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Biomedical subjects

R V Dowden

Publications and source records attributed to R V Dowden.

At least 55 records · Page 3Linked to original sources
PubMed1983

Breast reconstruction--selection, timing, and local recurrence.

Although reconstruction is now a standard part of the care of breast cancer patients, certain unresolved issues surround local recurrence. A percentage of women can be expected to develop local recurrence after mastectomy, whether or not they have reconstruction. This study provides a baseline for local recurrence in breast reconstruction candidates. Between 1955 and 1975, 1,110 patients underwent modified radical mastectomy at the Cleveland Clinic. This group of patients was analyzed to provide information about local recurrence in breast reconstruction candidates. The data were also analyzed for the effects of timing and nodal status. On the basis of this study, we have concluded that the number of involved axillary lymph nodes alone should not exclude a woman from having reconstruction. We also conclude that there is no oncological justification for imposing a specified waiting time between mastectomy and reconstruction.

Breast↗
PubMed1983

The effect of hyaluronidase and dimethyl sulfoxide (DMSO) on experimental skin flap survival.

Hyaluronidase has been shown clinically and experimentally to reduce the effects of tissue ischemia in myocardial infarction and hemorrhagic shock. Dimethyl sulfoxide (DMSO) has been shown to reverse the effects of cerebral ischemia in the primate model. A caudally based dorsal skin flap in the rat was used to study the effects of these two drugs in physiological doses on skin flaps, and to investigate their mechanisms of action. This study demonstrates that both hyaluronidase and DMSO, which are nontoxic in physiological doses, can increase the surviving length of an experimental skin flap. It is hypothesized that these substances exert their effect by decreasing tissue edema and by aiding in the transport of nutritive substances to the flap during its acute phase.

Animals↗
PubMed1983

The value of the anterior rectus sheath in the transverse abdominal island flap.

We report a major modification of technique for the transverse abdominal island flap, namely, taking the anterior rectus fascia with the muscle. We believe that this protects the fine vascular network supplying the flap. This has resulted in a more reliable flap, confirmed by increased fluorescein uptake, and significant reduction in operating time.

Abdomen↗
PubMed1983

The L-shaped combined vertical and transverse abdominal island flap for breast reconstruction.

The occasional patient will present for reconstruction after mastectomy who refuses a foreign-body implant or is desirous of reconstruction by autogenous tissue. An unfavorable midline abdominal scar that extends both below and above the umbilicus will preclude the use of the standard lower or upper transverse abdominal island flaps for such purposes. For these highly select circumstances, we present our experiences with two such patients where a combination of an L-shaped vertical and transverse rectus abdominis myocutaneous flap was employed. In this procedure, the vertical component is planned to provide the external skin cover, while the ipsilateral hemiellipse transverse component is deepithelialized and buried deep to the vertical component to provide the bulk and mound projection.

Adult↗
PubMed1983

Excision and grafting in treatment of recurrent pilonidal sinus disease.

Most failure and recurrences after excision and grafting occur during the first five months postoperatively. We concluded that this most likely indicated inadequate excision rather than inefficacy of the procedure. For small pilonidal sinus with minor sinus tract and shallow natal cleft, excision with primary closure would seem to be the best procedure. However, for extensive or recurrent sacrococcygeal pilonidal disease, wide excision with primary split thickness skin grafting is superior. We reviewed 58 patients who had undergone excision of extensive or recurrent pilonidal disease, with primary skin grafting. More than 72 per cent of these patients had recurrent disease when first seen at the Cleveland Clinic. The average hospital stay was 9.8 days; the total disability period, time off work, was 28 days; recurrence rate, 1.7 per cent, and failure rate, 3.4 per cent. This procedure is recommended for recurrent or extensive pilonidal disease.

Female↗
PubMed1982

Muscle flaps and the vascular detour principle: the soleus.

We present a concept in muscle and myocutaneous flap transfer whereby distally based flaps can, under very special circumstances, be transferred with an augmented arc of rotation and more reliable circulation. The concept is the inclusion of adjacent longitudinal vessels in the elevation, within which vessels the flow is reversed. To our knowledge this concept has not been previously described. The soleus muscle and eight other muscles have been found to be potentially useful in this regard. We report here our experience with 3 clinical cases of the distally-based soleus flap with a reversed pedicle, exemplifying the vascular detour principle. Our limited experience indicates no impairment of blood supply to the limb in short-term follow-up. Until further studies confirm the safety of major vessel sacrifice in a limb, we recommend only judicious use of this flap in highly selected situations.

