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Biomedical subjects

L R Chick

Publications and source records attributed to L R Chick.

11 recordsLinked to original sources
PubMed1996

Familial polythelia without associated anomalies.

Of the many forms of supernumerary breast tissue, the most common form is the isolated presence of an accessory nipple, polythelia. While familial polythelia is recognized, it is extremely rare. In the past several years, polythelia has been noted to be associated with nephrourological anomalies. All reports of such a relationship are in random, nonfamilial cases of polythelia. We report three cases of polythelia in a family over two generations who had no urinary tract abnormalities. Discussion includes a comprehensive review of familial polythelia and its association with renal anomalies. From this review, the association of familial polythelia with nephrourological abnormalities will be delineated. Although in this report of a single family with polythelia we did not demonstrate any renal anomalies, we feel that a thorough physical exam, urine analysis, and renal ultrasound should be pursued in any patient with a significant familial history of polythelia.

Adolescent↗
PubMed1995

In vivo 31P-NMR studies of age and energy metabolism in an animal flap model.

Changes in phosphate energy metabolism with time in a rat flap model were followed noninvasively with in vivo 31P-NMR. The influence of age on high-energy phosphate metabolites in perfused and ischemic ends of 3 x 10 cm dorsal flaps was noted from 30 minutes to 7 days after closure in 6-, 12-, and 24-month-old (n = 4, 7, and 8, respectively) male Fischer 344 rats. Phosphocreatine to inorganic phosphate ratios showed younger animals exhibiting significant returns to preinjury energy status in 2- and 3-mm ischemic layers. This behavior, 24 to 72 hours after closure, coincides with neovascularization of the flap tissue. By contrast, 12- and 24-month-old animals experienced statistically significantly lesser high-energy rebound, developing greater necrosis in the ischemic regions. Early intracellular pH lowering, indicative of lactate production, was somewhat greater in the flaps of younger animals. The in vivo 31P-NMR methods thus provide metabolic insights into flap behavior correlating with physiologic influences of aging.

Aging↗
PubMed1992

Noninvasive assessment of metabolism in wounded skin by 31P-NMR in vivo.

Phosphorus-31 nuclear magnetic resonance techniques using shallow penetrating coils have been used to noninvasively monitor severity and metabolic changes over time in skin wounds in rats. Ratios of phosphocreatine (PCr) to inorganic phosphate (Pi) indicate energy status in both thermal wounds and surgical flaps. In partial and full-thickness scald wounds, reductions in PCr/Pi ratios correlated with burn depth and improved over time postinjury, suggesting wound revascularization. No decrease in intracellular pH was noted in these wounds; the phosphate shifts may be primarily the result of tissue degradation followed by restoration of the microvasculature. Distal regions of caudally based dorsal 3 x 10 cm full-thickness skin flaps reveal progressively lower PCr/Pi ratios to 3-6 hours after elevation as well as drops in pH up to 0.5 units, presumably as a result of anaerobic glycolysis in these tissues. After 24 hours, the intracellular pH returned to normal (7.1-7.2) and the PCr/Pi ratios approached 70%-90% of the well-perfused proximal regions within 3-7 days. These results indicate the establishment of a microvasculature from the underlying bed as the distal regions survive as free grafts. The data demonstrate the potential usefulness of the technique in noninvasive measurement of the biochemical response to injury and wound healing in living organisms.

Animals↗
PubMed1992

Free flaps in the elderly.

Microsurgical transfer of tissue has become a primary tool of the reconstructive surgeon. The elderly, as a growing segment of our society, are requiring free-tissue transfers in proportion to their numbers. To investigate the potential morbidity of free-tissue transfers in the elderly, we studied consecutive populations of 31 patients above the age of 65 years and 90 patients below the age of 65 years. Complication rates were 65 and 49 percent, respectively. Premorbid medical conditions were present in 87 percent of patients 65 years and older and in 72 percent of those under 65 years. Medically related complications in free-tissue transfers, previously unreported in the literature, were 35 percent in the elderly group and 10 percent in the younger group. Wound-healing complications were seen in equal proportions between groups. The rates of wound and medically related complications observed in the elderly group were nearly double those observed in the younger group; however, after correction for the presence of preexisting medical conditions, no significant differences were seen between the two groups. These observations suggest that age alone is not a variable in risk for free-tissue transfers. Elective microsurgery can be performed in the elderly patient with a high expectation of success.

Adolescent↗
PubMed1992

Early free-flap coverage of electrical and thermal burns.

