William S. Halsted: plastic surgeon.
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Baltimore↗
Biomedical subjects
J W Futrell
Publications and source records attributed to J W Futrell.
The influence of tissue expanders on grafted vessels.
Interpositionally grafted arteries and veins were expanded with a 20cc tissue expanders in 50 Sprague-Dawley rats. The grafts were done on both hind legs, one side was expanded and the remaining side was used as control. The average gain in length of expanded grafted arteries and veins was over 4 and 6 times that of the controls respectively. The differences in the patency rates between expanded and control grafts were not statistically significant. Histologic examination revealed that there were no changes in the areas of the media and lengths of the inner elastic laminae of the expanded arterial grafts. In both expanded and control vein grafts, marked intimal thickening was noticed, although these changes were not statistically significant. Expansion of grafted vessels can be safely carried out without loss of vessel patency.
Animals↗
The critical relationship between free radicals and degrees of ischemia: evidence for tissue intolerance of marginal perfusion.
UNLABELLED: Skin-flap ischemia has been associated with the presence of free radicals. In this study, two enzyme systems involved in free-radical metabolism were used to compare a distal skin flap to a skin graft. Forty-two rats were divided into several test groups. A 10 X 3 cm dorsal rat flap was used, and tissue biopsies for xanthine oxidase and malonyldialdehyde (MDA) were obtained 2.5, 5.5, and 8.5 cm from the base of the flap at the hours given. In group I (control), the flap was outlined but not elevated, and biopsies were obtained. In group II, the flap was elevated, and biopsies were obtained at 6 hours. In group III, the flap was elevated, the distal 4 X 3 cm was amputated and replaced as a full-thickness skin graft, and biopsies were obtained at 6 hours. In group IV, the flap was elevated, and biopsies were obtained at 12 hours. In group V, the flap was treated as in group III, and biopsies were obtained at 12 hours. In group VI, the flap was elevated, and biopsies were obtained at 24 hours. In group VII, the flap was treated as in group III, and biopsies were obtained at 24 hours. RESULTS: Xanthine oxidase was significantly higher in all distal biopsies compared to proximal biopsies. Xanthine oxidase also increased with time. Malonyldialdehyde increased over time as well as with distance from the flap base. Distal flap biopsies at 24 hours had greatly increased levels of malonyldialdehyde compared to skin grafts (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Analysis of Variance↗
Presuturing--a new technique for closing large skin defects: clinical and experimental studies.
We have developed a new technique termed presuturing for aiding in the closure of large skin defects which may have otherwise required a skin graft or flap. This technique is based on biomechanical properties of skin (creep, stress relaxation) which allow skin to stretch beyond its inherent extensibility. Presuturing is performed under local anesthesia and consists of plicating intact skin over the area of planned excision the night prior to operation. Experimental studies in a pig model showed the decrease in force required to close a standard-sized wound to be 40.1 percent less than control (p less than 0.001). Fourteen patients who underwent wide excision of skin lesions had their wounds presutured. All but one wound could be closed primarily without undermining. Presuturing seems to be an easy and clinically useful technique in aiding the primary closure of large defects.
Adult↗
Immunomodulation of intradermal mammary carcinoma using staphage lysate in a rat model.
Staphage lysate (SPL), a preparation of Staphylococcus aureus obtained by bacteriophage lysis, is an interferon-inducer and stimulator of T and B lymphocytes. Does SPL, as an immunopotentiator, have an effect on the growth and metastases of an intradermal mammary carcinoma? To answer this question, a study using SPL in female Fischer rats injected with 7 x 10(6) viable 13762 mammary tumor cells on the midback were used. Four groups were created with 10 animals in each group. Group I was the control group. They received no treatment. Group II received 0.3 ml of medium in which SPL was carried on alternate days. Group III received 0.3 ml SPL on alternate days. Group IV were sensitized with dead staphylococcal organisms prior to SPL treatment as in Group III. Tumor diameters were recorded on days 10, 13, 17, and 21, and autopsies were performed to determine the extent of metastases. Histologic examination and serum antibody measurements were performed. The mean tumor diameters on day 21 were: Group I: 4.1 +/- 0.2 cm; Group II: 3.80 +/- 0.19 cm; Group III: 3.04 +/- 0.13 cm; and Group IV: 2.97 +/- 0.14 cm. Rats receiving SPL treatment in Groups III and IV had significantly smaller tumors (P less than .001). The incidence of axillary lymph node involvement was: Group I: 100%; Group II: 87.5%; Group III: 62.5%; and Group IV: 40%. Lung metastases were seen in all groups. Groups I and II had 100% incidence of grossly visible nodules, whereas Groups III and IV had 75% and 70% involvement. Gross findings were confirmed by microscopic examination.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
The gluteus maximus muscle: experimental and clinical considerations relevant to reconstruction in ambulatory patients.
