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Biomedical subjects

F A Valauri

Publications and source records attributed to F A Valauri.

At least 19 recordsLinked to original sources
PubMed1994

Hematomas requiring surgical evacuation following face lift surgery.

This study evaluates hematomas requiring surgical evacuation following a face lift. Twenty-three hematomas occurred with 1236 consecutive face lifts (1.86 percent). All hematomas occurred within 48 hours. Fifty-seven percent were identified at less than 15 hours, 26 percent from 15 to 24 hours, and 17 percent from 24 to 48 hours. The incidence of hematomas for surgeons who performed more than 50 face lifts in this study varied from zero to 3.83 percent. This difference in incidence was statistically significant. A multivariant analysis of predetermined variables was done. Age, preoperative tests, medical history, gender, perioperative medications, type of anesthesia, number and combination of procedures, and treatment of the SMAS did not independently affect the incidence of hematomas. Preoperative and postoperative blood pressure did not affect the incidence. The incidence of hematomas with general anesthesia in this study was 7 of 630 (1.11 percent). In a similar 1973 study at this institution, the incidence with general anesthesia was 3.26 percent. This improvement was attributed to a change in anesthetic technique. Intraoperative hypotension was avoided in the current series. The incidence of hematoma in the local anesthesia group was 3.72 percent, and in the monitored intravenous sedation group it was 0.87 percent. Meticulous hemostasis, done with the patient's blood pressure in a normotensive state, appeared to be of primary importance.

Face↗
PubMed1993

Unrecognized injuries in patients referred for emergency microsurgery.

Replantation of amputated parts and emergency microvascular repair of injured extremities are the two most common applications of clinical microsurgery. A major complication of emergency referral of such cases is the existence of the other injuries unrecognized at the time of initial evaluation. We have reviewed this complication within a series of emergency microsurgical cases referred to this unit. Several reports examining this problem of missed injuries exist in the general trauma literature. To our knowledge this study is the first to look at this important problem in the context of acutely injured patients referred for emergency microsurgery. A retrospective analysis of patients referred to Davies Medical Center over a 7-year period was performed. Nine of 1100 patients (0.8%) transferred to our unit for microsurgical evaluation and treatment had unrecognized coexisting injuries that put those patients at high risk for injury-specific morbidity and demanded immediate changes in the original care planned at the time of referral. Brief case histories of these patients are outlined. We review the trauma literature of such injuries. A concise protocol elucidating the guidelines and pitfalls of emergency microsurgical referral is offered.

Adolescent↗
PubMed1992

Thumb and finger reconstruction by toe-to-hand transfer.

Toe transplantation provides a means of restoring a thumb or finger in a single microsurgical procedure with tissues anatomically similar to those lost or absent. Although formidable, these toe transplantation procedures can be accomplished by experienced teams of microsurgeons with a high rate of success.

Female↗
PubMed1991

The use of medicinal leeches in microsurgery.

Medicinal leeches have been used to treat a variety of ailments for thousands of years. During the past decade the leech has become valuable for salvaging surgically uncorrectable venous insufficiency which is occasionally encountered after microsurgical free flap and replantation procedures. Leech anatomy and physiology are reviewed. Indications and the technique for application of medicinal leeches is discussed, as well as potential complications of leeching.

Amputation, Traumatic↗
PubMed1989

Creation of neovascularised free flaps using vein grafts as pedicles: a preliminary report on experimental models.

In a rat model, based on the concept of neovascularisation, an interposition vein-grafted arterial-venous fistula pedicle was used to create neovascularised skin, muscle, and bone free flaps. The important feature of these flaps is that neovascularisation of the selected flap tissues was achieved with a vein graft, unlike earlier studies using local arteries and veins as pedicles. Within a few weeks sufficient neovascularisation developed to support free transfer of the flaps based on the implanted vein graft pedicle. After successful transfer these flaps were harvested for histological examination. The implications of the clinical application of this technique are discussed.

Abdominal Muscles↗
PubMed1989

An experimental model for ear reconstruction with moulded perichondrial flaps: a preliminary report.

Attempts to create a pinna by moulding cartilage fragments have been reported previously by Peer. The regenerative capabilities of perichondrium are well known. Combining these concepts, we succeeded in creating a cartilage pinna by implanting perichondrial flaps between the leaves of a methylmethacrylate mould. Ten rabbits were divided into two groups, the first using vascularised perichondrial flaps and the other using free perichondrium into which an arterial and venous pedicle was implanted. Both of these preparations were placed in the moulds in a subcutaneous pocket. Six weeks later, these constructions were harvested and histological examination conducted. Active cartilage growth was noted in both groups. The construction was completed by coverage with a split thickness skin graft. Clinically, this new procedure may provide a means of pinna reconstruction with a thin flexible cartilage framework, with excellent relief.

