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Biomedical subjects

P G Arnold

Publications and source records attributed to P G Arnold.

At least 19 recordsLinked to original sources
PubMed2000

Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy.

CONTEXT: Prophylactic mastectomy is a preventive option for women who wish to reduce their risk of breast cancer. There has been concern about possible negative psychological sequelae following this procedure. However, few data are available regarding long-term satisfaction and psychological and social function following this procedure. OBJECTIVE: To evaluate patients' long-term satisfaction and psychological and social function following prophylactic mastectomy. DESIGN, SETTING, AND PARTICIPANTS: Descriptive study of all women known to be alive (n = 609) who had a family history of breast cancer and elected to undergo bilateral prophylactic mastectomy at a large, tertiary US health care clinic between 1960 and 1993, 94% (n = 572) of whom completed a study questionnaire. MAIN OUTCOME MEASURES: Satisfaction with procedure and effects on psychological and social function, based on responses to the study-specific questionnaire. RESULTS: Mean time from prophylactic mastectomy to last follow-up was 14.5 years. Most women (70%) were satisfied with the procedure; 11% were neutral; and 19% were dissatisfied. Among the psychological and social variables, the most striking finding was that 74% reported a diminished level of emotional concern about developing breast cancer. The majority of women reported no change/favorable effects in levels of emotional stability (68%/23%), level of stress (58%/28%), self-esteem (69%/13%), sexual relationships (73%/4%), and feelings of femininity (67%/8%). Forty-eight percent reported no change in their level of satisfaction with body appearance; 16% reported favorable effects. However, 9%, 14%, 18%, 23%, 25%, and 36% reported negative effects in these 6 variables, respectively. CONCLUSIONS: This study suggests that positive outcomes following prophylactic mastectomy include decreased emotional concern about developing breast cancer and generally favorable psychological and social outcomes. These must be weighed against the irreversibility of the decision, potential problems with implants and reconstructive surgery, and occurrence of adverse psychological and social outcomes in some women. JAMA. 2000;284:319-324

Adaptation, Psychological↗
PubMed1999

Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer.

BACKGROUND: Options for women at high risk for breast cancer include surveillance, chemoprevention, and prophylactic mastectomy. The data on the outcomes for surveillance and prophylactic mastectomy are incomplete. METHODS: We conducted a retrospective study of all women with a family history of breast cancer who underwent bilateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. The women were divided into two groups - high risk and moderate risk - on the basis of family history. A control study of the sisters of the high-risk probands and the Gail model were used to predict the number of breast cancers expected in these two groups in the absence of prophylactic mastectomy. RESULTS: We identified 639 women with a family history of breast cancer who had undergone bilateral prophylactic mastectomy: 214 at high risk and 425 at moderate risk. The median length of follow-up was 14 years. The median age at prophylactic mastectomy was 42 years. According to the Gall model, 37.4 breast cancers were expected in the moderate-risk group; 4 breast cancers occurred (reduction in risk, 89.5 percent; P<0.001). We compared the numbers of breast cancers among the 214 high-risk probands with the numbers among their 403 sisters who had not undergone prophylactic mastectomy. Of these sisters, 38.7 percent (156) had been given a diagnosis of breast cancer (115 cases were diagnosed before the respective proband's prophylactic mastectomy, 38 were diagnosed afterward, and the time of the diagnosis was unknown in 3 cases). By contrast, breast cancer was diagnosed in 1.4 percent (3 of 214) of the probands. Thus, prophylactic mastectomy was associated with a reduction in the incidence of breast cancer of at least 90 percent. CONCLUSIONS: In women with a high risk of breast cancer on the basis of family history, prophylactic mastectomy can significantly reduce the incidence of breast cancer.

Adolescent↗
PubMed1999

Early and long-term results of prosthetic chest wall reconstruction.

