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Biomedical subjects

G B Irons

Publications and source records attributed to G B Irons.

At least 19 recordsLinked to original sources
PubMed1990

Results of treatment of tibial and femoral osteomyelitis in adults.

From January 1, 1971, to December 31, 1985, 425 patients with chronic osteomyelitis of the femur or tibia were seen at the authors' institution. The success rate in this recent experience was 84.4% compared with 50.9% in the authors' results published in 1970. A classification of chronic osteomyelitis is as follows: (1) hematogenous osteomyelitis; (2) osteomyelitis in united fractures (fracture with union); (3) osteomyelitis in nonunion (fracture with nonunion); and (4) postoperative or posttraumatic osteomyelitis in which bone was not fractured. For management of the scarring of surrounding soft tissue, there has been a change to excision of the scarred tissue and reliance on muscle flap, free-tissue transfer, or closure of soft tissues without irrigation with antibiotic solution. In recent years, free microvascular osseous grafts have permitted more aggressive resection of the involved osseous tissue. The predominance of gram-negative organisms and penicillin-resistant Staphylococcus aureus and the occurrence of methicillin-resistant S. aureus continue.

Adult↗
PubMed1989

Experience with 80 rectus abdominis free-tissue transfers.

Eighty patients receiving rectus abdominis free-tissue transfers are discussed. The operations were performed between July of 1983 and December of 1986. Specifically, the patients were followed in the clinic to determine the extent and degree of donor-site morbidity. Sixty-two flaps were transferred to the lower extremities, 15 to the head and neck, 2 to the arm, and 1 was placed intrathoracically. Osteomyelitis was the most common indication for free-muscle transfer in 33 patients, soft-tissue defects in 26, and facial soft-tissue augmentation in 14 patients. In the 80 rectus abdominis free-muscle transfers, there were 9 local complications. A seroma occurred in 4 patients, wound infection in 3, and an abdominal wall hernia occurred in 1 patient. The success rate for muscle transfer was 93 percent with six flap losses. Because there is a low incidence of donor-site complications, the surgical dissection is relatively easy, and the relative consistency and size of the deep inferior epigastric pedicle are good, the rectus abdominis muscular unit is now one of the most frequently used free-tissue transfers at our institution.

Abdominal Muscles↗
PubMed1989

The management of intraosseous arteriovenous malformations in the head and neck area.

It is necessary that the treatment of arteriovenous malformations in general be undertaken by a team that consists of a radiologist who is experienced in angiography and embolization and a plastic surgeon. The latter should be well versed in angiographic techniques and should be able to comprehend the dynamics of these malformations. In this report, three patients with high-flow, high-shunt arteriovenous intraosseous malformations of the head are presented. Two of these presented as emergencies with almost uncontrollable bleeding and were initially treated with embolization and then mandibular resection and reconstruction within the first 48 hours. In one patient, a further reconstructive procedure using free vascularized tissue was carried out. A third patient with involvement of the maxilla, again presenting with bleeding, was treated with embolization and, because of the deformity that would be created by resection, was simply observed. However, this patient is to be reassessed in the future and may well come to maxillectomy. It is emphasized that the treatment of these patients requires careful assessment, embolization, and resection as indicated after discussion between radiologist and surgeon.

Adolescent↗
PubMed1989

Free tissue transfer for reconstruction of the weight-bearing portion of the foot.

Twenty-eight patients treated with free tissue transfer for soft-tissue coverage of the weight-bearing portion of the foot were investigated over a minimum follow-up period of 12 months. Seven were treated with a sensory innervated flap transfer, and 21 had a noninnervated skin or muscle flap transfer. Secondary procedures to debulk or sculpture the flap were necessary in seven patients. Complications occurred in six patients and were either related to lack of protective sensibility (in three) or excessive flap mobility (in three). Impaired flap sensibility was more common in noninnervated flaps, but excessive flap mobility was more typical of cutaneous flaps. The merits of an innervated cutaneous flap, which may be excessively bulky, must be weighed against those of a well-contoured muscle flap without sensory innervation.

Adolescent↗
PubMed1988

Membranous basal cell adenoma of the parotid gland. Malignant transformation in a patient with multiple dermal cylindromas.

The rare association of dermal cylindroma (turban tumor), trichoepithelioma, eccrine spiradenoma, and membranous basal cell adenoma of the parotid gland has been previously reported. It is believed that this combination represents a peculiar inherited tumor diathesis involving neoplasms of presumed ductal origin, eccrine in the skin and intercalated in the parotid gland. We describe a patient in whom the basal cell adenoma of the parotid gland underwent malignant transformation.

Adenoma↗
PubMed1987

Experience with one hundred consecutive free flaps.

Our first 100 free flap operations are reviewed. The location and cause of the defects requiring free flaps, the flaps used, and the outcome are tabulated. The lower leg was the most common site of defect. Osteomyelitis and trauma were the most common causes. The latissimus dorsi and tensor fascia lata were the most useful flaps. Of the 15 patients with failed flaps, wound closure was accomplished by other methods in 13 and 2 underwent amputation. One of the patients with a successful free flap ultimately underwent amputation because of recurrent osteomyelitis.

Adolescent↗
PubMed1986

Soft-tissue coverage for the treatment of osteomyelitis of the lower part of the leg.

For treatment of chronic osteomyelitic wounds of the lower part of the leg, a three-stage approach is necessary: (1) adequate debridement of bone and soft tissue, (2) control of infection by open packing with frequent dressing changes and use of intravenously administered antibiotics, and (3) healthy soft-tissue coverage and obliteration of dead space. If the bone is unstable, it can be immobilized temporarily by means of external fixation. Bone grafting can be accomplished by use of conventional bone grafting after healing of the soft tissues, a vascularized bone graft, or open bone grafting. Soft-tissue coverage is provided by a local muscle flap or a free muscle flap. We prefer to cover the muscle with a skin graft. The muscle flaps described in this article obliterate dead space, provide soft-tissue coverage, act as a bed for skin grafts, and improve the vascularity of the wound.

