Biomedical subjects

N E Hugo

Publications and source records attributed to N E Hugo.

12 recordsLinked to original sources

PubMed1992

The effect of fibrin glue on skin grafts in infected sites.

Fibrin bonding of skin grafts to wounds is an essential part of the graft-adherence process. Bacteria, in concentrations greater than 10(5)/gm of tissue, are associated with graft failure. Sixty-five rats were randomly divided into three groups, dorsal split-thickness skin grafts were harvested, and the sites were inoculated with Staphylococcus aureus. After incubation, each wound was quantitatively biopsied and treated with saline, fibrin glue with aprotinin, or fibrin glue alone. We found that the addition of commercially available fibrin glue with or without the antifibrinolytic agent aprotinin is capable of restoring graft adherence to normal levels in graft sites infected with greater than 10(5) bacteria/gm of tissue. Fibrin glue may have potential for increasing skin-graft take in the clinical situation where the graft bed is infected.

Animals↗

PubMed1992

When does a random flap die?

A random flap can be constructed, its circulation determined, and the ischemic portion identified. Left untreated for a period, the critical ischemia time, the ischemic portion will die and is clinically recognized several days later. What is not known is when this tissue, destined to die, actually dies. To ascertain this time, we compared the percent necrosis of a distal 3 x 3 cm segment of a 10 x 3 cm reverse McFarlane random flap with a known distribution of necrosis to the percent necrosis of the distal 3 x 3 cm of full-thickness skin grafts taken from a similar reverse McFarlane flap at 0, 4, 8, 12, and 16 hours after pedicle construction. Implicit in this experiment is the assumption that necrosis of the full-thickness skin grafts in excess of that of control animals represented skin no longer viable. Sometime between 8 and 12 hours, the percent necrosis of the full-thickness skin grafts surpassed that of the control, and it was concluded that this graft was dead prior to grafting. Thus it is suggested that critical ischemia time and death of the flap tissue are nearly identical, and the latter occurs at between 8 and 12 hours.

Animals↗

PubMed1991

Perforation of the hard palate associated with cocaine abuse.

Cocaine abuse is associated with serious systemic complications. Snorting cocaine can also cause complications of the nasopharyngeal structures. Repeated episodes of vasoconstriction and subsequent ischemia may cause this destruction. We present a patient with perforation of the nasal septum and palate and collapse of the nasal dorsum. The destroyed anatomy was reconstructed by using standard surgical techniques. Palatal destruction is a rare entity and, to our knowledge, this patient is the first reported patient with palatal destruction due to cocaine insufflation.

Adult↗

PubMed1991

Skin closure with dye-enhanced laser welding and fibrinogen.

The topical application of wavelength-specific dye and fibrinogen has been used to enhance laser closure of vascular anastomoses. We compared the closure of skin incisions by two different dye-enhanced, fibrinogen-based laser welding systems [argon laser (power density 4.78 W/cm2) with fluorescein isothiocyanate dye (n = 32) and diode laser (power density 9.55 W/cm2) with indocyanine green dye (n = 32)] with closure by interrupted 5-0 nylon suture (n = 64) and examined tensile strength, hydroxyproline production, histology, and cosmesis. Two 3-cm full-thickness incisions were made on the shaved backs of 64 rats. One incision was closed with suture, whereas the other, after treatment with the appropriate dye, was welded with either argon- or diode-lasered fibrinogen. At postoperative days 5, 10, 15, and 28, the closure sites were harvested and sectioned for analysis. Initially, wounds closed with argon-lasered fibrinogen showed less inflammatory response, greater collagen production (34.61 +/- 0.74 mg/gm), and greater mean peak stress at rupture (64.85 lbs/in2) than those closed with suture (16.42 +/- 3.20 mg/gm, 26.68 lbs/in2) (p less than 0.05). By 15 days, both argon and diode laser closures are superior in strength and collagen production to suture closure (p less than 0.05). At 28 days, diode laser closures (1315.60 lbs/in2) are stronger than suture closures (998.09 lbs/in2), whereas both are stronger than argon laser closures (813.16 lbs/in2) (p less than 0.05). Cosmetically, argon-welded wounds consistently appeared finer and lacked cross-hatched suture scars.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

PubMed1990

Clinical experience with immediate breast reconstruction using tissue expansion or transverse rectus abdominis musculocutaneous flaps.

We retrospectively reviewed our experience with immediate breast reconstruction in 103 consecutive patients with stage 0 or I breast carcinoma between May 1983 and April 1988. Two reconstructive techniques were used, that is, either tissue expansion with secondary prosthesis implantation (60%) or transverse rectus abdominis musculocutaneous (TRAM) flap (40%). Chemotherapy was administered in 22% of patients without delay or compromise. The mean length of follow-up is 30 months. The complication rate was equal for both groups (24%) with infection being most common in the group of patients with tissue expansion and partial flap necrosis being most common in the group of patients with TRAM flaps. Aesthetic results were superior with use of the TRAM flap. Our experience concurs with previous reports that documented satisfactory results with immediate breast reconstruction without compromising further therapy. We conclude that although the tissue expansion technique yields acceptable results, the TRAM flap yields superior aesthetic results in terms of both appearance and consistency.

