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Biomedical subjects

G G Hallock

Publications and source records attributed to G G Hallock.

At least 145 records · Page 8Linked to original sources
PubMed1989

Cranial nasal bone grafts.

Reconstitution of the nasal scaffolding with maintenance of soft tissue proportions either following severe facial trauma or as a sequela to aesthetic rhinoplasty misadventures frequently is best achieved using the stability afforded by bone grafts. Split cranial bone grafts offer many advantages and may be the donor site of choice, and may even allow such surgery to be performed on an outpatient basis in some cases. The use of miniplate or screw osteosynthesis, now commonly accepted as a superior technique in craniomaxillofacial procedures, may simplify fixation of these calvarial nasal bone grafts with an apparent decrease in the risk of resorption.

Adult↗
PubMed1989

Aesthetic approach to the rectus abdominis free tissue transfer.

Refinements in microsurgery should include not only the selection of an appropriate flap based on the requirements of the recipient defect, but consideration to minimize any donor site morbidity. This concept is analyzed for preoperative assessments, when using any of the variants of the rectus abdominis muscle or musculocutaneous flaps that may be approached via vertical, horizontal, or suprapubic incisions that are chosen to avoid conspicuous scars. Of perhaps greater importance, preservation of abdominal wall integrity is possible, preventing late complications of hernia or eventration by using fascial-sparing techniques.

Abdominal Muscles↗
PubMed1989

Refinement of the fibular osteocutaneous flap using tissue expansion.

The most serious objection to many otherwise advantageous cutaneous donor areas may be the cosmetic deformity from the exposed skin graft that is required for wound closure. Any contemplated fibular osteocutaneous composite tissue transfer that would result in such an obviously large donor defect therefore deserves consideration for pretransfer tissue expansion or simultaneous placement of tissue expanders at the time of flap elevation. Post-transfer expansion of the lateral lower leg donor site following semi-urgent reconstructions has provided significant aesthetic improvement, allowing the transformation of skin-grafted or open areas into a more acceptable linear scar.

Adult↗
PubMed1989

The extended temporoparietal fascia "non-free" flap.

The extended temporoparietal fascia flap is a logical variation of previously accepted extended free tissue transfers, which are unique in that the recipient and donor vessels are identical. This local scalp flap permits adequate distant ipsilateral skull coverage with minimal patient inconvenience. If desired, retrograde fascial perfusion from cephalad collaterals allows the completion of long interposition vein graft microanastomosis to the superficial temporal vessels before creating any recipient site defect without fear of flap warm ischemia time. Although the patient described had complications, the concept of the extended temporoparietal fascia flap has been proved to be an intriguing option for head and neck reconstruction.

Fasciotomy↗
PubMed1989

The role of external cranial fixation in simplifying scalp composite tissue transfer.

The use of external devices for cranial suspension or immobilization may facilitate the transfer of skin grafts or flaps needed for scalp coverage. Skull tongs are readily available in any trauma center. Following composite tissue transfer to the skull, skull tongs can prevent compromise of the microanastomoses or the flap itself by eliminating pressure or shear forces that might otherwise jeopardize these reconstructive efforts.

Bone Nails↗
PubMed1989

Polyglactin 910 mesh for support of the donor defect of the double-pedicled rectus abdominis musculocutaneous flap.

The most significant concern in using the lower rectus abdominis musculocutaneous flap is creation of an eventration or even a frank hernia of the abdominal wall. Frequently, reinforcement using an alloplastic implant following closure of the double-pedicled donor defect is required. In an effort to avoid the use of any foreign materials, particularly if the goal in breast reconstruction is to use only autogenous tissues, strong consideration for incorporating an absorbable mesh is advocated to provide abdominal wall support.

Abdominal Muscles↗
PubMed1989

Local knee random fasciocutaneous flaps.

Extensive wounds of the knee region have previously mandated utilization of a local muscle or free flap to achieve healing. The recent successes of fasciocutaneous flaps in the lower leg region have been extrapolated for use of local, randomly oriented anteromedial or anterolateral knee flaps in addition to previously described posterior calf flaps; results have been equally acceptable as the standard established by muscle flaps for knee coverage. For small- or moderate-sized noncontaminated parapatellar wounds, less morbidity has been observed using instead these simple local knee fasciocutaneous flaps.

Aged↗
PubMed1989

Utilization of the burn unit for nonburn patients: the "wound intensive care unit".

Burn units and experienced burn nurses are valuable, expensive resources that are underutilized when the burn census is low. Burn facilities can be used to treat other conditions or injuries to provide optimum wound management or to provide overflow intensive care unit beds. We studied via a questionnaire survey the admission profiles of 120 burn units in the United States to determine frequency of utilization for nonburn injuries. One hundred sixteen burn units routinely treat nonburn injuries. Seventy-seven burn units also accept overflow patients from other critical care units. A significant amount of nonburn wound care is being provided by burn units in the United States, with potential benefit to both the patient and the burn unit. The implications of the use of burn facilities as "wound intensive care units" are discussed.

Burn Units↗
PubMed1989

Lower limb salvage with autoclaved autogenous tibial diaphysis: case report.

