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Biomedical subjects

K D Wolff

Publications and source records attributed to K D Wolff.

At least 19 recordsLinked to original sources
PubMed2005

Reversible ischaemia after raising a radial forearm flap with ulceration of three fingers in a cigarette smoker.

The radial forearm flap is a standard method for the reconstruction of intraoral defects of soft tissues. We report the case of a middle-aged man who developed ischaemia in three fingers after a fasciocutaneous radial flap had been raised. The preoperative Allen test to diagnose occlusion of radial or ulnar artery was satisfactory. Soon after the operation the patient resumed smoking and four weeks later he developed ulcers on the thumb, index, and middle fingers. Only after he had stopped smoking and been given acetylsalicylic acid and heparin did blood flow and capillary hemoglobin oxygenation increase. As a result, his radial fingers recovered completely.

Anticoagulants↗
PubMed2002

[Indications for primary surgical therapy of vascular abnormalities in infancy].

LASER THERAPY: Since the introduction of laser therapy for treatment of hemangiomas and vascular malformations, primary surgical therapy has gradually lost importance. Particularly hemangiomas, but also venous malformations and lymphangiomas, are nowadays primarily treated by different types of lasers. Especially the Nd:YAG laser with a percutaneous or transcutaneous application technique often leads to satisfying results. SURGICAL THERAPY: Surgical therapy is mostly used secondarily in late childhood or in adults after several laser applications for excision of residual scars or other corrective procedures. Despite these improvements in laser therapy, there is still an indication for primary surgical treatment in subcutaneous vascular malformations and in rapidly growing hemangiomas after unsuccessful laser therapy. Even in large vascular anomalies, safe excision with only a little blood loss is possible if the tumors are encapsulated. CASE REPORTS: In this paper we want to point out the necessity of primary surgery in three children in whom complications such as loss of sight, facial nerve palsy, and a lethal outcome due to massive hemorrhage in a cystic lymphangioma could be avoided.

Arteriovenous Malformations↗
PubMed2001

Anatomic position of the lingual nerve in the mandibular third molar region with special consideration of an atrophied mandibular crest: an anatomical study.

The position of the lingual nerve in the mandibular third molar region was measured and documented in 68 cadaver dissections (34 adult cadaver heads). In 8.8% of the dissections, the lingual nerve was found at or above the level of the alveolar crest. In the horizontal plane, the nerve contacted the lingual plate of the third molar in 57.4% of the specimens. There was also a significant relationship between the degree of mandibular crest atrophy and the distance from the nerve to the molar region. The distance decreased with the degree of atrophy. There was no significant difference between the two sides of the head. These results demonstrate the vulnerability of the lingual nerve as it medially passes the mandibular third molar and may help avoid lingual damage during surgery in the third molar and retromolar region of the mandible.

Aged↗
PubMed2000

[Primary thinning and de-epithelialization of microsurgical transplants from the lateral thigh].

To expand the indicational spectrum of the myocutaneous vastus lateralis flap, which is often too voluminous for intraoral application, we performed extreme, primary thinning of the fat and muscle component of this microsurgical transplant in 14 patients. After subfascial localization of the 0.5- to 1.0-mm-thick perforating vessel, it is exposed through the fascia and muscles up to its exit from the descending branch of the lateral circumflex femoral artery. After isolating the perforating vessel, it is no longer necessary to include parts of the vastus lateralis muscle in the flap. The fatty tissue of the remaining epifascial fat component is completely removed except for a ca. 1- to 2-cm-wide cuff of fatty tissue and fascia around the perforating vessel. When performing this primary radical removal of the subcutaneous fatty tissue, care should be taken not to injure the deep subdermal vascular plexus. In addition to the thinning procedure, de-epithelialization of the skin was performed using scalpel blade dissection (five patients) or carbon dioxide laser (6 W, five patients). This thinning technique was used for covering ten intraoral and four extraoral defects and enabled the raising of skin flaps with a thickness of 3-5 mm even in obese patients. The vessel pedicle length of thinned flaps was between 12 and 16 cm; flap size varied between 4 x 5 and 9 x 15 cm, and the donor sites were directly closed. In one case, there was a partial necrosis (20%), but the remaining flaps healed without complications. On the intraoral flaps, a thin, smooth and pliable surface developed after re-epithelialization within 3-6 weeks. The described method expands the application possibilities of the myocutaneous vastus lateralis flap for a large number of intraoral and flat defects with minimal donor-site morbidity.