Abdominal Muscles↗

PubMed1990

Mammary hypertrophy is not associated with increased estrogen receptors.

Estrogen promotes secondary female sex characteristics, including breast enlargement. Since excessive breast hypertrophy is unrelated to elevated serum estrogen levels, it has been postulated that the enlarged breast is a hypersensitive "target organ." At the cellular level, estrogen crosses the cell membrane, is bound to a cytoplasmic estrogen receptor (ER), and induces the formation of specific anabolic proteins. In breast cancer, this estrogen receptor is regarded as a measure of the sensitivity of the cell to estrogen. To determine if mammary hypertrophy is related to an increase in the number of estrogen receptors, we assayed breast tissue, not fat, from 25 consecutive breast reductions. The median age of patients was 26 years (17 to 77 years), with 752 gm per breast removed on average. Twenty-four percent of the patients were taking estrogens, primarily birth control bills. Cellular estrogen-receptor status was measured by a standardized cytosol extraction radioactive estradiol technique. Estrogen receptors were undetectable (less than 3 fmol/mg cytosol protein) in all patients. We conclude that estrogen receptors alone, and hence estrogen, are not a determinant in mammary hypertrophy. If the enlarged breast is a "target organ," it is by another mechanism.

Adult↗

PubMed1990

Single-stage management of sternal wound infections.

Deep median sternotomy wound infection is a significant source of morbidity after cardiac operations. Accepted approaches in treating this complication include débridement with either sternal closure over an irrigation system or open dressings and closure by secondary intention. Muscle flaps are often used in subsequent procedures for wound closure. A single-stage procedure was developed to eliminate irrigation, open wound management, or reoperation for muscle flap closure. This approach consists of débridement and immediate closure with a pectoral musculocutaneous flap. The following report describes 31 patients treated by such a method. Compared with results of previous techniques in treating sternal wound infections, hospital study is decreased, fewer reoperations are needed, and patient management is simplified.

Cardiac Surgical Procedures↗

PubMed1989

Fluorometric analysis of an attempt to reclaim ischemic flaps in rats with Fluosol.

An experiment was designed to answer two questions as they apply to random skin-flap survival: Is there a therapy that can improve random skin-flap survival when given postoperatively? And if so, when does one start such a therapy? Fluosol-DA 20% (Fluosol) has increased random skin-flap survival when given preoperatively in our laboratory. An experiment was devised to see if it could rescue failing flaps. One-hundred Sprague-Dawley rats were divided into a control (N = 25) and five experimental groups (N = 15). All had 10 X 13 cm reverse McFarlane random flaps raised and reinset. The experimental groups underwent hemodilution with either Ringer's lactate or Fluosol at 4, 8, and 12 hours after flap elevation. All were kept in 50% oxygen for 72 hours postoperatively. The flaps and their corresponding necrotic areas were measured on day 7. As to when to institute a therapy, we simultaneously evaluated the use of a microfluorometer as a monitor of flap survival. Analysis of flap survival showed little difference between control and experimental Ringer's lactate or Fluosol groups. Analysis of the microfluorometric data led to the following points. First, as a monitor of flap viability, it is limited by a lack of specificity and sensitivity. Second, comparison of the data from portions of the flap destined to live with those destined to die suggests that it may not be failure of circulatory inflow that leads to flap death.

Animals↗

PubMed1988

Augmentation mammaplasty by cadaver fat allografts.

Two Soviet women were treated for complications of breast hardening and tenderness following augmentation mammaplasty using cadaver fat allografts. The cadaver fat grafts were excised and replaced with silicone-gel prostheses in the submammary pockets. The implants were found to contain necrotic fat tissue with areas of fibrosis and calcification; however, no signs of rejection were evident. Both patients had a successful postoperative outcome.

Adipose Tissue↗

PubMed1987

Use of computer analysis in flap research.

A computer based analysis of survival of experimental rat skin flaps is presented. The two commonly used experimental flaps, the modified McFarlane dorsal skin flap and the ventral skin flap, are compared. The analysis of the data showed that although the McFarlane flap is random, and the ventral flap based on one epigastric vascular bundle is both axial and random, there was no statistically significant difference in the percent of survival of these flaps. The advantages of the computer based method are discussed.

Animals↗

PubMed1979

Reduction mammaplasty with a single superiorly-based pedicle.

We have reduced 68 breasts in 34 women, transposing the nipple-areolar complex on a single superiorly-based pedicle. The complication rate was 4.4 percent. The method appears to be safe, and it produces better shaped breasts than we obtained by operations using double pedicles.

Adolescent↗

PubMed1978

Irradiation-induced polyglandular neoplasia of the head and neck.

Eighteen patients are presented with twenty-one tumors of the head and neck, which include ten salivary gland tumors and eight parathyroid adenomas. Eight of the patients also had thyroid neoplasms. All patients had a history of prior irradiation to the head and neck. Seventy per cent of the salivary gland tumors and 37 per cent of the thyroid tumors were malignant. Recommendations are made for detection and treatment.

Acne Vulgaris↗