Biomedical subjects
Publications and source records attributed to F C Iwuagwu.
This report describes a simple technique of retrieving retracted proximal flexor tendon ends in Zone II injuries. This technique utilizes steel wires that are readily available in any hand set in the operating room. We have found that this is a consistently successful and atraumatic technique.
Distal division of the flexor digitorum profundus (FDP) within 10mm of its insertion is commonly treated in the same manner as avulsion of the FDP, using the "button" technique or bone suture anchor fixation. Button and bone suture anchor fixation techniques have been associated with significant complications. Importantly, both lead to shortening of the FDP which may cause flexion contracture at the distal interphalangeal joint. This study compared the breaking strength of a multistrand distal suture with reattachment using the "button-on-the-nail" technique in a laboratory cadaver model of distal FDP division. The data showed that multistrand distal suture repair was at least as strong as reattachment and has the theoretical advantage of avoiding some of the acknowledged complications of reattachment techniques.
Juvenile xanthogranuloma is a relatively rare cutaneous lesion. In order to make an early diagnosis and be alert to the possibility of visceral complications and associated medical conditions, plastic surgeons should be aware of the entity. The classic presentation is that of successive eruptions in the head, neck and upper trunk of initially red papules or nodules which later become yellow and finally brown flattened plaques or macules. This report is of an unusual variant with atypical histology including frequent mitoses and a lack of Touton giant cells.
Postburn scarring and contracture affecting function remain the most frustrating late complications of burn injury. Various techniques are used to release contractures; the choice depends on their location and/or the availability of unaffected skin adjacent to the contracture or elsewhere. A retrospective review was carried out of the case notes of patients who had skin grafting for the release of postburn contracture at the Burns Unit, City Hospital, Nottingham between May of 1984 and August of 1994 to evaluate the experience over this period. Information was obtained about the burn injury, contracture site, interval between burn and release of contracture, indication, age at first release, intervals between releases, operative details (donor and graft sites), complications and nonoperative treatment, and follow-up to the end of the study period. A total of 129 patients underwent skin grafting for release of contractures as opposed to any other method of correction. Full-thickness skin grafts were used in 81 patients (63 percent) and split-thickness skin grafts in 26 (20 percent). Twenty-two patients (17 percent) had both types used on different occasions. Flame burns (41 percent) were the most common causes, followed by scalds (38 percent). Two hundred thirty-nine sites of contracture were released, with the axilla (59) and the hand/wrist (59) being the most common sites involved, followed by the head/neck region (42). It was found that for the same site, release with split-thickness skin grafts was associated with more rereleases of the contracture than with full-thickness skin grafts. Also, the interval between the initial release and first rerelease was shorter than with full-thickness skin grafts (p < 0.048). It was also noted that children required more procedures during growth spurts, reflecting the differential effect of the growth of normal skin and contracture tissue. Patients reported more satisfaction with texture and color match with the full-thickness skin grafts. There was comparable donor-site and graft morbidity with both graft types. The use of skin grafts is simple, reliable, and safe. Whenever possible, the authors recommend the use of full-thickness skin grafts in preference to split-thickness skin grafts in postburn contracture release.
Fluid therapy by the oral route is the accepted method of treatment for smaller burns in children (less than 10%). [Settle JAD. Burns - the first five days. Essex: Smith and Nephew Pharmaceuticals Ltd, 1986.] A phone survey was carried out of all the hospitals in the United Kingdom that manage burns, to record their oral fluid therapy practices for burns (5-10% BSA) in paediatric patients. Included in the survey was an assessment of the uniformity of the contents of the fluids, their palatability and acceptance by patients and any side-effects from this form of treatment. There appears to be no uniformity in policies regarding fluid therapy in children with this percentage of burns. Treatment ranged from a formula guided resuscitation therapy (as practised generally with large burns) to a 'drink as you like' policy. Fluids used varied from electrolyte to non-electrolyte containing solutions and fruit juices and were, therefore, markedly different in content. The electrolyte solutions were reported as being non-palatable unless flavoured with fruit juices. No complication was reported although one unit queried a possible case of fluid overload. Potential complications from this mode of therapy are discussed. The cost implications of using various fluid types are also presented.
The effect of loading on the early cellular response to tendon injury was studied in a partial tenotomy (window) model in the extensor digitorum longus of the rat. Normal use of the limb was allowed, such that tendons were either loaded (group 1) or unloaded (group 2) when a distal tenotomy was performed. Thirty-four male Fischer rats were used. The tendons were harvested at intervals of 6 hours and 1, 3, 5, and 7 days. Quantitative cell counts were performed on light microscopic cross-sections of the window and tendon substance together with recording of cell orientation. Matrix changes in the tendon, window, and tendon-window junction were observed on transmission electron microscopy. There was a rapid and extensive change in the tendon structure with rapid loss of definition of the window edge, and an increase in cellularity of the tendon substance. The loaded tendons demonstrated less cellularity at 5 days (window cell density 3.48 +/- 0.49 cells per 0.01 mm2) with better longitudinal orientation of cells and matrix than the unloaded tendons(8.38 +/- 1.1 cells per 0.01 mm2). The numbers of inflammatory cells in both groups were roughly comparable (5 days: loaded 0.411 +/- 0.071 cells per 0.01 mm2; unloaded 0.554 +/- 0.11 cells per 0.01 mm2), but the unloaded windows had more fibroblasts at 5-day and 7-day stages (5 days: loaded 3.08 +/- 0.44 cells per 0.01 mm2; unloaded 7.82 +/- 1.0 cells per 0.01 mm2; p < 0.016). Cell counts in the tendon substance were also higher in the unloaded (3.99 +/- 0.44 cells per 0.01 mm2) than the loaded (1.95 +/- 0.45 cells per 0.01 mm2) tendons at 5 days. This study demonstrated that the cellular response after injury in this extensor tendon model is affected by tensile loading, there being increased cell numbers in both the window and tendon substance in the unloaded tendon.
Silicone breast implants have been used for augmentation mammoplasty for cosmetic purposes as well as for breast reconstruction following mastectomy for more than three decades. Though the use of the silicone gel filled variety has been banned in the USA except for special cases, they continue to be available elsewhere in the world including the UK. Despite the immense benefit they provide, their usage is associated with some complications. Most of these are related to the surgery and can be reduced by good surgical management. The major complications associated with their use is adverse capsular contracture, an outcome which can be very frustrating to manage. This article reviews the commonly reported complications and suggested management alternatives.