Biomedical subjects

H S Matloub

Publications and source records attributed to H S Matloub.

At least 73 records · Page 4Linked to original sources

PubMed1992

Transfer of an inferior rectus abdominis myocutaneous flap following enterostomy.

A rectus abdominis myocutaneous flap was successfully transferred in a patient in whom a mucous fistula had previously been brought through the midportion of the muscle. The flap was used to close a large defect in a paraplegic. Previous enterostomy is not a contraindication to the use of this flap. Preoperative arteriography to confirm the presence of a patent deep inferior epigastric artery is recommended prior to flap transfer.

Abdominal Muscles↗

PubMed1992

High-resolution bone scintigraphy of the adult wrist.

Bony anatomic landmarks of the wrist (e.g., pisiform, hook of hamate, radioulnar joint, and styloid processes of the radius and ulna) were routinely identified in 28 adult patients examined for wrist pain. With the wrists prone and immobilized, bone scintigrams were obtained for 500,000 counts with an asymmetric (133 to 161 keV) Tc-99m energy window and either a converging (best choice) or straight-bore, high-resolution collimator. High-resolution scintigraphy precisely localized degenerative joint disease (nine patients), scaphoid fractures (five), pisiform fracture (one), lunate avascular necrosis (one), radioulnar arthritis (one), septic or inflammatory arthritis (six), ulnocarpal impingement (two), and reflex sympathetic dystrophy syndrome (two). Images obtained palm down with the wrist in ulnar deviation helped identify increased uptake within the scaphoid. Fracture and significant bone or joint disease were excluded in one patient.

Adult↗

PubMed1992

Scalp reconstruction with a prefabricated abdominal flap carried by the radial artery.

Custom prefabrication of free flaps provides an unlimited variety of applications, since flaps can be created with expendable tissues and without restriction to naturally occurring vascular territories. These principles also can be used to customize flaps that could not be completed by conventional means. We report a case of scalp reconstruction using a random-pattern abdominal flap in which a radial artery fascial flap was induced to serve as the vascular carrier. In addition to providing durable scalp coverage, the prefabricated free flap enabled salvage of an abdominal flap that would otherwise have been aborted after intermediate transfer to the forearm.

Abdomen↗

PubMed1992

Elimination of the vertical scar in reduction mammaplasty.

We describe a technique to eliminate the vertical portion of the inverted-T incision in patients who have combined enlargement of the breasts and moderate to severe ptosis. Initial preoperative markings are made, placing the new nipple site at the level of the transposed inframammary crease. The nipple-areola complex is then retained on a vascularized pedicle, with major reduction of the breast tissue being done in the medial and lateral quadrants. The nipple and breast tissue are then tucked underneath the superior skin segment and placed in this new position as one would do with the umbilicus in an abdominoplasty. Excess vertical skin is removed, and horizontal excess is collected at the midline as a small dog-ear. We have found that this dog-ear reduces markedly with time, rounding out the inferior portion of the breasts. The remaining small amount of excess skin can then be removed under local anesthetic at a later date. We have performed this procedure on 20 patients, with follow-up from 6 to 24 months.

Adolescent↗

PubMed1992

Silicone gel infiltration of a peripheral nerve and constrictive neuropathy following rupture of a breast prosthesis.

Following rupture of a subpectoral breast prosthesis, massive amounts of silicone gel migrated into the arm of a patient. The patient developed painful paresthesias and decreased sensation in the cutaneous distribution of the superficial radial nerve. Nerve conduction studies showed both an increase in distal latency and decreased amplitude in this nerve compared with the normal opposite side. Subsequent neurolysis confirmed dense fibrosis surrounding the nerve. Silicone droplets also were observed within the thickened epineurium of the median nerve, but no electrophysiologic evidence of neuropathy occurred. Multiple debridements of the subcutaneous tissue of the arm were necessary. In one of these specimens, histologic sections demonstrated silicone gel infiltration of a subcutaneous nerve. This is the first reported case of silicone gel infiltration of a nerve and constrictive neuropathy associated with a prosthesis rupture.

Female↗

PubMed1992

Short-term effect of silicone gel on peripheral nerves: a histologic study.

The effect of silicone gel on the peripheral nerve was studied in Sprague-Dawley rats. Silicone gel was placed either extraneurally (N = 36) adjacent to or injected directly in the sciatic nerve (N = 20). Nerve histology was studied every 2 weeks over a 20-week period. Extraneural silicone gel elicited an intense inflammatory response characterized initially by predominantly histiocytes with a few eosinophils, lymphocytes, and foreign-body giant cells. The cellular response peaked at 4 weeks, after which time collagen deposition increased and the thickness of the cellular infiltrate surrounding the gel decreased. The gel was temporarily contained by the inflammatory response, but throughout the time course of the study, gel migration and breakup into smaller droplets occurred. Each droplet appeared to initiate the inflammation-fibrosis cycle anew. Perineural fibrosis was marked by 20 weeks, but there was no penetration of the epineurium by the gel. Intraneurally injected silicone gel also caused a delayed, but similar inflammatory response, eventually followed by fibrosis surrounding the gel. Intraneural gel tended to remain in larger droplets and did not migrate over the duration of this study. No direct evidence of gel toxicity to peripheral nerves was observed in either the extraneural or intraneural gel groups despite the initial intense inflammatory response and subsequent fibrosis.

