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Biomedical subjects

L S Zachary

Publications and source records attributed to L S Zachary.

At least 19 recordsLinked to original sources
PubMed1997

The use of quantitative bacteriologic assessment of bone.

The purpose of this paper was to examine whether quantitative bacteriologic assessment of bone is a reliable indicator of the adequacy of debridement of draining wounds involving bone. This is a retrospective review of 31 consecutive patients treated for draining posttraumatic/ surgical wounds involving bone. Nineteen patients met the necessary criteria and were included in the study. These patients underwent radical debridement of bone and soft tissue, intraoperative assessment of the debrided wound by rapid slide quantitative bacteriologic assessment, and closure with well-vascularized tissue. Clinical assessment of vascularity and rapid slide quantitative bacteriologic assessment of cancellous bone and soft tissue were the only prerequisites used in determining the appropriateness of wound closure in this study. At the time of most recent follow-up, none of the 19 patients had recurrent wound drainage. Two patients required a second procedure to partially elevate their flaps and drain recurrent soft-tissue infections. None of the patients had recurrence of bony infection. Seventeen patients who presented initially with fractures or osteotomies all had successful bone unions. This study demonstrates that the technique of rapid slide quantitative bacteriologic assessment of cancellous bone is a useful adjunct to surgical judgment and allows one to close draining wounds (frequently with complex wound closure options) with a high level of confidence.

Adolescent↗
PubMed1993

Prosthesis placement after total phallic reconstruction.

Total reconstruction of the phallus is now technically feasible. The successful reestablishment of sexual function in these patients is possible using the neurosensory radial forearm flap. The innervated neophallus develops tactile and erogenous sensation within 4 to 6 months of neurorrhaphy. Unperceived chronic pressure with subsequent tissue ischemia is the leading cause of delayed prosthesis extrusion. The development of protective sensation within this reconstructed neophallus allows for the safe placement of a penile prosthesis permitting intromission. The development of erogenous sensation allows for orgasm. We report on the successful implantation and long-term retention of penile prostheses in 4 patients after total phallic reconstruction.

Adult↗
PubMed1993

Forequarter amputation wound coverage with an ipsilateral, lymphedematous, circumferential forearm fasciocutaneous free flap in patients undergoing palliative shoulder-girdle tumor resection.

Closure of massive soft-tissue defects in patients undergoing forequarter amputation for shoulder-girdle tumors may present a daunting challenge. This report describes two patients whose forequarter amputations were closed using ipsilateral, lymphedematous, circumferential forearm fasciocutaneous free flaps.

Aged↗
PubMed1993

The structural basis of Felice Fontana's spiral bands and their relationship to nerve injury.

In 1779, Felice Fontana, using a six-power hand-held magnifying lens, described what appeared to be spiral bands surrounding the peripheral nerve. He hypothesized that these bands were due to an optical illusion related to the underlying undulations of the individual nerve fibers, which he was the first to observe with an early microscope. The present study examines the historical basis of Fontana's work, confirms with intrafascicular dissection that the bands are an illusion created by unstretched nerve fibers, and relates their clinical disappearance to current concepts of the pathophysiology of chronic nerve compression and nerve injury.

Animals↗
PubMed1993

Endogenous versus toxin-induced diabetes in rats: a mechanical comparison of two skin wound-healing models.

This study was designed to compare skin wound healing in three groups of Wistar rats: normal, genetically diabetic, and streptozotocin-induced diabetic. All diabetic animals received daily insulin. Full-thickness midline dorsal skin wounds were analyzed biomechanically for strength, toughness, and elasticity (Young's modulus) at 1 and 3 weeks after wounding. Wounds from normal controls were the strongest, toughest, and least compliant. Genetically diabetic rat wounds were the weakest and had the lowest elastic modulus. Wounds from the streptozotocin-induced rats were intermediate for all parameters measured (ANOVA, p = 0.001). Toxin-induced diabetes is less detrimental to skin wound healing than diabetes of endogenous origin. Whether this is due to basic differences in the models or to differences in duration of diabetes is unknown.

Animals↗
PubMed1990

The radial forearm skin graft-fascial flap.

The radial forearm flap has become a versatile flap for upper extremity reconstruction. The use of the forearm flap for hand reconstruction in the patient with previously burned forearms has not been widely appreciated. In those patients whose forearms have been previously split-thickness skin-grafted on fascia, we have employed the reverse radial forearm flap as a skin graft-fascial flap for hand reconstruction and have obtained excellent functional results. Three patients at various intervals postburn are presented to demonstrate use of this flap for wrist contracture release, coverage of arthroplasties, first web space contracture release, and acute salvage of phalanges and tendons. Assessment of the hand's vascular anatomy and careful treatment of the donor area have contributed to no added morbidity and an excellent aesthetic result at the donor site.

Adolescent↗
PubMed1989

Relationship of intraneural damage in the rat sciatic nerve to the mechanism of injury.

The degree of nerve injury is difficult to determine and varies according to the mechanism of injury. Experimental nerve avulsion, cut, crush, and saw injuries were produced in male Sprague-Dawley rats. The extent of nerve damage was assessed histologically and by intraoperative observations on days 1, 8, and 21 post-injury. Nerve avulsions produced the most severe injury, followed by saw, crush, and cut mechanisms of injury. The intraoperative observations on day 1 were not predictors of the degree of injury at day 21. Avulsion injuries are most suitably treated secondarily by a nerve reconstruction technique, not by a primary repair.

Animals↗
PubMed1989

Reconstruction of large cranial defects in the presence of heavy radiation damage and infection utilizing tissue transferred by microvascular anastomoses.

