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Biomedical subjects

J R Sanger

Publications and source records attributed to J R Sanger.

At least 55 records · Page 3Linked to original sources
PubMed1994

The nasolabial fold: an anatomic and histologic reappraisal.

The nasolabial fold was analyzed by anatomic and histologic evaluation of the tissue planes that create and surround the fold. A fascial-fatty layer exists in the superficial subdermal space extending from the upper lip across the nasolabial fold to the cheek mass. The SMAS is present in the upper lip as the superficial portion of the orbicularis oris muscle. Traction on the SMAS or periosteum lateral to the nasolabial fold can deepen the fold, while traction on the fascial-fatty layer lessens the fold. The fascial-fatty layer and skin of the cheek mass are suggested as the primary ptotic elements responsible for facial aging.

Adipose Tissue↗
PubMed1993

A comparison of upper arm and forearm tourniquet tolerance.

This study examined the use of upper arm and forearm tourniquets for hand surgery. 40 subjects (20 males, 20 females) were randomly assigned to one of four groups: left upper arm, left forearm, right upper arm and right forearm. Tourniquets were applied to these areas. Subjects were asked to rate their discomfort at 10-minute intervals and the total time of tourniquet tolerance was recorded. The results of a three-factor ANOVA revealed no statistically significant differences in either pain rating or tourniquet tolerance between any of the groups. In addition, forearm tourniquets were used in 18 clinical cases. None of the individuals with tourniquet times less than 30 minutes required any medication in order to tolerate this procedure. Of the 13 patients with tourniquet times greater than 30 minutes, ten required medication in order to tolerate the procedure. We conclude that patients tolerate upper arm and forearm tourniquets equally.

Adult↗
PubMed1993

Spiral fracture fixation techniques. A biomechanical study.

The mechanical strengths of five common fixation techniques for spiral fractures have been tested. A total of 240 cadaver metacarpals and proximal phalanges were fractured and fixed by either crossed K-wires, interosseous loops, a dorsal mini-plate, a single compression screw or K-wire plus cerclage wire. Specimens were subjected to torsional and cantilever bending tests. A single compression screw provided the best overall fixation for the proximal phalanx. In addition, a single compression screw provided better fixation than any of the other techniques when proximal phalanges and metacarpals were subjected to torsional tests (P < 0.05). In apex dorsal bending tests of metacarpals, the screw provided fixation superior to interosseous wires, crossed K-wires, or dorsal mini-plates (P < 0.05). These results indicate that the use of a single compression screw provides the most satisfactory biomechanical advantage for spiral fracture fixation.

Biomechanical Phenomena↗
PubMed1993

The corkscrew sign in hypothenar hammer syndrome.

Arteriography of an adult manual labourer presenting with numbness and cold intolerance in the middle and ring fingers of the right hand demonstrated filling defects in the digital arteries of these two fingers associated with a corkscrew-like configuration of the ulnar artery in Guyon's canal. This arterial segment was subsequently excised revealing intramural necrosis and fibrosis and nonocclusive intraluminal thrombosis. An arteriogram performed 2 years previously for an unrelated condition revealed a similar but less pronounced corkscrew configuration of the artery, suggesting that this finding could be a marker for arterial injury which may eventually lead to embolization or thrombosis with accompanying ischaemic symptoms.

Adult↗
PubMed1993

The extrinsic blood supply of the ulnar nerve at the elbow: an anatomic study.

The extrinsic vasculature of the ulnar nerve as it relates to the treatment of cubital tunnel syndrome has not previously been described in detail. For a study of the anatomy, 18 fresh-frozen cadaver upper limbs were dissected after intra-arterial injection of latex. Two major pedicles were present in all 18 specimens--the superior ulnar collateral artery proximally and the posterior ulnar recurrent artery distally. A single minor pedicle, the inferior ulnar collateral artery, was present in 5 of 18 specimens. Total vessel length as well as distance to the medial epicondyle for the extrinsic arteries was measured. On the basis of these anatomic dissections, it is suggested that the extrinsic vascular supply can be preserved during anterior transposition of the ulnar nerve, even after extensive mobilization of the nerve.

Arteries↗
PubMed1993

Surgical anatomy of the SMAS: a reinvestigation.

There has been considerable disagreement in descriptions of the SMAS. Fresh cadaver dissection, combining anatomic dissection done with the aid of the operating microscope and histologic cross section of facial tissues, was performed in 24 facial halves. Histologic preparation was made on tissue macrosections, each 10 cm in length. Consistent findings include the following: (1) Although the SMAS is closely applied to the superficial surface of the parotid gland, a thin but distinct parotid fascia can be identified between parotid gland and SMAS. (2) The SMAS terminates superiorly within 1 cm below the zygomatic arch, and is not continuous with the temporoparietal fascia. (3) The SMAS in the cheek lies in continuity with the orbicularis oculi muscle of the lower eyelid. (4) Considerable variability exists in the histologic appearance of the SMAS in different facial regions within a single cadaver, as well as in a given facial region between cadavers. Because of its variability, histologic identification of the SMAS should be made in continuity with known reference structures, such as the platysma.

