Biomedical subjects
Publications and source records attributed to R Gumener.
A case of gigantic orbital neurofibromatosis (2,500 gm) is presented. It is believed to be the largest such tumor reported since the famous elephantiasis neurofibromatosis pictured in von Bruns' Chirurgischer Atlas in 1857.
Sandwich epicranial flaps are prefabricated composite flaps that have multiple uses in reconstructing the middle and the lower facial region. Sandwich epicranial flaps always comprise the galea and a full-thickness skin graft; they may, in addition, include the temporal muscle and a fragment of parietal bone. According to their composition, four types of sandwich epicranial flaps are described. Experience with a use of 36 sandwich epicranial flaps (13 with vascularized bone) is reported. A few examples demonstrate the use of sandwich epicranial flaps in dramatic facial mutilation following noma in children. The sandwich epicranial flap can be performed at any age, does not require microsurgical anastomoses, and has a low complication rate. It is particularly useful for major reconstructive procedures in children.
The vascular anatomy of the subcutaneous or adipose layer of the leg is described. The major arteries of the distal thigh and leg were injected with either a colored latex or an India ink and gelatin mixture to demonstrate the principal sources of blood supply to the skin and the superficial tissues of the leg. Microdissection and the technique of Spalteholz for dehydrating and clearing the tissues (rendering them transparent) facilitated the study of the direct and indirect arterial branches which form the three principal networks: the deep fascia, the subcutaneous or adipose layer, and the skin or the dermoepidermic layer. The results are of practical importance since the fascio-subcutaneous tissue layer can be used as a flap for covering soft tissue defects of the leg.
Explore the source record for details and available documents.
Sensibility and sensory reinnervation were investigated in 19 patients who underwent, after mastectomy, a breast reconstruction using myocutaneous flaps. A comparative study in reinnervation of the flaps has been performed either after surgery with a latissimus dorsi flap with prosthesis or after surgery with a simple or double pedicle transverse rectus abdominal flap. Ten patients with latissimus dorsi flaps and 9 patients with transverse rectus abdominal flaps were tested. The tests included stimulation with touch, pressure, pin prick, and temperature. The patients were also interviewed regarding their impressions, a subjective sensibility. These results show that the recovery of sensibility by patients who underwent surgery with the transverse rectus abdominal flap technique is superior, objectively and subjectively.
Facing urethro-perineal lesions with large soft tissue defects, the surgeon has to set himself a fourfold target. First, the urethral lesion has to be repaired, and second it needs immediate protection. Third, the tissue defect needs to be filled up, and forth the skin should be closed. A double team surgery, combining the urethral repair and its immediate covering by a gracilis musculo-cutaneous flap, has given functional and morphological results. The highly vascularized muscular portion of the flap prevents local infection and warrants good wound healing in an ischemic region. Its bulk may fill the perineal defect and protect a delicate urethroplasty. With the growing collaboration between urologic and plastic surgeons, this technique will probably find wider indications, possibly when dealing with important perineal trauma.
A reversed fasciosubcutaneous tissue flap in the leg is described. This distally based flap is vascularized by the perforating cutaneous branches of the peroneal and tibialis posterior arteries. It must carry all its subcutaneous tissue. A study on the vascularization of the subcutaneous tissue reveals the predominance of the vascular network in this layer with regard to the dermal or fascial plane. The dermal vascular network at the donor site is sufficient to let the skin survive without its underlying subcutaneous vascular support. The flap can reach the malleolar and heel region. The advantages of this technique are (1) easy dissection, (2) preservation of the major vascular pedicles of the lower limb, (3) skin preservation at the donor site, thus preserving the shape of the limb, and (4) versatility (it is supple and can adapt to every surface, and it can be grafted on the deep or the superficial side). The addition of this technique to the armamentarium of the reconstructive surgeon has proved to be very useful in repairing soft-tissue defects in the lower limb. Often it can replace the classical fasciocutaneous flap or even a free flap.
Tumors of the orbital region which may develop during infancy and childhood have multiple origins and a specific treatment should be applied to each lesion as regards the degree of malignancy, the extent of the tumor and the age of the child. The plastic surgeon is usually called when the surgical treatment or the radiotherapy have been mutilating. It is then necessary to offer the most satisfactory reconstruction to the child, taking into account the possibility of a recurrent disease or the future development of the orbital cavity. The following priorities should be observed: 1) The tumoral resection should be as complete and as curative as possible. 2) The sight of the eye should be saved if possible; 3) The skeletal reconstruction should be performed if possible with autologous bone graft taken from the skull area. 4) The soft tissue reconstruction is performed by a series of plastic surgery methods. The use of the temporal muscle is common. 5) The final esthetic result often depends on the choice and the quality of additional corrections (canthopexy, mucosal graft, correction of enophthalmos, etc). The surgery of orbital tumors is a team work (neurosurgery, ophthalmology, otolaryngology, plastic surgery). The presence of the plastic surgeon during the initial treatment is highly recommendable and often permits an immediate reconstruction.
Explore the source record for details and available documents.
The galea aponeurotica has been used by various surgeons either as a supporting sheet or as a blood carrier for bringing flaps to various areas of the face. In this study, we first reviewed the anatomy of the scalp vascularization by means of cadaver injections. The arteries and veins are mainly located in the galea and numerous anastomotic vessels are present over the vertex. The physiology of this vascularization has been studied by percutaneous PO2 registration after occlusion of various vessels by means of a tourniquet placed around the head. The superficial temporal arteries have been found to be the most important vessels for designing flaps over the head. On the basis of these experiments, several patients have been operated upon. The possibility of using a skin island from the retroauricular region based on subcutaneous tissue only is described.
We present an anatomical study and clinical applications of a subcutaneous tissue flap in the limbs. This tissue, located between dermis and muscular aponeurosis, is an anatomical entity nourished by a well-developed vascular network. It is used mainly as a local flap able to bear a skin graft. Elastic, resistant, and well padded, it gives good coverage for soft tissue defects while leaving the surrounding skin untouched. In some circumstances, this simple technique can avoid delicate procedures, such as free flaps, or unsightly donor site defects after fasciocutaneous flaps.
The authors report an anatomical study on the vascularisation of the subcutaneous tissue, which is an anatomical entity with a very rich vascular network. This leads to the concept of an original flap and suggests a modification of the concept of the fasciocutaneous flap.
Explore the source record for details and available documents.
This paper records our experience with a new technique of providing cover for soft tissue defects of the upper extremity using flaps consisting of subcutaneous tissue only and relying on the arterial anastomotic network of this tissue layer to sustain its vascularisation. The experimental basis of this technique is described in detail and two illustrations of the clinical use of this technique are given. The main advantages of this type of flap are its ready availability from the local tissues, its elasticity, the absence of functional and aesthetic disturbance at the donor site and the preservation of the natural contour of the limb.
A depressed supratarsal sulcus can be filled by means of a soft-tissue arterial flap including subcutaneous tissue, galea, and periosteum. The donor site is the temporal region, and the flap is passed subcutaneously into the upper eyelid. The same type of flap can also be used as filling material in other situations, such as Treacher-Collins malar bone defects. The correction of a depressed supratarsal sulcus by anophthalmic orbits is to be done only after complete and careful adjustment of the eye prosthesis by the ocularist, or after adjustment of the socket itself.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.