Biomedical subjects

J R Sanger

Publications and source records attributed to J R Sanger.

At least 73 records · Page 4Linked to original sources

PubMed1992

The versatile metacarpal and reverse metacarpal artery flaps in hand surgery.

Vascular anatomy of dorsal metacarpal arteries was investigated in fresh cadaver dissections and by injection of methylene blue. Origin and termination of the vessels were studied, as well as their connection to the palmar vasculature. Vascular territories and elevation of flaps based on these vessels are also discussed. The second dorsal metacarpal artery was found to be the most consistent. This vessel has a large distal connection to the palmar vessels which allows both proximal and reverse elevation. Representative cases and surgical technique are described.

Adult↗

PubMed1992

Graded work exposure to promote work return after severe hand trauma: a replicated study.

Fifty-one patients with posttraumatic stress disorder after work-related hand injuries were placed on a graded work exposure program to facilitate return to work. These patients consisted of an initial group of 25 patients and a replication group of 26 patients. The program returned 92% of the initial group and 88% of the replicated group to work with their previous employers. At 6-month follow-up, 88% of the initial group and 80.1% of the replication group were still working full-time at the jobs to which they had returned. All of the patients not working with their previous employer at follow-up had appraisal/projected flash-backs, which have previously been associated with a 90% failure to return to work. This intervention was successful with 73% of the patients experiencing such flashbacks. In conclusion, graded work exposure was an effective treatment to promote return to work for patients experiencing significant psychological symptomatology after severe hand injury.

Accidents, Occupational↗

PubMed1992

Psychological adjustment following work-related hand injury: 18-month follow-up.

Severe, work-related hand injuries are often accompanied by a significant number of psychological symptoms that are frequently associated with posttraumatic stress disorders. These symptoms occur in the following four domains of psychological functioning: cognitive, affective, physiological, and behavioral. This study examined the incidence of a variety of symptoms occurring with work-injured patients. Interviews were conducted at 1 week, 3 months, 6 months, 12 months, and 18 months after injury. Symptom frequencies were recorded. The results indicate that many of these symptoms were persistent 18 months later and continued to be significantly debilitating. The results support the need for psychological intervention after severe, work-related hand injuries.

Accidents, Occupational↗

PubMed1992

Tire explosion injuries to the upper extremity.

Several articles have been published that bring attention to the destructive potential of tire explosions. Although the severity of tire explosion injuries to the head and neck region is well established, only one previous article has reported injuries to the upper extremity. Fourteen patients with upper extremity tire explosion injuries have been treated by us from 1980 to 1988. Each injury was caused by single-piece wheel assemblies, as opposed to multipiece wheel assemblies, which have traditionally been associated with the injury. Three representative patient reports are discussed. Prevention of this injury can be achieved by increased public awareness, formal industrial safety training, tire servicing with dedicated equipment including restraining devices or barriers, complete evaluation of wheel/tire serviceability before tire mounting, separation of servicing of single and multipiece wheels, and complete tire deflation before servicing.

Accidents, Occupational↗

PubMed1992

Self-inflicted midline facial gunshot wounds: the case for a combined craniofacial and microvascular team approach.

Self-inflicted gunshot wounds to the face are extremely complex and difficult to manage. In the past, these patients have been treated by debridement, hemostasis, and soft tissue closure with reconstruction deferred to a later time. This approach consigned the patient to significant facial contracture and scarring, which is impossible to adequately correct secondarily. As a result of this traditional approach, patients had substantial disfigurement as well as dysfunction. At the Medical College of Wisconsin, we have begun an aggressive multispecialty team approach in which the maximum possible reconstruction is performed acutely. This has resulted in superior aesthetic and functional results, and in a substantially lower number of hospitalizations, surgical procedures, and hospital days. This approach includes the spectrum of current plastic surgical techniques including the craniofacial approach using open reduction with accurate miniplate reconstruction and acute bone grafting as well as soft tissue reconstruction and replacement using composite multiple-stacked free tissue transfer. We believe the overall approach provides a superior result and we will continue a program of aggressive and acute intervention.

Adult↗

PubMed1992

Penile replantation after self-inflicted amputation.

In 4 men with self-inflicted penile amputation, replantation was successful using microsurgical technique. Postoperative complications were minimal. In 1 man who had amputated his penis and then amputated his scrotum and testicles, a small skin graft was necessary to close a portion of the defect. A mild urethral stricture that developed in this man responded to dilation. Return of sensation was excellent. Normal erections were reported by all men. Microsurgical replantation is the treatment of choice for this injury and is superior to other techniques of penile reattachment, which have a high incidence of distal necrosis, fistula and stricture formation, as well as incomplete or absent sensation and compromised erectile function. Of concern in this group of men is the high incidence of previous or subsequent penile mutilation. Two of the 4 men have a history of recurrent self-mutilation. The follow-up in this series is longer than previously reported and the overall psychiatric pathology appears to be quite severe and persistent.

Adult↗

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↗

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↗