Adipose Tissue↗
PubMed1993

Management of osteoradionecrosis of the mandible.

Osteoradionecrosis (ORN) of the mandible is a severe complication that follows ionizing radiation therapy in patients undergoing treatment for head and neck cancers. The occurrence of ORN usually implies other coexisting problems and should not be thought of as a "bone only" defect. For treatment to be effective, all tissues involved must be addressed.

Humans↗
PubMed1992

Anastomotic failure due to acute vasculitis in free flap transfer: a case report.

We report a case of anastomotic failure secondary to acute vasculitis in a free flap. Following transfer of a latissimus dorsi myocutaneous flap, massive hemorrhage from the anastomosis occurred six days postoperatively. This was associated with segmental infarctions of the areas of the flap, which was removed. Transmural necrosis of the thoracodorsal artery, secondary to acute vasculitis was demonstrated by histology. Subsequent biopsies revealed an autoimmune vasculitis.

Acute Disease↗
PubMed1992

Histochemical discrimination of fibers in regenerating rat infraorbital nerve.

In rat dorsal root ganglia, histochemical staining of carbonic anhydrase (CA) and cholinesterase (CE) yields a reciprocal pattern of activity: Sensory processes are CA positive and CE negative, whereas motor processes are CA negative and CE positive. In rat infraorbital nerve (a sensory peripheral nerve), we saw extensive CA staining of nearly 100% of the myelinated axons. Although CE reactivity in myelinated axons was extremely rare, we did observe CE staining of unmyelinated autonomic fibers. Four weeks after transection of infraorbital nerves, CA-stained longitudinal sections of the proximal stump demonstrated 3 distinct morphological zones. A fraction of the viable axons retained CA activity to within 2 mm of the distal extent of the stump, and the stain is capable of resolving growth sprouts being regenerated from these fibers. Staining of unmyelinated autonomic fibers in serial sections shows that CE activity was not retained as far distally as is the CA sensory staining.

Animals↗
PubMed1992

Glomus tumor imaging: use of MRI for localization of occult lesions.

Magnetic resonance imaging has been performed in six patients with glomus tumors of the hand and correlated with clinical surgical histopathologic findings and with angiography in one case. Two of the patients had obscure pain without the classic clinical and radiologic findings of glomus tumors. The MRI examinations depicted the tumors in excellent detail and facilitated diagnosis in the two patients with atypical presentation. In all six cases the diagnoses were confirmed at surgery. The MRI proved valuable as a noninvasive and accurate means for the early diagnosis of occult glomus tumors.

Adult↗
PubMed1992

Predictive value of psychological screening in acute hand injuries.

Difficulties in adjustment frequently accompany severe hand injuries. The purpose of this study was to determine whether presurgical screening could predict long-term adjustment problems. One hundred thirteen patients with severe hand injuries completed a presurgical questionnaire evaluating flashbacks, avoidance, and causal factors pertaining to the injury. Patients were evaluated by a psychologist within 5 days after surgery and again 6 months later. Flashbacks initially occurred with equal frequency in occupationally and nonoccupationally injured groups. At 6-month follow-up 50% of the occupationally injured patients and 25% of the nonoccupationally injured patients had flashbacks. Avoidance of the activity at which patients were injured was also assessed. Among occupationally injured patients, 52% initially reported no avoidance compared with 17% at follow-up. Patients with nonoccupational injuries showed more initial avoidance (68%), with slightly less at follow-up (61%). Of the occupationally injured patients, 46% initially reported personal error or fatigue as the cause of their injury, but only 6% reported this as the cause at follow-up; it is interesting that at 6-month follow-up 81% of this group reported machine failure or lack of safeguards. Among nonoccupationally injured patients, 71% reported personal error as the cause of injury presurgically and 66% at 6-month follow-up. Presurgical screening appears to be a valid means of identifying persons at risk of ongoing adjustment problems after hand injury. A screening interview can easily be conducted in less than 5 minutes.

Accidents, Occupational↗
PubMed1992

The transverse gracilis musculocutaneous flap.