Six cases of large defects of the scalp, skull, and dura following tumor ablation and radiation are presented. Each was accompanied by chronic infection in the irradiated defect. Efforts to reconstruct the resulting defects with local flaps were not successful. One-stage reconstruction was then accomplished in each case utilizing a latissimus dorsi musculocutaneous or myo-osteocutaneous free flap transferred by microvascular anastomoses. The versatility of the latissimus dorsi musculocutaneous and/or osseous flap allows single-stage reconstruction of these complex defects.

Adult↗
PubMed1988

Fingerstick felons.

Blood drawing through the fingerstick technique is growing in popularity. Generally considered harmless, it is widely used both in hospitals and at home for monitoring blood glucose concentrations. We report 2 cases of hand infections requiring surgery that resulted from fingerstick blood glucose concentration determinations in immunosuppressed patients. This potentially serious side effect of using the fingerstick technique may be minimized by drawing the blood from the volar forearm or from other areas of the body.

Aged↗
PubMed1988

Mycobacterium chelonei tenosynovitis.

Most atypical Mycobacterium infections of the hand are caused by Mycobacterium marinum. We are presenting a rare case of a Mycobacterium chelonei tenosynovitis. The correct diagnosis is important because the chelonei species is resistant to most antituberculosis drugs. Treatment should include surgical debridement and long-term chemotherapy after sensitivities have been determined.

Amikacin↗
PubMed1987

Progression of the zone of injury in experimental nerve injuries.

The extent of injury a nerve sustains after different mechanisms of injury is often difficult to determine at the time of injury. This study was designed to define the zone of injury for avulsed and transected nerves in an experimental animal model. We were able to demonstrate a progressive zone of injury in the avulsed nerves which would preclude primary neurorrhaphy while the zone of injury in a transected nerve tended to decrease during the three week period of observation.

Animals↗
PubMed1987

The role of thromboxane in experimental inadvertent intra-arterial drug injections.

Inadvertent intra-arterial injection of drugs produces a well-defined clinical syndrome whose pathophysiology remains unclear. This study was designed to determine the role of the inflammatory mediator, thromboxane, in intra-arterial drug injections. The rabbit ear model, as described by Kinmonth and Sheppard, was used. Five of the experimental groups were treated with specific or nonspecific thromboxane blocking agents and two groups served as controls. Immunohistochemical staining of the control ears showed elevated levels of thromboxane within the first 6 hours postinjury. The specific thromboxane blocking agents, methimazole and Aloe vera, showed almost complete blockade of thromboxane production. The percentage of ear survival was significantly greater in the group treated with topical Aloe vera (p less than 0.05) and even greater survival was achieved in the combined Aloe vera/methimazole group (p less than 0.01). On the basis of these results, we have begun treatment of such injuries with specific and nonspecific thromboxane blocking agents.

Animals↗
PubMed1987

Squamous cell carcinoma occurring in hidradenitis suppurativa.

A patient is described who had severe hidradenitis suppurativa of the perineum for three years. Excision of the involved area demonstrated a well-defined squamous cell carcinoma. A review of the literature shows only 12 reported cases of squamous cell carcinoma occurring in patients with hidradenitis suppurativa; most patients developing cancer in chronic inflammatory lesions have had longstanding disease. In this case there was a short interval between disease onset and the occurrence of a squamous cell carcinoma.

Carcinoma, Squamous Cell↗
PubMed1986

Combined prostacyclin and thromboxane synthetase inhibitor UK 38485 in flap survival.

Thromboxane, a prostanoid derivative, is a central mediator of the progressive dermal ischemia seen in the distal dying flap. Prostacyclin; a vasoactive prostanoid derivative, has been found to enhance ischemic flap survival. This study examines the effects of prostacyclin and UK 38485 (specific thromboxane synthetase inhibitor), separately and combined, in axial flap survival in the pig. Each increased flap survival over control flaps; their combined use demonstrated an even greater flap survival (p less than 0.005).

Animals↗
PubMed1985

Cefoxitin concentration in wound fluid.

The concentration of cefoxitin was determined in fluid obtained from human surgical wounds during the first postoperative day. Intravenous administration of cefoxitin sodium at a dosage of 1 or 2 g every six hours rapidly produced wound-fluid concentrations greater than the minimal inhibitory concentration for most susceptible organisms. After three hours, wound-fluid concentrations surpassed the serum concentrations of cefoxitin. The higher dosage resulted in higher wound-fluid levels.

Cefoxitin↗
PubMedDate not supplied

Distribution of pedal burns by source and depth.

The source and depth relationships of both isolated burns to the feet and pedal burns as part of multifocal thermal trauma are evaluated. Five years of cases at the University of Chicago Burn Center were selected at random and retrospectively reviewed. There were 33 isolated burns of the foot, with a source distribution of 70% scald, 9% grease, 9% hot solid, 6% flame, and 6% other. In patients with multifocal burns that included that foot, there were 89 cases, with a source distribution of 42% scald burns, 5% grease, 2% hot solid, 39% flame, 5% electrical, 1% frostbite, and 6% other. Source versus depth and grafting needs are presented. Admission to hospital which was delayed from the date of burn showed an increased need for grafting and a longer hospitalization than those admitted on the same day. Immediate admission for compliance of proper treatment protocol is advocated. Isolated pedal burns were most commonly sustained at home, indoors, and in the kitchen. A significant number of isolated burns to the feet were from a scald source, partial thickness in depth, and required no grafting. Much of the wound management involved treating elements found in traumatic, dysvascular, and diabetic pedal lesions.

Adolescent↗