Biomedical subjects
Publications and source records attributed to I T Jackson.
Most reconstructive surgeons will not commonly need to use the transverse cervical tube pedicle flap in facial reconstruction but this straightforward and simple technique can be very useful in certain instances. Some of the techniques of reconstructive surgery which have stood the test of time should not be forgotten even when the most recent reconstructive options are available.
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It is now accepted that calvarial bone is a suitable material for grafting in the facial area. From an extensive experience of using calvarial grafts in all regions of the face, the orbit has been singled out for this study. A group of 222 patients who underwent 279 calvarial grafts has been examined. The majority of patients had post-traumatic or congenital deformities. Reconstructions were performed with split-thickness cranial bone grafts and in some cases, the full-thickness of the cranium was used. The follow-up period ranged from 3 months to 4 years with an average of 20 months. After the first operation, 86% of the sample attained satisfactory aesthetics on clinical examination. There were 13 (4.6%) complications, most occurring during harvesting full-thickness calvarial grafts. From this study it is seen that orbital reconstruction can be performed using calvarial bone to obtain satisfactory aesthetic and functional results. This can be accomplished with minimal donor site morbidity.
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Over a 24-month period, 18 patients had 33 expanders placed in the extremities. Twelve expansions were performed in the upper extremity, and 21 in the lower extremity. Indications for expansion include scarring, excision of skin grafts, tumor excision, burn scars, tattoos, or unacceptable incisional scars for revision. Of the 12 expansions performed in the upper extremity in seven patients, nine were successful. Nine expansions in the thigh and two expansions in the region of the knee were completed without complication. Three expansions were performed in the distal lower extremity following crush injury to remove scarring, and all three failed. Seven expansions were performed in the foot for removal of scarred tissue. There was one infection, two skin necroses on the dorsum of the foot, and one implant exposure. Seven complications in the lower extremity occurred in these areas with an infection rate of 20%. The remaining 23 expansions were performed for soft tissue defects in the upper extremity or in the lower extremity above the level of the mid-calf, with only two complications of implant exposure or infection. Therefore, the infection rate and complication rate in the upper extremity and above the knee was only 6%. Overall, 23 of the 33 expansions, or 70%, were taken to completion with a successful advancement of expanded flaps. Overall, complications occurred in 30% of patients, all eventually requiring removal of the expander.(ABSTRACT TRUNCATED AT 250 WORDS)
This study compared the vascularity and resorption of calvarial bone flaps based on an undisturbed pedicle and on a previously (4 weeks) detached pedicle of the superficial fascia (galea) and periosteum and free calvarial bone grafts. Nine adult pigs were used, in three of which a silicone rubber compound was injected intravascularly immediately after the transfer confirmed the vascularity of both pedicled bone flaps. In six pigs, volume changes were assessed intraoperatively by a water displacement method and also 12 weeks postoperatively. Both pedicled bone flaps preserved their original volume, whereas free skull grafts showed approximately 50% of volume loss (p less than 0.001). Decalcified hematoxylin and eosin sections of the specimens obtained 12 weeks postoperatively showed a normal calvarial appearance in both pedicled bone flaps and extensive fibrous tissue infiltration into free grafts. It is suggested that a previous detachment of galea and periosteum does not interfere with the use of vascularized calvarial bone graft, which may provide a more predictable result than a free bone graft.
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Twenty adult rabbits were used to evaluate the biocompatibility and osteoconductivity of Bio-Oss, an inorganic bovine bone mineral, in the reconstruction of full-thickness skull defects. Skull defects were treated with either autogenous bone dust, porous hydroxyapatite granules, Bio-Oss particles, or were left untreated as controls. Histological examination of decalcified sections showed incorporation of Bio-Oss into the host tissue without a significant inflammatory reaction. Measurement of the profile area occupied by the bone revealed that Bio-Oss, hydroxyapatite, and the control had the same amount of bone ingrowth, whereas autogenous bone dust produced a greater amount of bone (p < 0.01). We conclude that Bio-Oss, like porous hydroxyapatite, has sufficient osteoconductive properties and can also be used as a bone substitute material.
A study to assess the effects of an intraluminally placed tissue expander in the rabbit jejunum was performed. Oval expanders (8 cm3) were placed via a midline coeliotomy through an enterotomy on the antimesenteric border of the jejunum. The reservoir was tunnelled subcutaneously through the abdominal wall. Expansion was carried out through this port at 7-10-day intervals using 0.5-cm3 increments. At the end of the experiment, angiography was performed and routine haematoxylin and eosin-stained sections were produced. Angiography revealed an increase in vessel diameter and vascular density of the specimen. Histology showed an increase in villi size, an increase in the number of goblet cells and a marked increase in the thickness of the muscular layer. The possible applications of this technique are discussed.
Considerable evidence suggests that factor XIIIa, a blood coagulation factor, also functions in tissue repair, and specifically in the dynamic process of fibroplasia. On the other hand, the dynamic process of tissue expansion would require a loosening of the dermis, the opposite of fibroplasia. We examined the effects of tissue expansion on the expression of factor XIIIa in pig skin. Standard immunohistochemical procedures were used coupled with a rabbit antibody to factor XIIIa. In this report, we demonstrate that the normal expression of factor XIIIa in pig dermis is completely inhibited at the apex overlying the tissue expander. Factor XIIIa inhibition during expansion supports the thesis that this substance is important in the production and maintenance of fibroplasia.
The use of Proplast in the restoration of contour defects and for reconstruction of alveolar ridges is described. An evaluation of the results of treatment suggests it is a useful material for the restoration of facial contour, but that there is a significant risk of infection when the intra-oral approach is adopted.
The procedure of interpositional arthroplasty of the wrist joint in rheumatoid arthritis, using silicone sheeting, is described. The results and complications of sixty arthroplasties are presented.
We report the experiences in 6 major craniofacial centers, with similar teams but in different parts of the world, in a total of 793 craniofacial operations. The mortality rate was 1.6%. Complications developed in 16.5% of the cases (including infections in 4.4%). This surgery has many potential advantages, not least of which is its psychosocial effects on previously disfigured patients. Certain problems seem inherent, however, for there are not yet any satisfactory solutions to them. Some of the factors that reduce morbidity and improve results include the use of hypotensive anesthesia, a reduction in operating time, rigid stabilization of the mobilized bones at the end of the operation, a diminution in the number of incisions, and extensive antibiotic therapy.
Due to the recent upsurge in self-inflicted tattoos in teenagers it was decided to employ for their removal the method of salabrasion, i.e. abrasion with table salt. This technique was recently used by Manchester (1973, 1974) for the removal of commercial tattoos. Fourteen patients with twenty-eight tattoo or only tiny flecks of pigment remaining visible; eleven showed a fair response, i.e. the tatoo, although much lighter in colour, was still legible but the patient was satisfied with the result; three showed a poor response, i.e. the tattoo appeared as if untreated; four (two patients) defaulted. In general, as could be expected, the darker the tattoo the more difficult was its removal and those on fingers were particularly resistant.
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A technique for nasal lengthening is described in 3 cases using nasolabial flaps for lining and an island forehead flap for skin reconstruction. It is basically a 2-stage procedure with short hospitalisation.