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Biomedical subjects

K K Yim

Publications and source records attributed to K K Yim.

15 recordsLinked to original sources
PubMed1995

Experimental microvenous thrombosis following anastomosis with a knotted suture.

An experimental model for producing venous thrombosis was developed in end-to-end anastomoses of femoral veins in rats. The anastomoses were performed using a suture (9-0 suture-70 microns needle) with a knot 1 cm from the needle. The knot was formed by making either six or eight half-hitches in one throw of the suture. Vessel patency was assessed through the direct "milking test" at 20 min and 24 hrs. The incidence of thrombosis when using one knot with six half-hitches ranged from 20% to 40% and with eight half-hitches, from 50% to 70%. The incidence of femoral vein thrombosis varied directly with the presence and size of the knot. In this model, thrombosis was induced by exaggerating vessel injuries that may occur when performing routine microvascular anastomoses. This study demonstrates a reproducible thrombogenic model which mimics clinical practice and may be used to study the effects of local and systemic antithrombogenic agents.

Anastomosis, Surgical↗
PubMed1995

Secondary procedures to improve function after toe-to-hand transfers.

From August 1990 to December 1992, 139 toe-to-hand transfers were performed on 99 patients. Crush, avulsion, and combined crush and avulsion were the mechanisms of injury in 92.8% of the cases. Average duration of follow-up was 17 months (1 to 40 months). 133 transfers were successful, an overall survival rate of 95.7%. 19 transfers (14.3%) required secondary procedures for functional improvement. The incidence of secondary procedure on tendon, bone, joint and soft tissue was 9.0%, 1.5%, 2.3% and 3.0% respectively. Flexor tenolysis was the single most common secondary procedure (6.8%). The results of secondary procedures were satisfactory in all but one instance. Transient neurapraxia of an ulnar digital nerve after tenolysis was the only complication of the secondary procedures.

Adolescent↗
PubMed1995

Single third-toe transfer in hand reconstruction.

Eighteen third-toe transfers to the hand were performed from 1984 to 1993 in 15 patients. These patients had multiple amputations, and follow-up ranged from 5 to 78 months with an average of 27 months. Single third-toe-to-hand transfer was elected when (1) the second toe was not available or not suitable for transfer, (2) the second toe was located in the same foot where the great toe had been transferred to the thumb and the second toe was, therefore, spared for gait, or (3) the third toe was a better size match.

Adolescent↗
PubMed1995

Intraosseous wiring in toe-to-hand transplantation.

Although there are many reports on bony fixations in finger replantations, information pertaining to fixation methods in toe-to-hand transplantations is scarce. The results of intraosseous wiring were evaluated in 68 toe-to-hand transplantations in 47 patients. Clinical and radiological evaluation of bony union was conducted an average of 30 months after the procedure. There was no malunion. There was one painless pseudarthrosis, with an overall nonunion rate of 1.5%. Intraosseous wiring is a simple, quick, dependable, and consistent method of fixation in toe-to-hand transplantation.

Adolescent↗
PubMed1995

Lemierre's syndrome: a case of postanginal septicemia and bilateral flank abscesses.

Lemierre's syndrome is characterized by pharyngeal infections in young healthy adults with secondary septic thrombophlebitis and multiple metastatic infections. In the preantibiotic era, Lemierre's syndrome was common and lethal. With the advent of antibiotics, Lemierre's syndrome has become such a rare entity that the diagnosis is often delayed or missed. With prompt recognition, appropriate antibiotic therapy, and surgical drainage of metastatic abscesses, the majority of patients can be cured. A case of Lemierre's syndrome in a 22-year-old previously healthy man treated on a plastic surgery service is presented. Surgeons who can be consulted for deep space infections should be aware of this disease so that the diagnosis and treatment can be initiated promptly to prevent patients from succumbing to this life-threatening but curable disease.

Abscess↗
PubMed1995

Pulp plasty after toe-to-hand transplantation.

Pulp plasty is a simple procedure that is used to debulk the bulbous-appearing pulp of a transplanted digit after toe-to-hand transplantation. A retrospective review of the effect of pulp plasty on the appearance and function of the debulked digit was conducted of 82 digits on 51 patients. Pulp plasty was performed on average of 14 months after toe-to-hand transplantation; the average follow-up interval was 20 months. Subjective improvement in appearance and function was reported in 67.1 and 63.4 percent, respectively, of the debulked digits. Painful scarring was rare, and hypersensitivity was not reported. Sensation was not affected adversely by pulp plasty. The procedure was considered to be worthwhile in 87.8 percent of the cases. Pulp plasty is a simple and effective procedure after toe-to-hand transplantation that enhances the appearance and function of the transplanted digit. Patient satisfaction with the procedure is high.

Adolescent↗
PubMed1994

Fibula osteoseptocutaneous flap for mandible reconstruction.

The fibula free flap has become an established flap for mandible reconstruction when vascularized bone is desirable. Recreating mandibular contour, providing soft tissue coverage, and restoring masticatory function are equally important in mandible reconstruction, and these can be provided by the fibula osteoseptocutaneous flap. This article is a summary of the anatomy, indications, and operative technique of the fibula osteoseptocutaneous flap accumulated from 49 consecutive mandible reconstructions.

Ameloblastoma↗
PubMed1994

Fibula osteoseptocutaneous free flap in maxillary reconstruction.

