Survival of skin flaps based on scar.
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Animals↗
Biomedical subjects
L E Edstrom
Publications and source records attributed to L E Edstrom.
Usefulness of the innervated tensor fascia lata flap in paraplegic patients.
Pressure sores in paraplegic patients are a well-known problem. Such patients can develop pressure necrosis and skin breakdown in spite of preventive measures and adequate surgical management. The occurrence and recurrence of these problems is due in large part to the patient's inability to perceive pressure discomfort in the insensible sitting area. Use of the innervated tensor fascia lata flap has great value in selected patients. A series of 9 patients is presented. In all patients, postoperative sensibility in the flap was maintained as in the preoperative stage. Follow-up of these patients shows that all flaps have remained healed and functioning The neuroanatomical features of the innervated tensor fascia lata flap make it a promising method for covering pressure sores and avoiding subsequent complications.
Fascia↗
Combined use of vascular bypass and myocutaneous flap reconstruction in salvage of an ischemic limb.
Successful limb salvage and rehabilitation were achieved in a patient with chronic ischemia and a deep tibial ulcer by combining arterial reconstructive surgery with myocutaneous flap coverage of the defect. Without adequate and expeditious soft tissue coverage, recovery would have been prolonged, and the likelihood of successful rehabilitation would have been seriously jeopardized.
Chronic Disease↗
Malignant mesothelioma: a metastasis to the face.
Malignant mesothelioma can be a confusing disease, resembling either carcinoma or sarcoma. Although it usually causes death rapidly by local and regional spread, distant metastases may be seen more frequently as more effective therapy controls local disease and prolongs life. Our patient's local and then regional mesothelioma was controlled by aggressive treatment, which allowed him nearly two years of productive life before a metastasis to the right infraorbital region occurred. He died shortly thereafter with widesspread metastases. This is the first reported case of mesothelioma metastatic to the face. This case also emphasizes the association of malignant mesothelioma with asbestos exposure, and points out advances in pathologic techniques that aid in the diagnosis of the disease.
Facial Neoplasms↗
The gastrocnemius myocutaneous flap.
Medial and lateral gastrocnemius flaps are large flaps that can be taken in the lower extremity with no delay. They have a wide arc of rotation from above the patella in the thigh to the upper portion of the lower tibia. Both flaps can be taken simultaneously. They can cover extremely large defects of the anterior leg or knee. The use of these flaps with their ready availability, excellent blood supply, and wide range of coverage has tremendously facilitated immediate correction of severe injuries of the knee and lower leg.
Humans↗
The use of a rapid new technique in the demonstration of cutaneous catecholamines.
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Abdominal Muscles↗
Providing useful and protective sensibility to the sitting area in patients with meningomyelocele.
About 62 percent of the patients with meningomyeloceles will have essentially normal sensation in the area supplied by the lateral femoral cutaneous nerve (which is also the territory of the extended tensor fasciae latae flap), despite the fact that they may have complete anesthesia in their sitting area. In these, pressure sores can be healed and future ones prevented by transposing a sensation-bearing tensor fasciae latae flap to provide virtually normal sensibility in the sitting area.
Buttocks↗
Prospective randomized treatments for burned hands: nonoperative vs. operative. Preliminary report.
It has been suggested that deep partial-thickness burns of the hand which remain unhealed by 14 days should be excised and totally resurfaced. Controlled data supporting this suggestion is not available. Therefore, a prospective randomized study was performed on 222 burns of the hand to evaluate if excision and skin grafting had any advantage over conservative management. Full-thickness burns were eliminated from the series by excision and grafting them as soon as possible after the diagnosis had been made. To eliminate the very superficial burns, randomization did not take place until the wound had remained unhealed for ten days and would not heal for at least another week. In the two groups, the first ten days were managed similarly with topical antibacterials, escharotomies when necessary, and splinting in the "safe" position. Conservatively managed hands were treated with scarlet red gauze dressing as soon as all eschar had been removed. Those cases randomized into the excision and grafting group were operated upon approximately day 14. Physical therapy was the same in both groups except for the immediate period after grafting. Results were recorded by active and passive joint measurements and photographs on predetermined days throughout the study. In this study, spontaneous healing, taking as much as five weeks, gave acceptable results, comparable to excision and grafting performed at two weeks. The use of range of motion exercises, accurate splinting and pressure allowed optimal healing and prevented stiffness and contractures in both groups. There was no significant difference between the two treatment modalities.
Bandages↗
The diabetic foot: an alternative approach to major amputation.
Of the complications of diabetes mellitus, none is more devastating than gangrene of the foot and the threat of leg amputation. The pathophysiology of vascular insufficiency, neurotrophic changes, and infection leading to this gangrene have been reviewed. Based on this pathophysiology, an approach for conservative surgery of the diabetic foot has been outlined. Using known principles of wound healing and the management of soft tissue infection, obviously necrotic or infected tissue is debrided and the wound managed conservatively. The use of debriding adjuncts such as the pulsating jet lavage, topical antibacterials, and biologic dressings are suggested to control the infection so that the wounds can be closed with either skin grafts or local flaps. This method can result in salvage of many feet and the maintenance of biped ambulation since the outlook for the diabetic with a major amputation is markedly different from the nondiabetic amputee.
Amputation, Surgical↗
A method for the evaluation of minor degrees of breast asymmetry.
We have found the study of split-and-reversed photographs useful in the preoperative evaluation of patients presenting for corrective surgery of the breasts. It puts double emphasis on minor asymmetries, and can be used as an objective tool in planning procedures to correct these, and in evaluating the results. Asymmetry in volume is, however, less readily demonstrated by this technique than is asymmetry of shape.
Breast↗
Conservative management of the ulcerated diabetic foot.
Four cases are presented of the conservative treatment of the diabetic foot. Using the known principles of wound healing and of management of soft tissue infection, the obviously necrotic or infected tissue was debrided and the wounds were managed conservatively. The use of such debriding adjuncts as a pulsating jet lavage, topical antibacterials, and biological dressings, has controlled infections--so that the foot wounds could be closed then with sking grafts or local flaps. This resulted in the salvage of these feet, with maintenance of biped ambulation.
Adult↗
The undelayed Mütter flap in head and neck reconstruction.
Twenty-one mastoid-occiput-based shoulder flaps have been used to reconstruct patients with head and neck cancer. When the tip of the flap does not extend beyond the midclavicle, this flap can safely be elevated and transferred into its final position without delay procedures. Not requiring secondary sectioning and implantation, the Mütter flap can successfully be used to reconstruct multiple defects within its arch. Its utility thus rivals the more commonly used medially based deltopectoral flap and forehead flap.
Head and Neck Neoplasms↗
A simple technique to treat drooling: lip resection and muscle flaps.
a simple technique to correct the lax oral sphincter has been developed. A wedge resection of the bulky, atonic lower lip is performed leaving a pedicle flap of orbicularis oris muscle on either side of the resection. The muscle flaps are tunnelled submucosally toward the opposit commissures and anchored. This gives excellent stability to the lower lip and prevents drooling.
Facial Paralysis↗
The mucoperiosteal palate flap for closure of oral cavity defects.
We have used a modification of a mucoperiosteal flap described by Lane for cleft palates in 3 patients with oral cavity defects from tumor ablations. The flap provides excellent lining for repairs when alternative flaps are unavailable. The vascularity of the flap and its texture allow a watertight closure which does not hinder the patient's ability to talk or eat.
Aged↗
The efficacy of systemic antibiotics in the treatment of granulating wounds.
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Animals↗