Continuous infusion of muscle relaxant facilitates closure of the TRAM-flap donor site.
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Atracurium↗
Biomedical subjects
M F Fatah
Publications and source records attributed to M F Fatah.
Facial palsy and achondroplasia: a rare association.
The association of facial palsy and achondroplasia is rare. The authors present two cases of such association. To their knowledge this has never been described before in the medical literature. Both patients underwent a two-stage facial reanimation procedure using nerve grafting and a free gracilis muscle transfer with very satisfactory functional and cosmetic results.
Achondroplasia↗
A survey of general surgeons' attitudes towards breast reconstruction after mastectomy.
Within the last 15-20 years there have been many changes in the management of breast cancer. Along with changes in treatment, possibilities for breast reconstruction have become increasingly sophisticated and commonplace. Despite the availability of breast reconstruction, we have noted large variations in referral patterns. Because the surgical treatment of breast cancer is largely undertaken by general surgeons, we investigated general surgeons' attitudes towards reconstruction using a postal questionnaire. In 1995, a questionnaire involving hypothetical criticisms was sent to general surgical members of the Association of Surgeons of Great Britain and Ireland. A total of 136 surgeons responded, 79 (58%) of whom had a specialist interest in breast cancer. Each surgeon saw an average of 68 new cases of breast cancer per year (range 0-400). The general surgeons were concerned about three areas: (1) 32.3% felt that breast reconstruction might adversely delay the detection of local recurrence; (2) 16.6% were worried that breast reconstruction has high morbidity; and (3) 17.4% said that patients did not want breast reconstruction despite being advised of its availability. To investigate these concern's further, an extensive literature search was undertaken. There is no evidence that breast reconstruction delays the detection of local recurrence. With appropriate patient selection, the morbidity of reconstructive options appears very acceptable. Finally, immediate breast reconstruction has psychological benefits when compared with delayed reconstruction.
Attitude of Health Personnel↗
Preventing seroma in the latissimus dorsi flap donor site.
A technique for preventing seroma in latissimus dorsi flap donor sites is presented. The procedure involves quilting the donor site skin flaps to the underlying tissues with absorbable sutures. In a single surgeon series, a retrospective group (n = 16) of non-quilted donor sites was compared to a prospective group of quilted donor sites (n = 11). The age range and indications for surgery were similar for each group. The incidence of donor site seroma was reduced from 56% to 0% after introduction of the new technique (P = 0.003). The mean volume of postoperative drainage was significantly less in the quilted group (320 ml vs. 608 ml; P < 0.05) and the drains were removed significantly earlier (mean 3.9 days vs. 7.3 days; P < 0.01). There was no significant difference in donor site drainage and time to drain removal between the non-quilted group that developed a seroma and those that did not. The procedure is easy to learn, straightforward to perform and requires no special instrumentation. We commend it to all surgeons who use latissimus dorsi flaps.
Adolescent↗
Pathological findings in breast reduction surgery.
A retrospective analysis of pathological findings in 157 female patients undergoing breast reduction is presented. In 33 months 295 breasts were reduced. 25.6% of these patients had an abnormal pathology report, but no cases of premalignant disease or breast cancer were found. A postal questionnaire sent to consultant members of the British Association of Plastic Surgeons in 1994 found 89% routinely sent breast reduction tissue for pathological study. 42% had seen at least one case of breast cancer reported from this tissue. Recommendations for the use of pathology in breast reduction surgery are proposed.
Adolescent↗
Fibrous hamartomas of the scalp in infancy.
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Hamartoma↗
A composite lateral arm flap for the secondary repair of a multiply ruptured Achilles tendon.
Reported uses of the lateral arm flap for Achilles tendon reconstruction are few, and all refer to delayed primary repair. We would not only like to suggest its use for secondary repairs but also to recommend the incorporation of a suitable olecranon fragment with the triceps tendon graft as a workable anchoring device. This provides a more secure insetting in the all too common operative situation of a short, frayed distal stump and, most important, helps to insure against postoperative rerupture.
Achilles Tendon↗
Prevention of cranial reossification after surgical craniectomy.
An experimental study in rats was designed to see whether the pericranium, used as a graft over the dura, can prevent or delay osseous reunion after craniectomy. A 10 x 3-mm section of the frontal and parietal bones, including the coronal suture line, was resected in 15 rats. Pericranium was then used as a free graft on one-half of the defect to cover the dura and separate it from the cut edges of the craniectomy. The other side acted as a control. All animals were killed 2 months after operation, the skull was removed, and any remaining bony defect on either side of the midline was revealed. The area of residual defect in 13 specimens was determined by statistical image analysis using the Oxford Modular Cataract Image Analysis System (Oxford, England) and Wilcoxon's rank sum test and showed a highly significant difference between the treated and the untreated sides (p = 0.002).
