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Biomedical subjects

M S Granick

Publications and source records attributed to M S Granick.

At least 19 recordsLinked to original sources
PubMed1992

Posttraumatic upper extremity wound coverage utilizing the extended deep inferior epigastric flap.

The extended deep inferior epigastric artery (DIEA) flap was used in 4 patients with traumatic mid upper extremity wounds. Although there are numerous flaps available for resurfacing upper extremity defects, including the groin, thoracoepigastric, and a host of microvascular flaps, in each of these patients a preoperative consideration necessitated a novel approach. The DIEA flap is based on an axial vascular watershed resulting in a long, thin, well-vascularized, supple skin flap, which proved extremely effective in solving the reconstructive needs of these patients. The flap is technically simple to elevate and quite versatile. In all patients, the flaps survived and healing of the wounds was achieved. The DIEA flap should be considered a valuable reconstructive alternative when faced with elbow and forearm defects.

Abdominal Muscles↗
PubMed1992

Pencil-core granuloma.

Noncaseating granulomas present as a delayed foreign-body reaction to retained pencil-core fragments. The clinical appearance of the lesion can closely resemble melanoma. Surgeons who use pencils as surgical marking implements should be aware that there is a potential risk of developing late pencil-core granulomas. This risk can be reduced by carefully removing any pieces of pencil lead from the wound.

Adult↗
PubMed1990

Plastic surgery in the elderly.

Plastic surgery has an ever-increasing role in the management of medical problems in the elderly. These procedures can be performed with minimal risk to the patient in order to maximize the quality of life for these patients and their families.

Aged↗
PubMed1989

Chronic osteomyelitis of the clavicle.

Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics.

Abscess↗
PubMed1988

Necrotizing sialometaplasia masquerading as residual cancer of the lip.

Necrotizing sialometaplasia is a benign disorder that histologically can mimic carcinoma. It is thought to develop as a result of ischemia or adjacent tissue injury. A patient is described who underwent a Mohs' micrographical fresh-tissue excision of one-third of the upper lip for basal cell carcinoma. By the time she was ready for reconstruction, a marked eczematous reaction developed to a polymyxin neomycin preparation (Neosporin ointment) at the wound edges. Reexcision of the wound margins before a flap reconstruction revealed necrotizing sialometaplasia on histopathological examination. This incidental finding fortunately was not mistaken for residual tumor. To prevent over-diagnosis and over-treatment of presumed malignancies, an awareness of necrotizing sialometaplasia is essential for all surgeons operating on mucosal surfaces in the head and neck.

Aged↗
PubMed1987

Recurrent breast carcinoma at the time of breast reconstruction.

Detection of recurrent breast carcinoma following reconstruction of mastectomy defects is of concern to plastic surgeons and oncologists. During the past four years we have found recurrent, previously undetected breast cancer in 4 patients at the time of reconstruction. The recurrent disease presented differently in each patient: as fascial thickening, as a small node hidden under a pectoralis muscle stump, as a microscopical tumor contained within the mastectomy scar, and as a small mass which developed during the interim between the last office visit and the scheduled surgery. All of the patients received additional treatment and one has been reconstructed. Our study of these patients prompts the following recommendations: carefully reexamine the patient just prior to reconstruction; biopsy any abnormal tissue; submit all excised mastectomy scars for histological examination; create and examine the recipient pocket before raising a flap; and reconsider the patient for reconstruction following additional cancer therapy.

Adult↗
PubMed1987

Severe perifolliculitis capitis with osteomyelitis.

This report describes a severe case of perifolliculitis capitis with the rare complication of skull osteomyelitis, a combination not previously reported. The patient demonstrated the typical features of perifolliculitis capitis, namely, rubbery, hard, elevated nodules involving almost the entire scalp with multiple deep-seated abscesses. Bone was exposed in two areas and the diagnosis of skull osteomyelitis was confirmed by skull x-ray films and bone biopsy specimens, which grew Staphylococcus aureus. The patient was treated with enteral hyperalimentation, intravenous antibiotics, and multiple debridements of the scalp, including the involved periosteum and outer cortex of the exposed bone, followed by reconstruction with split-thickness skin grafts. A complete eradication of the disease with closure of all open wounds and clearance of osteomyelitis of the skull was achieved.

Adult↗
PubMed1987

Is experimental muscle flap temperature a reliable indicator of its viability?

