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Biomedical subjects

M Ninkovic

Publications and source records attributed to M Ninkovic.

At least 37 records · Page 2Linked to original sources
PubMed2001

The lateral arm flap.

The authors contend that the conventional flap (LAF) and the ELAF should be considered among the best choices of all possible fasciocutaneous flaps for head and neck reconstruction. Easy and quick dissection under tourniquet, design variability, and potential sensory innervation make these flaps superior to other fasciocutaneous flaps. The ELAF provides the same pliable, thin fasciocutaneous tissue and a longer pedicle than the RFF. In contrast to the RFF, the donor site can be closed primarily and heals with an acceptable scar without any functional deficit. The authors therefore strongly recommend clinical application of these flaps in head and neck reconstruction.

Aged↗
PubMed2000

Anatomic and functional studies of the male and female urethral sphincter.

A total of 28 human specimens (14 male, 14 female) was used to perform macro- and microscopic studies on the morphologic basis of the urethral continence mechanism. Furthermore, functional studies were performed in six sheep, with the aim of looking at the pudendal and autonomic innervation of the urethra and the rhabdosphincter, as well as the changes of autonomic innervation after selective denervation. Transurethral ultrasound was performed in 34 continent patients, in order to visualize the contractions of the rhabdosphincter. The membranous urethra is innervated by branches of the autonomic pelvic plexus. The rhabdosphincter is an omega-shaped loop of striated muscle fibers that is innervated by the pudendal nerves. These results are supported by the results of animal experiments that show that the autonomic nerves predominantly innervate and regulate the upper part of the urethra, whereas stimulation of the pudendal nerves leads to a contraction of the lower part of the sheep urethra. In electron-microscopy, marked degeneration of the smooth muscle cells could be seen in the sheep with bilateral denervation.

Adult↗
PubMed2000

Reconstruction of the lower urinary tract using autologous muscle transfer and cell seeding: current status and future perspectives.

Functioning free-muscle transfer has established itself for the treatment of skeletal muscle deficiency over the last two decades. The capability of skeletal muscle to empty a spherical reservoir has been shown to be lessened if the muscle has contracted due to dissection. Currently there is no established curative treatment for bladder acontractility. Experimental data and preliminary clinical results have shown that innervated free latissimus dorsi muscle (LD) may serve as a substitute for a dysfunctional detrusor. In a clinical protocol, latissimus dorsi detrusor myoplasty (LDDM) was applied in 11 patients (age 9-68 years) with bladder acontractility due to spinal cord injury (seven patients), congenital malformations (two patients), detrusor myopathy (one patient), and idiopathic causes (one patient) who had required catheterization for bladder emptying for a minimum of 2 years. In all, 10 of 11 patients were capable of voiding volitionally, with eight of them no longer requiring catheterization, throughout the follow-up period of 12-46 months. Transplanted LD activity was confirmed by ultrasonography and flow-mode computerized tomography. It can thus be concluded that emptying of the bladder can be induced through the contractility of reinnervated free LD that has been wrapped around the bladder. An innervated free-LD flap does not undergo the severe muscle fibrosis, contracture, and atrophy that occur after transfer of completely or partially denervated pedicled muscle. Apart from the restoration of deficient detrusor function, microneurovascular transfer of a free-LD flap may be combined with tissue engineering to serve as a basis for bladder augmentation and substitution.

Adolescent↗
PubMed2000

Limb salvage after fulminant septicemia using a free latissimus dorsi cross-leg flap.

A 15-year-old boy survived fulminant meningococcal septicemia, with extensive tissue necrosis involving the face and the right arm, complicated by peripheral gangrene of the fingers on both hands and the distal parts of the feet. Although still often fatal, the mortality of fulminant septicemia has dropped substantially in the past decades, leading to more survivors, and requiring concurrent reconstruction of all extremities. This report discusses the advantages of using a single, free, latissimus dorsi (LD) myocutaneous cross-leg flap to salvage both feet, and the use of pedicled groin flaps bilaterally for coverage of fingers and hands, as illustrated by this case.