Adult↗
PubMed1982

The role of the rectus abdominis myocutaneous flap in breast reconstruction.

The rectus abdominis myocutaneous flap has been used in 10 patients requiring the importation of skin, subcutaneous tissue, and muscle for postmastectomy reconstruction. It was preferred to the latissimus dorsi myocutaneous flap under the circumstances highlighted in Table I. The flap has proved reliable and easy to raise, with a consistent anatomic location of the arterial venous pedicle. In 10 such flaps performed, one partial necrosis occurred in a patient who was extremely obese and had had a previous laparotomy that may have interfered with the integrity of the underlying blood supply to the rectus abdominis muscle. A minor complication of cellulitis in the donor-site wound was due to an idiosyncratic allergy to sutures used in the subcutaneous tissue. One instance of abdominal contour deformity was noticed in a patient in whom the anterior rectus sheath had been reconstituted by advancing the fascia of the external oblique muscle to meet the linea alba in the midline. In summary, we believe that the rectus abdominis myocutaneous flap, in certain select circumstances, produces a reliable, readily accessible myocutaneous flap to import tissue to the anterior chest wall for adequate mound reconstruction after mastectomy.

Abdominal Muscles↗
PubMed1980

Muscle flap reconstruction of shoulder defects.

Defects of the shoulder area pose difficult problems for the hand surgeon, especially when associated with irradiation or exposed, infected bone. The development of muscle and myocutaneous flaps has greatly simplified the reconstruction of such defects. This report discusses the use of the pectoralis and the latissimus flaps for this purpose, with case examples and emphasis upon technique and applications.

Adult↗
PubMed1980

The vastus lateralis muscle flap: technique and applications.

The vastus lateralis muscle can provide a broad sheet of muscle for repair of defects of the lower abdomen, groin, perineum, hip, and ischium. The authors limit the use of the vastus lateralis muscle to situations in which more traditional techniques are not feasible. This muscle is especially suitable for defects involving irradiated tissue, infected bone, or infected prosthetic material. Although the vastus lateralis muscle has no cutaneous component, it may be used to augment an overlying tensor fascia lata flap.

Abdominal Muscles↗
PubMed1979

The breast reconstruction patient and her health insurance carrier.

To determine policies of health insurance companies regarding payment for breast reconstruction following mastectomy, we polled 50 companies selected at random, as well as every Blue Cross-Blue Shield company. To verify that insurance carriers' replies represented their practices, we polled 96 plastic and reconstructive surgeons in 47 states. Although most health insurance carriers claim to fully cover breast reconstruction following mastectomy for cancer, practices vary widely; many postmastectomy patients receive incomplete or no coverage for reconstruction. Two major reasons for discrepancies appear to be (1) inadequate coverage prompted by unrealistic conception of reconstruction on the part of carriers and (2) specific contractual exclusion. We suggest (1) educating lay and professional persons about breast reconstruction, (2) encouraging more realistic coverage from insurance companies, and (3) if necessary, legislative protection for the postmastectomy patient.

Breast↗
PubMed1979

Advising the mastectomy patient about reconstruction.

Breast reconstruction deserves critical consideration and discussion in each patient's case. The psychologic benefits from the procedure are enormous. Reconstructive goals are: skin coverage, contour restoration and formation of the nipple-areola. The prospect of reconstruction must have no effect on the procedure for extirpation of the cancer. Breast reconstruction is now possible even after the removal of large amounts of skin and muscle.

Breast↗
PubMed1979

Reconstruction of the breast after mastectomy for cancer.

General surgeons are taking a more active role in the treatment of all the problems which face the patient who undergoes mastectomy. For many of these women, an important part of their adjustment is achieved by reconstruction of the breast. The number of women requesting reconstruction of the breast after mastectomy is increasing, and more women faced with mastectomy are asking their general surgeons for information about the procedure. It is hoped that as reconstruction of the breast becomes more widely appreciated, women will be encouraged to perform more frequent self-examinations and to seek earlier treatment of carcinoma of the breast. It is tempting to speculate that one ultimate benefit may be an improvement in the survival figures associated with this disease.

Breast↗