Through detailed anatomical study and latex injection of 24 cadaver legs, the blood supply to the skin overlying the gracilis muscle was examined. The proximal pedicle entered the gracilis muscle 10 +/- 2 cm below the pubic tubercle. The dissections identified both septocutaneous and musculocutaneous perforators from the proximal gracilis pedicle. These branches had a pronounced tendency to travel in a transverse direction, supplying the cutaneous territory over the adductor longus and sartorius anteriorly and extending for > 5 cm beyond the posterior margin of the gracilis muscle. This information led to a "new" transverse design of the gracilis musculocutaneous flap, such that the vascular perforators are invariably included in the cutaneous portion of the flap. In contrast, the traditional design, because of skin mobility, may allow elevation outside the skin territory of the muscle perforators.

Adult↗
PubMed1992

The occipital artery flap for transfer of hair-bearing tissue.

The posterior scalp is investigated as the donor site for the transfer of hair-bearing tissue based on the occipital artery. The dissection of fresh cadavers was performed and the occipital artery was noted to have three major branches including a vertical, transverse, and descending branch. The vessel connection across the midline allowed transfer of the posterior scalp to the desired recipient site. This vessel provides the possibility of transfer of large areas of hair-bearing tissue to a single stage. The variability of flap design is described as well as the technical considerations for a successful transfer.

Adult↗
PubMed1992

The composite lateral arm free flap: vascular relationship to triceps tendon and muscle.

We studied the vascular relationship of the lateral arm flap to triceps tendon and muscle in 16 dissected cadaver arms. We designed composite lateral arm free flaps containing fasciocutaneous components, triceps muscle, and/or triceps tendon. Vascular communication between the lateral arm fascia and triceps tendon was negligible. In contrast, a mean of 3.6 vessels passed through triceps muscle from the posterior radial collateral artery to the harvested triceps tendon; in each dissection at least 1 vessel entered the proximal 5 cm and 1 vessel entered the distal 5 cm of harvested tendon. Methylene blue injections confirmed that perfusion of the triceps tendon was through triceps muscle and not through lateral arm fascia. We used the composite lateral arm free flap in 6 patients, 3 with triceps muscle and 3 with triceps tendon. Baltimore Therapeutic Evaluation testing in those patients where triceps tendon was harvested showed no deficit in elbow extension. Complete coverage of composite defects was achieved with a single surgical procedure in all patients.

Adolescent↗
PubMed1992

Characteristics of prosthetic mesh and autogenous fascia in abdominal wall reconstruction after prolonged implantation.

This study evaluated two types of prosthetic mesh and autogenous fascia in long-term abdominal wall reconstruction for rats. Marlex mesh, Gore-Tex patch, and autogenous fascia were implanted and left in place for 1 year. Materials were removed and evaluated using tensile strength of the material, tensile strength of the suture line, and adhesions. No change in the tensile strength of any of the materials were found at 1 year follow-up. Tensile strengths were significantly greater for Gore-Tex patch and Marlex mesh than the autogenous fascia. The Marlex mesh, however, had a weak and a strong tensile strength direction. These were significantly different (p < 0.05). Suture line tensile strength was greater for autogenous fascia and Marlex mesh than it was for the Gore-Tex patch, which was significantly weaker (p < 0.05). The greatest number of adhesions were seen in the Marlex mesh group. No significant difference was present in adhesions between Gore-Tex patch and autogenous fascia. In summary, autogenous fascia showed virtually no adhesions and good suture line strength. While it was the weakest of the three materials examined, the strength was still within the normal range and adequate for abdominal wall reconstruction.

Abdominal Muscles↗
PubMed1992

Coverage of widely separate defects of the lower extremity: application of cluster analysis.

A patient with lower extremity reconstruction is presented with a radial forearm free flap designed using the cluster analysis method of cutaneous perforators. The cutaneous vascular anatomy of fasciocutaneous flaps is discussed as well as the application of the mathematical model of analysis of the vascular territories within specific flaps to assist in "custom" flap design. The ultimate goal of this technique is the creation of flaps that provide a more precise and anatomical reconstruction of the proposed defect.

Adult↗
PubMed1992

The medial arm flap.

The reports of transfer of the medial arm flap have been inconsistent, and confusion remains about its anatomy and use. In 40 fresh cadaver arms, the vascular supply to the medial side of the arm was studied after latex injection. The superior ulnar collateral artery was present in 39 of 40 dissections and was the most consistent prominent blood supply to this area. In 57.5% of dissections, direct cutaneous arteries > 1.0 mm were present, and in 47.5%, multiple muscular cutaneous arteries > 1.0 mm were present. Although the blood supply to the medial arm flap is multiple, at least one pedicle > 1.0 mm can be found in all dissections. To date, 10 consecutive medial arm flaps were used to cover upper and lower extremity defects without any flap loss. With knowledge of the anatomical variations, the medial arm flap is a plausible reconstructive option.

Adult↗