The gluteus maximus muscle and other haemodynamically related structures have been used for the reconstruction of significant defects in the perineum, sacrum, lumbar area and hip in 35 patients. The preservation of muscle function was achieved in all of 20 ambulatory patients and documented by gait analysis, muscle strength testing and EMG studies. Dye injection studies of the first perforating artery, inferior gluteal artery and superior gluteal artery led to the design of new flaps based on this arterial system. They include: medial advancements with extension above the sacrum, lateral advancements, lower gluteus advancements, the tensor fasciae latae gluteal extension and modifications of the gluteal thigh flap. These findings significantly increase our ability to close difficult wounds within the perineal, sacral, lumbar and trochanteric regions.
Adult↗
Severe perifolliculitis capitis with osteomyelitis.
This report describes a severe case of perifolliculitis capitis with the rare complication of skull osteomyelitis, a combination not previously reported. The patient demonstrated the typical features of perifolliculitis capitis, namely, rubbery, hard, elevated nodules involving almost the entire scalp with multiple deep-seated abscesses. Bone was exposed in two areas and the diagnosis of skull osteomyelitis was confirmed by skull x-ray films and bone biopsy specimens, which grew Staphylococcus aureus. The patient was treated with enteral hyperalimentation, intravenous antibiotics, and multiple debridements of the scalp, including the involved periosteum and outer cortex of the exposed bone, followed by reconstruction with split-thickness skin grafts. A complete eradication of the disease with closure of all open wounds and clearance of osteomyelitis of the skull was achieved.
Adult↗
Augmentation of skin flap survival with allopurinol.
Although allopurinol is primarily known as an effective medication for gout, it has been shown to enhance tissue survival in a wide range of ischemic conditions. The study reported here investigated the effects of allopurinol on flap survival in a dorsal rat model. In a preliminary study, animals were given varying doses of allopurinol (0 to 400 mg per kilogram). A clinically efficacious dose was established upon conclusion of the test period by laboratory determinations and necropsy data. Other animals were divided into 3 groups: 1 (saline control), N = 11; 2 (50 mg per kilogram of allopurinol daily), N = 10; 3 (100 mg per kilogram of allopurinol qd), N = 11. Flaps were raised and necrosis assessed at 8 days. Flaps treated with allopurinol 100 mg per kilogram had significantly better survival than the controls (p less than 0.001) and 50 mg per kilogram (p less than 0.01). Allopurinol 50 mg per kilogram had no effect on flap survival.
Allopurinol↗
The plantar digital web space island flap for reconstruction of the distal sole.
A neurovascular flap of interdigital web space skin based on the plantar circulation is described. The flap is useful for reconstructing distal plantar defects that do not have an adequate surface for skin grafting. It leaves a donor defect in a non-weight-bearing area and does not disrupt the structural integrity of the foot. The surgical anatomy and operative approach are detailed. The key to the approach is to preserve the fat pad around the neurovascular bundle during the dissection. Six patients have successfully undergone this procedure and have been followed for at least 2 years postoperatively. The plantar island flap is a reliable flap for repairing plantar defects overlying the metatarsal heads.
Female↗
The causes of skin ulcerations associated with venous insufficiency: a unifying hypothesis.
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Free Radicals↗
Rapid elongation of arteries and veins in rats with a tissue expander.
The saphenous arteries and veins of 40 rats were elongated with 20-cc tissue expanders underlying the leg adductor muscles. The mean rate of successful elongation of the vessels was 84 +/- 47 percent SD, with a maximum gain of 140 percent. The fastest mean elongation velocity reached 45 percent per day. Thrombosis occurred only with stretching velocities of more than 10 percent per day, which seemed to be a safe margin. Distribution of the volume into many intervals was safer than infrequent high-volume injections. Histology showed no reduction in vessel wall diameter or loss intimal integrity. Subendothelial cellular proliferation was an indicator of this rapid regeneration. Microvascular anastomoses performed in elongated arteries and veins had the same patency rate (90 percent) as in controls.
Animals↗
A new surgical approach to closure of large lumbosacral meningomyelocele defects.
A new method for the reconstruction of large thoracolumbar and lumbosacral meningomyelocele defects is described in which latissimus dorsi and gluteus maximus myocutaneous units are advanced medially and reapproximated in the midline, permitting primary closure of the defect in three layers. The flaps are based on the thoracodorsal and superior gluteal vessels and the intervening thoracolumbar fascia, providing tension-free, durable, and viable soft-tissue coverage over the dural repair. No lateral relaxing incisions, delays, or skin grafts are necessary. This technique has been used successfully in the repair of nine large meningomyelocele defects, and uncomplicated wound closure was achieved in all cases. The anatomic basis, technique, advantages, and functional implications of our approach are described. The flaps described do not alter the nerve supply of the muscles and merely redefine the muscle origins; therefore, no functional deficit from the reconstructive surgery is anticipated.