Because of the clinical concept of progressive tissue necrosis, the concept of immediate excision and coverage of high-tension electrical burns and deep thermal burns has been a controversial subject. Recent clinical and laboratory research has cast doubt on this concept. We present a series of five patients who suffered severe extremity electrical and thermal injuries in whom early excisions were performed with immediate free-flap reconstruction. Special importance is given to radical debridement of all questionably nonviable tissues, excepting intact tendons, nerves, and bone. In these tissues, anatomic continuity is more important than apparent viability. No infections or wound-healing complications were seen as a result of this protocol. Of eight digital nerves that did not function at the initial examination, five subsequently recovered two-point discrimination of less than 10 mm.

Adult↗
PubMed1991

Surgical alternatives in Dupuytren's contracture.

The treatment of Dupuytren's contracture is still controversial. The use of subcutaneous fasciotomy is useful in the medically unstable patient in whom long-term results may be a moot point. Limited fasciectomy is preferred over radical excision as a simpler operation and because of fewer complications. Wound closure is still a major point of contention. A prospective, randomized study of open wounds versus skin grafts versus closed procedures is needed to give more information regarding the long-term results. Currently, at our institution, we perform limited fasciectomy and leave the palm open. Early and aggressive mobilization is thought to be the key to good results.

Dupuytren Contracture↗
PubMed1990

Island scalp flap for superior forehead reconstruction.

An island scalp fasciocutaneous flap, based on the posterior superficial temporal vessels, is described for single-stage reconstruction of full-thickness forehead and scalp defects. The hairline can be precisely determined and tailored to restore symmetry. By removing the hair-bearing dermis of the forehead portion of the flap and placing a full-thickness skin graft, aesthetic reconstitution of the forehead skin is achieved. This flap is especially useful when exposed calvarium limits other techniques.

Adult↗
PubMed1990

Calcium carbonate gel therapy for hydrofluoric acid burns of the hand.

Hydrofluoric acid is used extensively as an industrial cleaning agent for metals and glass. Many workers are injured by cutaneous contact of the acid with exposed skin surfaces, particularly hands. Hydrofluoric acid burns are characterized by delayed onset of symptomatology with skin ulceration, and severe pain may be of extended duration. Treatment of hydrofluoric acid burns traditionally has consisted of local infiltration or intraarterial injections of calcium solutions. These injections are painful and frequently require retreatment. A new treatment utilizing a topical gel of calcium carbonate is described. Nine patients have been treated for hydrofluoric acid burns of the hand with calcium carbonate gel applied topically and covered with occlusive glove dressings. A gel slurry is compounded from calcium carbonate tablets and K-Y Jelly. Fingernails of the affected fingers are removed if a subungual burn is obvious. The gel is put into a surgeon's glove and placed over the burned hand. The patient replaces the glove and slurry every 4 hours for 24 hours. After the first day, the glove is discontinued unless there is resumption of painful symptoms. Full range of motion is encouraged during this interval. The calcium carbonate gel technique was successfully utilized in nine patients with no further need for injection therapy. In these patients, pain relief was obtained within 4 hours of treatment, with no further progression of skin ulceration. No reconstructive procedures were required in any patient, and only one patient did not return to full-duty work within 1 week. There were no long-term sequelae from burns treated with this topical therapy, except one patient, who presenting 24 hours after the burn, developed a digital tip neuroma that was excised.

Adult↗
PubMed1989

A history of tendon operations.

The pendulum of arguments and popular operations swings back and forth, anchored to the problem of tendon healing and adhesions. The following passage, commenting on tendon repairs done by a famous 17th century surgeon, from the Course of Chirurgical Operations by Dionis in 1710, has relevance for history and the future of tendon operations. . . . When M. Bienaise, one of the most famous Chirurgeons of Paris, began the Performance of this Operation about fifty years past, it pass'd for his Invention; of which he reap'd all the Honor and it all the Charms of Novelty; but on Examination it appearing that it had been talk'd about two thousand years before he hit on it, it was consequently discover'd he only reviv'd an Ancient Practice of the Greeks, and that Guido and several others had practised it. 'Tis indeed true, twas grown obsolete, he brought it into use again, and we are oblig'd to him for having try'd it on his Dogs, after that employ'd on Men, and then encouraging us to the performance of an Operation which prevents the laming of a great many wounded patients.

History, 17th Century↗
PubMed1988

Brief history and biology of skin grafting.

Skin grafting is a modern addition to surgery but with ancient roots. Its biology has come to light only within the last 50 years, and research continues into its basic mechanisms. A brief history of skin grafting from Susruta to Reverdin and Ollier and the mechanisms of skin grafting featuring recent research effects are reviewed.

Graft Survival↗