Animals↗

PubMed1992

Peripheral nerve anatomy and innervation pattern.

This article discusses three basic parts of peripheral nerves. A description of the nerve fiber includes sections on both myelinated and unmyelinated axons. The anatomy of the peripheral nerve at the cellular level is reviewed encompassing the nerve, the surrounding connective tissue framework, and the supportive vascular supply. Finally, normal and abnormal innervation patterns of the hand and forearm are presented. Anastomosis and variations of the normal anatomy are discussed.

Forearm↗

PubMed1991

Histochemical staining of nerve endings as an aid to free muscle transplantation.

Histochemical staining techniques that identify intact motor nerve fascicles are available to aid free muscle transplantation. Cholinesterase activity of myelinated axons can be identified by Karnovsky and Roots's technique. Axon viability can be assessed based on the presence of axoplasmic enzyme activity. By reacting serial sections for cholinesterase activity and carbonic anhydrase activity, which labels sensory axons, an accurate cross-sectional map of regenerating or functional sensory and motor nerve fibers can be constructed. Resolving the motor and sensory identities of fascicles in a mixed peripheral nerve should lead to more precise coaptation of recipient motor fibers to the motor nerve of the transferred muscle and enhance reinnervation.

Adult↗

PubMed1991

Diagnosis of an anomalous superficialis muscle in the palm by magnetic resonance imaging.

Anomalous muscles of the upper extremity are encountered occasionally and in most cases, identification has been made at operation. Plain radiographs do not visualize soft tissues well. Magnetic resonance imaging provides good definition of soft tissue structures. We report a case of an anomalous flexor digitorum superficialis muscle in the palm, that was seen initially as a mass associated with a previous injury and pain. Magnetic resonance studies showed the mass to be a muscle belly in the palm. Preoperative identification of anomalous muscles is possible with magnetic resonance imaging.

Adult↗

PubMed1991

Classification system for factitious syndromes in the hand with implications for treatment.

We evaluated 29 patients with factitious disorders in the hand who received Worker's Compensation benefits. Three types of factitious hand disorders based on physical presentation were self-mutilation and wound manipulation, edema, and finger and hand deformities. Two distinct psychological diagnoses present were factitious disorder with physical symptoms and conversion disorder. The Minnesota Multiphasic Personality Inventory revealed two personality profiles: emotionally dependent and angry and hostile. Behavioral treatment was implemented. The emotionally dependent group responded well, with 80% returning to work. The angry and hostile group had a much poorer response, with 21% returning to work. None of the self-multilating patients returned to work. We recommend a combined evaluation by a physician, a psychologist, and a hand therapist to achieve a definitive diagnosis for these disorders. The identification of psychological profiles assists in ascertaining which patients will be responsive to behavioral treatment.

Accidents, Occupational↗

PubMed1991

Effects of litigation on maintenance of psychological symptoms after severe hand injury.

Severe psychological symptoms after severe work-related hand injury, manifested as posttraumatic stress disorder, are not significantly potentiated or sustained by concomitant litigation if the patient has had early psychologic intervention. This study does not support assumptions about "accident neurosis" that delays recovery from the psychological sequelae of severe work-related hand injury.

Accidents, Occupational↗

PubMed1991

Venous anatomy of the thumb.

The venous anatomy of 20 thumbs (10 pairs) was detailed by latex injection. The thumbs were studied on the dorsal, palmar, radial, and ulnar surfaces. Characteristic patterns were found; these included a dominant longitudinal network, palmar veins within the pulp, oblique veins at the interphalangeal joint on the radial side, and a web space vein. A layered vascular pattern with a superficial fine network overlying a deeper system was noted. Cross sections were taken at the metacarpophalangeal joint and at the proximal and distal phalanges. The distribution of the vessels in cross section reveals consistent dorsal veins at all levels, as well as palmar veins distal to the interphalangeal joint in all thumbs. Palmar veins were present over the length of the proximal phalanx in more than 65% of the thumbs.

Humans↗

PubMed1991

Basal cell carcinoma of the lower leg occurring in association with chronic venous stasis.

A patient with basal cell carcinoma found within a chronic venous stasis ulcer of the lower leg is reported, and the literature is reviewed. Basal cell carcinomas found within venous stasis ulcers tend to be multifocal and of the sclerosing type. Tumors often extend into the reticular dermis but have never been reported to extend deep to subcutaneous tissue. The plastic surgeon should familiarize himself with these entities when dealing with what appears to be chronic nonhealing venous stasis ulcers. Such ulcers warrant an incisional biopsy. Once a diagnosis of basal cell carcinoma is made, excision of the lesion down to the underlying muscle fascia and coverage with a split-thickness skin graft is usually curative. Because of the multifocal nature of these lesions, all other suspicious or hyperpigmented lesions of the leg should also be biopsied.