Animals↗
PubMed1989

Free-flap free flap.

We present a patient who sustained bilateral below-knee amputations that were treated with skin grafts as initial coverage. A latissimus dorsi free flap was later used as definitive coverage of one stump. Then at a subsequent operation a portion of the same latissimus dorsi free flap was reharvested, again as a free flap, and transplanted to cover the contralateral stump. Thus one latissimus dorsi free flap was used twice as a free flap (free-flap free flap) to cover bilateral amputation stumps in sequential operations.

Adult↗
PubMed1989

Thumb reconstruction--great toe transfer.

Thumb reconstruction has a long and exciting history spanning more than 100 years. Reflecting on the evolution of techniques, the problems encountered and solved, and the advancement of technologies, one is struck by the versatility of surgeons in their varied approaches to the restoration of the thumb. Philosophical differences over the relative advantages and disadvantages of each operation have fueled debate over the choice of technique, but a unifying concept in reconstruction "to replace the lost tissue with like tissue" must be sought. The ideal reconstruction is one that replaces all of the lost structures, provides restoration of all function, and has no donor site morbidity. Homotransplantation of the thumb fits each of these criteria and may well be available some day. The experimental work of Furnas and others with limb transplantation is bringing us ever closer to realizing this goal. Even now, cadaver preparations of bone, joint, and tendon together with wrap-around flaps are being used clinically for thumb reconstruction. The initial reports are favorable, and these procedures portend exciting prospects for the future when immunological barriers can be selectively overcome. Some 10 years ago Dr. Littler, in discussing thumb reconstruction, wrote "Just as the neurovascular pedicle method of composite tissue transfer unshackled the older but limited procedures and made possible more accurate planning in substituting for the structural loss, so must the new freedom, afforded the transfer of composite tissue through microvascular surgery, not fail to utilize established structural and functional principles. Nor must the urge to use the free transfer method lure the surgeon from a safer, more predictable procedure." In the decade since Dr. Littler expressed these sentiments, a great deal of progress has been made in microsurgery, and we feel that there is ample evidence in our clinical experience as well as that of the literature to allow us to state with confidence that great toe to thumb transfer is a safe, reliable, and efficient means of thumb reconstruction that offers significant advantages over other techniques and few disadvantages. Anatomically, the great toe is nearly identical to the thumb and provides a transplant with tendon, bone, joint, and innervated skin elements that, in many instances, restores the attributes of the lost thumb in a superior fashion compared with other procedures. Our series now consists of 80 great toe transplants and the results continue to be gratifying. In short, great toes make great thumbs.

Humans↗
PubMed1988

Antibiotic sensitivities of Aeromonas hydrophila cultured from medicinal leeches.

Increased use of medicinal leeches (Hirudo medicinalis) for the treatment of venous congestion in flaps and replanted parts has coincided with reports of soft tissue infections following leech application. We cultured the gullets of 20 medicinal leeches to re-examine the antibiotic sensitivities of Aeromonas hydrophila, the leech enteric organism associated with reported infections. These isolates reflected reported resistance to penicillin and first generation cephalosporins as well as sensitivity to gentamicin, tetracycline and chloramphenicol. Additionally, the cultures were sensitive to cefamandol, cefoxitin and two third generation cephalosporins (cefoperazone and cefotaxime). These findings suggest that cefamandol, cefoxitin and some third generation cephalosporins may have a role as perioperative antibiotics in replantation and flap surgery. These antibiotics might provide prophylaxis against Aeromonas hydrophila infection when leech use is required.

Aeromonas↗
PubMed1988

Neovascularized free fat flaps: an experimental model.

Using the concepts of neovascularization and microsurgical free transfer, two types of free fat flaps were developed in a rat model. The technique for construction of the flap was to use either a free fat graft or a pedicle fat flap that were then wrapped around a predetermined vascular bundle, subsequently to neovascularize the enveloping fat tissue. Once adequate neovascularization occurred, these flat flaps could then be harvested on a neopedicle consisting of the enveloped artery and vein. These preparations were later examined for viability, and then freely transferred to the contralateral femoral vessels. After transfer, the flaps were again examined for viability and prepared for histologic examination. Both of these studies revealed that successful neovascularized free fat flaps could be created, employing techniques of neovascularization, and that those created using a pedicle fat flap in the initial stage reliably succeeded in neovascularization and free transfer, in contrast with the less successful free fat graft technique.

