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Biomedical subjects

J C Grotting

Publications and source records attributed to J C Grotting.

At least 19 recordsLinked to original sources
PubMed1992

Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery.

Aeromonas hydrophila infections are a recognized complication of postoperative leech application, and can occur with measurable frequency in populations of patients treated with leeches. We review 11 previously reported leech-related Aeromonas infections and analyze seven unreported cases. These infections range from minor wound complications to extensive tissue loss and sepsis. Often, these infections followed leech application to tissue with questionable arterial perfusion. Onset of clinical infection in these patients ranged from within 24 hours of leech application to 10 days or more after leech application. Late infections may represent bacterial invasion from colonized necrotic tissue. Based on these observations, we recommend that leech applications be restricted to tissue with arterial perfusion to minimize contamination of necrotic tissue. We also recommend that patients treated with leeches receive antibiotics effective against Aeromonas hydrophila before leech application. Patients treated with leeches and discharged with eschars or open wounds might benefit from oral antibiotic therapy until wound closure. These precautions may minimize or eliminate this complication of leech use.

Adolescent↗
PubMed1991

The free abdominoplasty flap for immediate breast reconstruction.

As free flap breast reconstruction has become more common, we have sought to further refine donor sites. A woman is presented in whom a free flap from the low abdominal wall based on the superficial inferior epigastric artery and vein is used. This procedure results in total sparing of the rectus abdominis muscles and may be applicable in thinner women with smaller breasts, who cannot spare the larger ellipse of the conventional transverse rectus abdominis musculocutaneous (TRAM) flap. As we have sought to further refine breast reconstruction using autogenous tissue, microvascular tissue transfers are assuming a more important role. At the present time, it is possible to evaluate each individual woman for the most appropriate and available donor tissue to achieve a symmetrical reconstruction. In any given woman, it may be more appropriate to use the abdomen, hips, or buttocks, depending on the size and shape of the opposite breast and where the tissue can be most easily spared. We report here a woman in whom immediate breast reconstruction was performed using only the excess skin and fat of the lower abdominal wall pedicled on a unilateral superficial inferior epigastric artery and vein.

Breast Neoplasms↗
PubMed1991

Prevention of complications and correction of postoperative problems in microsurgery of the lower extremity.

Prevention of complications in microsurgery of the lower extremities begins with proper patient selection and patient preparation. Complications are highest in elderly patients who have had multiple trauma, smokers, patients with arterial or venous insufficiency, and those with hypercoagulability. Some patients may be best served by primary amputation. If multiple flaps are required, a higher success rate can be achieved with simultaneous rather than sequential transfers. However, for simultaneous transfers, a higher re-exploration rate must be anticipated. The key to avoiding long-term problems with infection is adequate preparation of the wound. Multiple debridements may be necessary. If early coverage can be obtained in trauma cases, a lower rate of chronic osteomyelitis has been observed. Attention to details in the operating room, such as patient warmth and perfusion, will increase the success rate. Recipient vessels must be out of the "zone of injury" and normal in appearance and pulsatility. It is safer to use normal recipient vessels and vein grafts than to attempt anastomoses to vessels affected by "post-traumatic vascular disease." If thrombosis occurs in the early postoperative period, prompt re-exploration can result in flap salvage, with a high degree of predictability if the cause of the thrombosis can be determined and corrected.

Adult↗
PubMed1990

Functional restoration in the upper extremity using free muscle transplantation.

Since 1973, fourteen free muscle transfers for functional upper limb reconstruction have been performed in twelve patients at the Ralph K. Davies Medical Center in San Francisco. All of the patients in this series had lost finger flexion, extension, and/or thumb opposition and were not candidates for simpler methods of reconstruction because of weakness or traumatic loss of balancing musculature. The 12 patients have been followed for one to 9 years. All muscles were successfully transferred without flap loss. Evaluation of the EMG data has shown evidence of reinnervation beginning at approximately two months with fibrillation potentials decreasing and recruitment of increasing numbers of motor units over two to three years. Eleven of the 14 muscles attained movement against resistance; two had movement against gravity and one regained only a flicker of motion. In our experience, the use of free muscle transplantation to restore function is not only technically feasible, but moreover, has resulted in a relatively high degree of patient satisfaction.

Adolescent↗
PubMed1989

Free-flap reconstruction of large head and neck defects in the elderly.

