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Biomedical subjects

R T Manktelow

Publications and source records attributed to R T Manktelow.

At least 55 records · Page 3Linked to original sources
PubMed1984

Functioning free muscle transplantation.

Functioning free muscle transplantation to the extremity is technically feasible based on microvascular anastomosis and fascicular nerve repair. Success depends on precise operative technique and a vigorous program of postoperative therapy. The most important operative details are the nerve repair and placement of the muscle at optimum tension. The forearm should be considered for muscle transplantation if there is a lack of finger flexion as a result of the loss of flexor musculature and if simpler techniques of tendon transfer are unavailable. The long-term results of 12 muscle transplantations to the forearm are presented. Eleven muscles survived completely and provided useful function, Nine provided a full range of finger motion. The maximum grip strength obtained with this procedure was 50% of normal grip strength.

Adolescent↗
PubMed1984

Facial contour reconstruction with free flaps.

Augmentation of facial soft tissues is frequently required in Romberg's disease, lateral facial dysplasia, lipodystrophy, and following tumor resections. The buried deepithelialized free groin flap provides a satisfactory solution to this problem. Technical refinements have ensured the survival of the flap and the sophistication of the contour correction. These refinements are a careful analysis of the defect, appropriate contouring prior to revascularization of the flap, slight over-correction of the eyelid defect, and a submandibular incision for improved exposure. The groin flap provides the soft, natural reconstruction desired by the patient. All patients with Romberg's disease maintained the bulk of their reconstructions.

Adult↗
PubMed1984

Muscle transplantation by fascicular territory.

In some muscles, distinct and separate portions of the muscle are each under the control of a different fascicle of the motor nerve. Although there is some slight overlap in areas, this unit, a single fascicle muscle territory, is present in the gracilis muscle. Microneurovascular techniques have improved the reliability of muscle transplantation for the reconstruction of facial paralysis. The amount of movement obtained depends on many factors, including the amount of muscle transplanted and the adequacy of its reinnervation. The ability to transplant a small segment of a muscle based on the fascicular territory enables the surgeon to supply the amount of movement that each individual patient requires.

Adult↗
PubMed1982

A study of blood flow and pressure in the vessels supplying a free flap.

A canine inferior epigastric free flap was studied to determine the normal hemodynamic parameters in a free flap operation. Following revascularization, mean arterial blood flow in the vessels supplying the flap was 4.1 to 4.8 ml/min/100 gm of tissue. Meticulous suture anastomosis did not adversely affect mean flow. Furthermore, resistance in the flap did not change throughout the procedure. Further studies, using this and other models, are underway to examine the hemodynamics of failing flaps. The current study provides the baseline data necessary for this continuing work, which may provide an insight into preventive or therapeutic measures directed at improving free flap survival.

Abdomen↗
PubMed1982

Management of ulnar artery aneurysm in the hand: a case report.

Despite the common occurrence of trauma to the hand, arterial aneurysms in this area are rare. The authors describe the symptoms, signs and microvascular treatment of a true aneurysm of the ulnar artery in the palm of an 18-year-old youth. Although there is no clear evidence that vascular restoration is needed after resection of the aneurysm, the authors believe that reconstruction of the ulnar artery using microvascular techniques will ensure that blood supply to the digits is adequate.

Adolescent↗
PubMed1981

Survival following vascular compromise in an island skin flap.

A model for evaluating vascular compromise in an island skin flap is presented. Survival is seen earliest following loss of the artery. Both artery and vein ligation groups show equal survival from the second day on with complete survival after the third day. Longer healing, up to 5 days, is required before the loss of both vessels can be withstood. Survival of island flaps in Wistar rats is not dependent on circulation through the vascular pedicle after 3 to 5 days.

Animals↗
PubMed1981

Step osteotomy: a precise rotation osteotomy to correct scissoring deformities of the fingers.

A scissoring deformity of the fingers frequently results from malunion of a phalangeal or metacarpal fracture. If union occurs with rotation, the injured digit will scissor with an adjacent digit on flexion of the hand. Malrotation can be corrected by a technique of step osteotomy of the metacarpal with removal of a longitudinal strip of bone. The placement of the transverse cuts of the osteotomy determines the direction of rotational correction and the width of dorsal strut determines the amount of rotational correction. Firm fixation with two interosseous wires ensures good bony union and allows early mobilization.

Finger Injuries↗
PubMed1980

Survival of a free flap after 20 hours of immediate post-operative venous occlusion.

