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Biomedical subjects

J R Sanger

Publications and source records attributed to J R Sanger.

At least 19 recordsLinked to original sources
PubMed1997

Paraformaldehyde effect on ruthenium red and lysine preservation and staining of the staphylococcal glycocalyx.

The utility of lysine in glutaraldehyde-ruthenium red fixatives for the preservation and/or staining of the fibrous staphylococci glycocalyx was improved by inclusion of paraformaldehyde. Short, 20 min prefixation times for paraformaldehyde-glutaraldehyde fixatives containing lysine, with or without ruthenium red, were compared to an extended overnight fixation. Samples were often lost in fixatives that did not contain paraformaldehyde at extended fixation times hampering the effective use of these fixatives for clinical or environmental applications. Inclusion of paraformaldehyde in the fixation with lysine permitted longer fixation times as well as stabilized the staphylococcal glycocalyx. Thus, the technical usefulness of fixatives employing lysine was significantly improved.

Fixatives↗
PubMed1997

Use of Mitek suture anchors in head and neck reconstruction.

Attachment of soft tissue to bone is a common problem encountered in head and neck reconstruction. Soft-tissue attachment is encountered in the formation of slings to recreate oral competence. We report the use of the Mitek suture anchor in 7 head and neck reconstruction patients (5 underwent an attachment of a tensor fascia lata sling for oral competence and 2 underwent an attachment of a gracilis musculocutaneous free flap to recreate facial symmetry). Use of the Mitek anchor facilitates soft-tissue-to-bone attachment. Minimal dissection is required and secure bony fixation is obtained.

Adult↗
PubMed1997

Granular cell tumor of uncertain malignant potential.

Granular cell tumor is an uncommon soft-tissue tumor that is usually benign and readily treated with complete resection. Malignant granular cell tumors are perhaps the rarest of all soft-tissue tumors, and they commonly metastasize to regional lymph nodes and the lungs. We present a case of granular cell tumor that exhibited both gross and microscopic features suggestive of malignancy without evidence of metastasis through a relatively short 16 months of follow-up and review the literature pertaining to granular cell tumors of uncertain malignant potential.

Abdominal Neoplasms↗
PubMed1996

Magnetic resonance imaging scanning in the diagnosis of zone II flexor tendon rupture.

This study was undertaken to determine the usefulness of magnetic resonance imaging (MRI) in the diagnosis of flexor tendon rupture in patients who had prior surgery. Magnetic resonance imaging scans were performed on 11 digits (16 tendons) with the clinical diagnosis of flexor tendon rupture. Clinical suspicion correlated with MRI and surgical findings. Clinical examination yielded a 60% accuracy in diagnosis. MRI differentiated rupture from adhesions with a 100% accuracy rate. The MRI scan is a valuable tool in diagnosing tendon ruptures and may help reduce the incidence of unnecessary tendon explorations.

Adolescent↗
PubMed1996

Complications and salvage of an ectopically replanted thumb.

The ectopic replantation of a thumb is described after a mutilating hand injury. The case was followed by a series of complications and surgical procedures to treat these complications. Through perseverance and multiple microsurgical procedures the patient attained a functional hand. The patient's psychological and physical course is described.

Accidents, Occupational↗
PubMed1995

Combination latissimus dorsi and groin free flap with double microvascular transfer.

A combined free tissue transfer using the skin and muscle supplied by the thoracodorsal artery and the superficial circumflex iliac artery (groin flap) was transferred to reconstruct a large lower extremity soft-tissue defect. The combination of these two flaps allowed coverage of a large tissue defect, more reliable coverage than either of these flaps alone, and direct donor site closure.

Adult↗
PubMed1995

Tissue humoral response to intact and ruptured silicone gel-filled prostheses.