Advanced-stage and recurrent malignancies of the head and neck place severe demands on both the surgical team and the patient. Marked alterations in cosmesis and function are to be expected following major ablative surgery. The use of free tissue transfer with microvascular anastomoses has provided the head and neck surgeon the freedom to resect these lesions aggressively and to provide the patient with improved cosmesis, function, and protection of vital structures. A series of six cases involving patients at The University of Alabama at Birmingham over the past year is presented.

Aged↗
PubMed1989

Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction.

Immediate breast reconstruction using the transverse abdominal myocutaneous island (TRAM) flap was performed in 54 patients over the past 3 years at our institution. This represented approximately 59 percent of patients undergoing all types of immediate breast reconstruction. In 10 patients, the abdominal island flap was transferred as a free flap based on the deep inferior epigastric pedicle. These patients were compared with the other 44 patients, in whom the flap was transferred using the conventional technique. The TRAM flap is well suited for immediate breast reconstruction because the procedure can be carried out simultaneously with mastectomy using separate operating teams and instruments. The operation is safe and relatively free of complications. The free TRAM group compared favorably with the conventional group in terms of complications, operating time, estimated blood loss, hospitalization, and return to functional baseline. The free TRAM flap appears to be as safe as the conventional technique with the advantages of a more limited rectus muscle harvest, improved medial contour of the breast due to the lack of tunneling, and perhaps a healthier flap because of the large donor vessels.

Abdominal Muscles↗
PubMed1988

Clinical evaluation of flap viability with a dermal surface fluorometer.

A dermal surface fluorometer was used to monitor vascular perfusion in 22 patients who underwent reconstructive surgical procedures with a variety of flaps (e.g., skin flaps, musculocutaneous flaps, fasciocutaneous flaps, and Z-plasties). Sodium fluorescein (1.5 mg per kilogram of body weight) was administered intravenously at the completion of the operative procedure. Quantitative fluorescence readings were obtained at different points in each flap by means of the surface fluorometer (Fluoroscan). The readings were taken at several time intervals and compared with those of normal skin (control). A perfusion ratio was determined in each case according to the following formula: flap reading/(normal skin control reading X 100). Partial necrosis occurred in 4 patients, correlating with low fluorescein perfusion measurements. From our findings, it appears that a perfusion ratio of 15% or greater 10 minutes following injection will accurately predict tissue viability. No systemic reactions were observed in these patients. We believe that this minimally invasive technique should be of considerable assistance in the postoperative evaluation of flap viability.

Adult↗
PubMed1988

Sapphire ring constriction syndrome.

An uncommon case of a partially embedded ring under the skin is presented. A technique for removal is described. All previously reported cases as well as ours occurred in mentally handicapped individuals.

Adult↗
PubMed1987

Acute microwave injury to the hand.

An acute microwave oven burn injury to the hand resulting in second- and third-degree burns to the left long finger is presented. Excision and coverage using a cross-finger flap resulted in full return of function. Because of the difficulty in evaluating the extent of tissue necrosis, we recommend hospitalization for most microwave injuries where obvious soft tissue damage has been sustained.

Burns↗
PubMed1987

Microarterial sutureless sleeve anastomosis using a polymeric adhesive: an experimental study.

A new technique for microarterial sutureless anastomosis that involves telescoping one vessel into the other and placing a microdrop of a polymeric adhesive (iso-propyl-cyanoacrylate) is described. Sixty-six anastomoses were performed in rat femoral arteries with a patency rate of 95 percent. Light and electron microscopic studies were conducted at regular intervals, starting immediately to 90 days postoperative. From this experimental study, it appears that the described method of anastomosis is faster and easier to perform and at least as reliable as the conventional end-to-end suture anastomosis. In addition, it was observed that tissue reaction to the glue remained primarily adventitial and did not disturb vessel patency.

Animals↗
PubMed1987

Pressure sore carcinoma.

The development of squamous cell carcinoma in pressure sores is a rare event, considering the high incidence of pressure sores within the elderly and paraplegic populations. The clinical courses of 10 patients with pressure sore carcinoma have been reviewed. The presence of a velvety, cauliflower-like growth on the surface of a long-standing pressure sore should alert the surgeon to the possibility of malignant degeneration. Most of these tumors are well-differentiated squamous cell carcinomas. Of the 10 patients, 8 (80%) died from massive local recurrence or distant metastases an average of 17 months after resection and flap closure despite having apparently localized disease. One patient was disease free when lost to follow-up at 2 years, and 1 patient is without evidence of recurrence or metastases 3 months postoperatively. Altered immunocompetence may play a role in the rapid progression and high mortality associated with this tumor after surgical manipulation.