A case report illustrating survival of a free flap after 20 hours of immediate post-operative venous occlusion is presented. This represents the most dramatic salvage of a free flap in the authors experience. It suggests that the late diagnosis of venous obstruction may not preclude satisfactory reexploration and repair of a thrombosed vein. Nevertheless, it is the authors' opinion that the shorter the interval of venous obstruction the more satisfactory will be revision of the anastomosis.

Adult↗
PubMed1980

An anatomical study of the pectoralis major muscle as related to functioning free muscle transplantation.

The prerequisites for a functioning free muscle transplant are reviewed. A method for studying the anatomy of the pectoralis major muscle is presented, giving special attention to the detail of the neurovascular structures. Fifteen meticulous dissections, documented by sketches and photographs, provide the data base. This work is summarized in Table I and Figure 3. The variability is stressed in Table II. None of the variations observed preclude the use of the inferior four-fifths of the sternocostal muscle as a functioning free muscle transplant. The length and bulk of this muscle are advantages for its use in replacing forearm flexors. The multiple innervations may be an advantage or disadvantage, depending on the availability of the motor nerves in the recipient site. The time-consuming dissection is a disadvantage. With this knowledge, the reconstructive surgeon can assess the advisability of using the pectoralis major muscle as a functioning free muscle transplant.

Female↗
PubMed1980

Microvascular free flaps in head and neck reconstruction.

Microvascular free tissue transfer can be applied to head and neck reconstruction where: (a) conventional flaps have been used successfully, (b) conventional flaps are extremely difficult to use and such procedures are undertaken with reservation and (c) conventional flaps cannot accomplish the reconstructive goal. The authors describe examples of these applications and summarize their experience in their first 10 cases. All flaps survived completely; there were four minor complications. Reconstruction with microvascular free flaps has many advantages over conventional techniques. The flap tissue retains its vascularity-important in irradiated tissue-there are no open wounds and this single-stage procedure is associated with a high rate of flap survival. Specifically, the flap can be oriented with ease, without restriction caused by a tight pedicle. The donor sites are less conspicuous and previous use of conventional donor sites is not important. Most importantly compound skin and bone flaps can be used simultaneously to reconstruct mandibular and lining defects. This application is not possible wtih techniques other than free flap transfer.

Carcinoma, Squamous Cell↗
PubMed1980

Head and neck reconstruction following resection of carcinoma, using microvascular free flaps.

Our experience with 15 microvascular free-flap transfers is documented and discussed. We feel that the procedure is an effective means of reconstruction for complex and extensive defects. Rapid advances have been made in all areas of cancer surgery. It is important that these patients be afforded a speedy and, preferably, immediate reconstruction and rehabilitation. Conventional techniques do not satisfy all the required goals.

Aged↗
PubMed1979

Use of microvascular flaps including free osteocutaneous flaps in reconstruction after composite resection for radiation-recurrent oral cancer.

Fourteen patients underwent microsurgical free flap procedures for reconstruction after composite resection of radiation-recurrent oral cancer. The use of attached metatarsal bone in nine patients for mandibular reconstruction is in our view a significant advance in this field. Two failures occurred, one due to sepsis and one to delayed thrombosis. Our experience indicates that this procedure deserves a place in the surgical treatment of patients afflicted with oral malignancy.

Adult↗
PubMed1979

Digital replantation: a functional assessment.

With the advent of microvascular anastomosis it has become technically and practically feasible to replant amputated digits. In the last 5 years the achievements in this field of surgery have shown considerable improvement. Success is initially measured in terms of survival of the amputated digits but finally in terms of function. This paper presents a functional assessment of the authors' 33 digital replantations in 20 patients. In all of these patients the period of follow-up has been longer than 2 1/2 years. An 85% survival rate for the replanted digits was obtained. Of the 17 patients who have surviving digits function in 15 was judged to be significantly improved by the procedure. These results have permitted the development of guidelines for selecting patients who will benefit most from the procedure.

Adolescent↗
PubMed1978

Free muscle transplantation to provide active finger flexion.

Free muscle transplatation is a procedure which involves the transfer of a skeletal muscle from one location in the body to another. Viability is maintained by microvascular anastomoses of the muscle's artery and vein to a suitable artery and vein in the recipient site. Voluntary muscle contraction is obtained by suturing of the muscle's motor nerve to an appropriate motor nerve in the recipient site. Two cases are presented; one using the gracilis and the other using the pectoralis major muscle. The indication for each transplantation was the traumatic loss of long flexor musculature to the digits. In both cases transplanted muscles survived and are functioning well. Excellent grip strength and nearly a full range of finger movement were provided by the transplanted muscle.

Adolescent↗