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Biomedical subjects

Gedge D Rosson

Publications and source records attributed to Gedge D Rosson.

16 recordsLinked to original sources
PubMed2006

Chemotherapy-induced neuropathy.

Increasingly, surgeons are becoming aware of the successful treatment of symptomatic peripheral neuropathy by surgical decompression of peripheral nerves. Armed with the knowledge that patients can have underlying neuropathy with overlying anatomic compressions, surgeons have affected improvement in diabetes-induced neuropathy, neuropathy of unknown etiology, and chemotherapy-induced neuropathy. This article details the most well-known culprits in chemotherapy-induced neuropathy and discusses the putative mechanisms of action, medical management, and surgical data.

Animals↗
PubMed2006

Robotics in plastic and reconstructive surgery: use of a telemanipulator slave robot to perform microvascular anastomoses.

Many methods for microvascular anastomoses exist, including use of magnifying loupes (x 2.5, x 3.5, x 4.5, x 6), but the operating microscope remains the gold standard. The authors present the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) as an alternative method for performing microvascular anastomoses. The da Vinci robot has fully articulating microinstruments with six degrees of freedom, the ability to filter tremor, the capability to perform telesurgery, and the advantage of 3-D visualization. It offers full and dynamic control over the operating camera, allowing variable positioning and the ability to scale down movements. Its drawbacks include initial high cost, lack of haptic feedback, decreased participation of the first assistant, and lack of widespread availability. In this feasibility study, multiple microanastomoses were performed in canine tarsal and superficial femoral vessels.

Anastomosis, Surgical↗
PubMed2006

Wound healing in denervated tissue.

Sacral and trochanteric pressure sores in patients with plegias, and foot ulceration in patients with diabetic neuropathy, are similar because these wounds occur in tissues that do not have normal innervation. While it is recognized that insensitive tissue increases the likelihood of ulceration and recurrence of ulceration, this review attempts to answer the question, Is wound healing impaired in denervated tissue? A review of the scientific literature of the past 35 years demonstrates that all phases of wound healing are impaired in denervated tissue, and these mechanisms are different from those related to one of the underlying diseases, diabetes. Understanding the value of innervation, a goal of wound healing should be to seek strategies that provide reinnervation to these at-risk tissues.

Animals↗
PubMed2005

Robotics in microsurgery: use of a surgical robot to perform a free flap in a pig.

We present the concept that a surgical robot may be used to successfully perform a free flap. To study different microsurgical techniques, a porcine free flap model was developed in our laboratory. Dissection of the free flap model and isolation of the vessels were completed under traditional loupe magnification. The da Vinci robot was then used to perform vessel adventitiectomy and microanastomoses. The model was observed for 4 h postoperatively, noting flap color, temperature, capillary refill, and Doppler signal. At the end of this period, the flap was noted to be viable; anastomoses were evaluated and found to be grossly and microscopically patent. Advantages conferred by the da Vinci robot include elimination of tremor, scalable movements, fully articulating instruments with six degrees of spatial freedom, and a dynamic three-dimensional visualization system. Drawbacks include the cost and the absence of true microsurgical instruments.

Anastomosis, Surgical↗
PubMed2005

Internal mammary perforators: a cadaver study.

Microsurgeons currently employ the internal mammary artery and vein as recipient vessels for microvascular reconstruction of the breast with increasing frequency. Recent reports have demonstrated that the perforating branches of the internal mammary artery and vein can also be used as recipient vessels. The purpose of the following cadaver study was to determine the location and diameter of these internal mammary perforators and whether they are suitable as recipient vessels. Ten fresh cadavers were obtained for this project. Using a micrometer under loupe magnification, bilateral measurements were taken of the perforators from the first five interspaces. The largest arterial perforator averaged 1.74 mm in diameter and the largest venous perforator averaged 1.78 mm in diameter. The largest perforators were most commonly found in the second interspace. Based on the results of this study, the internal mammary perforators appear to have suitable diameter for microvascular anastomosis and should be considered.

Aged↗
PubMed2005

Devascularizing complications of free fibula harvest: peronea arteria magna.

