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Biomedical subjects

L B Colen

Publications and source records attributed to L B Colen.

33 records · Page 2Linked to original sources
PubMed1990

Posterior hindfoot reconstruction.

From August 1983 through December 1988, 25 patients with complex wounds involving the posterior hindfoot underwent reconstruction of that region. The present study reviews the use of microsurgical free-tissue reconstruction in this complex anatomic area. A questionnaire was sent to all patients; 60 percent responded, with a mean postoperative period of 2.1 years. Our experience shows that complex wounds involving soft tissue, bone, tendon, and nerve may be successfully reconstructed by the judicious use of free-tissue transfer combined with standard adjunctive techniques. When flap donor tissue is carefully selected, a one-stage reconstruction without the need for contour revision should be possible. Patient satisfaction has been excellent and solidly healed wounds have been maintained.

Adolescent↗
PubMed1990

Wound healing in diabetes mellitus.

Diabetes mellitus is a complex metabolic disorder whose components have several direct and indirect effects on the healing of wounds. This article examines how diabetes affects wound healing from the standpoint of alterations in the microvasculature, nerve function, and the immune system.

Diabetes Mellitus↗
PubMed1989

Limb salvage despite extensive tissue loss. Free tissue transfer combined with distal revascularization.

Extensive lower-extremity tissue loss may preclude limb salvage despite successful arterial reconstruction. We attempted to avoid limb loss in such patients by combining arterial bypass with microvascular free tissue transfer. Fourteen patient (12 diabetic), 33 to 74 years of age, presented with extensive tissue loss in 15 lower extremities, exposing bone or tendon on the heel, ankle, lower part of the leg, or hindfoot. Mean ulcer size was 5 X 8 cm. Four patients had had previous contralateral below-knee amputations. Femorodistal (seven), popliteal-distal (three), or femoropopliteal (four) bypass, or tibial angioplasty (one), was performed to provide sufficient inflow for free tissue transfer. Serratus anterior, scapular, latissimus dorsi, rectus abdominis, gracilis, ulnar, or temporalis free flaps were used. One free flap failed due to venous thrombosis and was corrected with a second flap. Limb salvage was achieved in 14 (93%) of 15 limbs during a mean follow-up of 24 months. The single amputation occurred due to severe foot ischemia in a patient whose femorodistal bypass remained patent only to the viable free flap. The remaining 13 patients (14 limbs) became ambulatory, including those with free flaps to weight-bearing regions.

Adult↗
PubMed1989

The integrated approach to suppurative mediastinitis: rewiring the sternum over transposed omentum.

Acute mediastinitis after cardiopulmonary procedures remains a devastating complication and a challenge to the reconstructive surgeon. A review of the literature and our own experience confirm the need for early aggressive drainage followed by timely reconstruction. In carefully selected patients, the sternum may be reclosed, provided that omental tissue has been transposed into the defect between the myocardium and the posterior cortex of the sternum. The technique is outlined and the results are analyzed and compared with three additional patient subgroups: (1) sternal wounds rewired over drains, (2) sternal wounds rewired with drains and irrigation catheters, and (3) wounds closed by sternal excision and muscle-flap transposition. To date, nine omental transfers have been performed with complete success. Mediastinal drainage routinely ceases after 3 to 5 days, and hospitalization has averaged 10 to 14 days. Early open debridement allows establishment of drainage and permits close evaluation of the character of the bony sternum. Muscle flaps may then be used in those patients with multiply fractured or frankly necrotic sternal tissue, while sternal closure over omental flaps may be used in all other patients. Adherence to this protocol has allowed for bacteriologic control of the wound, minimal morbidity, and no mortality.

Acute Disease↗
PubMed1988

Efficacy of muscle flaps in the treatment of prosthetic vascular graft infections.