OBJECTIVE: The purpose of this report is to evaluate our results in patients who underwent prosthetic bony reconstruction after chest wall resection. METHODS: We retrospectively reviewed all patients who underwent chest wall resection and reconstruction with prosthetic material at the Mayo Clinic. RESULTS: From January 1, 1977, to December 31, 1992, 197 patients (109 male patients and 88 female patients) underwent chest wall resection and reconstruction with prosthetic material. Median age was 59 years (range, 11-86 years). The indication for resection was recurrent chest wall malignancy in 65 patients (33.0%), primary chest wall malignancy in 62 patients (31.5%), contiguous lung or breast carcinoma in 58 patients (29.4%), and other reasons in 12 patients (6.1%). Three patients (1.5%) each had an open draining wound. This review covers 2 time periods. Sixty-four patients (32.5%) underwent reconstruction with polypropylene mesh during the period from 1977 to 1986. One hundred thirty-three patients (67.5%) underwent reconstruction with polytetrafluoroethylene from 1984 to 1992. Soft tissue coverage was achieved with transposed muscle in 116 patients (58.9%), local tissue in 81 patients (41.1%), and omentum in 3 patients (1.5%). There were 8 deaths (operative mortality rate, 4.1%). Ninety-one patients (46.2%) experienced complications. Seromas occurred in 14 patients (7.1%). Wound infections occurred in 9 patients (4.6%; 5 patients with polypropylene mesh and 4 patients with polytetrafluoroethylene). The prosthesis was removed in all 5 patients with polypropylene mesh and in none of the patients with polytetrafluoroethylene. Follow-up was complete in 179 operative survivors (94.7%) and ranged from 1 to 204 months (median, 26 months). A well-healed asymptomatic wound was present in 127 patients (70.9%). CONCLUSIONS: Chest wall resection and reconstruction with prosthetic material will yield satisfactory results in most patients. Little difference exists between polypropylene mesh and polytetrafluoroethylene.

Adolescent↗
PubMed1999

Care of the degloved penis and scrotum: a 25-year experience.

Injuries to the penis and scrotum are both physically and mentally traumatic. If poorly managed in the acute setting, these injuries may become long-term problems or permanent disabilities. The purpose of this study was to review our approach to degloving injuries of the penis and scrotum and to present our experience. Over the past 25 years, we have cared for eight patients with complete degloving injuries of the genitalia. Farm equipment accidents were responsible for the majority of injuries. We attempted to close all wounds of the denuded penis and near-total avulsed scrotum at the initial operative intervention using the method of repair described. Postoperatively, all patients had an acceptable appearance and normal mictural and erectile function. We conclude that degloving injuries of the penis and scrotum can be best treated with this approach definitively in the acute setting with successful functional and aesthetic results.

Adult↗
PubMed1999

Muscle flaps in osteomyelitis of the lower extremity: a 20-year account.

Between 1977 and 1993, 64 patients had local muscle flap transposition as an integral portion of treatment for lower-extremity osteomyelitis. All muscle flaps were performed by a single surgeon. There were 54 men and 10 women with an average age of 45 years (range, 16 to 87 years). Median follow-up period was 9.3 years (range, 5 to 21 years). The muscles used included medial gastrocnemius (n = 28), soleus (n = 19), lateral gastrocnemius (n = 13), and peroneus tertius (n = 1). At final follow-up, the recurrence free rates at 5, 10, and 15 years were 94, 92.5, and 86 percent, respectively. These long-term results support the use of local muscle flap transposition as an important management method in the treatment of lower extremity osteomyelitis; however, the risk of treatment failure may arise after extended periods of time.

Female↗
PubMed1997

Chest wall reconstruction.

Chest wall resection and reconstruction continue to provide a formidable challenge. Prolonged hospitalization of 2 to 3 weeks in often necessary, and patients at our institution have undergone an average of two operations to achieve final closure. However, in multiple reviews of the senior author's personal experience, 85% of patients alive 30 days after operation had a healed, asymptomatic chest wall. Most late deaths occur as a result of the underlying disease process, usually malignancy.

Female↗
PubMed1996

Chest-wall reconstruction: an account of 500 consecutive patients.

Our experience with 500 consecutive chest-wall reconstructions over the past 18 years is reviewed. Of the 500 patients, 286 were male and 214 were female. Their ages ranged from 1 day to 85 years (average 55 years). Among the patients, 275 had chest-wall tumors, 142 had infected median sternotomies, 119 had radiation necrosis, and 121 had combinations of the three. Skeletal resection of the chest wall was done in 443 patients. An average of 3.9 ribs were resected in 241 patients. Total or partial sternectomies were performed in 231 patients. Four-hundred and seven patients underwent 611 muscle flaps: 355 pectoralis major, 141 latissimus dorsi, and 115 others, including serratus anterior, rectus abdominis, and external oblique. The omentum was transposed in 51 patients. Chest-wall skeletal defects were closed with polytetrafluoroethylene soft-tissue patch in 116 patients, polypropylene mesh in 55, and autogenous rib in 13. The 500 patients underwent an average of 2.3 operations. Hospitalization averaged 21 days. There were 15 perioperative deaths. Twenty-three patients required tracheostomy. The average duration of follow-up was 57 months. There were 229 late deaths; the cause of death was cancer in 147 patients, cardiac in 49, pulmonary in 7, and other in 26. Four-hundred and three of the 485 patients (83.1 percent) who were alive 30 days after the operation had excellent results and had a healed, asymptomatic chest wall at the time of death or last follow-up. We conclude that chest-wall reconstruction is safe, durable, and associated with long-term survival.