Adult↗
PubMed1987

An anatomic study of the venous drainage of the transverse rectus abdominis musculocutaneous flap.

The authors studied the venous drainage of the abdominal wall and its application to the transverse rectus abdominis musculocutaneous flap on 12 cadavers by injecting methylene blue and methyl methacrylate to follow the venous pathways. The nonvascular tissues of the specimens injected with methyl methacrylate were corroded away to show the three-dimensional arrangement of the vessels. We describe the veins of the anterior abdominal wall in relation to the transverse rectus abdominis musculocutaneous flap. The venous drainage of the transverse rectus abdominis musculocutaneous flap when used for breast reconstruction occurs from the cutaneous part of the flap to the inferior deep epigastric veins through vertical perforators that are mainly periumbilical. From there the flow is through the deep superior epigastric veins into the internal mammary vein. The deep inferior epigastric veins were found to have valves that prevent retrograde flow. In designing the flap, its safety is increased if it includes the periumbilical perforators. Thinning the flap should be done at the deep surface to preserve Scarpa's fascia and the superficial epigastric system.

Abdominal Muscles↗
PubMed1986

Craniofacial reconstruction after tumor resections using vascularized outer table calvarial bone flaps.

The outer table of calvarium is a useful donor site for facial reconstruction after resection of tumors. Large defects, especially when associated with multiple operations and radiotherapy, are poor recipient beds for nonvascularized bone grafts. A technique for the transfer of vascularized outer table has been developed and used in 11 patients for reconstruction of tumor defects. Satisfactory correction of both functional and esthetic problems has been achieved with satisfactory long-term stability and low morbidity.

Adolescent↗
PubMed1986

Anatomic basis for vascularized outer-table calvarial bone flaps.

The vascularization of the scalp and calvarium was studied in cadavers to better define the design of vascularized split- or full-thickness calvarial bone flaps. Selective dye injections of the superficial temporal and internal maxillary arteries established a horizontal and vertical network of vessels within and between each layer of the scalp. The periosteum of the frontoparietal region continues over the temporal aponeurosis as a separate, distinct layer, the innominate fascia, which is irrigated by numerous proximal branches of the superficial and deep temporal arteries. The periosteum can sustain the outer table of the calvarium by means of multiple small, vertical perforators. Between the periosteum and the outer table is a thin areolar layer of subperiosteum which continues beneath the temporal muscle. We feel that vascularized outer-table calvarial flaps can safely be pedicled using only the temporal aponeurosis, innominate fascia, and periosteum without including the galea or temporal muscle.

Blood Vessels↗
PubMed1986

Vascularized outer-table calvarial bone flaps.

Based on an anatomic study of the vascularization of the calvarium in cadavers, a technique for the transfer of vascularized outer-table calvarial bone has been developed. The outer table of the calvarium receives numerous small perforators from its overlying periosteum. The periosteum is continuous with a distinct fascial layer overlying the temporal aponeurosis which we have termed the innominate fascia. Because of a network of anastomosing vessels from proximal branches of the superficial temporal artery and perforating branches of the deep temporal artery, the outer table of the calvarium can be carried on a pedicle which contains the temporal aponeurosis, innominate fascia, and periosteum. Thirty-seven vascularized outer-table calvarial bone flaps have been performed for a variety of craniofacial reconstructive deformities. Remarkable stability and lack of resorption have led the authors to favor this method of reconstruction particularly in poorly vascularized or previously infected recipient beds.

Adolescent↗
PubMed1979

Control of blood glucose in experimental diabetes by means of a totally implantable insulin infusion device.

Near-normal glucose tolerance tests in diabetic dogs were obtained during basal rate insulin infusions in restrained animals by use of extracorporeal infusion pumps and in conscious, unrestrained animals by means of implanted infusion pumps. Even better regulation of blood glucose in diabetic animals was obtained by the addition of predetermined pulses of insulin at higher flow rates than the basal flow rate, accomplished by use of a transcutaneously activated valve mechanism attached to the implanted infusion pump. We conclude that near-normal blood glucose concentrations can be maintained throughout the day in the dog by these means and that similar approaches, using implantable infusion pumps, in man may lead to better long-term control of diabetes than is currently available.

Animals↗