Adolescent↗
PubMed2000

Gastrocnemius myotendinous flap for patellar or quadriceps tendon repair, or both.

The authors' experience with simultaneous reconstruction of the quadriceps femoris or patellar tendon or both and soft tissue defect using a musculotendinous unit of the gastrocnemius muscle is presented. Five patients with a partial or complete defect of the quadriceps or patellar tendon or both and additional large soft tissue defects underwent reconstruction applying this technique as a one-stage surgical procedure in different variations. In cases with a partial defect of the tendon or loss of tendon thickness, the thick aponeurosis from the deeper aspect of the gastrocnemius was dissected and transferred as a pedicled tendon flap to reconstruct the tendon defect. In cases with a complete defect of the tendon, the superficial layer of the Achilles tendon together with the deep aponeurotic layer of the gastrocnemius muscle served to reconstruct the tendon. In both procedures the gastrocnemius muscle belly provided soft tissue coverage and was covered with a split thickness skin graft. One patient had a marginal deep necrosis develop that had to be covered with the other gastrocnemius muscle in a second operation. One patient with chronic polyarthritis and infection of his knee prosthesis declined additional reconstruction surgery and had the leg amputated. The average followup was 3.5 years. All patients achieved good results in active extension of the knee with an extension deficit of only 5 degrees to 15 degrees. The range of flexion was at least 90 degrees. The surgical technique described in this report provides functional tendon reconstruction and adequate soft tissue repair simultaneously.

Adolescent↗
PubMed2000

Incidence of vertebral fractures in the first three months after orthotopic liver transplantation.

BACKGROUND AND OBJECTIVES: High rates of bone loss and increased fracture incidence have been reported in patients undergoing liver transplantation, mainly within the first post-operative year. The pathogenesis of post-transplantation bone disease has not been clearly established, but the high doses of glucocorticoids used for immunosuppression may contribute. The use of lower doses in recent years has been associated, in some studies, with lower rates of bone loss and decreased fracture incidence. The aim of this prospective study was to establish the incidence of vertebral fractures in the first 3 months in patients undergoing liver transplantation for chronic liver disease and to identify risk factors for fracture in these patients. DESIGN AND METHODS: Thirty-seven adults with end-stage liver disease were studied prospectively prior to and 3 months after liver transplantation. Vertebral fractures were assessed semi-quantitatively from lateral spine X-rays and bone mineral density measured using dual energy X-ray absorptiometry. RESULTS: Prior to transplantation, prevalent vertebral fractures were present in 13 patients (35%). New fractures developed after transplantation in 10 patients (27% of total) and were significantly more common in those with a prevalent vertebral fracture pre-operatively (P<0.02). Osteoporosis, defined as a bone mineral density T score below -2.5, was present in 39% of patients prior to transplantation, but bone mineral density was not helpful in predicting incident fracture, whether measured before or after transplantation. Over the 3-month study period, significant bone loss occurred in the femoral neck (P<0.05) but not the lumbar spine. CONCLUSIONS: Our results demonstrate a high incidence of vertebral fracture in the first 3 months after liver transplantation and indicate that prevalent vertebral fracture is an important risk factor for the subsequent development of fracture in these patients. Prevention of post-transplantation bone disease should focus both on optimizing bone mass prior to transplantation and preventing bone loss in the early post-operative period.

Absorptiometry, Photon↗
PubMed1999

A new classification for the standardization of nomenclature in free flap wound closure.

A profusion of terms are currently used to describe free flap wound closure. It is important to broadly standardize nomenclature when embarking on a comparison of functional outcomes between institutions. Therefore, a series of 68 "emergency" (within 24 hours) free flaps performed by a single surgeon were reviewed with respect to a total experience of 188 free tissue transfers to formulate a consistent nomenclature applicable to free flap wound closure in general. The nomenclature presented divides free flap closure into three categories: "primary free flap closure" (12 to 24 hours), "delayed primary free flap closure" (2 to 7 days), and "secondary free flap closure" (after 7 days). This system is analogous to the standard terms "primary," "delayed primary," and "secondary wound closure." It is consistent with known biologic and microbiologic principles of wound closure in general and should provide a simple basis for classifying free flap wound closure. Illustrative examples are presented to highlight the classification scheme.

