Biomedical subjects

K E Koger

Publications and source records attributed to K E Koger.

7 recordsLinked to original sources

PubMed1998

Use of the balloon dissector in minimally invasive aesthetic and reconstructive surgery.

The use of minimally invasive surgery continues to evolve in all fields of surgery with new developments in techniques and instrumentation. One instrument that has evolved and become useful in the field of plastic surgery is the balloon dissector. The purpose of this paper is to examine the role of the balloon dissector in minimally invasive aesthetic and reconstructive plastic surgery. We define the concept of the fascial cleft-the loose areolar space between fascial linings. In addition, the balloon dissector and its use is described. The optical cavity created by the balloon dissector device is discussed, along with the two techniques used to maintain the optical cavity, and manual retraction and carbon dioxide insufflation. The application of the balloon dissector in various regions of the body is discussed along with its use in free tissue transfers. Three patients are presented to illustrate the application of the balloon dissector.

Adult↗

PubMed1996

Perforated jejunal diverticula.

Jejunal diverticular (JD) perforation is an uncommon cause of acute abdominal pain in the elderly. From 1971 to 1994 we treated 13 such patients, 9 men and 4 women, with a mean age of 68 years. All patients experienced sudden onset of abdominal pain, nausea and vomiting, and leukocytosis (range of white blood cell counts, 14,000-21,000). On physical examination, three patients had localized peritonitis, were thought to have appendicitis, and underwent immediate laparotomy and segmental jejunal resection for perforated JD. The remaining 10 patients had abdominal tenderness without peritoneal signs. They were hospitalized and managed expectantly. All experienced worsening signs and symptoms and underwent exploratory laparotomy and resection of the involved jejunal segment 13 hours to 8 days after admission. Although 6 of 13 patients had had JD documented previously, in only 2 patients was perforated JD diagnosed preoperatively. In 8 of 13 patients peritoneal contamination was minimal and was contained within the leaves of the mesentery. Soilage was severe with abscess formation in 5 patients. The longer the delay in operative intervention, the greater the peritoneal soilage. The 3 patients undergoing immediate surgery had minimal contamination. Of the 10 patients initially observed, the mean interval before operation was 74 hours in the 5 patients with severe soilage versus 21 hours in those with minimal contamination. The postoperative course was uneventful in 11 patients. Two patients died. Surgical consultation was delayed (8 days, 12 days) in both patients, who had severe peritoneal contamination and died of sepsis. In conclusion, JD perforation is an uncommon and frequently overlooked cause of acute abdominal pain in elderly patients. Timely operative intervention and resection of the involved jejunum are the keys to a successful outcome. Because the presentation and physical findings of perforated JD can be highly variable, a history of preexisting JD should arouse suspicion for JD perforation as the etiology of acute abdominal pain in the elderly.

Abdominal Pain↗

PubMed1996

Sternal plating for the treatment of sternal nonunion.

BACKGROUND: Sternal nonunion, defined as sternal pain with clicking, instability, or both for more than 6 months in the absence of infection, is an uncommon complication of median sternotomy. Nonunion is frequently complicated by the presence of multiple transverse fractures, which make simple rewiring inadequate. METHODS: Six patients with debilitating pain secondary to sternal nonunion were treated with the technique of sternal plating between 1989 and 1995. RESULTS: Sternal plating corrected sternal instability and provided excellent pain relief in all 6 patients. All patients reported an improved quality of life and were able to resume recreational activities. Two patients have had plate removal for late bursa formation. Sternal healing was complete in both instances. CONCLUSIONS: Sternal plating, which is based on the tension-band principle, is an effective treatment of sternal nonunion. The technique is applicable to both simple and complex nonunions. The stainless steel plates resist bending stresses, and the cortical bone resists compressive forces. The technique requires minimal dissection of the posterior sternal border, is not circumferential, and provides secure sternal approximation.

Aged↗

PubMed1994

Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation.

Patients with gigantomastia have severely distorted anatomical breast structures. Reduction mammaplasty in such cases using the inferiorly based pedicle containing the nipple-areola complex can be technically difficult, yield poor results, and cause postoperative complications such as nipple necrosis and loss. Alternative traditional methods such as amputation mammaplasty with free nipple-areola transplantation usually results in a flattened, nonaesthetic breast with poor projection. This unacceptable result is due to the lack of central breast tissue required for normal anatomical projection. Herein, we describe a method of reduction mammaplasty for gigantomastia combining free nipple transplantation and an inferiorly based pyramidal parenchymal flap for augmentation of breast fullness and nipple projection.

Adult↗

PubMed1993

Surgical scar endometrioma.

Relatively few instances of surgical scar endometrioma have been reported. Herein we review 24 patients treated for this condition at the institutions at which we work between 1972 and 1992. The age of the patients ranged from 17 to 47 years, with an average age of 31.7 years. Surgical scar endometriomas occurred after operations including cesarean section (19 patients), appendectomy (two patients), episiotomy (two patients) and hysterectomy (one patient). The interval between prior surgical treatment and the onset of symptoms ranged from one to 20 years, with an average of 4.8 years. All patients were treated by wide excision. Seventeen of 24 patients were available for follow-up evaluation. The interval between excision and follow-up evaluation ranged from 1.2 to 14.0 years, with an average of 6.4 years. None of the patients had recurrence of surgical scar endometrioma. Patients with the classic presentation of a painful surgical scar mass that increases in size or tenderness during menstruation need no further evaluation of the lesion before excision. Ultrasonographic examination and fine needle aspiration biopsy should be used preoperatively in women who have a constantly painful or asymptomatic mass in a surgical scar. Because medical management yields poor results, wide excision of surgical scar endometriomas is the treatment of choice.

Abdominal Muscles↗

PubMed1993

Laparoscopic reduction of acute gastric volvulus.

The traditional surgical treatment of gastric volvulus involves upper abdominal laparotomy with gastric detorsion, fixation, and, when present, repair of associated diaphragmatic hernia. We describe a case of organoaxial gastric volvulus associated with a paraesophageal hernia in a poor risk patient, which was successfully treated with laparoscopic detorsion and percutaneous endoscopic gastropexy. This approach avoided the morbidity of a laparotomy and allowed the rapid recovery of gastric function.

Acute Disease↗

PubMed1991

Quantification of gas denucleation and thrombogenicity of vascular grafts.

In vitro methods were developed to measure the air content of vascular graft walls and the thrombogenicity of this air. Gas content (volume %) of expanded polytetrafluoroethylene (ePTFE) grafts from different sources ranged from 75.5 +/- 0.4% to 61.8 +/- 0.3%. Exposure of Vitagraft ePTFE to a vacuum prior to saline immersion replaced 87.5% of the gas nuclei with saline (denucleation). Acetone and ethanol immersion produced 98.9% and 94.3% denucleation, respectively. Denucleation was essentially complete when vacuum exposure was followed by hydrostatic pressure treatment at 500 psig or greater. The influence of gas content on thrombogenicity was determined by immersing graft samples in whole canine blood and weighing the adherent thrombus. Denucleation significantly reduced adherent thrombus weight compared with control grafts (p less than 0.001). Air in Vitagraft walls was responsible for 84% of the adherent thrombus weight at four minutes. The described methods could be employed to assess the hemocompatibility of various biomaterials.

Adhesiveness↗