PubMed Health⌕ Search

Biomedical subjects

R J Restifo

Publications and source records attributed to R J Restifo.

25 records · Page 2Linked to original sources
PubMed1997

Timing, magnitude, and utility of surgical delay in the TRAM flap: II. Clinical studies.

Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction was performed in 15 patients 1 week after a preliminary delay procedure. The indications for surgical delay were obesity, smoking, prior radiation therapy, a requirement for large volumes of transmidline tissue, or combinations of these risk factors. The delay procedure consisted of outpatient ligation of the deep and superficial inferior epigastric vessels. Prior to and 1 week following the delay procedure, noninvasive Doppler examinations of the superior epigastric vessels were performed. Following the delay procedure, the diameter of the superior epigastric artery increased from 1.3 +/- 0.2 to 1.8 +/- 0.3 mm (p < 0.001) and the calculated superior epigastric artery flow increased from 7.25 +/- 0.8 to 18.2 +/- 2.7 ml/min (p < 0.001). Breast reconstruction in these high-risk patients was successful without major ischemic complications, but a tendency toward unreliability of zone IV was noted. This clinical observation is consistent with the findings in our animal studies (part I). The preliminary delay procedure was well tolerated with minimal morbidity. We feel that a preliminary delay procedure is a very useful option for breast reconstruction patients at high risk for TRAM flap vascular compromise.

Ambulatory Surgical Procedures↗
PubMed1997

A new experimental model: the vascular pedicled cutaneous flap over the mid-dorsum of the rat.

The cutaneous vascular anatomy of the mid-dorsum in the rat and its role in flap design was studied in the rat. The investigation consisted of anatomic dissection, methylene blue injection into the axial artery, and flap harvesting in live animals. Dissection and injection revealed that the mid-dorsum of the rat derives its blood supply largely from the 10th intercostal artery, here referred to as the middle dorsal artery, which originates from the lateral aspect of the thoracic aorta. The cutaneous vascular territory of the middle dorsal artery was defined as follows: the medial border, midline of the dorsum; the lateral border, midaxillary line; the cephalic border, a line joining the medial and lateral borders midway between the level of the axilla proximally and 1 cm above the base of the rib cage distally; and the caudal border, a line drawn midway between the latter point proximally and the anterior superior iliac spine distally. Both unilateral and bilateral vascular pedicled island cutaneous flaps were harvested in living rats based on and exceeding the vascular territory delimited by methylene blue injection. Flaps limited to this territory with intact middle dorsal arteries showed total survival, while oversized flaps underwent partial necrosis peripherally. Because of its simplicity, reliability, and consistent vascularity, this flap has potential applications in the study of flap hemodynamics.

Animals↗
PubMed1996

Frequent clones of p53-mutated keratinocytes in normal human skin.

The multiple genetic hit model of cancer predicts that normal individuals should have stable populations of cancer-prone, but noncancerous, mutant cells awaiting further genetic hits. We report that whole-mount preparations of human skin contain clonal patches of p53-mutated keratinocytes, arising from the dermal-epidermal junction and from hair follicles. These clones, 60-3000 cells in size, are present at frequencies exceeding 40 cells per cm2 and together involve as much as 4% of the epidermis. In sun-exposed skin, clones are both more frequent and larger than in sun-shielded skin. We conclude that, in addition to being a tumorigenic mutagen, sunlight acts as a tumor promoter by favoring the clonal expansion of p53-mutated cells. These combined actions of sunlight result in normal individuals carrying a substantial burden of keratinocytes predisposed to cancer.

Adult↗
PubMed1996

Prostacyclin production at the human microvascular anastomosis: its effect on initial platelet deposition.

The human microvascular anastomosis represents a localized environment with strongly thrombotic tendencies. In previous studies, an increase in initial platelet deposition at a human ex vivo anastomosis was measured. It is postulated that this increase in anastomotic platelet deposition was due to a reduction in anastomotic prostacyclin production as a consequence of local endothelial cell injury or loss. Instead, in this study, an increase in anastomotic prostacyclin production over unsutured controls (control 1093 +/- 222 pg/ml of 6-keto prostaglandin F (PGF) 1-alpha, n=21; anastomosis 2494 +/- 414, n=21, mean +/- 1 SEM, p=0.005) is demonstrated. Anastomotic prostacyclin production was augmented by addition of arachidonic acid (0.1 mM) (39,000 +/- 11,300 pg/ml of 6-keto PGF 1-alpha, n=7, p<0.001) and suppressed by the preincubation of vessel segments with aspirin in a dose-dependent fashion (1mM) (83+/-22 pg/ml of 6-keto PGF 1-alpha, n=21, p<0.001); aspirin (0.1 mM) (312 +/- 56 pg/ml of 6-keto PGF 1-alpha, n=7, p<0.001). In further studies using a perfusion apparatus of human blood pumped through human placental artery segments, suppression of prostacyclin production did not augment initial platelet deposition (control anastomosis 4.9 +/- 2.2 x10(6) platelets per cm2, aspirin treatment 6.0 +/- 2.8 x 10(6) platelets per cm2, n=5, mean +/- 1 SEM, p>0.05). Suppression of platelet function with aspirin (0.1 mM) also did not decrease initial platelet deposition onto the anastomosis (5.8 +/- 2.8 x 10(6) platelets per cm2, n=r, p>0.05). In this model system, initial platelet deposition at the anastomosis may not be dependent upon cyclooxygenase pathways.

Anastomosis, Surgical↗
PubMed1995

The natural history of pressure sores in a community hospital environment.

A retrospective review of the medical records of a community hospital during a recent 2-year period identified 100 patients with a pressure sore at admission or who developed one thereafter. The mean age of the group was 82.5 years, with three fourths being women. Although 40% of patients were admitted from home, only 20% were discharged home. A minority (27%) of patients in the cohort were independently ambulatory. Likewise, a minority (40%) were alert and orientated at admission and able to feed themselves (46%). Associated conditions that impeded mobility, such as arthritis, joint contractures, hemiplegia, and paraplegia, were noted in 65% of the cohort. A total of 173 pressure sores were noted in 100 patients. The majority (89%) was located caudal to the apex of the iliac crests. No statistically significant variation in wound location or type was found between surviving or expiring patients or between patients whose wounds improved as compared to those whose wounds deteriorated. Seventy-four percent of pressure ulcers were grade II, that is, involving the subdermal layers, or worse. Again, no significant difference in pressure sore grade was noted between patients who lived and patients who died. Topical treatment of pressure sores was universal, though no logical approach was seen. No statistical advantage was achieved by any particular agent or combination of agents. Most patients (79%) were managed on pressure-release surfaces (sheepskin, eggcrate, gel cushion) or air flotation systems (Clinitron, Flexicare). Interestingly, no significant benefit was noted in wound healing or survival rate as related to bed type.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Microsurgery for cranial base tumors.

Local or regional flaps usually are sufficient for reconstruction of defects of the cranial base. In some cases, however, free-tissue transfer may be the best or the only choice. Reasons for choosing free-tissue transfer over other methods of reconstruction include previous radiation, previous surgery, limited arc of rotation of pedicle flaps, lower complication and failure rates of free flaps, and specific tissue requirements that only can be met with a free flap. The anatomy, available flap choices, indications, and technical considerations applicable to cranial base reconstruction with microvascular surgery are discussed.

Esthetics↗