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Biomedical subjects

R J Spence

Publications and source records attributed to R J Spence.

At least 19 recordsLinked to original sources
PubMed2001

Methods and results of rhinophyma treatment.

Rhinophyma is a disfiguring soft-tissue hypertrophy of the nose. It is an uncommon disease that primarily affects Caucasian men in the fifth to seventh decades of life. Nine cases from the authors' series and a comparison of results following various treatment modalities are presented. Eight of the patients were Caucasian and one was African American. Excision of the diseased tissue with a scalpel or Goulian dermatome using loupe magnification provided the safest means of preserving the underlying sebaceous gland fundi that permit spontaneous re-epithelialization with the least scarring.

Aged↗
PubMed2000

Increased alpha2-adrenergic constriction of isolated arterioles in diffuse scleroderma.

OBJECTIVE: Vasospasm and ischemic organ injury are important in the pathogenesis of systemic sclerosis (SSc; scleroderma). The present study was performed to determine whether SSc arterioles have an intrinsic disturbance in vasoconstrictor activity. METHODS: Skin biopsy samples were obtained from the upper arm of 11 patients with diffuse SSc (clinically uninvolved skin) and 8 age- and sex-matched control subjects. Dermal arterioles were dissected from the biopsy sample and mounted in a myograph for continuous monitoring of arteriolar diameter. The resting internal diameter of control and SSc arterioles was similar (mean +/- SEM 164+/-15 micro and 166+/-18micro, respectively). RESULTS: Dermal arterioles displayed no spontaneous constrictor activity in the absence of stimulation. Vasoconstriction in response to KCI, a receptor-independent activator of smooth muscle, or to phenylephrine, a selective alpha1-adrenergic receptor (alpha1-AR) agonist, was similar in control and SSc arterioles. However, constrictor responses to UK 14,304, a selective alpha2-AR agonist, were increased in SSc compared with control arterioles (maximal constriction responses of 25+/-5% and 67+/-4% [mean +/- SEM] in control and SSc arterioles, respectively; P = 0.000014). Mechanical denudation of the endothelium did not alter reactivity to alpha2-AR activation, indicating that the enhanced constriction in SSc was not mediated by changes in endothelial dilator activity. Indeed, in arterioles constricted with phenylephrine, the endothelial stimuli acetylcholine or bradykinin evoked endothelium-dependent relaxation that was similar in control and SSc arterioles. CONCLUSIONS: Vascular smooth muscle in SSc arterioles displayed a selective increase in alpha2-AR reactivity. The endothelial dilator function appeared normal. Altered activity of smooth muscle alpha2-ARs may contribute to the vasospastic activity that is a prominent feature of the SSc disease process.

Adrenergic alpha-2 Receptor Agonists↗
PubMed2000

Escharotomy and fasciotomy of the burned upper extremity.

Escharotomy and fasciotomy are performed in the burned upper extremity to prevent and treat the sequelae of circumferential full-thickness burns and high-voltage electrical burns. Indications to perform these procedures are determined primarily by clinical examination but can be supplemented by measurements of subfascial pressures. The techniques are designed to avoid further complications. Options for wound closure are discussed. The use of allograft as temporary coverage of fasciotomy incisions may allow delayed primary closure.

Arm Injuries↗
PubMed1998

Burns of the hand and upper limb--a review.

This review article addresses the principles and controversies associated with thermal injury to the hand and upper limb. Accepted principles are outlined and areas of controversy are discussed in a balanced manner. The importance of hand burns is described functionally and epidemiologically. Burns appropriate to outpatient care are defined and treatment discussed, including debridement, topical therapy, rehabilitation and follow-up. The general principles of inpatient management are given, including the controversial issue to timing of surgery and treatment of the exposed tendon or joint. The extent of surgery, methods of wound closure and difficult problem of palm burns are also discussed. Reconstructive principles are outlined and a problem oriented approach to the most common reconstructive problems given.

Ambulatory Care↗
PubMed1997

The enhancement of wound healing with human skin allograft.

Although clean incisional wounds can be closed easily, contaminated wounds, wounds with tissue loss that cannot be closed primarily, and chronic wounds are generally not closed and suffer the effects of being open. It follows that wound healing would be enhanced if these wounds could be closed. This article describes how skin allograft biologic dressings are used to close such wounds temporarily to bestow the benefits of wound closure. It also describes the benefits of human skin allografts and the history and basic science related to their use. Reference is made to newer wound covers that have the potential to provide similar benefits to open wounds.