Adipose Tissue↗
PubMed2000

Primary thinning of the myocutaneous vastus lateralis flap.

To expand the indicational spectrum of the myocutaneous vastus lateralis flap, which is often too voluminous for intraoral application, primary thinning of the fat and muscle component of this microsurgical transplant was performed in 14 patients. The surgical technique includes subfascial localization of at least one myocutaneous perforating vessel of the lateral circumflex femoral artery and its dissection through the fascia, muscles and fatty tissue up to the skin. The epifascial fatty tissue is completely removed except for a 1-2 cm wide cuff around the perforating vessel. The thinning technique was used for covering 10 intraoral and 4 extraoral defects and enabled the raising of skin flaps with a thickness of 4 mm even in obese patients. The vessel pedicle length of the thinned flaps was between 12 and 16 cm; flap size varied between 4x5 and 9x15 cm and the donor sites were directly closed. In one case, there was a partial necrosis (20%), but the other flaps healed without complications. The described method allows the raising of thick myocutaneous as well as thin skin flaps from the same donor region.

Adipose Tissue↗
PubMed1999

Magnetometry of injury currents from human nerve and muscle specimens using superconducting quantum interferences devices.

Acute lesions of polarized membranes lead to slowly decaying ('near-DC') injury currents driven by the transmembrane resting potential gradient. Here we report the first recordings of injury-related near-DC magnetic fields from human nerve and muscle specimens in vitro using Superconducting Quantum Interference Devices (SQUIDs) operated in a conventional magnetically shielded room in a clinical environment. The specimen position was modulated sinusoidally beneath the sensor array by a non-magnetically fabricated scissors lift to improve the signal-to-noise ratio for near-DC fields. Depending on the specimen geometry the field patterns showed dipolar or quadrupolar aspects. The slow decay of human nerve and muscle injury currents was monitored for several hours from a distance of a few centimeters. Thus DC-magnetometry provides a sensitivity which might allow the remote detection of injury currents also in vivo.

Animals↗
PubMed1998

Intracapillary haemoglobin oxygenation and interstitial pO2 in venous flaps: an experimental study in rats.

In order to be able to objectively evaluate capillary perfusion of venous flaps, we created arterialised venous flaps, venous flow-through flaps, and unilateral pedicled venous island flaps in the epigastric vascular system of Wistar rats and determined their oxygen supply with two different methods. Interstitial pO2 was polarographically measured with a probe placed intracutaneously in the center of the 4 x 2.5 cm flaps and continuously recorded on a connected computer. Moreover, we also noninvasively determined the oxygenation of the intracapillary haemoglobin with a micro-lightguide spectrophotometer. The statistical evaluation showed comparable results for both measurement methods: Arterialised venous flaps had a better oxygen supply with a pO2 of 16 mmHg and an Hb oxygenation of 23% than the other types of venous flaps, but they have a poorer oxygen supply than conventionally perfused flaps (pO2: 24 mmHg, Hb oxygenation: 30%). Venous flow-through flaps (pO2: 9 mmHg, Hb oxygenation: 17%) and unilateral pedicled venous island flaps had a significant better oxygen supply than skin flaps without any vascular connection. The results show that the capillary system in all types of venous flaps is reached by some of the inflowing oxygenated haemoglobin over the entire flap surface to different degrees.

Animals↗
PubMed1998

[Syringomatous carcinoma of the facial skin. Case report of a rare tumor entity].

A rare case of well-differentiated syringomatous carcinoma of the nose, at first histologically misdiagnosed as morpheiform basal cell carcinoma, presented as an ulcerated nasal mass. Recurrence of the tumor and repeated histological examination of tissue specimens led to revision of the primary diagnosis. The histological features of the two entities are compared. The clinician should be aware that knowledge of the biological behavior of this tumor is sparse (based on less than 100 cases) and that the tumor possesses some features of malignancy, requiring a very careful and close follow-up.