Biopsies of the fibrous capsule in 31 women undergoing explanation of gel-filled breast prostheses and in 3 women with silicone gel-associated granulomas were tested for the presence of IgG, IgM, IgA, C3 complement, and fibrin using fluorescent antisera. Of a total of 41 prostheses removed, 9 were found to be ruptured but contained within the fibrous capsule or immediately adjacent to it. In the 3 women undergoing granuloma excision only, the sites were the arm (2) and the chest/axilla (1). In one patient, IgG, C3, and fibrin were detected in the capsule of an intact prosthesis. C3 and fibrin were present in the capsule surrounding one ruptured prosthesis. Fibrin was detected in the capsule of one other patient. Bilateral capsules surrounding intact prostheses removed from 4 patients with collage-vascular diseases were negative for C3, fibrin, and immunoglobulins, as were the 3 granulomas from distant sites. Hematoxylin and eosin stains revealed a typical foreign-body response to gel in almost all cases. Both T- and B-cell lymphocytes are present in the infiltrate surrounding silicone gel. In this study, chronic exposure to silicone gel-filled prostheses did not result in antibody deposition or complement activation in the fibrous capsule or in the tissue surrounding gel droplets.

Antibody Formation↗
PubMed1994

The effect of frostbite on the reconstructed ear.

A 17-year-old patient whose left ear was reconstructed using a lateral arm fascia and skin graft had done well until one episode of cold exposure approximately two years after the reconstruction. This thermal injury resulted in a localized area of composite tissue loss demonstrating that the reconstructed ear had a higher susceptibility to cold temperatures. The transferred fascia did, however, allow a stable base for granulation and reepithelialization, showing the continued vascularity and regenerative capacity of the transferred tissue. A discussion is provided regarding the susceptibility of free transferred fascia and its regenerative capacity.

Adolescent↗
PubMed1994

The nasolabial fold: a photogrammetric analysis.

The nasolabial fold was analyzed by studying changes with aging in the nasolabial fold and adjacent soft-tissue features. Chronologic photographs were obtained from 19 older subjects, taken approximately every 10 years, from age 20 to their present age. In a separate phase of the study, facial portraits in repose and smiling were taken of young and old adult subjects with a mechanical frame used for setting an objective point of reference. Facial landmarks were identified and depth measurements were made in the anteroposterior direction. Relative lengths of selected points also were determined in the other dimensions (in the coronal plane) from photographs; these distances were normalized by using lower face length (distance from medial canthus to menton) for the vertical orientation and interpupillary distance to normalize horizontal dimensions. It was found that with aging there is anterior, lateral, and inferior displacement of the cheek mass with a resultant deepening of the nasolabial fold, while relationships between the upper lip and the fold itself remain constant. Also with age, the lateral commissure was found to move laterally, while the apparent angle of the nasolabial fold was decreased; this latter dimension was reflected by a decrease in the horizontal component of the fold length. These results support the theory that nasolabial fold deepening with age is caused by changes in the cheek mass and its support.

Adult↗
PubMed1994

Temporary ectopic implantation of an amputated penis.

A case of temporary ectopic implantation of an amputated penis to the forearm followed by subsequent return to its anatomic position is reported. The penis was amputated by a riding lawnmower, and massive contamination of the perineum and an extensive hematoma precluded immediate replantation. The penile vessels were attached to the radial artery and venae comitantes on the forearm, where it survived completely. After 4 weeks, the edema and hematoma of the perineum had resolved, and the penis was returned to its anatomic position by microsurgical technique. Arteries, veins, and nerves were repaired. The penis survived in its entirety. Return of sensation has been excellent. A urethrocutaneous fistula developed that required secondary closure with local flaps. Temporary ectopic replantation of the penis is a useful salvage procedure when the perineum is heavily contaminated or too extensively damaged for immediate replantation.

Adult↗
PubMed1994

The free-fillet flap for reconstruction of the upper extremity.

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wounds. However, in cases of complete extremity amputation, the transfer of pedicled flaps from the amputated part is not possible. In such instances, we have designed free-fillet flaps from the amputated limb to provide wound coverage when replantation of the amputated part was contraindicated. This technique allows immediate wound coverage and preservation of functional amputation stump length, without the morbidity of an additional donor site. We present three cases that demonstrate the utility of this technique as an additional reconstructive option in patients with unreplantable upper-extremity amputations.

