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Biomedical subjects

N D Futran

Publications and source records attributed to N D Futran.

18 recordsLinked to original sources
PubMed1998

Preoperative color flow Doppler imaging for fibula free tissue transfers.

Fibula osteocutaneous free tissue transfer to reconstruct the oromandibular complex is a widely recommended technique following oncologic resection. Preoperative determination of adequate perfusion to the donor extremity is necessary to assure lower extremity viability after flap harvest. Vascular variations and/or peripheral arterial occlusive disease (PAOD) may exist whereby sacrifice of peroneal vessels can cause ischemia to the lower leg and foot. Additionally, variability of cutaneous perforators can make the fibula skin paddle viability unpredictable. Color flow Doppler (CFD) is a reliable modality to preoperatively assess the lower extremity in fibula osteocutaneous free tissue transfer patients. Prospective CFD examination of 38 consecutive patients (76 legs) considered for fibula free flap reconstruction was performed. A standard protocol was designed to evaluate the lower extremity vasculature and identify cutaneous perforators with CFD. Findings were studied with respect to flap choice, operative findings, and reconstruction outcomes. Number of cutaneous perforators and their impact on skin paddle design were also recorded. Color flow Doppler's ability to image peroneal vessels as well as determine collateral and distal perfusion were effective. CFD accurately identified bilateral vascular anomalies in one patient (2.6%), and significant arterial disease in three patients (7.9%). Cutaneous perforators were also accurately mapped and confirmed intraoperatively in 31 patients. In several instances, the information provided by the CFD examination altered flap selection, 4/38 patients (10.5%), or skin paddle design, 5/32 patients (15.6%). Color flow Doppler allowed successful fibula transfer in all the free flap candidates with normal exams. It has the advantages of low cost and no morbidity. CFD allows for accurate mapping of fibula cutaneous perforators which facilitates skin paddle design. We recommended the use of preoperative CFD in all patients being considered for fibular free flap surgery.

Fibula↗
PubMed1998

Reconstruction after temporal bone resection.

Reconstruction of soft tissue defects after temporal bone resection can vary from simple closure of the external auditory canal to complex flap coverage of extensive defects. Between 1987 and 1996, 34 patients underwent lateral skull base resections and reconstruction for invasive carcinoma of the temporal bone. Seven underwent sleeve resection and/or radical mastoidectomy. Sleeve resection was managed with tympanoplasty, canalplasty, or obliteration of the external auditory canal (10). There were 24 lateral temporal bone resections and four subtotal temporal bone resections. Larger defects created by lateral and subtotal temporal bone resections required closure with a combination of temporalis flaps and local rotational cutaneous flaps (13). Lower island trapezius flaps (five), free flaps (four), and pectoralis major flaps (two) were also used. Indications and efficacy of each method are discussed, and treatment outcomes are presented.

Adult↗
PubMed1998

Spectral analysis of photoplethysmograms from radial forearm free flaps.

OBJECTIVE: Photoplethysmography utilizes a green-light-emitting diode to transmit light into a tissue. Reflected light from hemoglobin in dermal capillary red blood cells is received by a photo detector and is analyzed as light intensity along a frequency spectrum. This method of analysis allows for the removal of "noise" above (stray light and alternating current [AC]) and below (room vibrations and respiratory motion) the peak signal (1 to 2 Hz) and results in a means to distinguish between perfused and nonperfused tissues. METHODS: Twenty-two of 30 consecutive radial forearm free flap (RFFF) patients were enrolled in an approved human studies protocol to collect descriptive data for RFFFs that were perfused, arterial occluded, and venous occluded. The protocol was performed following completion of flap elevation and prior to pedicle ligation, flap inset, and microvascular anastomoses. Six 90-second measurements per flap were obtained (n = 132), processed by fast Fourier transform (FFT), and analyzed by blinded reviewers to determine their state of perfusion. Signal was collected 5 minutes after the onset or release of individual vessel occlusion. RESULTS: The reviewers' interpretations were compared with the status of the pedicle and analyzed for sensitivity (0.96), specificity (0.95), and positive predictive value (0.98). CONCLUSIONS: FFT analysis of photoplethysmograms from RFFF patients provides an accurate and rapid means for determining RFFF pedicle vessel patency. Photoplethysmography may provide a clinically useful tool for postoperative perfusion monitoring of free flaps in the future.

Equipment Design↗
PubMed1997

Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx. Free vs pedicled soft tissue transfer.

