Biomedical subjects
Publications and source records attributed to N Zoltie.
The recovery of patients from major head and neck surgery can be compromised by severe upper gastro-intestinal complications. We present two cases with such problems and discuss the rationale for our current management of prophylaxis.
This report describes the use of tissue expansion for late reconstruction of giant exomphalos. An unexpected advantage was reconstruction of the anterior rectus sheath using the posterior capsule formed by the tissue expanders.
A simple method of protecting an exposed skin graft is presented. It is cheap, easy to use, and applicable to most sites of the body, even in areas with contours that might otherwise be thought difficult to protect.
Eighteen free flap reconstructions of acute hand trauma were compared with 12 groin flap repairs as historical controls. The free flap group had a similar success rate, with fewer operations (though the same total operating time) and shorter hospital stay than the groin flap group. Complications were the same in both groups, but less secondary procedures were necessary in the free flap group. If flap cover is necessary, free flaps are a better way of obtaining skin cover in acute hand trauma.
Thirteen digital clefts (eight patients) were reviewed in which full-thickness plantar instep skin was used in syndactyly release. The results are presented, emphasising the good colour match of plantar instep skin with digital skin. There was a surprising lack of morbidity in the thirteen donor sites.
A method of meshing large sheets of split skin using the Zimmer dermamesher with a standard carrier is described.
Four cases of malignant melanoma of eyelid skin are reported. Management of the condition is discussed, with a review of the literature. The conclusions lead us to recommend wide surgical excision for those melanomas arising on the lash margins. If the melanoma is clear of the eyelid margin, smaller margins may be adequate.
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The veno-arteriolar reflex was measured in 10 subjects in whom an area of denervated skin was present in the lower limb following free flap transfer of skin and subcutaneous tissue 3 weeks to 2 years previously. The vasoconstrictor response to dependency was measured in the skin of the flap, in adjacent innervated skin and after chemical dilatation of cutaneous vessels in the skin of the flap. This veno-arteriolar reflex resulting in a reduction of blood flow of 30-40% was present and equal in both normal and denervated skin. The response was abolished by chemical vasodilatation. The results indicate that sympathetic innervation is not essential for the veno-arteriolar reflex, and suggest that myogenic mechanisms may be more important than previously believed.
Five successful free flap transfers have been performed using the deep circumflex iliac artery system in sheep. The system is capable of providing cutaneous, myocutaneous, or osteomyocutaneous flaps, and details regarding these flaps are described.
The sheep provides a suitable model for simulation of grade III human tibial trauma. Management in humans can easily be simulated in the sheep. But variability can be controlled, and the effect of particular methods of management can be compared more accurately than in the human situation, with more scientific assessment possible.
The cosmetic end result was assessed in a small series of volar forearm donor sites taken under identical conditions. In most cases the donor site remained paler. This was cosmetically acceptable to all patients except 2 young women.
The results of 100 free microvascular transfers to the lower limb are presented. These show a high success rate with successful salvage of 95 limbs. The major complications were infection and delayed healing, osteomyelitis, and non-union. Early skin cover, within 14 days of injury, reduced the incidence of complications by half. Aggressive debridement and provision of early skin cover should be the aim of management of tibial trauma with tissue loss.
The anatomy of the a circumflexa ilium profunda supplying the flank of the sheep was investigated in 25 sheep. Two constant branches were identified by dissection and angiography, and the cutaneous areas they supply identified. The arterial system was put to two separate experimental uses successfully.
Fifteen cases of electrical burns to the hand are described resulting from the use of electric lawn-mowers. These injuries caused significant morbidity and time off work, and one death. Most of the burns appear to have been preventable, and ways of averting these injuries are discussed.
A method of repairing split earlobes preserving the hole is presented. It is simple, sound, has a good cosmetic appearance, and is more resistant to recurrence of the split than other methods.
In a prospective sequential double blind trial 288 patients with acute abdominal pain were given sublingual buprenorphine 200 mcg, sublingual buprenorphine 400 mcg, or placebo. Pain relief was proportional to the number of tablets administered; buprenorphine had no difference in effect compared to placebo. Physical signs altered in proportion to dosage, but this had no effect on clinical diagnosis. We conclude that patients with acute abdominal pain may be given buprenorphine without fear of masking the diagnosis.
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