Aged↗
PubMed1998

Indications for the vastus lateralis flap in oral and maxillofacial surgery.

OBJECTIVE: To find out the applications, usefulness and advantages of the microsurgically anastomosed vastus lateralis flap. We evaluated the results of 60 consecutive oral and maxillofacial reconstructions and established typical indications for use of this flap. DESIGN: The transplant was applied as a pure muscle flap in 17 cases, four of those being a split-skin flap for coverage of defects on the scalp. Further reconstructions were done with myocutaneous flaps for the tongue (n = 13), floor of the mouth (n = 16) and external skin defects (n = 6) as well as to close perforating defects (n = 8). RESULTS: The long and high-calibre vascular pedicle, the unvarying anatomy, and the time-saving possibility of simultaneously resecting the tumour and raising the flap in the head and neck region proved to be particularly advantageous during flap transfer. The best results were obtained in extensive, deep, or perforating defects and in tongue reconstruction; neuromuscular connection of the transplant is possible. Pure muscle transplants have only a few indications for application in the oral cavity because of their tendency to shrink. Donor site morbidity was generally low; the flap was lost in 5 cases. CONCLUSION: This hitherto rarely used transplant is well-suited for maxillofacial reconstructions if the correct indications apply.

Carcinoma, Squamous Cell↗
PubMed1998

Management of animal bite injuries of the face: experience with 94 patients.

PURPOSE: Because of the large number of bacteria in the oral cavity, animal bite wounds are generally contaminated, and their treatment is difficult because of the risk of infection, especially in extensive injuries. This report describes the management of a large series of patients and recommends treatment guidelines on the basis of the results. PATIENTS AND METHODS: Ninety-four animal bite wounds on the face and head were analyzed according to the type of animal, location and extent of the soft tissue wound, duration and type of surgical treatment, occurrence of infections and their pathogen spectrum, as well as the choice of antibiotic therapy. RESULTS: Dogs caused 91% of the bite wounds. Infections developed in 4 of 53 patients who underwent primary wound closure with minor edge excision and prophylactic administration of oral penicillin. Without antibiotic administration, 2 of 15 patients had infections, which were treated on an outpatient basis. Of 26 patients with initially delayed treatment, 18 showed clinical inflammatory symptoms with a wide spectrum of pathogens (Escherichia coli, Streptococcus, Enterococcus, Staphylococcus epidermidis, and Proteus) on presentation. CONCLUSION: Extensive animal bite wounds on the face, even with soft tissue defects, should be treated according to the criteria of a esthetic reconstructive facial surgery. In view of the low infection rate, routine antibiotic prophylaxis is not justified.

Adolescent↗
PubMed1998

Hemoglobin oxygenation of venous-perfused forearm flaps.

To understand how venous flaps function we investigated whether blood flowing via the venous network reaches the capillaries of the skin. While measuring spectrophotometrically intracapillary hemoglobin oxygenation of fasciocutaneous forearm flaps in 12 patients, flap perfusion was changed by manipulating nutrient vessels. Conventionally perfused radial forearm flaps had an intracapillary hemoglobin oxygenation of 51% to 74% but decreased to 6.9% to 12.2% within 90 to 120 minutes after arterial occlusion and perfusion only from the cephalic vein entering the flap cranially (type I venous flap). Radial forearm flaps without any vascular connection showed no oxygenated hemoglobin after 180 to 240 minutes in the capillary network. After microsurgical vein anastomosis and release of the blood flow only via the cephalic or accompanying veins, hemoglobin oxygenation returned immediately to about 10%. We conclude from our results that there is actual capillary perfusion, albeit very slight, in type I venous forearm island flaps.

Adult↗
PubMed1998

Cutaneous hemoglobin oxygenation of different free flap donor sites.

