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Julian J Pribaz

Publications and source records attributed to Julian J Pribaz.

6 recordsLinked to original sources
PubMed2006

Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures.

BACKGROUND: Open lower leg fractures with exposed bone or tendon continue to be challenging for plastic surgeons. Microvascular free-tissue transfer increases the ability to close wounds, transfer vascularized bone, and prevent amputation, yet remains a complex, invasive procedure with significant complication rates, donor-site morbidity, and failure rates. This review documents the changing treatment protocol in the authors' institution for these injuries. METHODS: Two hundred ninety consecutive open tibia-fibula fractures over a 12-year period (1992 to 2003) were retrospectively reviewed and methods and outcomes were compared by grouping the fractures into 4-year intervals. RESULTS: The number of open lower extremity fractures increased, whereas the distribution of Gustilo grade I to III fractures remained unchanged. Overall, free-tissue transfer was performed less frequently and constituted 20 percent of reconstructions in period 1 (1992 to 1995), 11 percent in period 2 (1996 to 1999), and 5 percent in period 3 (2000 to 2003). For the most severe fractures, Gustilo grade III, free-flap reconstruction has decreased significantly, constituting 42 percent, 26 percent, and 11 percent of procedures in periods 1, 2, and 3, respectively. Local flaps for grade III fractures have remained relatively constant throughout the study. In contrast, local wound care for grade III fractures, including skin grafts, delayed primary closures, and secondary intention closures has significantly increased from 22 percent to 49 percent of reconstructions from periods 1 through 3. In 1997, the authors began to use the vacuum-assisted closure device and now use it in nearly half of all open fractures. Despite this trend, there has been no change in infection, amputation, or malunion/nonunion rates and a decrease in reoperation rate with at least 1-year follow-up. CONCLUSIONS: These results demonstrate a change in practice, with a trend down the reconstructive ladder, currently using fewer free flaps and more delayed closures and skin grafts with frequent use of the vacuum-assisted closure sponge. Possible reasons for this change are a better understanding of lower leg vascular anatomy and better use of improved wound care technology.

Adult↗
PubMed2005

Thermal diffusion probe analysis of perfusion changes in vascular occlusions of rabbit pedicle flaps.

BACKGROUND: The purpose of this study was to show the efficacy of a novel tissue blood flow measuring device in an animal model. Thermal diffusion technology evaluates changes in perfusion in small volumes of tissue. METHODS: The thermal diffusion probe device is a long, 0.9-mm-diameter flexible catheter with two thermistors, which are placed directly into the tissue; it excites an active thermistor to a constant temperature slightly above the tissue baseline and collects data on the power dissipated in the active thermistor. It also continuously monitors the baseline tissue temperature using an additional passive thermistor placed outside the heated field. In this study, rabbit epigastric pedicle flaps were instrumented with two thermal diffusion probes (peripheral and deep) to continuously monitor flap perfusion. RESULTS: Twenty-five vascular occlusion studies were performed in 16 flaps. Blood vessel occlusions (arterial, venous, and arteriovenous) were easily detectable with this system. Waveforms for arterial and arteriovenous occlusions differed from those for venous occlusions. Probes in both peripheral and deep tissue locations were sensitive to changes in tissue perfusion. CONCLUSION: Thermal diffusion probes may provide a useful clinical method for monitoring flap perfusion.

Animals↗
PubMed2005

A simple guide to inframammary-fold reconstruction.

In breast reconstruction, the inframammary fold (IMF) is one of the most difficult anatomic structures to faithfully recreate. Nonetheless, it is critical to achieving optimal aesthetic outcome. We describe our technique for reconstructing the IMF as a secondary procedure after breast reconstruction using a Steinman pin template based on the curvature of the normal contralateral IMF. Twelve cases of IMF reconstruction using this technique have been performed with good aesthetic outcome and high reliability, with the longest follow-up being over 10 years. Advantages include (1) use of the Steinman pin template based on the contralateral side maximizes attainable symmetry, (2) an additional incision is not required, (3) precise suture placement is facilitated by visualization of the pin inside the breast cavity, and (4) use of a running internal mattress suture avoids a scalloped appearance, and smooth curvature of the IMF over its entire width is easily and reliably obtained. This technique is applicable to postoperative deformities from breast reconstruction using flaps, implants, or both.

Adult↗
PubMed2004

Continuous and real-time blood perfusion monitoring in prefabricated flaps.

The Thermal Diffusion Probe (TDP) System allows continuous real-time measurement of tissue perfusion in flaps. The authors used a TDP with two thermistors, one active, the other passive, embedded in a 0.9-mm diameter catheter to measure continuous tissue perfusion in rabbit epigastric flaps. The distal thermistor is heated to 2 degrees C above the tissue baseline temperature. The power required to maintain this temperature difference is mathematically related to the tissue perfusion in the volume surrounding the probe tip. Central and peripheral TDPs were placed. The TDP effectiveness in detecting and measuring daily tissue perfusion in buried epigastric flaps was tested. Contralateral epigastric pedicles were transposed into the flaps prior to ligation of the original pedicle. Flaps with transposed pedicles showed a progressive and significant increase in tissue perfusion during the initial 3 weeks of the experiment, compared to flaps without the pedicle transfer. The TDP System is a useful experimental method for the continuous and real-time quantification of flap perfusion and may be helpful in making clinical decisions about prefabricated flap transfer.

Animals↗
PubMed2003

Clinical applications of tissue engineered constructs.

The reconstruction of soft tissue defects poses a challenge for plastic surgeons and tissue engineers. The construction of a biologically, functionally, and cosmetically successful replacement part will involve the combination of a composite that contains endoderm, mesoderm, and ectoderm. It will be active in immune surveillance and function. It must be durable to withstand the stress and strain encountered by the skin. Such a composite will involve the use of bone, cartilage, muscle, blood vessels, nerves, connective tissue, dermis, and epidermis. Fortunately, many of these tissues are among the best studied by tissue engineers. The future of this field will likely involve to some degree the co-mingling of current reconstructive modalities, including the techniques of prefabrication and pre-lamination, with more aggressive and successful tissue engineering technology and the rapidly developing science of stem cell biology. Tissues synthesized in vitro with better structure, color, and texture can be pre-laminated to a site that has already been prefabricated. Prefabrication of a bio-absorbable matrix can create a well perfused scaffold onto which larger subunits can be prelaminated. The future of this field of endeavor is exciting, and, with further research, experience, and interdisciplinary collaboration, bioengineered tissue constructs will become a reality.

Burns↗