OBJECTIVE: To compare the cost and functional results of free and pedicled soft tissue reconstruction after posterior oral cavity and oropharyngeal extirpation. DESIGN: Retrospective study of 53 consecutive patients undergoing extirpation with primary soft tissue reconstruction from January 1, 1991, to December 31, 1995. Median follow-up was 298 days. SETTING: Academic tertiary care medical center. INTERVENTION: Twenty-four patients underwent reconstruction with a pedicled pectoralis major myocutaneous flap (PMMF); 29 patients, with a fasciocutaneous free flap (FF) (27 radial forearm, 1 lateral arm, and 1 scapular). MAIN OUTCOME MEASURES: Direct (inpatient hospital resources used and monetary costs) and intangible (post-operative complications and function) costs. RESULTS: Operative time was longer for FF reconstructions (P = .003), but both patient groups had similar intensive care unit and hospital stays. Treatment cost for FF reconstructions was $41,122, compared with $37,160 for PMMF reconstructions (P = .003). This difference was due to increased professional fees for FF reconstruction (P < .001) which was offset by intangible cost differences. The PMMF group tended toward an increased rate of flap-related complications, compared with the FF group. At last follow-up, 4 patients in the FF group (15%) and 3 in the PMMF group (15%) had their tracheotomy. In contrast, 17 (85%) patients in the PMMF group and 11 (39%) patients in the FF group required enteral tube feedings (P = .002). Also, 18 (64%) patients in the FF group were eating at least a soft diet compared with 6 (30%) patients in the PMMF group (P = .02). CONCLUSIONS: Comparison of direct costs reveals only a modest difference in reconstruction costs that is outweighed by the intangible costs of PMMF reconstruction. The functional benefits of FF reconstruction appear to justify its slight increased expense and its use rather than PMMF reconstruction after extirpation in the posterior oral cavity and oropharynx.

Adult↗
PubMed1997

Use of color Doppler flow imaging for preoperative assessment in fibular osteoseptocutaneous free tissue transfer.

Fibular osteocutaneous free tissue transfer represents state-of-the-art reconstruction of the oromandibular complex after oncologic resection. Because the blood supply of the fibular flap is based on the peroneal artery and venae comitantes, it is essential to determine preoperatively whether adequate perfusion to the donor extremity will persist after sacrifice of the peroneal pedicle. Vascular variations or peripheral arterial occlusive disease may exist whereby sacrifice of peroneal vessels can cause ischemia of the lower leg and foot. Therefore, angiography of the lower extremity and magnetic resonance angiography have been advocated to determine the arterial supply to the lower leg. Though accurate, these examinations carry risk for morbidity, and both are expensive. Color Doppler flow imaging is a noninvasive ultrasound examination used to measure antegrade and retrograde blood flow. We prospectively evaluated color Doppler flow imaging as a means of preoperative evaluation of the lower extremity for candidates for fibular flaps. Ability to image peroneal vessels and to determine collateral and distal perfusion were evaluated. The patients were compared with a control group of patients with peripheral arterial occlusive disease. Color Doppler flow imaging provided accurate hemodynamic information for all patients and allowed successful fibular transfer for all patients who received free flaps. The modality is comparable in accuracy with the angiography of the lower extremity and magnetic resonance angiography and has the advantages of low cost and no morbidity.

Angiography↗
PubMed1997

Pentoxifylline in the treatment of radiation-related soft tissue injury: preliminary observations.

Soft tissue or mucosal injuries following radiotherapy of head and neck cancer include ulceration (necrosis), fibrosis, pain, and atrophy. Current management includes analgesics, wound debridement, antibiotics, and physical therapy depending on the type of injury. Pentoxifylline is a methylxanthine derivative that produces dose-related hemorrheologic effects, lower blood viscosity, improved erythrocyte flexibility, and increased tissue oxygen levels. Twenty-six patients with late radiation complications (occurring more than two months after x-ray therapy) were given treatment with oral pentoxifylline: 15 for soft tissue necrosis (STN), six for fibrosis, and five for mucosal pain. Nine of 12 patients with STN completely healed. In all three failures osteoradionecrosis developed. Mucosal pain resolved in all five patients. Fibrosis improved in 67% of those patients. Pentoxifylline appears to accelerate healing of STN and reverse some late radiation injuries. This is the first series to our knowledge that documents activity of this agent in moderate radiotherapy complications such as fibrosis, pain, or mucosal fragility.

Administration, Oral↗
PubMed1996

The effect of topical vasodilating agents on microvascular vessel diameter in the rat model.