Abdominal Muscles↗
PubMed1988

Neovascularized bone, muscle, and myo-osseous free flaps: an experimental model.

Different techniques for creating neovascularized bone, muscle, and myo-osseous free flaps were examined and evaluated in an experimental model. Sprague-Dawley rats (n = 40) were divided into four equal groups: 1) cortical bone flap (clam flap); 2) cortical bone and muscle flap (clam-muscle flap); 3) cortical and cancellous bone chip flap (Marlex-mesh flap); and 4) cortical and cancellous bone chip flap (silicone-cone flap). After 3 1/2 weeks, when neovascularization of the flaps developed, they were reliably transferred as free flaps based on their neopedicles. Post transfer, histologic and intravascular latex injections studies were performed, revealing significant differences in the character of neovascularization in the various flaps. The most abundant neovascularization was evident in the cortical bone and muscle (clam-muscle) flap, and the least in one of the cortical and cancellous bone (Marlex mesh) flap preparations. The silicone-cone flap (cancellous bone chips placed in a cone of silicone) neovascularized and maintained bony architecture. This preparation stimulates a hostile wound environment and may prove useful clinically, if similar techniques can be applied to augment vascularization of conventional bone grafts in situ, either as cancellous bone graft or as augmented iliac crest or fibular cortical bone graft. If clinically applicable, flaps created by these techniques may provide versatile alternatives to conventional free flaps.

Abdominal Muscles↗
PubMed1988

Prefabricated neovascularized free muscle flaps: pedicle variations.

Current techniques of free muscle transplantation with microvascular anastomosis have the disadvantages of limitation of available donor sites, loss of donor muscle function, and the possibility of donor site defect or deformity. Using modifications of a "secondary tissue flap" created by neovascularization of a given tissue, neovascularized muscle flaps with pedicle vessels were created by wrapping external abdominal oblique muscles around the superficial inferior epigastric blood vessels. Different pedicle types were examined to explore possible differences in neovascularization. In 60 rats, four groups of neovascularized muscle flaps were created and transplanted as free flaps, with a high degree of success. After transplantation, neovascularization of the flaps was evaluated by histology and latex casts of vascular tree of the muscle flaps. Degree of neovascularization differed, depending on the type of vascular pedicle used to create the flap.

Abdominal Muscles↗
PubMed1988

Neovascularized free cutaneous cartilage flap transfer with microsurgical anastomosis: an experimental model in the rabbit.

In preparation for this study in rabbits, preliminary trials were conducted in rats rather than rabbits because they are more economical and are believed to develop neovascularization more rapidly. Using modifications of techniques described by Duarte, the superficial inferior epigastric vessels were planted between the folded leaves of full-thickness grafts of rat ear cartilage. These preparations showed signs of neovascularization and new cartilage formation adjacent to the pedicle when harvested from the groin three weeks later. Encouraged by the success of this preliminary investigation in the rat, we moved on to the rabbit ear model because it provides a larger area of cartilage to work with. The central vessels of the pinna were dissected out and then placed in a subcutaneous (extraperichondrial) pocket of a random-pattern, distally based, full-thickness ear flap. Three weeks later, the flaps, now neovascularized by their neopedicles of implanted central vessels, were harvested and transferred as free chondrocutaneous free flaps to the donor site of the same preparation created on the contralateral pinna. Modifications of these techniques may be useful where chondral or chondrocutaneous flaps are needed, such as for pinna, nasal alar, or nasal septal reconstructions.

Abdominal Muscles↗
PubMed1988

Prefabricated sensate myocutaneous and osteomyocutaneous free flaps: an experimental model. Preliminary report.

Principles of neovascularization have been reported for the successful creation of a variety of muscle and bone free flaps. This study demonstrates a simple and effective technique for construction of prefabricated sensate myocutaneous and osteomyocutaneous free flaps in a rat model. These experiments were carried out in 20 Sprague-Dawley male rats. In half the animals, a sensate myocutaneous flap was constructed by sandwiching the superficial inferior epigastric vessels between a laterally based external abdominal oblique muscle flap and a laterally based skin flap served by an identified cutaneous nerve. A similar preparation included a piece of iliac crest bone. Two to three weeks later, now neovascularized by the sandwiched vessels, the flaps were harvested and transferred as free flaps with high reliability. An increased number of potential donor sites, the versatility of design, and the ability to customize flaps to the specific recipient-site needs are proffered.

Animals↗