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Biomedical subjects

M C Robson

Publications and source records attributed to M C Robson.

At least 145 records · Page 8Linked to original sources
PubMed1982

One-stage composite reconstruction using the latissimus myoosteocutaneous free flap.

Head and neck reconstruction using a free flap composed of latissimus dorsi muscle and overlying skin and attached to vascularized posterior rib based on the thoracodorsal vessel was recently developed in our laboratory. Further clinical experience in the use of this flap is presented, along with a detailed explanation of the surgical technique. This flap provides internal lining, structural support, bulk, and external coverage for head and neck defects in one stage. Herein alternative composite free flaps have been compared with this flap.

Ameloblastoma↗
PubMed1982

Amniotic membranes as dressings following facial dermabrasion.

Facial dermabrasion produces a raw, painful, partial-thickness wound, quite similar to a split-thickness skin graft donor site. The various methods of dressing such wounds employing ointments, impregnated gauze, bulky absorptive dressings, xenografts, or allografts are time consuming, uncomfortable for the patient, and not infrequently characterized by localized purulence and delayed healing. Experience with amniotic membranes as biologic dressings, both experimental and clinical, prompted a trial of these membranes as a dressing following facial dermabrasion. Thirty-three patients undergoing facial dermabrasion were dressed with amniotic membranes following the procedures. The results following this dressing method were excellent. The biologic basis and the techniques of preparing and applying amniotic membranes as dressings following facial dermabrasion are presented. The advantages of amniotic membranes over the other presently employed dressing techniques following facial dermabrasion are discussed.

Amnion↗
PubMed1982

Accidental hypothermia treated with rapid rewarming by immersion.

Eighteen consecutive hypothermia patients were treated with rapid rewarming by immersion. Continous electrocardiographic monitoring, acid-base and central venous pressure measurements, vital signs, and fluid resuscitation with lactated Ringer's solution (tritrated to urine output) were employed as part of the therapeutic regimen. This regimen was associated with a single mortality. Rapid rewarming by immersion appears to be a safe, effective, and relatively simple method for treating accidental hypothermia victims.

Acid-Base Equilibrium↗
PubMed1982

Progression of thermal injury: a morphologic study.

The events that participate in the local pathophysiology of a burn would have not been completely described. This study defines the sequential morphologic changes following untreated partial-thickness burns. Guinea pigs received partial-thickness scald burns by 75 degrees C water immersion for 10 seconds. Skin samples were then obtained at 2, 8, 24, and 96 hours after the burn and examined by light and electron microscopy. A definite progression of the thermal injury was found, with maximum tissue destruction occurring 8 hours after the burn. At 24 hours after the burn, some improvement in the burn wound was noted, especially in the dermal microvasculature. At 96 hours, the damaged epidermis sloughed, exposing a dermis that contained areas resembling microabscesses.

Animals↗
PubMed1981

Evaluation of hand frostbite blister fluid as a clue to pathogenesis.

Observations on early pathophysiology of burning suggests that the release of prostaglandins and thromboxanes plays a role in dermal ischemia. Because of the similarities of the early-phase frostbite wound, blister fluids were aspirated from 10 patients with frostbite, and routine biochemical analysis, immunoelectrophoresis, immunodiffusion, and evaluation of prostaglandins E2, F2 alpha, and thromboxane B2 were performed. Potassium, serum glutamic-oxaloacetic transaminase (SGOT), creatine phosphokinase (CPK), and lactic dehydrogenase (LDH) levels exceeded normal serum values. All blisters were found to have IgM, IgG, IgA, C3a, and opsonin. PgE2 was present in levels less than normal, but PgF2 alpha and TxB2 were markedly elevated. Since the vasoconstricting metabolites of arachidonic acid, PgF2 alpha and TxB2, are known to mediate dermal ischemia in burns and pedicle flaps, it is suggested they may play a role in the pathogenesis of frostbite.

Aspartate Aminotransferases↗
PubMed1981

Methods and results of reconstruction with free flaps following resection of squamous cell carcinoma of the head and neck.

Our experience with 9 patients who have undergone reconstruction with free flap transfers following resection of squamous cell carcinoma in the head and neck area is presented. The dorsalis pedis flap was used in 3 patients, the iliofemoral (groin) flap in 4, and the latissimus dorsi myocutaneous flap in 2. Four patients had received preoperative irradiation. Despite minor partial flap necrosis in 3 patients and the development of oral cutaneous fistulas in 2, all the flaps were successful in providing the necessary coverage. Reoperation in 1 patient was necessary because of thrombosis of the venous anastomosis.

