Biomedical subjects
Publications and source records attributed to L H Wilkinson.
The development of the technique of tying the chain stitch knot as the beginning knot in a continuous suture has decreased the amount of suture material in the wound and has reduced operating time. Furthermore, no knot has come untied or developed other complications.
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Numerous surgical procedures have been introduced to facilitate weight loss in morbidly obese individuals. Gastric reservoir reduction, wrapping the stomach with an inert fabric, is one such procedure. Nissen fundoplication has been performed in conjunction with this approach to prevent postoperative gastroesophageal reflux. Gastric perforation and functional gastroesophageal obstruction occurring as late as 71 months after this operation represent late complications. Perforation has developed in 14.6% of stomachs wrapped with polypropylene mesh. Nissen fundoplication may contribute to this complication.
Surgery for breast cancer continues to evolve. Less radical procedures and increasing concern about appearance and rehabilitation are now the trend. Such considerations prompted a detailed anatomic study and review of the location and course of the medial and lateral pectoral nerves, the development of a technique for immediate reconstruction of the breast during modified radical mastectomy that protects the innervation of the pectoral muscles and incorporates them in the construction of a submuscular pocket to receive a silicone breast prosthesis, and the administration of low doses of heparin sodium to prevent necrosis of ischemic breast flaps. Fifty immediate reconstructions of the breast after modified radical mastectomy were performed in 48 women with carcinoma of the breast. We believe this procedure greatly enhances rehabilitation and quality of life without diminishing the ability to diagnose or treat recurrent disease.
Since 1976, in 100 morbidly obese patients, the lesser curvature of the stomach has been inverted by performing a Nissen's fundoplication followed by gastric wrapping. All but one are losing weight satisfactorily and have early satiety. There was one postoperative death from pulmonary embolus. No harmful metabolic or physiologic changes have been detected. This procedure corrects or prevents esophageal reflux and enables the patient to control morbid obesity.
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