Adolescent↗
PubMed1999

Mechanism of bone loss after liver transplantation: A histomorphometric analysis.

Organ transplantation is associated with increased bone loss and high fracture risk, but the pathophysiological mechanisms responsible have not been established. We have performed a histomorphometric analysis of bone remodeling before and 3 months after liver transplantation in 21 patients (14 male, 7 female) aged 38-68 years with chronic liver disease. Eight-micrometer undecalcified sections of trans-iliac biopsies were assessed using image analysis. Preoperatively, bone turnover was low with a tendency toward reduced wall width and erosion depth. The bone formation rate increased from 0.021 +/- 0.016 (mean +/- SD) to 0.067 +/- 0.055 microm2/microm/day after transplantation (p < 0.0002) and activation frequency from 0.24 +/- 0.21/year-1 to 0.81 +/- 0. 67/year-1 (p < 0.0001). No significant change was observed in wall width, but there was a trend toward an increase in indices of resorption cavity size. There was a small increase in osteoid seam width postoperatively (p< 0.02) and decrease in mineralization lag time (p < 0.001). No significant changes in indices of cancellous bone structure were observed in the postoperative biopsies. These results demonstrate a highly significant and quantitatively large increase in bone turnover in the first 3 months after liver transplantation. Although no significant disruption of cancellous bone structure was demonstrated during the time course of the study, the observed changes in bone remodeling predispose to trabecular penetration and may thus result in long-term adverse effects on bone strength.

Adult↗
PubMed1999

Changes in calcium homoeostasis in patients undergoing liver transplantation: effects of a single infusion of pamidronate administered pre-operatively.

Bone turnover, bone loss and fracture risk increase after liver transplantation. It has been postulated that peri-operative administration of a bisphosphonate might prevent bone loss and reduce fracture rate. We studied the effects of a single pre-operative dose of pamidronate on biochemical parameters of skeletal metabolism in the first month after liver transplantation. In a randomized, single-blind study, six of 12 patients with chronic liver disease received 60 mg of pamidronate intravenously on a single occasion 1-30 days before transplantation. Six other patients undergoing transplantation received no pamidronate. We measured serum calcium, phosphate, albumin, bone-specific alkaline phosphatase, plasma parathyroid hormone and tartrate-resistant acid phosphatase before pamidronate infusion and at frequent intervals during the first 30 post-operative days. In treated patients, plasma parathyroid hormone increased 12-fold over baseline values and remained elevated in comparison with baseline at days 26-30; serum calcium and phosphate fell significantly, returning to normal at around day 14 post-operatively. There were no significant changes in any parameter in the untreated group. No changes in bone formation or resorption markers were observed in either group. The large increase in plasma parathyroid hormone concentrations in the treated group is probably secondary to the fall in serum calcium. The magnitude of the increase is much greater than that seen after pamidronate infusion in other patient groups. The lack of change in, or correlation of, serum calcium and plasma parathyroid hormone in the untreated group suggests that additional factors release calcium from bone after liver transplantation, presumably by increasing bone resorption.

Adult↗
PubMed1998

Restoration of voluntary emptying of the bladder by transplantation of innervated free skeletal muscle.