The skin paddle in the fibula osteoseptocutaneous flap is thin, soft, and pliable, and it can be used for external skin coverage and intraoral linings. The flexibility of the fibula in three-dimensional positioning after multiple osteotomies is desirable in complex spatial skeletal reconstruction. The fibula osteoseptocutaneous flap is suitable for one-stage reconstruction of composite maxillary defects. The unique characteristics of the fibula osteoseptocutaneous flap and its application in the one-stage composite maxillary defect are discussed.

Adult↗
PubMed1994

The sensate fibula osteoseptocutaneous flap: a preliminary report.

The ideal oromandibular reconstruction calls for restoration of intraoral sensation as well as tissue replacement because the loss of sensation in the oral cavity impairs oral function. The versatility and flexibility of the fibula osteoseptocutaneous flap in complex three dimensional spatial positioning lends itself to be desirable in composite oromandibular reconstruction. It falls short of being ideal because the skin paddle of the flap is usually insensate and thus oral sensation is not restored. The skin paddle of the fibula osteoseptocutaneous flap is innervated by the lateral sural cutaneous nerve and this nerve can be preserved and reinnervated to restore sensation to the skin paddle. The sensate fibula osteoseptocutaneous flap may be the ideal flap for one stage composite reconstruction of oromandibular defects. This is a preliminary report on the sensory return of the sensate fibula osteoseptocutaneous flap in oromandibular reconstruction.

Adult↗
PubMed1994

Microvascular muscle and myocutaneous transplantation models in the rat.

Rat cutaneous free-flap models have received widespread attention, but muscle and myocutaneous free-flap models in the rat are relatively unknown. These latter models are reliable, reproducible, and economical. Survival of the transplanted tissue is dependent on the axial blood supply, with an all-or-none survival pattern. This article is a summary of the anatomy, transplantation characteristics, and potential application of these muscle and myocutaneous free-flap models in the rat.

Animals↗
PubMed1992

Muscle flap monitoring in a rat model with a variable gain quantitative fluorometer.

A variable gain dermofluorometer with a wide range of sensitivities capable of quantifying fluorescein emission from both skin and muscle was tested in a rat latissimus dorsi island muscle flap model. Quantitative fluorometric readings directly from muscle and skin sites that did not undergo surgery were taken at intervals over 2 hours after intravenous fluorescein injection. Muscle flaps with intact pedicles gave an inflow-outflow pattern. A no-outflow pattern was seen in muscle flaps with ligated pedicle veins and a no-inflow pattern was seen in muscle flaps with ligated pedicle arteries. These patterns were similar to the flow pattern seen with quantitative fluorometric monitoring in flaps with cutaneous components. These results suggest that quantitative fluorometry may be applicable to circulation monitoring in muscle flaps.

Animals↗
PubMed1991

Microvascular transfer of anterior and posterior gracilis muscles in rats.

A microvascular free muscle flap in rats using the anterior and posterior gracilis muscles with femoral vessels as its pedicle is presented. The gracilis muscles form a single unit supplied by the muscular branch artery and vein, averaging 0.3 mm and 0.4 mm in diameter, respectively. These small sizes preclude their use in transplantation. However, the muscular branch vessels in continuity with the femoral vessels can be used for the vascular pedicle in this muscle transplant. This muscle flap was transplanted to the contralateral femoral vessels by end-to-end anastomosis in 15 rats. Thirteen animals survived and 11 flaps were viable at 3 days for a success rate of 85%. The gracilis flaps averaged 674 mg in weight, 1.87 cm X 1.36 cm in size, and 7.23 mm in pedicle length. This free muscle flap model is reliable, relatively easy to perform, and provides adequate muscle bulk for pharmacologic and biochemical studies in transplanted muscle. No lower extremity complications were noted following femoral vessel ligations.

Anastomosis, Surgical↗
PubMed1991

Eleven consecutive combined latissimus dorsi and serratus anterior free muscle transplantations.

We reviewed our experience with 11 consecutive combined latissimus dorsi and serratus anterior free-muscle transplantations from 1980 to 1990. All 11 flaps were successful and there was minimal morbidity. This combined muscle flap is ideal for soft-tissue coverage in extensive lower extremity wounds, in mutilating hand injuries with dorsal and palmar defects, and in situations when a long vascular pedicle is needed to get out of the "zone of injury."

Adult↗
PubMed1991

Angiographic yield in penetrating extremity trauma.

Indications for angiography in the evaluation of penetrating extremity trauma remain controversial. Our experience was reviewed to determine the yield of angiography in penetrating extremity trauma and to correlate clinical findings with angiographic results. During an 81-month period from 1983 through 1989, 284 extremity arteriograms were carried out in 268 patients. The angiographic yield in patients with abnormal clinical findings was 51%. The angiographic yield in patients when proximity of the injury to major vessels was the only indication was 6% (7% with gunshot wounds and 0% with stab wounds). Neurologic deficit alone as an indication for angiography accounted for 55% of the angiograms interpreted as "negative" and none of those interpreted as "positive". We conclude that the use of angiography in patients with gunshot wounds to the extremity with "proximity injuries" to major vessels should continue, its use is not warranted in extremity stab wounds when proximity is the sole indication, and abnormal neurologic findings in the absence of other findings are a poor predictor of vascular injury.

Adolescent↗