Adult↗
PubMed1992

Anticentromere antibody as a predictor of digital ischemic loss in patients with systemic sclerosis.

OBJECTIVE: To determine the clinical and serologic risk factors for digital ischemic events in patients with systemic sclerosis (SSc). METHODS: Retrospective review of clinical and laboratory data and review of current clinical status of 98 patients with SSc, seen between 1985 and 1990. RESULTS: Amputation of 1 or more digits due to ischemia occurred in 20.4% of the patients; 9.2% had multiple digit loss. Sclerodactyly alone and anticentromere antibody (ACA) were associated with loss of 1 or more digits. Age, smoking status, duration of disease, or duration of Raynaud's phenomenon were not predictive for loss of digits. CONCLUSION: Patients with limited SSc who are positive for ACA have an increased risk of major peripheral vascular occlusive disease.

Adult↗
PubMed1992

Porcine dermal collagen as a wound dressing for skin donor sites and deep partial skin thickness burns.

Collagen was extracted by pepsin digestion from porcine skin, and collagen membrane was prepared by salt precipitation. The porcine collagen membrane was evaluated as a burn wound dressing in deep partial skin thickness burn wounds in rats. Burn wounds, 4 x 4 cm, were inflicted by exposure of skin to 75 degrees C for 15 s followed by de-epithelialization. Wound healing was assessed by planimetry of epithelialization on day 10 after injury. Open wounds exhibited 24 per cent of wound area re-epithelialized. Collagen membrane dressing significantly improved the healing to 69 per cent of wound area (P < 0.0001). In a completely separate experiment, the porcine collagen membrane was applied as a wound dressing to the donor sites of burn patients, and its effect on wound healing was compared with that of a petroleum jelly gauze dressing. The donor sites covered with petroleum jelly gauze had re-epithelialized by an average of 14.5 days (ranging from 13 to 16 days) after wounding. The wounds dressed with collagen membrane demonstrated a significant increase in the healing rate. Complete re-epithelialization was observed by 10.3 days (ranging from 10 to 12 days) after wounding (P < 0.0001).

Adolescent↗
PubMed1992

Bilateral reconstruction of the male nipple.

The opportunity to reconstruct the male nipple rarely presents itself. The loss of the nipple due to trauma or surgery is itself rare. Most patients consider its loss a minor problem and the nipple not worth reconstructing. The only description of a male nipple reconstruction in the literature is that of a unilateral reconstruction using a split-thickness graft from the opposite side with a suboptimal result. In this report, I detail the reconstruction of bilateral male nipples in the survivor of a severe burn. The final result is a culmination of three successive procedures performed to improve each previous result. The result of each procedure is critically analyzed, with an excellent final result. We conclude that the best male nipple reconstruction is that in which the areola and papilla are given independent attention during reconstruction. We recommend a single, safe, procedure that fulfills this requirement and can be performed under local anesthesia.

Adult↗
PubMed1992

Experience with novel uses of tissue expanders in burn reconstruction of the face and neck.

Total or subtotal resurfacing of the face with suitable, well-matched skin from the upper trunk and neck is usually difficult because of the dearth of unscarred donor site. Tissue expanders have been used primarily to construct local advancement flaps of tissue immediately adjacent to a tissue defect or deformity. These flaps often lack adequate mobility to allow coverage of large areas. In this report, I describe a clinical experience of 11 patients followed for 27 to 75 months in whom tissue expanders were used to develop large, full-thickness skin grafts or transposition flaps for total or subtotal resurfacing of the face and neck. Large, full-thickness skin grafts were developed from relatively small donor sites using tissue expanders. They behaved identically to unexpanded full-thickness skin grafts. They were found not to shrink with storage. The donor sites were closed primarily, obviating the need to graft the donor site. The tissue expander-enhanced transposition flaps appeared to have enhanced vascularity and provided ample, suitable tissue for reconstruction of the face and neck. Tissue expansion resulted in very mobile, thin, hearty flaps that provided excellently matched skin cover for the face and neck. Complications, some of which are unique to these techniques, and indications for the techniques are reviewed.

Adult↗
PubMed1992

Posttraumatic adaptation and distress among adult burn survivors.