Prosthetic vascular graft infection requires graft removal and often leads to limb loss. To determine whether vascularized muscle flaps could alter the course of graft infection, 18 mongrel dogs (18-29 kg) were randomized to one of three groups and underwent unilateral carotid artery bypass with 6-mm X 4-cm PTFE grafts. At implantation, the grafts were inoculated with Staphylococcus aureus, 2 x 10(7) organisms/wound. On Day 3, dogs with patent grafts underwent wound debridement, irrigation, and closure, and the treatment to which they had been randomized was carried out. Group A (n = 4, controls) received only dicloxacillin, 500 mg po bid, beginning on Day 4. Group B (n = 5) underwent transfer of a vascularized sternocephalicus muscle flap around the infected graft, but received no antibiotics. Group C (n = 5) underwent muscle transfer as in Group B and were given dicloxacillin as in Group A. Dogs were followed until anastomotic disruption occurred or for 60 days. Quantitative bacterial cultures were taken from sternocephalicus muscle and wound fluid at the time of debridement and at sacrifice. All dogs that received antibiotics without flaps or flaps without antibiotics (Groups A and B) experienced anastomotic disruption. Dogs that received both antibiotics and flaps (Group C) had a significantly lower incidence of hemorrhage (20%, P less than 0.05). At sacrifice, fewer bacterial colonies were cultured from muscle flaps of Group C as opposed to Group A dogs (0.05 +/- 0.02 x 10(5) vs 0.79 +/- 0.31 x 10(5), P less than 0.05). Muscle flaps with antibiotic therapy may prove to be effective treatment for infected prosthetic vascular grafts.

Animals↗
PubMed1988

The V-Y plantar flap for reconstruction of the forefoot.

Stable reconstruction of the forefoot remains a formidable challenge. The present study reviews our experience with a flap of plantar skin and fascia advanced in a V-Y manner to cover metatarsal head ulcers. Although this technique was used in a variety of clinical situations, 71 percent of the 38 patients were diabetic with neurotrophic wounds. The anatomic basis for flap design is reported based on 10 fresh cadaver dissections. Flap survival was 100 percent. Ulcer recurrence was related to the problems inherent in the hypesthetic foot. We feel that judicious manipulation of the bony architecture along with weight-dispersion shoe inserts assists in preventing recurrent ulceration.

Adolescent↗
PubMed1987

Limb salvage in the patient with severe peripheral vascular disease: the role of microsurgical free-tissue transfer.

Severe peripheral vascular disease has traditionally precluded the use of free-tissue transfer for lower extremity salvage. In the present series, 10 microvascular transfers performed over a 2-year period are critically evaluated. Vascular surgical consultation was obtained if the preoperative assessment revealed reconstructible vascular disease proximal to the offending wound. Flaps were performed for osteomyelitis in two cases and neurotrophic ulcers in eight cases. Seven of the 10 extremities had prior distal revascularization procedures before the tissue-transfer procedure. There were no anastomotic flap failures; however, one lower extremity underwent below-knee amputation due to sepsis and its cardiovascular sequelae. In properly selected peripheral vascular disease patients, limb salvage can be effected with microsurgical free-tissue transfer. The technique appears invaluable in those patients who have undergone prior contralateral amputation.

Aged↗
PubMed1986

Correction of congenital auricular deformities by splinting in the neonatal period.

Many congenital ear deformities involve abnormal plical folding. This appears to be a result of deficient intrinsic and extrinsic auricular muscle activity as well as intrauterine pressure effects. These deformities can usually be corrected by appropriate splinting in the neonatal period, a time when estrogen activity is increased and the ear is very malleable. The methods used and the results of treatment are presented.

Ear, External↗
PubMed1985

The segmental pectoralis major muscle flap: a function-preserving procedure.

A function-sparing pectoralis major muscle flap is presented. The flap is a medially based segmental transfer of a single intercostal portion of the pectoralis major muscle supplied by a single perforating branch of the internal thoracic artery. The segmental terminal nerve distribution of the medial and lateral pectoral nerves permits preservation of the remainder of the muscle in situ. Six cases of this procedure are presented with five successful outcomes. The single exception was in the loss of the distal tip when used to cover an irradiated carotid sheath to the base of the skull.

Aged↗
PubMed1979

The relationship between the number of sutures and the strength of microvascular anastomoses.

The relative strengths of microvascular anastomoses in rat femoral arteries were measured, comparing controls (no anastomosis) to those with 4, 6, 8, 10, 12, and 14 stitches. The ones in which 8 sutures were used most closely paralleled the control state, whereas those with 4 or 6 sutures were clearly inferior. With a greater number of sutures the vessel behaves as a "shorter" vessel, with the anastomosis becoming the weakest part of the vessel.

Adult↗