Microsurgical skin flaps raised from various body regions show differences in vascular architecture, cutaneous capillary density, and skin perfusion. Therefore, it can be expected that oxygenation of the skin is different at the various free flap donor sites. To determine the cutaneous oxygen supply, intracapillary hemoglobin oxygenation was measured on the donor sites of the radial forearm flap, scapula, latissimus dorsi, rectus abdominis, anterolateral thigh, and osteocutaneous fibula flap on 50 healthy subjects (25 men and 25 women aged 20 to 40 years). Measurements were performed noninvasively with the Erlangen Microlightguide Spectrophotometer (EMPHO) on skin areas of 6 x 8 cm in each region under resting conditions. The hemoglobin oxygenation of the skin in all donor regions varied between a maximum of 43.94 to 58.94 percent in the scapula region and a minimum of 13.89 to 29.45 percent in the lateral calf. High oxygenation values were also found on the skin over the latissimus dorsi muscle (34.56 to 48.45 percent), followed by the distal volar forearm (29.78 to 40.30 percent), whereas paraumbilical skin and the donor sites of the lower extremities were less oxygenated. By using the Wilcoxon test, significant differences were found between all donor regions except for the anterolateral thigh and lateral calf (p = 0.05). There were no gender-specific differences. From these results, it is concluded that, on young healthy subjects, regional oxygen supply on different free flap donor sites varies significantly. This finding must be considered in the interpretation of intracutaneous or transcutaneous PO2 measurements for flap monitoring.

Adult↗
PubMed1997

[Raising a radial flap with primary wound closure by prefabrication of split skin fascia flaps].

A disadvantage of the radial forearm flap is the removal of skin from a functionally important and aesthetically exposed region. To minimize the donor site morbidity with this flap, we have thus far used a two-phase procedure for intraoral defect coverage in 15 patients: In a first step, a 0.5-mm split thickness skin graft is transplanted to the forearm fascia and settles there over a period of 2 weeks. In step two, the prefabricated fascial-split thickness skin graft can be raised with complete preservation of the forearm skin and microsurgically transferred like a conventional radial forearm flap. We have obtained the following results with this procedure: (1) All skin grafts took completely on the forearm fascia. (2) Prefabricated fascial-split thickness skin flaps could be raised like conventional radial forearm flaps. (3) The very thin and moldable flaps were excellently suited for intraoral lining and showed complication-free healing. We conclude that tension-free, primary closure of the donor site can be achieved with minimal aesthetic and functional impairment.

Forearm↗
PubMed1997

Merkel cell carcinoma: report of ten cases with emphasis on clinical course, treatment, and in vitro drug sensitivity.

BACKGROUND: Merkel cell carcinoma (MCC) is an uncommon primary neuroendocrine skin tumor most often seen in the elderly. The clinical course varies. Treatment is controversial and few data on drug sensitivity are available. OBJECTIVE: We evaluated the clinical course and treatment of 10 MCC patients and determined MCC chemosensitivity. METHODS: Clinical records as well as laboratory and histopathologic data from 10 patients with MCC treated in our department were examined. Chemosensitivity to various chemotherapeutic agents and interferons of MCC cells from four patients was determined in a soft agar clonogenic assay. RESULTS: MCC behaved as an aggressive tumor with early and frequent local relapses (4 of 10 patients at a 2.2-month average), regional (4 of 10 patients at 2.5 months), and distant metastases (5 of 10 patients 9.6 months after excision of the primary tumor). In all but one patient, regional metastases preceded distant ones. Metastatic spread was associated with an average survival of 21 months from the initial diagnosis. Long-term survival (53+ and 65+ months) was observed in two women. Wide excision of the primary tumor, alone or combined with adjuvant chemotherapy and radiotherapy, was the most effective treatment. In advanced disease, chemotherapy and radiotherapy were not able to induce long-term remission. In vitro assays for MCC drug sensitivity revealed cisplatin, doxorubicin, and vindesine to be the most active. CONCLUSION: MCC has a poor prognosis in advanced stages; therefore the primary tumor should be aggressively treated. The in vitro clonogenic assay may help to identify the chemosensitivity profile of MCC and to optimize chemotherapy protocols.

Adult↗
PubMed1997

[Implant size and soft tissue behavior in different facial areas. An experimental study].