Follow-Up Studies↗
Enhanced neovascularization of rat tubed pedicle flaps with low perfusion of the wound margin.
To study the role of ischemia due to low perfusion as the inciter of neovascularization, caudally based 3 X 9 cm skin flaps were created on the dorsum of 50 Sprague-Dawley rats. After injection of 0.2 ml 10% fluorescein, the animals were divided into two groups. In group I (n = 25), the distal margin of the flap tip was 1 cm proximal to the border of the fluorescence (good perfusion). In group II (n = 25), the flap was cut 1 cm distally in the nonfluorescent part (poor perfusion). The tips of the tubed flaps were transferred to a wound bed on the right flank. After 10 days, the pedicles were ligated, so that flap survival depended totally on the new vascular supply from the inset area of the flap. The flaps in group I showed a significantly higher rate of necrosis of 52.4 +/- 15.1 percent versus 1.7 +/- 1.4 percent in group II (p less than 0.0001), although the flap length in group I (5.85 +/- 1.16 cm) was less than in group II (7.15 +/- 0.95 cm; p = 0.0001). A nearly three times larger amount of tissue based on the new blood supply survived in group II compared to group I. Xerograms after injection of PbO2-gelatine on day 10 showed an increased ingrowth of blood vessels in group II. After excluding the delay phenomenon as the cause for the difference in necrosis rate, it is concluded that the only possible explanation is an enhancement of neovascularization by a perfusion gradient between the wound margins.
Angiography↗
Anatomy of the saphenous nerve: relevance to saphenous vein stripping.
Sensory impairment in the saphenous nerve distribution after stripping of the long saphenous vein was studied in 14 patients undergoing bilateral vein stripping for symptomatic varicose veins. The vein was stripped upward in one leg and downward in the other to determine whether the direction in which the vein is stripped contributes to the incidence of such sensory impairment. Sensory evaluations at 12 weeks postoperatively revealed that ten of the 14 legs in the group that had the veins stripped upward demonstrated significant objective sensory deficits (P less than 0.001) compared with those that had the veins stripped downward (zero of 14). At 6 months the results were similar. To obtain anatomic correlation with the clinical findings, ten fresh cadaver dissections were carried out. In four of five legs in which the vein was stripped in an upward direction, the pretibial branch was avulsed off the main trunk and in two of five, the infrapatellar branch was avulsed. Such nerve avulsions did not occur on downward stripping. We recommend that the long saphenous vein be stripped downward to avoid sensory impairment in the saphenous nerve distribution.
Adult↗
Surgical anatomy of the internal oblique muscle: a practical approach.
In recent years pedicled and microvascular free muscle flaps, myocutaneous flaps, and vascularized bone grafts have become well accepted reconstructive techniques in the management of complex defects. The deep circumflex iliac artery-based internal oblique muscle pedicle flap, internal oblique free muscle pedicle flap, internal oblique free muscle flap, and the internal oblique-iliac crest microvascular free flap are the latest additions to the reconstructive surgeons' armamentarium. This report describes the surgical anatomy of the internal oblique muscle and the deep circumflex iliac artery from a practical viewpoint with particular emphasis on the vascular basis of the above mentioned flaps.
Abdominal Muscles↗
Free radicals: basic concepts concerning their chemistry, pathophysiology, and relevance to plastic surgery.
This paper is an attempt to present important concerns in the rapidly expanding field of free radicals to a plastic surgical audience. Mechanisms and a systematic approach to free-radical pathology are presented, with several illustrative areas discussed more deeply.
Animals↗
Elongation of axial blood vessels with a tissue expander.
The authors present a rat model and a surgical technique for the study of elongation of axial blood vessels using a tissue expander. The successful demonstration of elongation of axial vessels while maintaining patency further encourages use of the concept in other organ systems such as bowel, ureter, and so on.
Animals↗
Deferoxamine increases skin flap survival: additional evidence of free radical involvement in ischaemic flap surgery.
This study presents further evidence of free radical involvement in skin flap necrosis in a dorsal rat flap model. Rats receiving deferoxamine, a free radical scavenger and iron chelator had significantly less necrosis (p less than 0.001) than saline treated rats. In a separate experiment, tissue determinations for malonyldialdehyde (MDA) were consistent with the survival results in showing a significant decrease in MDA in all biopsy sites (p less than 0.05 or less), indicative of reduced lipoperoxidation in the deferoxamine treated rats.
Animals↗