OBJECTIVE: The purpose of this study was to examine the prevalence, natural history, and psychosocial impact of posttraumatic symptoms in adult burn survivors. METHOD: Forty-three adult inpatients at a regional burn center were assessed at discharge with standardized instruments to determine the presence of psychiatric disorder, assess personality, and quantify depression. Thirty-one patients were evaluated 4 months after discharge. RESULTS: Posttraumatic stress disorder was diagnosed in 7% of patients at discharge and in over 22% of patients at follow-up. Symptoms of avoidance and emotional numbing (DSM-III-R criterion C symptoms) tended to emerge after discharge from the hospital. While posttraumatic symptoms were associated with symptoms of depression, they were not strongly associated with psychosocial adjustment to illness; psychosocial adjustment was more strongly related to aspects of personality, the injury itself, and its treatment. CONCLUSIONS: Since adult burn survivors often develop new symptoms of posttraumatic distress after leaving the hospital, longitudinal surveillance is required to detect new cases and provide appropriate treatment. Survivors at risk for poor psychosocial adjustment after discharge may be identifiable during hospitalization, and preventive treatment strategies should be developed and tested for this population.

Adaptation, Psychological↗
PubMed1991

Expanding the limits of composite grafting: a case report of successful nose replantation assisted by hyperbaric oxygen therapy.

A successful nose replantation assisted by hyperbaric oxygen therapy is presented, with a brief discussion of the possible mechanisms and a brief literature review of the use of hyperbaric oxygen in tissue preservation and replantation. Although it is not certain that the hyperbaric oxygenation ensured the survival of the replanted nose in this 2-year-old girl, there was documented change in graft appearance during the initial hyperbaric oxygen treatment. A 1-month, 1-year, and 2-year follow-up is included.

Child, Preschool↗
PubMed1990

The post-occlusive hyperemic response in patients with systemic sclerosis.

We investigated post-ischemic hyperreactive cutaneous blood flow in patients with primary Raynaud's phenomenon and Raynaud's phenomenon secondary to systemic sclerosis (SSc). Reactive hyperemia was measured over a locally warmed area of skin, using a laser Doppler flowmeter, following 5 minutes of suprasystolic occlusion of blood flow. We found that patients with primary Raynaud's phenomenon had normal post-ischemic blood flow compared with normal controls. In contrast, patients with SSc had reduced levels of baseline and peak blood flow compared with either the primary Raynaud's phenomenon patients or the normal subjects. Infusion of carbaprostacyclin, a potent prostacyclin analog vasodilator, did not increase blood flow in the SSc patients, nor did it restore the reactive hyperemic response. These findings are consistent with the hypothesis that patients with the nonvasoconstricted condition of SSc have fixed structural defects that limit cutaneous microvascular blood flow.

Adult↗
PubMed1990

Cultured epidermis for the coverage of massive burn wounds. A single center experience.

Seven patients with a mean burn size of 69.6% total body-surface area underwent skin grafting with autologous cultured epidermis. They were compared with a historical group of 18 controls, with a mean burn size of 60%, who underwent grafting with conventional meshed split-thickness autograft. There were no statistically significant differences between the two groups in length of hospital stay, total number of surgical operations, or cost. There were no deaths and two major complications in the cultured epidermis group; there were six deaths and 11 major complications in the historical control group. Because of this encouraging early experience, a prospective, randomized study is now in order to evaluate this technology.

Adult↗
PubMed1988

Clinical use of a tissue expander--enhanced transposition flap for face and neck reconstruction.

Tissue expanders have been used in reconstructive surgery with increasing frequency, primarily to construct local advancement flaps of tissue immediately adjacent to a tissue defect or deformity. These flaps often lack adequate mobility to allow coverage of large areas. This report describes the use of tissue expanders to enhance the area and vascularity of shoulder skin to provide suitable, ample tissue that can then be used as large pedicled transposition flaps for reconstruction of the face and neck. It is a clinical study based on previous laboratory studies cited that demonstrates that large flaps with very narrow pedicles remain well vascularized and can be transposed to cover very large defects. The tissue expander appears to enhance the vascularity of the flap. The thinning of the dermis and subcutaneous tissue seems to make the donor skin more similar in quality to face and neck skin. These studies suggest that even larger flaps may be developed to supply tissue to resurface the entire face or very large portions of it.

Adult↗
PubMed1987

Vertical rectus abdominis musculocutaneous flap for chest wall reconstruction after irradiation.

We have used a contralateral vertical rectus abdominis musculocutaneous flap based upon the superior epigastric vessels in six patients to provide coverage after resection of locally recurrent breast carcinoma in irradiated tissues. Primary healing of defects as large as 16 cm X 35 cm has been obtained using this technique. Although there is no evidence to suggest that such a procedure significantly lengthens survival, it was clearly beneficial to the quality of life in these patients. Our results suggest that older patients with relatively indolent disease receive the greatest benefit from this procedure.

Abdominal Muscles↗