PubMed Health⌕ Search

Biomedical subjects

R L Walton

Publications and source records attributed to R L Walton.

14 recordsLinked to original sources
PubMed1992

Free flaps in the elderly.

Microsurgical transfer of tissue has become a primary tool of the reconstructive surgeon. The elderly, as a growing segment of our society, are requiring free-tissue transfers in proportion to their numbers. To investigate the potential morbidity of free-tissue transfers in the elderly, we studied consecutive populations of 31 patients above the age of 65 years and 90 patients below the age of 65 years. Complication rates were 65 and 49 percent, respectively. Premorbid medical conditions were present in 87 percent of patients 65 years and older and in 72 percent of those under 65 years. Medically related complications in free-tissue transfers, previously unreported in the literature, were 35 percent in the elderly group and 10 percent in the younger group. Wound-healing complications were seen in equal proportions between groups. The rates of wound and medically related complications observed in the elderly group were nearly double those observed in the younger group; however, after correction for the presence of preexisting medical conditions, no significant differences were seen between the two groups. These observations suggest that age alone is not a variable in risk for free-tissue transfers. Elective microsurgery can be performed in the elderly patient with a high expectation of success.

Adolescent↗
PubMed1992

Treatment of hand injuries by external fixation.

Thirty-five consecutive applications of external fixation to the hand, including 27 acute cases and 8 reconstructive procedures, were studied. In both settings, external fixation was used not only for skeletal stabilization but also for management of the soft tissues. Twenty of the 22 acute fractures healed, and six arthrodeses with interposition bone grafts resulted in fusion. Three septic nonunions resolved, and two united successfully. There were no complications. We recommend external fixation systems in the hand, and several case reports are included in the study to illustrate the various applications.

Adolescent↗
PubMed1991

Judgment and approach for management of severe lower extremity injuries.

Severe lower extremity injuries are devastating in their impact on the patient, his or her family, and the future. A critical evaluation of the results of previous salvage efforts provides the basis for the formulation of a treatment strategy. Success can be measured only in terms of functional outcome. The type of therapy is perhaps less important than the effectiveness of establishing a coordinated multidisciplinary approach to these injuries.

Amputation, Surgical↗
PubMed1990

Aesthetic results following partial mastectomy and radiation therapy.

This study was undertaken to determine the aesthetic changes inherent in partial mastectomy followed by radiation therapy in the treatment of stage I and stage II breast cancer. A retrospective analysis of breast cancer patients treated according to the National Surgical Adjuvant Breast Project Protocol B-06 was undertaken in 57 patients from 1984 to the present. The size of mastectomy varied between 2 x 1 cm and 15 x 8 cm. Objective aesthetic outcome, as determined by physical and photographic examination, was influenced primarily by surgical technique as opposed to the effects of radiation. These technical factors included orientation of resections, breast size relative to size of resection, location of tumor, and extent and orientation of axillary dissection. Regarding cosmesis, 80 percent of patients treated in this study judged their result to be excellent or good, in comparison to 50 percent excellent or good as judged by the plastic surgeon. Only 10 percent would consider mastectomy with reconstruction for contralateral disease. Asymmetry and contour abnormalities are far more common than noted in the radiation therapy literature. Patients satisfaction with lumpectomy and radiation, however, is very high. This satisfaction is not necessarily based on objective criteria defining aesthetic parameters, but is strongly influenced by retainment of the breast as an original body part.

Adult↗
PubMed1989

Microvascular thrombolysis to salvage a free flap using human recombinant tissue plasminogen activator.

Nonsurgical thrombolysis using tissue plasminogen activator (t-PA) in conjunction with intravenous heparin infusion was successfully used to salvage a free flap with acutely decreased arterial inflow thought to be due to anastomotic thrombosis. Intravenous infusion (12 mg/hr) of t-PA was stopped after 15 min of therapy when spontaneous bleeding was noted at the groin flap donor site. Concomitant treatment with intravenous heparin resulted in rapid improvement of flap perfusion and ultimately complete survival without surgical intervention. This report suggests that in selected cases, target-specific anticoagulant therapy may be beneficial in salvaging microvascular reconstructions complicated by thrombosis. Further experience is warranted to define more clearly the role, the risks, and the extended benefits of this new mode of nonsurgical therapy.

Adult↗
PubMed1989

Autogenous vein graft repair of digital nerve defects in the finger: a retrospective clinical study.

