage control laparotomy is associated with a significant complication and readmission rate, its long term survival and benefit is indisputable.

Adult↗
PubMed2005

Pedicled internal oblique rotational muscle flap for reconstruction of lateral pelvic defects: report of 4 cases.

Various local and distant flaps have been used to repair pelvic defects, including sartorius, rectus abdominis, rectus femoris, tensor fascia lata, vastus lateralis, gracilis, and omentum, each with benefits and disadvantages. The pedicled internal oblique rotational muscle flap has been described to cover pelvic wounds but may be underutilized. We present our experience with 5 pedicled internal oblique flaps in 4 patients (3 male, 1 female). The mean patient age was 32 years (23-47 years), and the mean follow-up was 8 months. All patients required coverage of the lateral pelvis after failure of conservative measures. There were no major complications. One patient experienced decreased sensation in the lateral femoral cutaneous nerve distribution, which resolved fully within 3 months. The internal oblique muscle provides local soft-tissue coverage with a predictable blood supply, and its proximity to the pelvis offers an alternative for reconstruction of lateral pelvic defects, with minimal associated morbidity.

Adult↗
PubMed2005

Human acellular dermal matrix for repair of abdominal wall defects: review of clinical experience and experimental data.

The use of prosthetic mesh for the tension-free repair of incisional hernias has been shown to be more effective than primary suture repair. Unfortunately, prosthetic materials can be a suboptimal choice in a variety of clinical scenarios. In general, prosthetic materials should not be implanted into sites with known contamination or infection because they lack an endogenous vascular network and are thus incapable of clearing bacteria. This is of particular relevance to the repair of recurrent hernias, which are often refractory to repair because of indolent bacterial colonization that weakens the site and retards appropriate healing. Although fascia lata grafts and muscle flaps can be employed for tension-free hernia repairs, they carry the potential for significant donor site morbidity. Recently, a growing number of clinicians have used human acellular dermal matrix as a graft material for the tension-free repair of ventral hernias. This material has been shown to become revascularized in both animal and human subjects. Once repopulated with a vascular network, this graft material is theoretically capable of clearing bacteria, a property not found in prosthetic graft materials. Unlike autologous materials such as fascial grafts and muscle flaps, acellular dermal matrix can be used without subjecting the patient to additional morbidity in the form of donor site complications. This article presents a thorough review of the current literature, describing the properties of human acellular dermal matrix and discussing both animal and human studies of its clinical performance. In addition to the review of previously published clinical experiences, we discuss our own preliminary results with the use of acellular dermal matrix for ventral hernia repair in 46 patients.

Bioprosthesis↗
PubMed2003

Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model.

This study investigates whether human acellular dermis (Alloderm; LifeCell, Branchburg, NJ) revascularizes when used to reconstruct abdominal wall defects in rabbits. This could prove useful in infected situations in which prosthetic mesh is suboptimal. Twenty-five rabbits were randomly assigned to one of three groups: primary closure (n = 5), expanded polytetrafluoroethylene (GoreTex; W.L. Gore, Flagstaff, AZ) repair (n = 10), or AlloDerm (LifeCell) repair (n = 10). The rabbits in the primary closure group received a 7 cm x 0.5 cm full-thickness abdominal wall defect that was closed primarily. A 7 cm x 3 cm full-thickness abdominal wall defect was created in the other two groups. The defects were repaired with a GoreTex Mycromesh (W.L. Gore), or AlloDerm (LifeCell) patch. At 30 days, the following endpoints were evaluated: (1) incidence of herniation; (2) presence of intra-abdominal adhesions; (3) the breaking strength of the patch-fascial interface; and (4) evaluation of graft vascularization by fluorescein dye infusion and histological analysis. There was no incidence of herniation in any of the rabbits. Visceral adhesions to the patch were found in all animals in the Gore-Tex (W.L. Gore) group but in none in the AlloDerm (LifeCell) group. The size of the patch was unchanged in all the rabbits except for two rabbits in the AlloDerm (LifeCell) group that stretched 1 cm in the transverse dimension. The change in size was not statistically significant (p = 0.17) when compared with the change in size in the Gore-Tex (W.L. Gore) group. The mean breaking strength of the primary closure group was significantly higher (521.2 N/mm2 +/- 223.0) than that of the two patch-repair groups (p < 0.05). But there was no significant difference between the mean breaking strength of the AlloDerm (LifeCell) fascial interface (288.6 N/mm2 +/- 97.1 SD) and that of the Gore-Tex (W.L. Gore) fascial interface (337.0 N/mm2 +/- 141.2). Fluorescein dye infusion and histological analysis confirmed vascularization of the AlloDerm (LifeCell) graft. This study demonstrates that AlloDerm (LifeCell) does become vascularized when used as a fascial interposition graft for abdominal wall reconstruction. AlloDerm (LifeCell) also performs mechanically as effectively as Gore-Tex (W.L. Gore) in ventral hernia repair at 1 month after operation in the rabbit model.

Abdominal Injuries↗