Biomedical subjects
Publications and source records attributed to R Rayment.
The clinical assessment of burn depth can be particularly difficult in children. A new technique is described for applying the pin-prick test in children. It is simple to perform, causes no distress, and has consistently given reliable results. A personal series of 196 cases is presented, with a 95 per cent diagnostic accuracy.
The technique of cross-facial nerve transplantation (CFNT), with or without the addition of vascularised muscle, has made it possible to achieve some voluntary movement of the paralysed side of the face in patients with unrecovered facial palsy. If normal faces are studied during conversation, it can be seen that there are two types of movement of the lips--those of emotional expression and those involved in the formation of vowel sounds and labial consonants. Smiles themselves can be classified roughly according to their length of muscle contraction--the longer "definitive" smile, and the shorter "flash" smile. It is the synergistic facial movement of the unpremeditated "flash" smile and the small movements in the formation of the vowel sounds and labial consonants which fail to occur in patients reanimated by revascularised, reinnervated muscle, despite the return of voluntary contraction and resting facial tone. This study was undertaken to try to determine why these synergistic facial movements of short duration are so difficult to achieve.
In order to reduce the incidence of skin edge necrosis following dissection of the inguinal lymph nodes, an abdominal rotation flap has been used to help with closure. This allows excision of the most vulnerable skin, and closure without tension. Our experience in 13 groin dissections is presented, with skin edge necrosis in one patient (7.6%). This is compared with previously reported series and the reasons for the precarious blood supply to the skin following groin dissection are discussed.
Radical surgery in the neck is hazardous after irradiation. Rupture of the carotid artery may lead to uncontrollable haemorrhage. Reported mortality rates following this serious complication are between 18% and 50% (Heller and Strong, 1979). We describe a simple method for controlling acute carotid haemorrhage using a standard Fogarty biliary catheter, with selective detachable balloon embolisation for permanent occlusion of the carotid artery.
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