Metastatic squamous cell carcinoma of the nasal tip: a case report.
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Carcinoma, Squamous Cell↗
Biomedical subjects
F R Heckler
Publications and source records attributed to F R Heckler.
Sports-related facial injuries.
Facial injuries suffered by the athlete will range from very minor to extremely complex. Regardless, all injuries can be accurately diagnosed if one is familiar with normal anatomy and conducts a thorough physical examination. Radiographs are then obtained as directed by the physical examination. Specific and timely treatment directed at correcting functional and cosmetic deformities will help to avoid lifelong disability and deformity. With adherence to these guidelines, many of the injuries suffered by athletes can be safely treated by a variety of physicians. More complex soft-tissue and bone injuries should be referred to a surgeon familiar and comfortable with facial plastic and reconstructive surgery.
Athletic Injuries↗
Gastrocnemius muscle transposition to the femur: how high can you go?
The gastrocnemius muscle flap has gained wide acceptance as a reconstructive technique for management of wounds of the knee and proximal tibia. The use of the muscle as a pedicle flap to the distal and middle femur has not been well quantified, and the proximal rotation arc has been underestimated. We report the use of the island gastrocnemius pedicle flap to reach two femur defects 21 and 26 cm above the joint line, achieved by taking advantage of the favorable location of the vascular pedicle above the joint line and the individual length of the medial gastrocnemius muscle belly. Evaluation of standard arteriograms suggests the location of the medial sural artery pedicle is an average of 32 +/- 14.5 (SD) mm above the inferior border of the femur. All vessel origins were found above the joint line by radiograph. A common sural artery origin was noted in 32% of patients at a mean distance of 35 mm proximal to the joint line. Despite a wide range, 62% of sural artery origins were within 1 cm of an axis drawn through the widest point of the femoral condyles.
Adult↗
Isolation of skeletal muscle for biomechanical circulatory assist.
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Back↗
Caution in the use of marking solutions.
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Humans↗
Oxygen free radicals and wound healing.
Oxygen-dependent mechanisms for intracellular killing by leukocytes result in the generation of highly reactive oxygen metabolites. These are called oxygen radicals. The purpose of this article is to define the oxygen free radical and the methods by which it is generated as well as the mechanisms by which these radicals produce injury. Specifically, recent studies investigating the role of oxygen-derived free radicals in wound healing are reviewed.
Free Radicals↗
Reconstruction of nonmarginal defects of the ear with chondrocutaneous advancement flaps.
Marginal defects of the ear are usually reconstructed with the Antia's chondrocutaneous flap. Reports of reconstruction of nonmarginal defects are scanty. The antia chondrocutaneous flap was adapted for reconstruction of defects up to 2 cm located in the triangular fossa, scapha, and the anthelix. For larger defects, the technique was further modified using composite chondrocutaneous flaps. The technique uses the principle of separation of the ear elements and redistribution for closure of defects in the nonmarginal areas of the ear with minimal sacrifice of the tissue, ear size, and ear shape. This technique is reliable, relatively simple, and a one-stage operation, as demonstrated in our series of seven patients.
Aged↗
Management of maxillofacial and neck soft-tissue injuries.
Maxillofacial injuries sustained during sporting events may involve any variety of soft-tissue or bony injuries. As in any traumatized patient, more extensive injuries must be excluded and the basic principles of maintaining an airway and restoration of circulation maintained. The face and neck take on a particular significance when one considers the complexity of function and significant aesthetic value of the structures of the face and neck. Careful inspection, palpation, and examination of function assure the accurate diagnosis of injuries. Specific injuries to the specialized areas of the face and neck are discussed with particular attention to the potential underlying injuries to the facial nerves, parotid duct, and lacrimal systems. The importance of recognizing septal nasal hematomas and external ear hematomas are discussed.
Athletic Injuries↗
Current thoughts on extravasation injuries.
Extravasation of therapeutic agents may cause skin and soft tissue ulceration. Treatment of these injuries, including the use of pharmacologic and surgical measures, is described.
Antineoplastic Agents↗
Augmentation of skin flap survival by parenteral pentoxifylline.
One prime factor implicated in flap necrosis is diminished blood flow. A known corollary of morbid ischaemia is an energy-dependent reduction in red blood cell deformability associated with an increase in whole blood viscosity. The newly available drug pentoxifylline is alleged to improve this red cell membrane defect in the low flow state, thereby improving the rheologic characteristics of blood. We studied its effect in a flap model with an ischaemic component and also measured changes in blood viscosity. A caudally-based dorsal flap in a rat model was used. Control (saline-treated) animals exhibited 74.8 +/- 9.8% flap survival. Three groups of animals were treated at different times with pentoxifylline with respect to date of surgery; all groups showed a statistically significant increase in flap survival compared to controls, ranging from 92.3 to 94.3% (p less than .01). Simultaneous viscometric measurements with a cone-plate viscometer were performed. The observed increase in flap survival did not, as suggested by other investigators, correlate dependably with viscosity reduction. Reasons for this are discussed.
Animals↗
Paced skeletal muscle for dynamic cardiomyoplasty.