Adult↗
PubMed1981

Cooling the burn wound to maintain microcirculation.

To evaluate the effect which cooling of burn wounds has upon dermal microvascular circulation, standard 10% BSA dorsal guinea-pig scald burns were created. In treated animals, the dorsal burned region was immersed in a circulating ice-water bath (0-3 degrees C) for 30 minutes at various time intervals postburn (10,20,30, and 60 minutes after scald). India-ink perfusion was used to determine the level of dermal vessel patency at 2, 4, 8, 24, 72, and 96 hours after burning. By 96 hours, significant differences could be seen in animals cooled 10, 20, or 30 minutes after burning. Those not treated until 60 minutes after burning had dermal perfusion essentially the same as control animals. 133Xe dermal washout studies were performed at 8 and 24 hours and corroborated these findings. Grossly, burn wounds cooled by 30 minutes after burn had markedly better healing than control animals and animals cooled 60 minutes after burning. We believe these data support the early use of cold water treatment of partial-thickness burn wounds, as demonstrated in this experimental study.

Animals↗
PubMed1981

Ultrastructural aspects of cooled thermal injury.

This study reports on the effects of early cooling on the morphology of partial-thickness burns. After 10% body surface dorsal scald burns at 75 degrees C for 10 seconds, guinea pigs were treated by ice-water immersion at 10 minutes postburn of only the burned surface for 30 minutes. Skin samples from treated and untreated burn wounds were examined at 2, 8, 24, and 96 hours postburn by light and electron microscopy. During the first 24 hours, cooling was associated with reduced loss of epidermis and reduced damage to the basement membrane. There was also less damage to the dermal microvasculature and less edema fluid compared to untreated burn wounds. At 96 hours, the cooled burn wounds demonstrated minimal dermal hemorrhage and polymorphonuclear leukocytic infiltration, compared to the untreated wounds. These results indicate that on a cellular level, cooling has beneficial effects on the experimental burn wound.

Analgesia↗
PubMed1981

Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers.

The presence of bacteria and local infection is an important factor in the local management of chronic pressure ulcers. For successful closure of the ulcer, the bacterial count should be 10(5) or less per gram of tissue in the granulating wound. In a prospective randomized study of 45 (eventually 40) hospitalized patients, silver sulfadiazine (Silvadene) cream and povidone-iodine (Betadine) solution were compared to physiologic saline for effectiveness in preparing pressure ulcers for closure. Quantitative bacteriologic techniques on tissue biopsy specimens were used for objective evaluation. In 100 percent of the ulcers treated with silver sulfadiazine cream (15 patients) the bacterial counts were reduced to 10(5) or less per gram of tissue within the three-week test period, compared to 78.6 percent in those treated with saline (14 patients) and 63.6 percent in those treated with povidone-iodine solution (11 patients). Moreover, the ulcers treated with silver sulfadiazine cream responded more rapidly, with one-third showing bacterial levels of less than 10(5) within three days, and half within a week.

Adolescent↗
PubMed1980

Increasing dermal perfusion after burning by decreasing thromboxane production.

Decreasing progressive dermal ischemia after burning could theoretically limit the amount of skin necrosis to the zone of coagulation. Methylprednisolone, aspirin, indomethacin, imidazole, dipyridamole, and methimazole have been shown to prevent dermal ischemia, suggesting that prostaglandins and/or thromboxanes may play a role in its pathogenesis. Specific antiprostaglandin antibodies (anti-PgE2, PgF2 alpha, PgI2, and TxA2) were reacted with tissue biopsies of burned guinea pig skin at various time intervals postburn. An immunoperoxidase technique with goat anti-rabbit immunoglobulin and horseradish peroxidase demonstrated the presence of the specific arachidonic acid metabolites. The burned tissue showed high levels of PgE2 and TxA2. The effects of three thromboxane inhibitors, imidazole, methimazole, and dipyridamole, on dermal ischemia were studied. Xenon133 washout studies were performed in burned and unburned areas. Tissue half-life of Xenon was prolonged in burned, untreated areas but this rapidly decreased in antithromboxane-treated burns. Repeated antiprostaglandin and antithromboxane antibody-immunoperoxidase studies on tissue from the thromboxane inhibitor-treated animals showed that PgE2, PgF2 alpha, and PgI2 were at the same levels as in untreated animals, but thromboxane (TxA2) was essentially absent, suggesting that thromboxane may be responsible for the progressive dermal ischemia after burning and that decreasing its production can increase dermal perfusion.

Animals↗