The authors present a case report of devascularizing complications following free fibula harvest. A retrospective review of 93 consecutively imaged limbs demonstrated a peronea arteria magna (PAM) prevalence of 5.3 percent in an urban population, which was used to perform a cost-effectiveness analysis for preoperative vascular imaging of the donor limb using magnetic resonance angiography (MRA) and traditional angiography (TA). Donor-site complications of fibula harvest range from 15 to 30 percent, but are rarely limb-threatening. Limb loss is a dreaded complication of congenital PAM, which can be present with a normal vascular exam. Some microsurgery groups advocate using no preoperative imaging of the donor limb; they rely on intraoperative assessment of the vascular anatomy. An aborted harvest due to aberrant anatomy leads to both direct and indirect added costs. The authors believe that MRA imaging of the donor limb, being minimally invasive, is cost-effective and indicated for free fibula transfers. For equivocal results, conversion to more invasive and costly TA may be necessary.

Adult↗
PubMed2005

Superficial peroneal nerve anatomic variability changes surgical technique.

UNLABELLED: Entrapment of the superficial peroneal nerve is an uncommon entrapment that occurs in sports trauma or fracture and dislocation as the nerve comes under pressure between the underlying muscles and the overlying fascia. Although the superficial peroneal nerve traditionally is depicted as being in the lateral compartment, we have found it in the anterior compartment in some patients. We hypothesized that patients with entrapment of the superficial peroneal nerve were more likely to have this anatomic variant than the normal population and that surgical decompression of both compartments would improve clinical outcome versus the historic surgical approach of decompressing just the lateral compartment. We retrospectively reviewed the location of the superficial peroneal nerve in a consecutive series of 35 limbs in 31 patients with entrapment of the superficial peroneal nerve. The results showed that the location of the superficial peroneal nerve was not different from the reported normal variation. However, the location of the superficial peroneal nerve in the anterior compartment in 47% of the patients in this series suggests that surgeons must explore the anterior and the lateral compartments in each patient with entrapment or neuroma of the superficial peroneal nerve. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series-no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.

Evidence-Based Medicine↗
PubMed2005

Abdominal wall neuroma pain after breast reconstruction with a transverse abdominal musculocutaneous flap: cause and treatment.

Breast reconstruction with either a pedicled or microvascular transfer of the transverse rectus abdominus musculocutaneous flap, whether with or without the muscle, is now the standard of care when patients choose an autologous form of reconstruction. Complications related to flap loss and abdominal wall weakness have been well described. Complications related to painful neuromas of the intercostal nerves, ilioinguinal and iliohypogastric nerves have not been described previously. The diagnosis and treatment of pain related to neuromas of the abdominal wall is discussed in this paper.

Abdominal Neoplasms↗
PubMed2004

Localization of the arcuate line from surface anatomic landmarks: a cadaveric study.

The arcuate line is a relevant structure when reconstructing the abdominal wall after rectus abdominis musculocutaneous flap harvest. Its location is classically taught to be half the distance from the pubic symphysis to the umbilicus, but recent anatomic literature provides evidence to the contrary. Better understanding of the relationship between the arcuate line and surface anatomic landmarks could facilitate better preoperative planning when harvesting a rectus abdominis musculocutaneous flap. A total of 32 arcuate lines were dissected in 18 cadavers, and the location was correlated to various surface anatomic landmarks. The arcuate line was found to lie at 74.6% of the distance from the pubic symphysis to the umbilicus, and 32.7% of the distance from the pubic symphysis to the xiphoid. This location was 1.8 +/- 1.7 cm superior to the level of the anterior superior iliac spines (ASIS). This study provides further support for the finding in the anatomic literature that the arcuate line is substantially more superior than classically described. This knowledge may prove useful in preoperative planning of rectus abdominis musculocutaneous flap harvest.

Abdomen↗
PubMedDate not supplied

Surgical approach to multiple interdigital nerve compressions.

A surgical approach is described that permits access to 2 web spaces with a single incision along the common metatarsal, dividing distally at the proximal phalanx, as a novel y incision. This has been found to be useful in patients with adjoining interdigital nerve compressions.

Foot Diseases↗
PubMedDate not supplied

Superficial peroneal nerve (superficial fibularis nerve): the clinical implications of anatomic variability.

