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Biomedical subjects

R D Acland

Publications and source records attributed to R D Acland.

At least 19 recordsLinked to original sources
PubMed1992

Microsurgical adjuncts in salvage of the ischemic and diabetic lower extremity.

Revascularization of distal occlusive disease in the diabetic has been markedly enhanced by microsurgical techniques. Extremely small, heavily calcified vessels are able to be reliably reconstructed using microsurgical techniques and high magnification. Additionally, revascularization followed by microsurgical free tissue transfer has proven to be a valuable alternative to amputation in patients with major soft-tissue loss, or bony or tendon lesions requiring soft-tissue reconstruction. Although metabolic risks are potentially high, we have experienced a very low morbidity and mortality with a thorough medical work-up and follow-through in conjunction with these major procedures. It is our expectation that judicious application of microsurgical techniques in treatment of the ischemic diabetic lower extremity will continue to improve the chances for long-term bipedal ambulation in this patient population.

Adolescent↗
PubMed1992

Microcirculatory disturbances following the passage of emboli in an experimental free-flap model.

Following completion of arterial repair in an experimental free-flap model, platelet emboli have been observed passing through the microcirculation downstream. The purpose of this experimental study was to observe and quantitate changes in capillary perfusion occurring subsequent to these events. The isolated rat cremaster model was used. For 6 hours subsequent to surgical injury of the main artery in this model, the number of emboli and the number of perfused capillaries downstream were counted. In eight rats having an intentional arterial wall injury, emboli were consistently seen during the first hour of reflow. In the nine control animals having no arterial injury, no emboli were seen. The presence of emboli in the cremaster muscle, resulting from the arterial injury, was associated with a significant reduction in the number of perfused capillaries. We suggest that the observed decrease in capillary perfusion was associated with microemboli that produced an adverse effect for several hours after their initial presence in the circulation.

Analysis of Variance↗
PubMed1979

The free iliac flap: a lateral modification of the free groin flap.

A lateral modification of the free groin flap, called the free iliac flap, is presented. By moving the outline of the free groin flap laterally, so that the medial margin lies lateral to the underlying femoral triangle, a flap is obtained which is uniformly slender and which has a long vascular pedicle. The anatomical findings, a method for safe dissection of the superficial circumflex iliac vessels, and the results of 18 clinical cases are presented.

Carcinoma, Squamous Cell↗
PubMed1979

Effects of cooling and intraluminally administered antiseptics on surgically induced ischemia of the intestine in dogs.

The efficacy of surface cooling and intraluminal antiseptic solutions for short term preservation of intestinal segments in preparation for free tissue transfer were investigated. Five segments of the small intestine and five segments of the colon were allocated to each group as follows: group 1, ischemia at 37 degrees C.; group 2, ischemia at 6 to 12 degrees C., and group 3, ischemia at 6 to 12 degrees C. plus povidone-iodine intraluminally. Histologic grading of segments allowed assessment of the efficacy of short term protection against ischemic changes. Surface cooling effectively prevented histologic evidence of ischemia. No additional benefit was observed using povidone-iodine intraluminally. Significant changes in tissue water content and evidence of bacterial invasion were not observed.

Animals↗
PubMed1979

Free intestinal autografts for reconstruction following pharyngolaryngoesophagectomy.

After pharyngolaryngoesophagectomy in four patients, free intestinal autografts were used for reconstruction. A microvascular technique and a simultaneous two team approach allowed this to be done immediately following the resection. No graft failures have occurred. Good function was present in three of the four patients at the last follow-up examination or at death. Follow-up intervals vary from seven to 15 months postoperatively. Special problems, such as irradiation, tumor site and the relative merits of the large versus the small intestine, are discussed.

Colon↗
PubMed1978

Microsurgical two-layer vasovasostomy: word of caution.

Microsurgical technique, with separate mucosal and muscular layer anastomosis, recently has been advocated as the most successful method of vasovasostomy. Unexpected difficulties may be encountered using this method; moreover, considerable practice in the microsurgical laboratory is mandatory before actual performance of the procedure. As with any innovation in surgical technique, a judgment of the clinical superiority of the two-layer anastomotic method must await substantiating results from other investigators.

Humans↗
PubMed1978

Revascularized periosteal grafts--a new method to produce functional new bone without bone grafting.

Rib periosteum was transplanted to the groins of 9 dogs. In half of the periosteal grafts, no microvascular anastomoses were done (free grafts); at 6 weeks after grafting they had become resorbed. The other periosteal grafts were revascularized by microvascular anastomoses of the intercostal vessels to local muscular vessels; at 6 weeks those with confirmed vascular patency had all formed substantial amounts of new bone. Five cm, full-thickness defects were created in the tibias of 10 dogs. The control animals (without grafting) did not heal in two months. However, the experimental dogs, with vascularized periosteal grafts in the defects regenerated their tibias with healthy new bone by 6 weeks--and were walking on them then.

Animals↗
PubMed1978

Microsurgical two-layer vasovasostomy: laboratory use of vasectomized segments.

A microsurgical laboratory model is described which uses optimally preserved human vasectomy segments. These preserved specimens retain their natural appearance and handling qualities, permitting ready availability of material for practice, which is mandatory before clinical performance. If laboratory facilities are not available, the model can be used for practice in a convenient area of the operating suite.

Humans↗
PubMed1978

An experimental study of end-to-side microvascular anastomosis.

Forty-nine end-to-side arterial anastomoses were carried out in dogs. The saphenous artery was anastomosed to the femoral artery. Variations in technique were made regarding the shape of the aperture in the large artery and in the incident angle of the small artery. Blood flow was measured in the immediate postoperative period with electromagnetic flowmeters on the saphenous and femoral arteries. There was no significant difference in flow between each of the four types of anastomoses studied. In each of the flow was slightly, but not significantly, higher than the preoperative level.

Animals↗
PubMed1977

Photomicrography through the operating microscope.

In summary, the production of high quality photomicrographs through the operating microscope requires considerable attention to detail. The author describes all the details which he has found essential for obtaining good photomicrographs for documentation and/or publication.

Microsurgery↗
PubMed1977

The histopathology of small arteries following experimental microvascular anastomosis.

We studied the histopathological changes present at various intervals after microsurgical anastomoses in the femoral arteries of 30 rats. The principal findings were (1) widespread loss of intima, (2) widespread necrosis of media, and (3) dehiscence of sutures. The possible causes for these, and their possible significance, are discussed.

Animals↗