This study was designed to assess the effects of environmental factors on experimental muscle flap temperature and to critically evaluate temperature as a modality for assessing vascular patency. A brief overview of the physiology of tissue heat transfer is presented. The right vertebral head of the biceps femoris muscle was used in albino New Zealand rabbits for monitoring temperature. Temperature was recorded simultaneously by means of thermocouples placed into the tested muscle, the contralateral control biceps femoris muscle, the ipsilateral control thigh compartment, and rectally (core temperature). The muscle flap temperature was recorded as a function of time during the following flap manipulations: steady state, exposed muscle, muscle elevated and then replaced with pedicles intact, and pedicles ligated. In addition, the effects of environmental manipulations on muscle flap temperature were evaluated. The constant findings demonstrated that the dominant aspects of muscle temperature are the temperature of the surrounding tissue, as well as the prevailing environmental conditions. Vascular occlusion did not alter muscle temperature. In 3 patients who underwent successful free-flap transfer, muscle temperatures were monitored and found to be labile, and altered by environmental manipulations. We concluded that temperature is an unreliable, nonreproducible method of assessing the vascular status of a muscle flap, unless all environmental variables are meticulously monitored and controlled.

Animals↗
PubMed1987

The plantar digital web space island flap for reconstruction of the distal sole.

A neurovascular flap of interdigital web space skin based on the plantar circulation is described. The flap is useful for reconstructing distal plantar defects that do not have an adequate surface for skin grafting. It leaves a donor defect in a non-weight-bearing area and does not disrupt the structural integrity of the foot. The surgical anatomy and operative approach are detailed. The key to the approach is to preserve the fat pad around the neurovascular bundle during the dissection. Six patients have successfully undergone this procedure and have been followed for at least 2 years postoperatively. The plantar island flap is a reliable flap for repairing plantar defects overlying the metatarsal heads.

Female↗
PubMed1987

Surgical skin-marking techniques.

Surgical skin-marking inks and dyes are in everyday use for designing and planning incisions in plastic and reconstructive surgery. We have traced the historical development of surgical skin-marking techniques from ancient times to the present. The biochemical characteristics of the commonly used marking agents are discussed. A three-part experiment utilizing a pig model was carried out to test the tissue inflammatory response to the various dyes and inks when used intradermally as tattoos, the persistence of such tattoos, and the ease of skin erasure for each of eight stains. Methylene blue and gentian violet are recommended as the best all-purpose marking agents. The use of proprietary inks is discouraged.

Animals↗
PubMed1987

A new surgical approach to closure of large lumbosacral meningomyelocele defects.

A new method for the reconstruction of large thoracolumbar and lumbosacral meningomyelocele defects is described in which latissimus dorsi and gluteus maximus myocutaneous units are advanced medially and reapproximated in the midline, permitting primary closure of the defect in three layers. The flaps are based on the thoracodorsal and superior gluteal vessels and the intervening thoracolumbar fascia, providing tension-free, durable, and viable soft-tissue coverage over the dural repair. No lateral relaxing incisions, delays, or skin grafts are necessary. This technique has been used successfully in the repair of nine large meningomyelocele defects, and uncomplicated wound closure was achieved in all cases. The anatomic basis, technique, advantages, and functional implications of our approach are described. The flaps described do not alter the nerve supply of the muscles and merely redefine the muscle origins; therefore, no functional deficit from the reconstructive surgery is anticipated.

Follow-Up Studies↗
PubMed1987

Severe amniotic band syndrome occurring with unrelated syndactyly.

A patient with severe amniotic band syndrome and true proximal syndactyly of the hand and foot is presented. The occurrence of these two seemingly unrelated anomalies may be pathologically linked with amniotic band syndrome in some as yet unexplained way or less likely may occur with amniotic band syndrome coincidentally.

Abnormalities, Multiple↗
PubMed1987

Sternotomy infections with Mycoplasma hominis.

Mycoplasma hominis caused sternal wound infections with mediastinitis in three patients. One infection occurred in a nonimmunocompromised man after coronary artery bypass grafting. The wound did not heal after repeated debridement, closed irrigation of the mediastinum with povidone-iodine solution, and antimycoplasmal chemotherapy; muscle flap grafting was eventually required. Two infections occurred in recipients of heart-lung transplants after the isolation of mycoplasma from bronchial secretions. Although no Mycoplasma species were isolated after specific antimycoplasmal therapy was begun, the wounds still did not heal. Both patients died of other complications. Infection of wounds after sternotomy is another of an increasing number of infections caused by M. hominis in the normal and immunocompromised host. Familiarity with the morphologic characteristics of M. hominis on bacteriologic culture media may increase the recognition of this pathogen in atypical clinical settings.

Adult↗