In order to predict augmentation results reliably in facial contour improvement, the thickness of the soft tissue and its deformation was reliably determined in 15 fresh cadavers after subperiostal insertion of self-made silicon implants ranging from 2 to 14 mm in diameter. Direct percutaneous measurements were made on the forehead, dorsum of the nose, malar bone, angle of the mandible, and the chin. Each region was subdivided into three zones. In 50 normal-weight subjects, the thickness of the facial soft tissues was also recorded sonographically with the aforementioned measuring points. The soft-tissue diameters decreased in the following order: malar region (8-14 mm), chin angle of the mandible-forehead dorsum of the nose (1-2 mm). In the malar region, the angle of the mandible and chin, there was a step-wise, significant compression of the soft tissues, which reduced the augmentation effect by up to 20% after subperiostal insertion of implants of up to 8 mm in diameter. Larger implant diameters (10-14 mm) no longer increased the compression effect. The thickness of the facial soft tissues at the implantation site was of decisive importance, since it defines the degree of buffer capacity. Preoperative sonographic measurement of soft-tissue thickness could therefore help to predict the augmentation result better; in the presence of a thick soft-tissue mantle (from 10 mm), we recommend selecting a 20% greater implant thickness in order to equalize the buffer effect and to avoid subcontouring.

Adult↗
PubMed1996

Monitoring of flaps by measurement of intracapillary haemoglobin oxygenation with EMPHO II: experimental and clinical study.

OBJECTIVE: To find out whether measurements of intracapillary haemoglobin oxygenation made with the non-invasive Erlangen microlightguide spectrophotometer (EMPHO II) provided accurate data about the oxygen supply as well as the blood flow to free flaps in rats and humans. DESIGN: Experimental, and prospective open clinical study. SETTING: University hospital, Germany. ANIMALS and SUBJECTS: Thirty male Wistar rats and 20 patients who underwent microsurgical transplant of free flaps (radial forearm, n = 8; osteocutaneous fibula, n = 7; and myocutaneous from the lateral thigh, n = 5). INTERVENTIONS: Measurement of the haemoglobin oxygenation of the skin before, during, and after transfer of the flap. MAIN OUTCOME MEASURES: Reproducibility and mean curves for haemoglobin oxygenation and haemoglobin concentration. RESULTS: All values were reproducible, and there were only slight fluctuations. Uninjured skin in rats (baseline value) oxygenation of the total haemoglobin concentration ranged from 15% to 45% (mean 23%). After the flaps were raised there was a slight increase (to a mean of 37%), probably as a result of reactive hyperaemia. There was a rapid decrease within a few minutes of arterial occlusion, and residual oxygenation of up to 20% after perfusion stopped. The flap was totally deoxygenated after 1 h. Venous occlusion caused a similar pattern and all flaps were deoxygenated by 30 min. In the clinical study ligation of the vascular pedicle caused a massive reduction in values but after anastomosis there was significantly higher haemoglobin oxygenation (P = 0.05) and this continued to increase postoperatively. There were no complications and oxygenation gradually and continuously decreased from the base of the flap to the periphery. CONCLUSION: The non-invasive EMPHO II provides reliable and easily assessable data about the circulation and supply of oxygen to a transplanted free flap.

Anastomosis, Surgical↗
PubMed1996

Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects.

Based on findings from anatomical dissections of the skin of the peroneal artery, we used the osteocutaneous fibula flap for combined replacement of the mandible and floor of the mouth in 24 patients, form November 1993 to December 1995. There were 22 primary and 2 secondary reconstructions; the mean age of the patients (2 women and 22 men) was 64 years. The length of the fibula segments ranged between 5.5 and 18 cm, the size of the skin component between 3 x 5 and 6 x 15 cm. Corresponding to the results of our anatomical studies, the skin island was exclusively raised form the distal third of the lower leg, and the donor sites were generally covered with split thickness skin grafts. The average length of the dissected vascular pedicle was 11 cm, so that a vein graft was only required in one case. Flap raising and tumour resection were always carried out simultaneously. Fibula osteosynthesis was done with titanium miniplates; the insertion of endosseous implants followed secondarily. The success rate was 95.8% with one transplant loss and pseudarthrosis in one case. Despite the limited width of the fibula, the shape of the mandible was satisfactorily reconstructed in all patients, and the thin, pliable component enabled intraoral coverage with only negligible surplus volume. Chronic wound-healing disturbances at the donor site of the skin island occurred in two cases; impairment of walking ability was not detected. According to our experience, the use of the osteocutaneous fibula flap is a valuable method for the reconstruction of composite mandibular defects.

Adult↗