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Biomedical subjects

R K Daniel

Publications and source records attributed to R K Daniel.

At least 19 recordsLinked to original sources
PubMed1992

The nasal tip: anatomy and aesthetics.

New anatomic observations and expanded aesthetics are presented based on an in-depth analysis of 50 patients undergoing primary open rhinoplasty. The alar cartilages can be conceived of as three crura (medial, middle, and lateral), each composed of two segments, plus distinct intervening junction points of aesthetic importance. The classic four-dot tip aesthetics can be expanded and wrapped around the nasal lobule in a three-dimensional fashion. Three nasal tip angles are easily defined (angle of tip rotation, angle of domal definition, and angle of domal divergence) and can be created surgically.

Esthetics↗
PubMed1991

Rhinoplasty and the male patient.

A review of male patients undergoing rhinoplasty indicates a surprising diversity of anatomy and especially skin coverage. When compared with rhinoplasty in the female adolescent, the goal must be more of a "balanced rhinoplasty" rather than a reductive rhinoplasty, and the techniques required are more diverse. Careful screening of patients is essential to eliminate a subgroup of men with severe psychologic obsessions.

Adolescent↗
PubMed1979

Free vascularized bone grafts in surgery of the upper extremity.

Free vascularized fibular grafts were employed in five patients with segmental bone defects following trauma or resection of tumors of the upper extremity with excellent results in three patients and satisfactory results in two. No donor site morbidity was experienced. A comparison with rib and iliac crest grafts indicates that the fibula is more suitable for reconstruction of long bone defects. The advantages of this technique are stability without sacrificing viability and a shorter immobilization period with more rapid incorporation and hypertrophy of the graft. The disadvantages are prolonged operating time, difficulty in assessing patency of anastamoses in the immediate postoperative period, and sacrifice of a major vessel in the lower extremity.

Adult↗
PubMed1979

Microvascular anastomoses for bone grafts in the treatment of massive defects in bone.

Six patients with large defects in bone are described in whom we performed microvascular anastomoses of grafted fibular vessels (arteries and veins) to vessels in the recipient site. Two other patients, with massive loss of bone and skin, were treated by grafting of osteocutaneous composites also using microvascular anastomoses. All but one defect healed successfully. There is a wide potential for applications of these two techniques in the treatment of large segmental bone defects secondary to trauma or following tumor resection.

Adult↗
PubMed1979

Pressure sores-a reappraisal.

Pressure sores are a common problem. They are casually accepted, their etiology is well defined, and treatment is standardized. How, therefore, can the subject justify reappraisal? On detailed review, evidence is presented showing that pressure sores can be minimized, that their pathophysiology is far from certain, and that their management is changing dramatically. During the past decade, new preventive measures have been adopted consisting of multidisciplinary tissue trauma clinics for paraplegic patients, based in rehabilitation hospitals, as well as early identification of the "at-risk" subgroup of geriatric patients who will require aggressive nursing care. Although pressure is the most widely accepted etiological factor, no sophisticated experimental studies have corroborated this hypothesis, and in fact, the majority of research conflicts with clinical observations. Recently, new surgical proceudres-myocutaneous and sensory skin flaps-have been devised to solve complex coverage problems which will possibly reduce the recurrence rate. An in-depth review of pressure sores is therefore warranted and will, we hope, stimulate renewed interest in this all-too-frequent clinical affliction.

Aging↗
PubMed1979

Free flap transfers for upper extremity reconstruction.

Ihre clinical cases are presented using different donor sites for free flap transfer to the upper extremity. The advantages and disadvantages of the 3 donor sites namely Iliofemoral, dorsalis pedis and latissimus dorsi are discussed.

Adolescent↗
PubMed1979

The intercostal flap: an anatomical and hemodynamic approach.

The intercostal island flap is a new omnipotential flap that is extremely valuable for torso reconstruction, provided one understands the intricacies of intercostal anatomy. Human cadaver dissections were done to determine the precise course and branching pattern of the lower (T7-T11) intercostal neurovascular bundles. On the basis of these dissections, the intercostal structures can be divided into four anatomical segments: vertebral, costal groove, intermuscular, and rectus. The anatomical segments can be safely combined in many ways to create versatile skin flaps. Three different clinical applications with requisite modifications in surgical technique are described in detail to exemplify important anatomical observations. The potential value of the intercostal island flap in reconstructive surgery is discussed.