Twenty-two digital nerve repairs were performed in the finger using autogenous vein grafts. Eighty-two percent of the repairs were available for follow-up. Results of sensibility return were assessed using moving two-point discrimination, Semmes-Weinstein monofilaments, and vibratory testing. Two-point discrimination averaged 4.6 mm for 11 acute digital nerve repairs using vein conduits 1 to 3 cm in length. Delayed digital nerve repair with vein conduits yielded poor results. Semmes-Weinstein values demonstrated comparable levels of return of slowly adapting fiber/receptors to the quickly adapting fiber/receptors, as evidenced by moving two-point discrimination tests. Vibratory sensibility was present in all. A review of previous experiences with end-to-end digital neurorrhaphies and digital nerve grafting suggests that repair of 1- to 3-cm gaps in digital nerves with segments of autologous vein grafts appears to give comparable results to nerve grafting. Further laboratory and clinical research is necessary to better define the role of interpositional vein conduits for repair of peripheral nerves.

Adolescent↗
PubMed1989

A history of tendon operations.

The pendulum of arguments and popular operations swings back and forth, anchored to the problem of tendon healing and adhesions. The following passage, commenting on tendon repairs done by a famous 17th century surgeon, from the Course of Chirurgical Operations by Dionis in 1710, has relevance for history and the future of tendon operations. . . . When M. Bienaise, one of the most famous Chirurgeons of Paris, began the Performance of this Operation about fifty years past, it pass'd for his Invention; of which he reap'd all the Honor and it all the Charms of Novelty; but on Examination it appearing that it had been talk'd about two thousand years before he hit on it, it was consequently discover'd he only reviv'd an Ancient Practice of the Greeks, and that Guido and several others had practised it. 'Tis indeed true, twas grown obsolete, he brought it into use again, and we are oblig'd to him for having try'd it on his Dogs, after that employ'd on Men, and then encouraging us to the performance of an Operation which prevents the laming of a great many wounded patients.

History, 17th Century↗
PubMed1988

Psoriatic arthritis mutilans: digital distraction lengthening: pathophysiologic and current therapeutic review.

A patient with advanced arthritis mutilans secondary to psoriatic arthritis had distraction lengthening of the index and long fingers of his left hand followed by interphalangeal joint debridement and iliac crest bone grafting. After operation, he demonstrated improved pinch (1.5 pounds to 8 pounds) and grip function (40 pounds to 60 pounds) in the hand and maintenance of the achieved digital length.

Arthritis↗
PubMed1985

Fasciocutaneous flap coverage for periolecranon defects.

Soft tissue defects in the periolecranon region are difficult to manage by standard techniques such as closure by approximation, split-thickness skin grafting, or healing by secondary intention. We employed cadaver injections and dissections to study the vascular anatomy of the periolecranon region in search of a suitable local flap for coverage of periolecranon defects. This report details our experience in 31 patients with a one-stage technique for elbow coverage employing a proximally based forearm fasciocutaneous flap. Surgical techniques and clinical applications are discussed; a satisfactory long-term outcome is documented in 30 of 31 patients. The advantages of using this model fasciocutaneous flap include enhanced vascularity, sensibility, and ease of elevation.

Adult↗
PubMed1985

The posterior calf fascial free flap.

Six posterior calf fascial free flaps were employed to reconstruct defects of the upper and lower extremities. One flap failed due to a constricting dressing. Two flaps sustained partial loss secondary to bleeding and hematoma formation. One flap dehisced at the distal suture line due to mobility of an underlying fracture. All surviving flaps eventually healed and resulted in stable, thin coverage. Donor-site morbidity has been minimal. Shortcomings of this flap model have been defined in the peculiarities of its thinness, diffuse vascular oozing, the extent of the vascular territory, and in postoperative monitoring. These problems are analyzed and recommendations for their resolution are presented. Fascia represents a unique tissue which offers an exciting new dimension in the reconstruction of certain defects--particularly those in which thinness is a desirable option. In the posterior calf model, the inclusion of fat represents an alternative modification that allows the surgeon to tailor the design to a variety of problems where fascia alone is too thin and a cutaneous flap is too thick. This concept may find its greatest application in wounds involving the hand or foot. We believe that this and other fascial flap prototypes may offer an ideal solution for reconstruction of major wounds of the extremities.

Accidents, Occupational↗
PubMedDate not supplied

Optimum management of hand blast injuries.

A series of 27 blast and gunshot injuries of the hand is presented. These wounds exhibit a spectrum of complexity and may include extensive soft tissue trauma complicated by burns, foreign bodies, fractures and amputations. A systematic management sequence is outlined to evaluate, treat, reconstruct and rehabilitate these hands, with the primary goal of obtaining early maximal function. Since these injuries vary in nature and complexity, this management sequence is specifically adapted to deal with the individual injury. A "reconstructive ladder" of techniques is utilized, ranging from "simple" (e.g., direct closure, skin grafts, local flaps) to "complex" (free flaps, toe-to-thumb transfer). The individual procedure selected is the most straightforward, consistent with expediency and early return of a functional hand. The return of these hands to function has been facilitated by recent advances in tissue assessment, free tissue transfer, and skilled hand therapy.

Adolescent↗