Adult↗
PubMed1994

The brachioradialis forearm flap: anatomy and clinical application.

The blood supply to the brachioradialis muscle and the skin of the forearm was studied in latex-injected arms. The dominant perforator to the muscle arose from the brachial artery (27.3 percent), radial recurrent artery (33.3 percent), or radial artery (39.4 percent). In all cases, adequate perforators exist from the radial artery so that transfer as either a muscle or musculocutaneous free flap based on this vessel is possible. In 10 arms the septocutaneous perforators from the radial artery were dissected to determine the relationship between the forearm and brachioradialis flaps. Transfer of the brachioradialis muscle as a free flap or combined with the radial artery forearm flap based on the radial artery and either the venae comitantes and/or the cutaneous veins is feasible. Four clinical cases demonstrate the usefulness of this flap.

Adult↗
PubMed1994

Reconstruction of lower third of face with three simultaneous free flaps.

A case of massive osteoradionecrosis is presented that required angle-to-angle resection of the mandible and replacement of skin of the chin and neck as well as the entire floor of the mouth. In this heavily irradiated patient, three microvascular free flaps were transferred in one operation. A large radial forearm flap was used to reconstruct the floor of the mouth. A second large radial forearm flap was used to reconstruct the chin and neck defects and a fibular osseous flap was used to reconstruct the mandible. All wounds healed primarily. For extremely complicated and large defects, the transfer of multiple free flaps may provide the best reconstruction.

Female↗
PubMed1994

Soft-tissue reconstruction of the oral cavity.

In our early experience with head and neck reconstruction, we evaluated our results mainly by the final contour of the mandible. With further experience, the bony reconstruction has become more and more accurate, and it is the intraoral soft-tissue reconstruction that poses the continued challenge. Better preoperative and postoperative evaluation will improve our operative planning, and our results will continue to improve. We must be able to compare our cases with those of other centers by appropriately categorizing deficits into specific structures removed to allow relevant comparison of results. We should no longer accept the simple view of the oral cavity deficit as a uniform soft-tissue loss that requires nothing more than closure. Nor can we continue to accept the evaluation of postoperative results of head and neck reconstruction by a simple external photograph; rather, this must be combined with a true visual and functional assessment of the oral cavity. In this way, the combined effort of head and neck surgeons will help to advance the cause of oral cavity reconstruction as rapidly as has occurred with reconstruction of the mandible.

Humans↗
PubMed1994

Reflex sympathetic dystrophy.

Early diagnosis of RSD is essential. A keen clinical awareness of this problem is required by all hand surgeons. RSD is a clinical diagnosis that may be supplemented by digital temperature, three-phase bone scan, and digital radiographs of the hand. A thorough examination is necessary to identify untreated or inadequately treated sources of RSD. Once diagnosed, prompt treatment of RSD is beneficial. Patients are referred to our anesthesia department for diagnostic and therapeutic stellate ganglion blocks. A trial of 2 to 3 blocks is attempted initially. After successful block is performed, as measured by a Horner's sign and extremity temperature, the patient is brought to the hand clinic where active range-of-motion exercises are started. A stress loading program is an important and essential part of our treatment protocol. Sympathetic blocks are performed on a biweekly basis until the pain is relieved. Consideration is given to long-acting stellate ganglion blocks with a continuous catheter infusion for patients who show a limited, but short-lived response to stellate ganglion blocks. For RSD that does not respond to the stellate ganglion block, we generally perform a bretylium intravenous regional block. Patients with RSD are referred to our hand psychologist for counseling, psychotherapy, relaxation therapy, and possibly biofeedback. We use a multitherapy approach with all available modalities to achieve the best success in breaking the cycle of pain and returning the patient to normal, productive function.

Autonomic Nerve Block↗