Aged↗

PubMed1991

Effects of axotomy on the cholinesterase and carbonic anhydrase activities of axons in the proximal and distal stumps of rabbit sciatic nerves: a temporal study.

The temporal changes in transected sciatic nerves of rabbits were studied using recently developed histochemical techniques for discriminating between sensory and motor axons. A segment of the nerve was removed to inhibit spontaneous regeneration across the gap. Staining characteristics of the proximal and distal nerve stumps were studied at 1, 2, 3, 4, 9, and 35 days following axotomy and compared with control sciatic nerves. In the control and test nerves, subpopulations of myelinated sensory axons were identified histochemically by carbonic anhydrase (CA) staining, and a subset of alpha motor axons were visualized by cholinesterase (CE) staining. Axon staining patterns were reciprocal; i.e., sensory axons were CA-positive and CE-negative, whereas motor axons were CE-positive and CA-negative. Histochemical activities persisted at day 35 after axotomy in the proximal stump and until day 9 after axotomy in the distal stump. This implies that these techniques may aid in both immediate and delayed primary nerve repair. With time, there is buildup of scar tissue adding to the proximal and distal stumps. Therefore, sections for demonstrating sensory and motor axons must be taken progressively further back from the nerve stump ends. Histochemical axon typing indicated that sensory axons regenerated earlier and to a greater degree than motor axons in the developing neuroma. Use of both the carbonic anhydrase and cholinesterase staining methods is more accurate than either technique alone as an adjunct for examining normal and injured peripheral nerves.

Animals↗

PubMed1990

Proximal phalangeal fracture after tendon pulley reconstruction.

A case is presented in which an A2 pulley reconstruction was done, encircling a previously fractured, multiply-operated proximal phalanx. Bone resorption occurred directly under the pulley, and the bone then fractured. It is postulated that the cumulative effect of these operations on the blood supply to the bone and abnormal pressure forces led to resorption of bone and subsequent fracture.

Bone Resorption↗

PubMed1990

Treatment of posttraumatic stress disorder after work-related hand trauma.

Posttraumatic stress disorder frequently accompanies severe work-related hand trauma and, when a patient attempts to return to work it can potentially be as debilitating as the hand injury. Four techniques were examined for their effectiveness in the treatment of the symptoms of posttraumatic stress disorder. Confronting and reprocessing of intrusive thoughts, combined with coping skills training, effectively reduced all symptoms except avoidance reactions. An early return to the worksite was useful with those patients who experienced mild avoidance reactions, although many patients were not able to use this. Graded work exposure was a highly successful technique for those patients with moderate avoidance reactions. For those with severe avoidance reactions, on-site job evaluations were used with good success. We believe that actual exposure to the worksite greatly enhances the ability of occupationally hand-injured patients to return to work for their previous employer. An algorithm for treatment is proposed.

Employment↗

PubMed1990

Sequential connection of flaps: a logical approach to customized mandibular reconstruction.

Microsurgery has improved the success rate for reconstruction of composite defects in the head and neck. Restoration of mandibular continuity alone is not adequate for reconstruction. Replacement of the oral lining with thin tissue is necessary to improve tongue mobility and to set the stage for later dental restoration. There is currently no ideal osteocutaneous free flap that provides unlimited length of bone, can undergo multiple osteotomies to produce the proper curve to the reconstructed mandible, and provides thin skin for oral lining. Combining free flaps can take advantage of the strengths of the individual donor sites and eliminate some of the problems with current osteocutaneous flaps. In six patients, a fibular osseous free flap was combined with either a radial forearm flap or a lateral arm flap to provide bone and oral lining in reconstruction of mandibular composite defects. In these selected patients, the fibula provided the blood supply for the second free flap, which was placed sequentially. The distal peroneal vessels were used to anastomose to the radial forearm vessels or the lateral arm pedicle. This approach allows the surgeon to customize the defect by improving both the functional and aesthetic aspects of reconstruction and is of use in cases where vascular access is limited, such as following head and neck surgery and radiation.

Bone Plates↗

PubMed1990

Thermal self-regulation for pain control in reflex sympathetic dystrophy syndrome.

Reflex sympathetic dystrophy syndrome is comprised of a variety of changes in vasomotor and trophic responsivity, as well as, stiffness, edema and severe pain. This study examined 20 patients with reflex sympathetic dystrophy syndrome who had failed to respond to a variety of techniques commonly used to treat this disorder. These patients had documented histories of reflex sympathetic dystrophy syndrome ranging from 18 to 60 months. All had been referred for psychological evaluation and provision of pain management. A combination of thermal biofeedback, relaxation training, and supportive psychotherapy were used to reduce subjective pain. The results indicate that patients were able to significantly increase their initial (p less than 0.0001) and postrelaxation (p less than 0.0001) hand temperatures, as well as to significantly reduce their subjective pain ratings (p less than 0.0001). This reduction in pain was maintained at 1-year telephone follow-up, with 14 of the 20 patients returning to work by that time. This intervention was effective as a pain reduction strategy for our patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments.

Adult↗