The purpose of this study is to refine further the knowledge about the anatomic variability of the superficial peroneal nerve in the middle third of the leg. Approaching the superficial peroneal nerve in this location is required: 1) when either the deep or the superficial peroneal nerve must be resected for the treatment of dorsal foot pain; 2) when a neurolysis of the superficial peroneal nerve is required; 3) when a fasciotomy must be performed either for trauma or for exertional compartment syndrome surgery; and 4) during elevation of a fasciocutaneous or fibular flaps. Because of the variability encountered during these procedures, a prospective study was carried out via lower extremity cadaver dissection with fresh, frozen specimens. A total of 35 nonpaired lower extremities and 40 paired lower extremities were dissected with 3.5 loupe magnification. The superficial peroneal nerve was identified in the lateral compartment immediately adjacent to the fascial septum in 72% of the specimens (54 of 75), with a branch in both the anterior and the lateral compartment in 5% of the specimens (4 of 75), and located in the anterior compartment in only 23% of the specimens (17 of 75). The clinical implications of these anatomic findings are that the surgeon operating in the anterior and lateral compartments of the leg should be aware that the superficial peroneal nerve may be located in the lateral compartment and may also exhibit branches in both the anterior and lateral compartments.

Adult↗
PubMedDate not supplied

Tibial intraneural ganglia in the tarsal tunnel: Is there a joint connection?

Intraneural ganglia are rare entities, and, as such, their pathogenesis has been extremely controversial. Recent evidence from intraneural ganglia occurring at more proximal sites-the peroneal nerve at the fibular neck (the most common site) and the tibial nerve at the knee-has suggested an articular origin rather than de novo formation. To our knowledge, of the 10 previous reports of tibial intraneural ganglia within the tarsal tunnel by others, a joint connection to the ankle joint was only identified in 2 cases. To support a hypothesis that tibial intraneural ganglia occurring within the tarsal tunnel region arise from neighboring joints, we analyzed 3 patients retrospectively, all of whom had magnetic resonance (MR) imaging and operative intervention. One of these patients was treated by a peripheral nerve surgeon specializing in foot and ankle surgery. The other 2 patients were the only ones previously published in the literature who had MR images available for reinterpretation. In none of these cases was a joint communication appreciated by radiologists interpreting the MR images preoperatively or by surgeons intraoperatively. Our review of these same cases demonstrated radiographic evidence of joint communications with the subtalar joints. Based on our findings in this article and our knowledge of intraneural ganglia occurring at more proximal sites, we believe that tibial intraneural ganglia within the tarsal tunnel originate from neighboring joints and that their connections to the joints (pedicles) are through articular branches. The importance of these connections is 2-fold: first, for their role in the pathogenesis of this entity, and second, for their potential therapeutic implications. As is highlighted by the clinical and radiographic follow-up in the 1 patient in this article and in many previously reported at other sites, intraneural cyst recurrence can occur if surgeons do not specifically address the articular connection.

Ankle↗
PubMedDate not supplied

Comparison of measures of large-fiber nerve function in patients with chronic nerve compression and neuropathy.

Measurement of large-fiber peripheral nerve function is critical to the assessment of patients with nerve injury, chronic nerve compression, and neuropathy. We evaluated the Semmes-Weinstein nylon monofilament (SWM), vibrometry, and the Pressure-Specified Sensory Device (PSSD) (Sensory Management Services LLC, Baltimore, Maryland) prospectively on the plantar surface of the hallux, bilaterally, in 35 patients with peripheral nerve problems related to nerve compression and neuropathy. Five patients had carpal tunnel syndrome and, therefore, had normal hallux measurements. Normative data for the SWM were obtained for 59 age-stratified people. A moderately strong Pearson product moment correlation was found for large-fiber nerve function between the PSSD and the SWM and between the PSSD and vibrometry. However, when these functions were compared with normative values for each neurosensory testing technique, sensitivity for detecting the presence of a peripheral nerve problem was 100% for the PSSD, 63% for the SWM, and 30% for vibrometry. False-positive test results were obtained for the hallux in 0% of normal feet when the PSSD was used, in 20% when vibrometry was used, and in 30% when the SWM was used as the test instrument. The PSSD was the most sensitive in identifying the presence of a large-fiber peripheral nerve problem in patients with pain or paresthesia in the foot related to the posterior tibial nerve.

Adolescent↗
PubMedDate not supplied

Tarsal tunnel surgery for treatment of tarsal ganglion: a rewarding operation with devastating potential complications.

Three patients who originally presented with a mass in the tarsal tunnel are described to develop an algorithm for management of the tarsal ganglion. All three patients had complications from ganglion excision, including complete division of the posterior tibial nerve, injury to the posterior tibial artery, and ganglion recurrence. The guiding principles relating to the presence of an extraneural versus an intraneural ganglion are developed. An example of a posterior tibial intraneural ganglion is presented.

Ganglion Cysts↗