Adolescent↗
PubMed1994

The effect of smoking on muscle transposition.

Smoking has been shown to be a complicating factor in normal wound healing. Both nicotine and carbon monoxide adversely affect multiple stages of the healing process. From 1976 to 1990, 1034 muscle flap procedures were performed on 722 patients on a single surgical service. A retrospective review of 300 patients completed; patients were divided into three groups: group 1, no smoking history; group 2, smokers for at least 10 pack/years but had quit for at least 1 year; and group 3, active smokers at the time of surgery. Patients were omitted who had diabetes, had received radiation therapy or chemotherapy, had a recurrent malignancy, or used steroids. A total of 300 consecutive patients were entered into the study. Active smokers were shown to have a complication rate significantly higher in the immediate postoperative period compared with nonsmokers and smokers who had quit. The most common complications were partial muscle necrosis and partial skin graft loss. This series suggests that active smoking at the time of muscle transposition significantly increases the rate of postoperative complications.

Humans↗
PubMed1994

Muscle-flap coverage for infected peripheral vascular prostheses.

Infection in a peripheral vascular prosthesis continues to be a serious complication in arterial reconstructive surgery and threatens the patient with loss of either limb or life. Infection rates at major centers are now low, ranging from 1 to 6 percent; however, limb loss and mortality rates for this complication range from 25 to 75 percent depending on the location of the graft and the extent of the infection. The use of muscle flaps in the management of acute wounds, infection-prone wounds, exposed orthopedic hardware, and osteomyelitis is now commonplace. Transposed muscle has been shown to be well-vascularized tissue that improves healing time and decreases local wound bacterial counts. After considering the preceding facts, we used muscle flaps for coverage of infected peripheral vascular prostheses in a highly select group of patients. These patients were "end of the line," and last-ditch efforts were made to salvage life or limb. Twenty-four infected vascular grafts in 20 patients have been analyzed. Ages ranged from 52 to 87 years. All patients had grade 3, stage I, II, or III peripheral graft infections, as previously defined by Szilagyi and modified by vonDongen. Aortofemoral reconstruction was the most common initial bypass procedure (14), followed by femoral popliteal (6), axillofemoral (2), iliofemoral (1), and subclavian/subclavian bypass (1). Staphylococcus aureus was the most common infecting organism. Muscles used for coverage were the rectus femoris (13), the sartorius (9), the rectus abdominis (1), and the pectoralis major (1). The graft material was composed of Dacron in 16 instances and polytetrafluoroethylene in 8.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Muscle flaps in irradiated wounds: an account of 100 consecutive cases.

Radiation-related wounds challenge surgeons in all disciplines of surgery. Wound-healing complications are commonplace, and solutions for reconstruction are limited. Muscle and musculocutaneous flaps have improved this situation. We ask the question, Does previous radiation of the muscle to be transposed affect the outcome? One hundred consecutive previously irradiated wounds closed with muscle or musculocutaneous flaps composed the group under consideration. These 100 patients had 151 muscles transposed. The overall complication rate for muscle transposition to close a radiated wound was 25 percent. Of the 100 patients who received radiation, 43 patients had the muscle transposed for wound closure from the primary field of radiation. Fifty-seven patients were closed with nonirradiated muscle. When the transposed muscle had been radiated, the complication rate was 32 percent; in 14 percent, the entire muscle died, requiring total removal and a second tissue transposition from a nonirradiated source to achieve closure. The subgroup using nonirradiated muscle had a complication rate of 19.3 percent; no patient in this group had complete flap death requiring a second tissue transposition. Two postoperative deaths, one in each group, unrelated to the operative procedure were recorded. We feel that nonirradiated muscle is the best choice for closure of a radiated wound, if possible.

Humans↗
PubMed1993

Management of intrathoracic defects.

Most intrathoracic transpositions involve the serratus anterior, pectoralis major, and latissimus dorsi muscles. These muscles provide an adequate mass and length of muscle for coverage of most structures in the mediastinum and have a single, dominant vascular axis. Winging of the scapula can occur with the harvest of the serratus anterior unless this is prevented by the maintenance of the upper two or three muscle slips as described previously. Even if winging does occur, we believe it to be a reasonable price to pay for control of the ongoing infection. Transposition of the latissimus dorsi and pectoralis major produce little if any significant cosmetic or functional defect in these ill patients. These muscles are transposed to assist in sealing of fistulas and to bolster vascular or visceral repair. We do not think that complete soft-tissue obliteration of the pleural cavity is necessary, and we continue to use the Clagett method of antibiotic-solution filling of the chest cavity at closure. In the irradiated patient with poor healing potential, intrathoracic muscle flaps may provide a means to salvage situations previously considered unsalvageable when the flaps are combined with sound principles of infection control; when used prophylactically, the flaps may prevent those same situations.