Animals↗
Innervation and functional reconstruction of the forehead.
The anatomy of the motor and sensory innervation of the forehead was studied by dissection of 10 cadavers. Some of the temporal branches of the facial nerve supply the frontalis muscle. They run along a line drawn from below the tragus to a point about 1.5 cm above the outer margin of the orbit where the branches enter the muscle from its deep aspect. There is wide variation in the number of branches and the pattern of anastomosis between them. The sensory innervation is from the frontal nerve, a branch of the ophthalmic division of the fifth cranial nerve. Although the pattern of division into four or five branches is very variable and often asymmetrical, there is an important common feature: the most medial branch changes from a submuscular to a subcutaneous plane immediately after leaving the orbit, while each of the successively more lateral branches travels to a higher level before this change takes place. On the basis of these anatomical findings, a functionally satisfactory reconstructive procedure was designed to close skin defects of the forehead of up to 6 cm in diameter, by raising innervated musculocutaneous local flaps.
Forehead↗
The treatment of donor sites with cultured epithelial grafts.
In a significant number of elderly patients, the healing of split skin donor sites can be delayed. The cultured allogenic epithelial graft (CAG) has been reported to heal leg ulcers. The mechanism of action may be to improve the healing environment and thus stimulate the host skin cells. A clinical trial was undertaken to compare the healing rate of the donor sites of elderly patients using CAGs and two commercially available dressings. Compared to Jelonet, CAGs (p = 0.008) and OpSite (p = 0.013) significantly reduced the number of patients with delayed healing. There was no significant difference between CAGs and the occlusive dressing, OpSite.
Aged↗
Recurrent multiple epidermoid inclusion cysts following rhinoplasty--an unusual complication.
Epidermoid inclusion cysts are a relatively common finding following superficial trauma. Inclusion cysts have previously been reported following rhinoplasty, but these have been mucosal cysts and one case of a paraffinoma. A case of multiple recurrent epidermoid inclusion cysts, developing in relation to rhinoplasty, is presented.
Adult↗
Raising the radial artery forearm flap: the superficial ulnar artery "trap".
An anomalous superficial ulnar artery was encountered during the raising of a free radial artery forearm flap. A description is given of the anatomy of the ulnar artery, its variation and vulnerability during the raising of a forearm flap.
Arteries↗
L-plasty technique in the repair of split ear lobe.
A new and effective technique for the repair of split ear lobe is presented and the mechanism of acquired cleft ear lobe from the wearing of earrings is discussed.
Ear Deformities, Acquired↗
The radial forearm island flap in early reconstruction of a severely burned hand.
The radial forearm island flap has been shown to give a reliable one stage reconstruction in upper limb trauma, providing thin pliable, and when required, innervated full thickness skin cover. We present one case which demonstrates the use of this versatile flap in early reconstruction of a severely burned hand.
Burns↗
The morbidity of split-skin graft donor sites in the elderly: the case for mesh-grafting the donor site.
An impression that the healing of split-skin donor sites in the elderly is significantly prolonged compared with that in younger patients was confirmed by retrospective and prospective clinical studies. Possible explanations are discussed. In a prospective clinical trial of 20 consecutive patients over the age of 60 part of the donor site was covered with a meshed skin graft leaving the remaining unmeshed area as a control. In all patients the mesh-grafted area was healed in 10 days while the control "unmeshed" area demonstrated the same morbidity we had noted in patients over 60 in our retrospective study. It is suggested that the mesh grafting of small split-skin donor sites in the elderly can accelerate the rate of healing and significantly reduce the demands on hospital and community resources.
Adolescent↗
The radial forearm island flap in upper limb reconstruction.
The radial forearm island flap may be used for resurfacing areas of skin in the upper limb. It allows a safe one stage reconstruction of skin loss providing thin, pliable and innervated skin cover. We present five cases which demonstrate the versatility of the flap.
Adult↗
Palmaris profundus of Frohse and Fränkel in association with carpal tunnel syndrome.
The occurrence of the anomalous Palmaris Profundus muscle in association with median nerve compression in the wrist in two patients is described. In one of the patients this muscle was a substitute for an absent Palmaris Longus in the left hand. In the right hand, and in the left hand in the second patient, this anomalous muscle was present in addition to the normal Palmaris Longus muscle.
Aged↗
A method of closing urethral fistulae using a purse-string or interrupted silk sutures.
A simple method of closure of urethral fistulae is described, using a purse-string suture for small fistulae and serial silk sutures for larger fistulae, with a skin flap for cover. No urethral catheter is required and hospitalisation is reduced to 3-4 days. Twenty cases have been treated in this way with no recurrence of the fistula and no stricture formation.
Humans↗