BACKGROUND: On the basis of studies with animals and experience with functioning muscle transfer in plastic surgery, we have developed a surgical technique to restore detrusor function for patients with bladder acontractility in whom there is no treatment alternative. METHODS: Three patients (aged 26 years, 28 years, and 68 years) with bladder acontractility as a result of spinal-cord injury (two patients) and chronic overdistension (one patient), who required catheterisation for bladder emptying for 5 years, 2 years, and 2 years, respectively, took part in our study. The patients were treated with microneurovascular free transfer of autologous latissimus dorsi muscle to the bladder to restore detrusor function. Follow-up included clinical and urodynamic evaluation, colour doppler sonography, intravenous urography, and flow-mode computerised tomography. FINDINGS: The three patients voluntarily emptied their bladders at 16 weeks, 16 weeks, and 30 weeks after surgery, respectively. There was no need for further catheterisation throughout the follow-up period. On urodynamic assessment at 12 months after the operation bladder capacity was found to be 600 mL, 600 mL, and 650 mL, residual urinary volume 0 mL, 50 mL, 90 mL, and maximum flow rate 26 mL/s, 25 mL/s, and 18 mL/s, respectively. Activity at the transplanted latissimus dorsi was confirmed by ultrasonography and flow-mode computerised tomography. INTERPRETATION: Microneurovascular free transfer of latissimus dorsi muscle to functionally restore a deficient detrusor muscle has proved to be successful for the three patients in our study. This technique may also be an option to restore the function of other smooth-muscle organs.

Adult↗
PubMed1998

Combined fasciocutaneous abductor hallucis-medialis pedis transposition flap for defect coverage of the medial ankle.

A new method to cover a deep defect of the medial ankle with exposed bone, tendon, or metal implant is presented. In two cases a combined medialis pedis and abductor hallucis muscle flap, each based on separate vessels but linked by the musculocutaneous perforators, was used successfully as an island transposition flap. Among other available options, this flap is, in our opinion, an ideal solution that has superior advantages.

Aged↗
PubMed1998

Facial reconstruction using a retroauricular-temporal free flap.

Large and deep soft-tissue defects of the face usually require resurfacing by free-tissue transfer. An appropriate free flap for facial reconstruction may be harvested from the retroauricular and temporal region utilizing two arterial pedicles (superficial temporal artery and posterior auricular artery). This flap provides normal color, texture, and thickness and thus is an optimal anatomic and aesthetic reconstruction with minimal donor-site morbidity.

Adult↗
PubMed1998

Fibrin glue as a delivery vehicle for autologous urothelial cell transplantation onto a prefabricated pouch.

PURPOSE: The purpose of the study was to investigate how in vivo expanded urothelium can be transplanted onto a prefabricated capsule-pouch for urinary reconstruction. MATERIALS AND METHODS: Urothelial cells from 40 rats were harvested for culture. A tissue expander was used to induce a capsule-pouch on which the cell culture were reimplanted ten days later. As delivery vehicle we compared standard culture media and fibrin glue. RESULTS: The histology demonstrated viable, multilayered clusters of urothelium cells only in the group using the fibrin glue delivery vehicle. CONCLUSION: We conclude that cultured urothelial cells can be successfully reimplanted onto a prefabricated capsule-pouch via fibrin glue, showing potential for urinary reconstructions.

Animals↗
PubMed1997

[Dynamic and functional abdominal wall stabilization, reconstruction of extensive abdominal wall defects].

The aim of any abdominal wall reconstruction is maximal functional stability and adequate soft tissue coverage. The anatomy, elevation and clinical application of the myofascial tensor fasciae latae transposition flap and of the microvascular musculocutaneous latissimus dorsi free flap are presented. Repairing extensive fascial defects and recurrent hernias with the tensor fasciae latae transposition flap provides strong, dynamic, and functional reconstruction of fascial continuity to prevent a further recurrence. Adequate functional and aesthetic repair of a full-thickness abdominal wall defect can be optimally managed by the innervated microsurgical latissimus dorsi free flap.

Abdominal Muscles↗
PubMed1997

Free-flap monitoring with tissue-oxygen measurement.

Flap monitoring by oxygen measurement with a microcatheter pO2 probe was carried out in 17 free flaps. The probe represents a new development among monitoring methods, allowing the measurement of oxygen pressure in all types of flaps including buried free flaps and vascularized bone grafts. Fourteen flaps survived with no problem. Three flaps with different degrees of problem are reported, and the advantage, and sources of error using this monitoring method are discussed.

Adult↗