Humans↗
PubMed1991

Long-term results of pectoralis major muscle transposition for infected sternotomy wounds.

During an 11.5-year period, 100 consecutive patients (79 male, 21 female) underwent repair of an infected sternotomy wound. Sixty-five patients had failed attempts at wound closure by other physicians. Median age was 61.5 years (range, 5 to 85 years). Reconstruction included muscle in 79 patients, omentum in 4, and both in 15. A total of 175 muscles were transposed, including 169 pectoralis major, 3 rectus abdominis, 2 external oblique, and 1 latissimus dorsi. Median number of operations was four (range, 1 to 11). Mechanical ventilation was required in 30 patients. Two perioperative deaths occurred, one related to sepsis. Median follow-up was 4.2 years (range, 1.3 to 13.5 years). Twenty-six patients had recurrent infection. Median time from our closure to recurrence was 5.5 months (range, 0.3 to 27.6 months). Cause of recurrence was inadequate removal of cartilage in 16 patients, bone in 6, and retained foreign body in 4. Eighteen patients had the wound reopened with further resection; 10 had another muscle or omentum transposition. There were 30 late deaths, only one related to recurrent infection. At the time of death or last follow-up, 92 patients had a healed chest wall. Transposition of the pectoralis major muscle remains an excellent method of management for infected sternotomy wounds. Failure is directly related to persistent infection of cartilage, bone, or retained foreign bodies.

Adolescent↗
PubMed1991

Management of the recalcitrant total-hip arthroplasty wound.

The infection rate for total-hip arthroplasty is around 1 percent. This small group is usually managed by complete removal of the prosthesis and the cement and closure over suction catheters to "collapse" the wound and eventually achieve a girdlestone arthroplasty. Occasionally, there are patients who have a persistent draining wound after this treatment and repeated efforts at wound closure. We present 27 patients who had recalcitrant, noncollapsible wounds of the hip that were present for many months to years. Twenty-eight cases of infected total-hip arthroplasties that did not respond to removal of the prosthesis and cement and closure were seen by the authors between January of 1977 and December of 1988. One patient had bilateral involvement. Average age was 64 years (range 33 to 79 years). There was an average of 4.2 previous surgical attempts at closure (range 1 to 21). Staphylococcus aureus was the most common organism, but the infections were virtually all multiple. Thirty-three muscles were utilized in 27 patients. The rectus femoris was used in 23 cases, the vastus lateralis in 8, tensor fasciae latae in 1, and combined latissimus dorsi-serratus anterior free-tissue transfers were carried out in 2. Multiple combinations of transpositions and free flaps were utilized. Follow-up ranged from 1 to 10 years, with an average of 6.4 years. Eighteen patients were ambulatory with minor degrees of pain, five ambulated with a cane, seven ambulated with a walker, six ambulated with crutches, and four ambulated unassisted, all of whom had reimplantation of their hip arthroplasty at least 12 months following the muscle flap procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Results of treatment of tibial and femoral osteomyelitis in adults.

From January 1, 1971, to December 31, 1985, 425 patients with chronic osteomyelitis of the femur or tibia were seen at the authors' institution. The success rate in this recent experience was 84.4% compared with 50.9% in the authors' results published in 1970. A classification of chronic osteomyelitis is as follows: (1) hematogenous osteomyelitis; (2) osteomyelitis in united fractures (fracture with union); (3) osteomyelitis in nonunion (fracture with nonunion); and (4) postoperative or posttraumatic osteomyelitis in which bone was not fractured. For management of the scarring of surrounding soft tissue, there has been a change to excision of the scarred tissue and reliance on muscle flap, free-tissue transfer, or closure of soft tissues without irrigation with antibiotic solution. In recent years, free microvascular osseous grafts have permitted more aggressive resection of the involved osseous tissue. The predominance of gram-negative organisms and penicillin-resistant Staphylococcus aureus and the occurrence of methicillin-resistant S. aureus continue.

Adult↗
PubMed1990

Refinements in intrathoracic use of muscle flaps.

Intrathoracic infections associated with infection, leakage, or bleeding of the airway, lung parenchyma, esophagus, heart or great vessels is a life-threatening situation that luckily is infrequently seen. Failure to control these infections with the usual techniques can often be attributed to the presence of persistent pleural space, continuing empyema or bronchopleural fistula. Intrathoracic transposition of extrathoracic skeletal muscle in these situations offers an effective of management. Our experience has been possible because of the continued integrated effort with our thoracic surgical colleagues. We have found the team approach to work best and will continue to use it.

Adolescent↗