Topical vasodilating agents maximize blood flow and prevent vasospasm in microvascular tissue-transfer procedures. Two commonly used agents are papaverine and lidocaine. Although these drugs have vasodilating properties, no studies have directly compared their vasodilating abilities in a controlled, in vivo model. We used videomicroscopy and direct microscopic measurements to compare the vasodilating capacity of papaverine, 1% lidocaine, and saline solution in the femoral artery of Sprague-Dawley rats. Degree of maximum dilation, ability to sustain dilation, average dilation over a 10-minute period, and time to achieve maximum dilation were considered. Both papaverine and lidocaine were found to be superior to saline solution as vasodilating agents. Papaverine was found to sustain vasodilation longer than lidocaine, suggesting that it is a superior vasodilating agent in microvascular anastomoses.

Administration, Topical↗
PubMed1996

Closure of the fibula free flap donor site with the Sure-Closure skin-stretching device.

Fibula osseocutaneous free tissue transfer represents state-of-the-art reconstruction of the oromandibular complex following oncologic resection. The width of the fibula skin paddle is usually limited by the ability to achieve primary wound closure. In some cases the donor site requires skin grafting and subsequent surgical procedures to achieve effective closure, or placement of a tissue expander. The recent development of an indexed tissue advancement system (Sure Closure) makes it possible to take advantage of the viscoelastic properties of skin to close large wound deficits in a single procedure. The system secures and brings together wound edges by applying graduated pressure with a metered force approximator. A series of 12 fibula osseocutaneous free flap defects is presented, which have been successfully closed using this simple, convenient, and safe device.

Bone Transplantation↗
PubMed1995

Rigid fixation of vascularized bone grafts in mandibular reconstruction.

OBJECTIVE: To evaluate the nature of complications and complication rates with the use of three different reconstruction plates for the rigid fixation of vascularized bone grafts in oromandibular reconstruction. DESIGN: We conducted a case series of 95 patients over a 6-year period, with a minimum follow-up of 6 months and a maximum follow-up of 66 months. SETTING: Academic tertiary referral medical center. PATIENTS: Forty-eight patients had vascularized bone grafts fixated to native mandible with AO stainless steel reconstruction plates; 25 patients, with AO titanium plates; and 22 patients, with titanium hollow screw reconstruction plates (THORPs). Types of vascularized flaps, mandibular defects to be reconstructed, and use of radiation therapy were similar among the three groups. INTERVENTION: The surgical approach involved oromandibular reconstruction with a vascularized bone graft rigidly fixated with a reconstruction plate. OUTCOME MEASURES: Clinically and radiographically noted complications and resultant treatment. RESULTS: In the grafts fixated with AO stainless steel reconstruction plates, three plate fractures, seven instances of loose screws, eight plate exposures, and two cases of nonunion occurred. No cases of plate fracture or nonunion occurred in the titanium or THORP groups. One titanium plate and two THORPs were exposed during the study period. One instance of loose screws occurred in the titanium group; none in the THORP group. Seventy-four percent of those complications occurred within 12.4 months (the mean follow-up time of the THORP group). The incidence of complications in the stainless steel group was significantly greater than that in the titanium or THORP groups. No statistically significant increase in the rate of complications was noted when radiation therapy was used as a component of treatment. CONCLUSIONS: To our knowledge, this is the first study to compare three different reconstruction plates for fixation in vascularized bone reconstruction of the mandible. AO THORPs are now used almost exclusively to rigidly fixate vascularized bone grafts because of their advanced design and their potential for osseointegration and because fewer screws are necessary to attain adequate fixation than with conventional AO reconstruction plates.

Adult↗
PubMed1995

Signal averaging and waveform analysis of laser Doppler flowmetry monitoring of porcine myocutaneous flaps: I. Acute assessment of flap viability.

Postoperative monitoring of microvascular free-tissue transfer is essential to the early identification and correction of vascular compromise. Laser Doppler flowmetry is a noninvasive monitor of capillary bed perfusion. Its current clinical use requires continuous monitoring and trend analysis to detect changes in capillary perfusion. This study investigated the hypothesis that signal averaging of laser Doppler flowmetry output triggered by a fixed point in the cardiac cycle would provide accurate information about the microvascular flow patterns not dependent on trend analysis. These results indicate that averaged waveform analysis allowed for a rapid, objective, and statistically significant distinction between a viable myocutaneous flap and one with vascular compromise in a porcine model. Moreover, this technique allows for distinction between venous and arterial insufficiency.

Animals↗
PubMed1993

Eye banking: techniques for eye preservation in selected neoplasms encroaching on the globe.