Adult↗
PubMed1985

Skeletal reconstruction by vascularized bone transfer: indications and results.

The indications for and the results of 60 consecutive microvascular bone transfers performed at our institution during a 50-month period are reviewed. All 60 patients were followed up for at least 1 year. The overall primary union rate was 67%, and the eventual union rate was 77%. The most frequent indication for the procedure was long-bone reconstruction after limb-salvage wide local resection of a malignant tumor. We achieved the best results with limb reconstruction after resection of a malignant tumor and with recipient sites that involved the forearm or mandible. In contrast, our results were least favorable with reconstruction after resection for chronic osteomyelitis and with reconstruction of defects of the shoulder girdle. Overall, vascularized bone transfer seems to be a valuable reconstructive technique for management of clinical problems that involve massive skeletal defects.

Bone Diseases↗
PubMed1985

Lower extremity salvage and reconstruction by free-tissue transfer. Analysis of results.

The application of soft tissue or bone free-tissue transfers to lower extremity salvage or reconstruction was assessed in a review of 86 consecutive procedures done during a 36-month period. This group included 65 cases of free skin or muscle flap transfer and 21 cases of free vascularized bone transfer. In terms of tissue viability, the success rate was 80.2% (78.5% for the soft tissue group and 85.7% for the bone group). With due consideration of indications, the incidence of secondary sepsis in patients with chronic osteomyelitis, and other potential complications, free-tissue transfers are valuable for salvage and reconstructive surgery of the lower extremity.

Adolescent↗
PubMed1985

Local muscle flaps in the treatment of chronic osteomyelitis.

When large soft-tissue and osseous defects remain after débridement of a chronic osteomyelitic lesion, application of a local muscle flap can be an effective way to achieve wound closure. Utilizing this surgical technique and specific antimicrobial therapy for the causal microorganisms, the infectious process was eradicated in thirty-nine of forty-two patients with osteomyelitis who were followed for at least two years after treatment. The osteomyelitic process was post-traumatic in origin--that is, a complication of a fracture or its treatment--in twenty-eight patients, the result of soft-tissue trauma without a fracture in eight, a complication of elective surgery in three, and the result of hematogenous seeding in three patients. Nine of the forty-two patients had an infected non-union. The infectious process involved the tibia in 62 per cent of the patients. Pseudomonas aeruginosa was the most frequently isolated causal organism. A soleus or gastrocnemius muscle flap was most frequently utilized to achieve closure. In five patients, a combination of two muscle flaps was utilized. Although this technique successfully eradicated the infectious process in 93 per cent of the patients, twenty-two patients required additional surgical treatment. Six required such treatment for a persistent non-union and two, for weakened diaphyseal bone after eradication of the septic process. A cancellous bone-grafting procedure was performed in all eight patients after the muscle flap had healed, and union was achieved in six of them. One patient eventually requested an amputation for a persistent non-union, and the remaining patient had a fibular synostosis performed for a persistent tibial non-union. A local muscle flap can be used in patients with a large defect of soft tissue and bone after débridement of an osteomyelitic lesion if the flap can be elevated and transposed into the defect without compromising its vascular supply. Although they are not applicable to the treatment of all patients with osteomyelitis, local muscle flaps can be extremely useful in the treatment of this lesion. When combined with thorough débridement and specific antimicrobial therapy, it has become a successful technique in the management of chronic osteomyelitis.

Adolescent↗
PubMed1979

Management of radiation necrosis and advanced cancer of the chest wall in patients with breast malignancy.

Aggressive resection, with individualized reconstruction by several methods, is of value in many patients with radiation necrosis and/or advanced breast cancer of the chest wall. Although this does not always significantly lengthen survival, it can improve the quality of life markedly in many instances. Remarkably large defects can be reconstructed with single-stage procedures.

Adult↗
PubMed1978

Panniculectomy and abdominoplasty.

The series involved 123 patients who had 126 excisions of the abdominal wall. In 84 patients, a large pannus of fatty tissue and skin was excised to expedite the approach to intra-abdominal disease or the repair of hernias. In 39 patients, the operation was an abdominoplasty done to improve the appearance of the abdomen or to excise relaxed or redundant tissues. Complications were minimal. The experience suggests that the surgeon should consider and utilize techniques to improve the general function and appearance of the abdominal wall and yet not compromise the treatment of the patient's major problem.

Abdominal Muscles↗
PubMed1978

Experience with and comparision of methods of reduction mammaplasty.

Experinece with bilateral reduction mammaplasty in 213 patients has been reviewed. Complications, while not infrequent, are rarely of a serious or lasting nature. In the experience of the authors, the McKissock procedure has yielded the most consistently good results, although very good results were occasionally achieved with all of the other techniques employed.

Adolescent↗
PubMed1978

Chemical burns and skin preparation solutions.

Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in those patients placed in the lithotomy position undergoing gynecologic operations, the burn being on the buttocks, and in those undergoing orthopedic operations, the burn being on the extremities and under a tourniquet. Thimerosal has been the most common agent to be implicated. The basic mechanism involves irritation coupled with maceration and pressure--conditions that can cause an acute pressure sore and superficial skin loss. To prevent these burns from occurring, the skin must not be abraded excessively before the final skin preparation solution is applied; the agent should not be allowed to pool and become trapped under the tourniquet or the torso of the patient, and the agent should be allowed to dry before the patient is draped. In our experience, the agent that has been the most effective and the least irritating to the skin during the time it has been used is povidone-iodine.

Adolescent↗