A massive crush injury of the lower extremity associated with avulsion of a 30-cm segment of the diaphysis of the tibia is reported. The patient refused consideration of amputation. Therefore, in this unique case, the noncomminuted fragment was autoclaved and replaced as a nonvascularized autogenous graft. Graft-host union was observed without complication, leading to full weight-bearing ambulation with a molded orthosis within 1 year of the injury.

Adult↗
PubMed1989

Local fasciocutaneous flaps for cutaneous coverage of lower extremity wounds.

Severe lower extremity trauma frequently results in a soft-tissue deficit that mandates wound coverage using some form of vascularized flap. The recent rediscovery of inclusion of the deep fascia during elevation of random skin flaps has enhanced the viability of large local flaps as a reconstructive option in the lower leg. In selected cases of relatively uncontaminated, moderate-sized defects, the choice of this maneuver has permitted closure of many defects which previously might have required a complex microsurgical tissue transfer. This series of 41 random-based local fasciocutaneous flaps in the lower leg in 38 patients has in all cases except two been successful in achieving preferred wound healing. Flap necrosis occurred only in these two cases presumably due to peripheral vascular insufficiency necessitating limb amputation in one patient. Eight (19%) had some form of complication, most occurring in the subset of flaps used for distal third lower leg wounds. The fasciocutaneous flap is conceptually simple, rapidly elevated and inset, and minimizes the region of surgical insult for many multitrauma patients who otherwise might have to forego any attempt for limb salvage.

Adult↗
PubMed1989

Free-flap coverage of the exposed Achilles tendon.

Posterior skin loss of the distal lower leg enhances the risk of exposure of the Achilles tendon. Most commonly, these wounds are a sequela to peripheral vascular insufficiency or else posttraumatic in origin. As a consequence, local flaps or skin grafts frequently are inadequate options for achieving coverage. Free-tissue transfers have proven to be a reasonable alternative in these situations for preservation of tendon function or even limb salvage. In this series of 12 patients, small defects were best covered with fasciocutaneous flaps, whereas the larger and usually chronic, concomitantly suppurating wounds required muscle flaps. Eighty-three percent (10 of 12) of patients remained ambulatory with healed wounds, obviating the need for extremity amputation.

Adolescent↗
PubMed1989

Extended applications of the carbon dioxide laser for skin deepithelialization.

The efficacy of the carbon dioxide laser for skin deepithelialization in humans was initially demonstrated using reduction mammaplasty as a clinical model. Twenty-two additional successful cases including use of this technique as an adjunct for other flap transpositions and overgrafting of skin grafts are described. These results document a role for the carbon dioxide laser in skin deepithelialization, where it provides an advantage when rigid skin immobilization is impossible or if there would be a risk to underlying structures if more conventional approaches were used.

Adult↗
PubMed1988

Laser treatment of rhinophyma.

The carbon dioxide laser, when used in the treatment of rhinophyma, allows accurate removal of the diseased tissue to the desired level without risk of exposure of any underlying osteocartilaginous structures. This ensures rapid reepithelialization that minimizes the untoward scarring that may occur from delayed healing using other sculpturing techniques. Precise tissue vaporization prohibits violation of surrounding normal tissues.

Anesthesia, Local↗
PubMed1988

The interposition arteriovenous loop revisited.

In clinical situations when both arterial and venous interposition vein grafts are mandatory, we invariably harvest a single graft of adequate length to create an initial arteriovenous loop. This concept deserves reemphasis, as satisfactory recipient anastomoses can be achieved prior to bisecting the loop, with subsequent immediate donor tissue transfer. Concern for prolonged warm ischemia time is thereby minimized.

Arteriovenous Shunt, Surgical↗
PubMed1988

Restoration of the foot using the radial forearm flap.

Large foot defects unsuitable for reconstruction by local foot flaps are most expediently salvaged with distant free-tissue transfers. Although muscle flaps are preferred for infected wounds, coverage of the clean or acute foot deformity may be better achieved with the innervated radial forearm fasciocutaneous flap. This almost ideal donor site has been used by us for all traumatic foot defects requiring free flaps during the previous year. Our results document that in the 5 available clinical examples, restoration of normal foot contour, durability during ambulation, and an excellent aesthetic appearance were achieved.

Adolescent↗
PubMed1988

Free flap donor site refinement using tissue expansion.

Posttransfer tissue expansion has been used to negate concern for the aesthetic donor site deformity following 15 free tissue transfers involving donor sites of the scalp, trunk, and extremities. There appears to be no contraindication to placing these implants immediately, as was done in 87% of cases, although it is recommended that expansion be delayed until adequate wound healing has occurred at any skin graft interface. This technique has had major positive benefits for refining the radial forearm flap and hair-bearing temporoparietal fasciocutaneous flap defects, which may have heretofore been avoided secondary to aesthetic concerns. Tissue expansion techniques should be considered as an important adjunct for any microsurgical reconstructive effort.

Adult↗
PubMed1988

A new double-armed microsuture.

A new double-armed microsuture using 70-mu micro-edge taper-point (M.E.T., Sharpoint, Reading, PA) needles swaged onto 10-0 (22 mu) monofilament nylon has been developed by us primarily to allow precision intraluminal suture placement. Applications of this minimally atraumatic double-armed suture in microvascular surgery include patching and tacking within the anastomotic region.

Humans↗