Removal of the globe and associated structures has been advocated for tumors invading the periorbital bone and periosteum, orbital fat, or extraocular muscles. In some patients with cancerous tumors encroaching on the globe, however, it may be possible to remove the tumor and save the eye. Tenon's fascia is a firm fibrous sheath surrounding the entire globe except the cornea. If the neoplasm spreads along fascial planes rather than through them, and if this layer remains free of tumor involvement, preservation of the globe can be considered. Oculoplastic reconstructive techniques may limit exposure and diplopia, allowing the eye to be "banked" in vivo, and saved as a spare for the future. Six patients with malignant tumors encroaching on the globe have had definitive surgical extirpation with preservation of the eye. Three patients have had the globe uncovered successfully. Five of six patients remain disease-free, with followup from 6 months to 6 years. No globes have been removed. These techniques appear to be therapeutically sound, preserve function and appearance, and improve patient morale. The indications and limitations of this approach to certain cases of periorbital cancer are discussed.

Aged↗
PubMed1993

The safety and efficacy of bedside tracheotomy.

Many institutions require that tracheotomies be performed in the operating room. Movement of critically ill patients dependent on multiple life support systems is technically difficult, labor intensive, and potentially dangerous for the patients. Between 1983 and 1992, 1088 tracheotomies were performed on patients ages 1 week to 94 years at the University of Rochester affiliated hospitals on critically ill patients as isolated procedures. The procedure was performed in the Intensive Care Units (ICU) on 996 patients, (92.9%), whereas 92 patients (7.1%) had tracheotomies in the operating room (OR1). An additional 346 tracheotomies took place in the operating room in conjunction with other head and neck procedures (OR2). Incidence of perioperative bleeding (within 48 hours) was 2.3% in the ICU group, 2.1% in the ORI group, and 2.0% in the OR2 group. Incidence of stomal infection was also similar among the three groups at 1.8%, 2.1%, and 1.5%, respectively. Tube dislodgement in all groups was a complication. No statistical differences were noted among the three groups (ICU, OR1, OR2) at the p < 0.01 level. Criteria for performing the tracheotomy in the ICU are delineated and discussed.

Adolescent↗
PubMed1993

Effects of cyanoacrylate tissue adhesives on cartilage graft viability.

Cartilage graft fixation using cyanoacrylate tissue adhesives has aided in the accuracy and stability of these grafts in facial reconstructive procedures. To objectively determine how these adhesives affect cartilage viability, freshly harvested cartilage from septoplasty procedures was bonded in vitro with one of four cyanoacrylate adhesives: Histoacryl, Bucrylate, Krazy Glue, or Eastman 910 monomer. Viable chondrocytes will incorporate the sulfur-35 (35S) isotope in the synthesis of chondroitin sulfate, and is therefore a reliable test of cartilage viability. The bonded cartilage specimens were stored from 3 days to 4 weeks at 4 degrees C and then were incubated with the 35S isotope. Autoradiographs were made and the sections were counterstained. Throughout the study period, there was no statistical difference in the viability of Histoacryl-bonded specimens as compared to the controls. Specimens bonded with Bucrylate, Krazy Glue, and Eastman 910 monomer statistically demonstrated markedly less viability compared to those bonded with Histoacryl at the P = .01 level of significance. Further, the cartilage separated from these latter adhesives at the longer study times, most likely secondary to cartilage devitalization. Histoacryl optimizes graft viability as compared to these other available cyanoacrylate tissue adhesives in vitro.

Autoradiography↗
PubMedDate not supplied

Single versus dual venous drainage of the radial forearm free flap.

PURPOSE: To compare single versus dual venous drainage of radial forearm free flaps (RFFF) and its impact on flap survival. DESIGN: A retrospective case series of 43 consecutive patients undergoing radial forearm free flap reconstruction for head and neck cancer defects, combined with a meta-analysis of 218 reported cases. SETTING: Two academic, tertiary referral medical centers. INTERVENTION: All 43 RFFF's were harvested and inset in a similar fashion. In 16 patients (group 1), two venous anastomoses were performed. In 27 patients (group 2) one anastomosis was created. The arterial anastomosis was similar in both groups. OUTCOME MEASURES: Clinically noted viability of the radial forearm free flap over the first 6 postoperative weeks. RESULTS: All 43 RFFFs maintained complete viability. No flap loss, complete or partial, was identified. Two patients in group 1 and one patient in group 2 developed postoperative pharyngocutaneous fistulae, but complete healing occurred with local wound care. One patient in group 2 developed a postoperative neck hematoma, which was evacuated with no insult to the free flap. Single venous anastomosis shortened operative time by 21 to 36 minutes. CONCLUSION: Though two venous anastomoses may provide a more fail-safe mechanism for adequate venous drainage, a single venous anastomosis employing a subcutaneous vein provides adequate drainage with reduced operative time and no additional morbidity. Meta-analysis statistically confirmed the equivalency of single and dual venous anastimoses (correction of amastimoses) with respect to flap survival.

Adult↗