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Biomedical subjects

L A Chait

Publications and source records attributed to L A Chait.

34 records · Page 2Linked to original sources
PubMed1980

Early surgical correction in the cerebral palsied hand.

The 5 year follow-up of 20 children suffering from cerebral palsy who had undergone early surgical release procedures for deformities of the hand has indicated certain positive advantages for this method of treatment. In all cases there was an improved cosmetic appearance of the hand and improved function to a greater or lesser degree, as compared with the preoperative state. Night splints have been retained, as it was found that deformities tend to recur if splintage is discarded completely. None of the patients has developed fixed contractures, and to date improvement in function has been sufficient to obviate the need for further surgical procedures.

Cerebral Palsy↗
PubMed1979

An anti-drooling operation in cerebral palsy.

Persistent drooling in cases of cerebral palsy can be successfully controlled by a combination of bilateral parotid duct translocation and bilateral submandibular gland excision. Ten children are described who underwent this operation with satisfactory results. Apart from mile transient postoperative swelling of the cheek, there have been no postoperative complications. The importance of bilateral submandibular gland excision is stressed and the operative details are described. These include elevating a flap of buccal mucosa distally from the orifice of the parotid duct and then burying this strip beneath the buccal mucosa posteriorly to emerge in the pharynx just above the tonsillar fossa. The edges are then sutured to the mucosa of the pharynx. In time the parotid secretions pass into the pharynx via the newly created tube of mucous membrane. The technique is simple and the end result is satisfactory.

Cerebral Palsy↗
PubMed1978

The no-reflow phenomenon in experimental free flaps.

The no-reflow phenomenon was studied following reconstitution of blood flow by microvascular anastomosis in an ischemic and denervated free epigastric flap in the rabbit. Microscopic, histological, angiographic, and hematological studies demonstrated the progressive nature of this obstruction to the peripheral blood flow after increasing periods of ischemia. This obstruction reached a point of irreversibility after 12 hours of ischemia, leading to ultimate death of these flaps. These results are consistent with the hypothesis that an ischemia-induced no-reflow phenomenon is caused by cellular swelling, intravascular aggregation, and the leakage of intravascular fluid into the interstitial space. Similarities between these experimental findings and human observations are made. The clinical importance of early diagnosis and treatment of ischemic tissues is emphasized.

Animals↗
PubMed1978

The effects of the perfusion of various solutions on the no-reflow phenomenon in experimental free flaps.

The effects of solution perfusion in the free epigastric flap of the rabbit, after normothermic ischemic periods of 8 hours or 12 hours, have been examined by operative microscopic and histological methods. A smaller group of animals was also studied in which the perfusion was done before the ischemic insult. An ischemia-related obstruction to the peripheral blood flow occurred in the absence of stagnant ischemic blood in this model. Although the 3 perfusion fluids studied were shown to penetrate to all levels of a flap after such an ischemic period, none of them had a beneficial effect on skin survival. However, the solution containing mannitol did have a protective effect on fat survival. Analogies between these experimental findings and the clinical situation are made, and the importance of the early diagnosis and treatment of ischemia in a flap is emphasized.

Abdominal Muscles↗
PubMed1977

Hallux-to-thumb transfer by microvascular anastomosis.

The replacement of a missing thumb with a big toe transferred as a free vascularized composite graft is described. The anatomical basis relating to this transfer is described and the methods and the advantages and disadvantages of this as alternative thumb reconstruction are discussed. To the best of our knowledge, this procedure is the first of its kind to be undertaken in South Africa.

Adolescent↗
PubMed1977

Free neurovascular flap from the first web of the foot in hand reconstruction.

To identify an anatomically reliable and functionally acceptable neurovascular free flap for use in hand reconstruction, 50 fresh cadaver feet were dissected under the operating microscope, with particular attention paid to the anatomy of the first web area. A distal communicating artery was seen in 100% of dissections, allowing either dorsal or plantar donor artery inflow to nourish the entire flap area. Because of the ease of dissection, the first dorsal metatarsal or dorsalis pedis is suggested as the donor artery, and a dorsal branch of the greater saphenous venous system is suggested as the donor vein. The deep peroneal nerve was seen to consistently innervate the first web and, along with the plantar digital nerves, is suggested as an anatomically identifiable donor nerve. Either part of the foot first web may be used alone or together as a free flap. When indicated further dorsal skin may be incorporated into the web flap to expand its application. Two-point discrimination studies of the lateral plantar surface of the great toe in 50 normal individuals showed an average of 11.2 mm. This was significantly better as a potential donor flap than the medial dorsum of the foot where the average was 32 mm. A single case demonstrating the application of this flap in hand reconstruction is presented.

Adolescent↗
PubMed1977

Preventing the high-riding nipple after McKissock breast reductions.

We reviewed 50 patients who had reduction mamaplasties done by us using the McKissock vertical pedicle technique. The results were satisfactory, except for the high-riding nipple which developed. We describe a minor modification which seems to prevent this complication.

Breast↗
PubMed1976

Skin cover in extensive hand injuries.

The concept of 'axial-based' flaps has revolutionised the replacement of full-thickness defects of the skin and subcutaneous tissue of the hand. The groin flap provides extensive skin replacement, and has the advantage of allowing considerable mobility of the hand, elbow and should during the period of attachment.

Abdomen↗
PubMed1975

Ulceration caused by cytotoxic drugs.

Five cases of severe ulceration of the dorsum of the hand and forearm, caused by the large extravasation of a cytotoxic agent, administered for haematological disorders, are presented.

Adult↗
PubMed1975

Dogbite injuries in children.

An analysis of 50 children suffering from severe dogbites showed that the face was the anatomical site of predilection (75%(, and that the breed of dog most commonly involved was the Alsatian (German Shepherd). Primary debridement and suture under general anaesthesia is the treatment of choice. Ampicillin has been shown to be the antibiotic giving the widest over-all prophylactic chemotherapeutic cover.

Adolescent↗
PubMedDate not supplied

New innovations in scar management.

As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. With this in mind, a scar management program has been adopted based on the modalities of wound support, hydration, and hastened maturity, all factors gleaned from scientific evidence published over the past 25 years. Tension on a scar in one axis will result in a stretched scar, probably initiated by neutrophils and their neutral proteases [18,26]. Tension on a scar from many directions or intermittently will result in a hypertrophic scar, possibly initiated by lymphocytes but definitely related to a prolongation of the inflammatory process, with increased fibroblast activity and overabundant extracellular matrix secretion [24,26]. The common initiating factor is the tension on the scar, and the critical element needed to counteract this tension is scar support. Clinical experience has shown us that the most reliable way to support a scar is by using microporous tape. Hydration is a second beneficial influence on scar control and is the basis of the use of silicone sheeting and gel [7,29,36]. Alpha Centella cream has two main components. The first is an extract from the plant Bulbine frutescens. This increases hydration under the tape by leaving a layer of fatty vesicles of glycoprotein on the skin surface. This also has antibacterial properties. The second component is the principal terpenoids extracted from the Centella asiatica plant. These include asiatic acid, madecassic acid, and asiaticoside. Centella asiatica has been documented to aid wound healing in a large number of scientific reports [5,12,21,22,33,34,40]. The most beneficial effect appears to be the stimulation of maturation of the scar by the production of type I collagen [4,19] and the resulting decrease in the inflammatory reaction and myofibroblast production. Thus these components have been incorporated into the formulation of a scar management program. This publication reviews much of the available literature relating to scar management and describes the formulation and use of a scar management program based on this information.

Anti-Infective Agents↗