Four patients, each with a history of myocardial infarction and diffuse coronary artery disease, underwent application of left latissimus dorsi (LD) muscle with intact neurovascular bundle to the anterolateral wall of the left ventricle. The muscle was conditioned over a six-week period subsequent to operation in 3 patients and was conditioned preoperatively with a burst stimulus in the fourth. Biopsy specimens confirm the experimental data that human skeletal muscle can be electrically conditioned over a six- to ten-week period to contain mainly fatigue-resistant type I fibers. All patients survived the procedure, and 3 showed improvement secondary to aneurysmectomy. In Patient 1, a modified resection was performed, and at 28 months after operation, at the 75-W level of exercise, the ejection fraction was 54% paced versus 45% nonpaced. In Patient 2, at 12 months, the ejection fraction at rest was 44% paced versus 30% nonpaced. Doppler echo studies confirmed the presence of the flap and its function in the paced and nonpaced mode. The third patient died of a sudden ventricular arrhythmia 2 months following operation. An infected, nonfunctioning, degenerated flap was found at autopsy. Patient 4 did not have an aneurysm. She received a bypass graft to the right coronary artery and underwent cardiomyopexy in an attempt to relieve medically refractory incapacitating chronic congestive heart failure. Ten months postoperatively, ejection fraction at rest was 33% paced versus 25% nonpaced. Constrictive myopathy has not been encountered in any of these patients.
Biopsy↗
Presuturing--a new technique for closing large skin defects: clinical and experimental studies.
We have developed a new technique termed presuturing for aiding in the closure of large skin defects which may have otherwise required a skin graft or flap. This technique is based on biomechanical properties of skin (creep, stress relaxation) which allow skin to stretch beyond its inherent extensibility. Presuturing is performed under local anesthesia and consists of plicating intact skin over the area of planned excision the night prior to operation. Experimental studies in a pig model showed the decrease in force required to close a standard-sized wound to be 40.1 percent less than control (p less than 0.001). Fourteen patients who underwent wide excision of skin lesions had their wounds presutured. All but one wound could be closed primarily without undermining. Presuturing seems to be an easy and clinically useful technique in aiding the primary closure of large defects.
Adult↗
Extensive and complex defects of the scalp, middle third of the face, and palate: the role of microsurgical reconstruction.
Twenty-one patients with gigantic defects of the scalp and middle third of the face and palate following excision of neglected or recurrent tumors, burns, and infections have undergone microsurgical reconstruction. Wide resection of the middle third of the face, orbit, and palate requires "complex" three-dimensional volume reconstruction, whereas extensive defects of the scalp and skull (exceeding 80 cm2) require coverage of the larger surface area soft-tissue defect and the exposed brain and dura. The latissimus dorsi free-muscle flap and split-thickness skin graft have become our methods of choice for extensive scalp and skull defects. The latissimus dorsi musculocutaneous free flap is preferable for reconstruction of complex palatal and external skin and orbital defects of the middle third of the face. Microsurgical free-tissue transfer reliably frees the oncologic surgeon from the constraints imposed by conventional reconstructive techniques and may therefore allow improved curative or at least palliative resection of these extensive tumors.
Adult↗
Axillary lymphadenopathy: a complication of BCG immunotherapy for melanoma.
We present a patient with a Clark level IV melanoma who received BCG immunotherapy by scarification for 12 months after wide excision. Six months after cessation of treatment, the patient developed regional lymphadenopathy that histology showed to be reactive epithelioid granuloma. Regional immunotherapy thus represents a potentially confusing factor in the post-operative assessment and management of the patient with melanoma.
Axilla↗
Paced latissimus dorsi used for dynamic cardiomyoplasty of left ventricular aneurysms.
Two patients are described, each with a large left ventricular aneurysm and severe coronary artery disease, and each with an ejection fraction lower than 30% and in congestive heart failure. In both, the left latissimus dorsi (LD) muscle was used in the repair of the ventricular aneurysm because preoperative studies demonstrated that there was concomitant coronary artery disease, and there was a strong suggestion that resection of the entire aneurysm would seriously compromise the residual ventricular capacity. One patient had an 18-year history of coronary occlusion with two infarctions. A large, calcified ventricular aneurysm developed, and despite vigorous medical treatment, intractable congestive heart failure and angina persisted. The diffuse coronary artery disease made this patient a poor candidate for bypass grafting. The other patient sustained an acute myocardial infarction 5 months prior to operation. The left anterior descending coronary artery was totally occluded, and a large apical aneurysm developed along with an akinetic anterior wall and septum. After his heart attack, the patient had progressive dyspnea on exertion. Following operation in both patients, the transpositioned LD, then a component in the repair of the left ventricular wall, was electrically trained to synchronously contract with each systole, driven by a standard dual-chamber cardiac pacemaker. Steady improvement and a return to normal activities were observed in both patients. There was an indication of improved ejection fraction with synchronous contraction of the skeletal muscle.
Back↗
Surgical skin-marking techniques.
Surgical skin-marking inks and dyes are in everyday use for designing and planning incisions in plastic and reconstructive surgery. We have traced the historical development of surgical skin-marking techniques from ancient times to the present. The biochemical characteristics of the commonly used marking agents are discussed. A three-part experiment utilizing a pig model was carried out to test the tissue inflammatory response to the various dyes and inks when used intradermally as tattoos, the persistence of such tattoos, and the ease of skin erasure for each of eight stains. Methylene blue and gentian violet are recommended as the best all-purpose marking agents. The use of proprietary inks is discouraged.
Animals↗
Lacrimal gland involvement in zygomaticofrontal fracture sites.
Injury to the lacrimal gland following fracture of the zygomatic complex is a rare occurrence. Recently, we have observed three cases of herniation of the lacrimal gland between the diastased frontal and zygomatic bone ends. We present these cases, postulate a mechanism for this phenomenon, and advocate open reduction and internal fixation in the primary management of severe distraction.
Adult↗
Technical and aesthetic considerations in the horseshoe incision and approach in axillary node dissection.
Previously described incisions for axillary dissection suffer from several drawbacks--extended dissection, limited exposure and visible scars. We have designed the horseshoe incision and approach to obviate some of the problems described. The incision is in the hair bearing area. The direct approach to the axillary content makes exposure excellent and the dissection is circumscribed to the axillary area. Our experience with this technique is encouraging.
Axilla↗