Adult↗
PubMed1978

Benign fatty tumors of the peripheral nerves.

Fatty tumors of the peripheral nerves, although rare, occur with sufficient frequency to pose problems in diagnosis and treatment. Moreover, the nomenclature of these tumors has suffered from controversy over their morpological description. These factors have contributed to a misunderstanding about the treatment of these localized nerve abnormalities leading, in the past, to unnecessary radical nerve excisions with resultant total motor and sensory deficit. This paper reviews the various types of fatty tumors, describes the morphology and pathophysiology of one such lesion, and provides a basis for a rational surgical approach.

Adolescent↗
PubMed1978

Mandibular reconstruction with free tissue transfers.

During the past ten years, immediate mandibular reconstruction has gradually fallen into disfavor because of the incidence of infection and the increasing use of preoperative radiation therapy. The difficulty lies in selection of the ideal material for mandibular replacement and the attainment of a healthy recipient bed. An attempt has been made to solve this problem with microsurgical techniques, and our experience in six free tissue transfers utilizing both free rib and free osteocutaneous groin flap transfers is reported. The evolution of these techniques has required confirmation of the feasibility of free flaps in the oral cavity as well as incorporation of a vascularized bone graft in free groin flaps. Based on this experience, the free osteocutaneous groin flap containing a vascularized portion of the iliac crest is preferred for reconstruction of combined and composite deficiencies of the lower jaw. Convincing demonstration of bone viability in composite flaps must await correlation of bone scans with tetracycline labelling.

Adult↗
PubMed1978

The great potential of the intercostal flap for torso reconstruction.

The intercostal flap has many uses for torso reconstruction, whether employed as an island flap or a free flap. With modifications, it can be used as a sensory skin flap, or as a compound osteocutaneous flap to restore stability in a chest wall construction, or as a skin flap with a permanent blood supply to provide stable cover after excision of radiation ulcers.

Adult↗
PubMed1978

Free flaps: an overview.

The free flap represents a dramatic one-stage procedure for distant transfer of skin flaps. The operative technique consists of: identification of healthy recipient vessels; isolation of viable island skin flap; distant transfer followed by revascularization via microvascular anastomoses. New techniques warrant classification of free tissue transfers into single tissue transfers (skin, muscle, bone, nerve) and compound tissue transfers (osteocutaneous, musculocutaneous). When compared to conventional techniques, free flap transfers offer shorter hospitalization and immobilization as well as a greater reconstructive potential. However, their utilization mandates extensive experience in multiple microvascular techniques and clinical microsurgery.

Adult↗
PubMed1978

Great toe to hand free tissue transfer.

Thumb reconstruction is a complex subject and the method selected for each patient deserves individual consideration. The method of free toe-to-hand transfer for thumb replacement should be chosen only when the surgeon is familiar with all alternative methods of thumb reconstruction and feels that this technique represents the most reasonable method available. For the surgeon a clear understanding of the anatomic similarities and differences between the normal thumb and great toe are mandatory. In well selected adults and children the failure rate for free toe-to-hand transfer should be very small. The advantages of a single staged thumb replacement from tissue of similar character and quality without local tissue sacrifice are tremendous. With improvement in techniques, experience and case selectiion, much free tissue transfers will actively compete with well established methods of thumb reconstruction. Surely the free toe-to-hand transfer for thumb replacement of today is a forerunner of thumb and hand transplantation of tomorrow.

Adult↗
PubMed1978

Microsurgical techniques in experimental lymphedema of the rabbit ear.

One of the main obstacles to the study of changes occurring in lymphedema and the effects of various therapeutic modalities has been the lack of a reproducible inexpensive experimental model. We believe that the rabbit ear model satisfies this requirement permitting both evaluation of changes which lead to development of lymphedema as well as evaluation of the efficacy of microsurgical techniques.

Animals↗