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Biomedical subjects

Ronald M Zuker

Publications and source records attributed to Ronald M Zuker.

11 recordsLinked to original sources
PubMed2006

First successful lower-extremity transplantation: technique and functional result.

Composite tissue transplantation has emerged as a viable alternative to prosthetics and complex reconstructive surgery. Thus far it is reserved for cases which cannot be effectively reconstructed and where it offers some benefits over prostheses. It has been used in the upper extremity with encouraging results and, most recently, in the face. This report outlines what is believed to be the first such use in the lower extremity. A normal lower limb in a 3-month-old ischiopagus twin who was not going to survive was transplanted to the appropriate pelvic position, revascularized, and reinnervated in an otherwise healthy sister. The limb survived and, because of the immune compatibility, did not require immune suppressive therapy. The return of muscle function in the transplanted limb is encouraging. The transplanted limb appears to be fully sensate. In addition to reinnervation, the limb is now spontaneously under the cortical control of the recipient.

Abdominal Muscles↗
PubMed2006

Indications and outcomes of free tissue transfer to the lower extremity in children: review.

Thirty-four free tissue transfers for reconstruction of various tissue defects to the lower extremities were performed in 32 children over a 20-year period (1980 to 1999). Patient ages ranged from 3 to 19 years (mean: 10.8 years). Four donor sites were used: gracilis muscle, latissimus dorsi muscle, iliac crest osteocutaneous, and vascularized fibula. Fourteen patients had tissue defects related to trauma: nine received a gracilis flap; five received a latissimus dorsi flap. Five patients had tissue defects related to malignant tumor resection: three patients with Ewing's sarcoma received free fibulae; one patient with an osteogenic sarcoma received a gracilis flap, and another received an iliac crest osteocutaneous flap. Fifteen patients had congenital anomaly-related tissue defects: five with talipes equinovarus received gracilis flaps; ten with congenital tibial pseudoarthrosis received free fibulae. Vascular outcome was assessed based on the achievement of flap perfusion and post-surgical vascular revisions. Complete flap survival was achieved in 32 cases (85.3 percent); partial flap loss in three cases (8.82 percent); and complete flap loss in two cases (5.9 percent). Early revision surgery for the five partial or failed flaps consisted of debridement and split-thickness skin graft or flap removal. No patients required vascular take-backs or experienced vascular spasm. There were no systemic problems associated with the long and complex surgeries. Functional outcome was assessed based on ambulation, post-surgical complications, and whether the flap served its intended purpose. Ambulation was achieved in all cases. Functional surgical revisions were required in 32.4 percent of cases, and included scar revisions, flap debulking, bone grafts, and pin insertion. The most prevalent morbidity was persistent leg-length discrepancy (35.3 percent of cases). Only one successful flap was unable to meet its intended purpose, as a tibial pseudoarthrosis persisted, despite initial excision and a well-perfused reconstruction. Results show that free tissue transfer is safe and dependable for tissue defects of the lower extremity in children. From the authors' experience, free flaps used for the repair of defects from congenital tibial pseudoarthrosis have a high vascular success, but also require an extensive rehabilitation course, with only moderate functional success. There was no significant difference between flap surgeries performed immediately, intermediately, or late after trauma. These procedures have a wide range of indications and, despite the need for surgical revision and an extensive rehabilitation course, functional and vascular success can be achieved.

Adolescent↗
PubMed2006

A comparison of commissure excursion following gracilis muscle transplantation for facial paralysis using a cross-face nerve graft versus the motor nerve to the masseter nerve.

BACKGROUND: The microneurovascular transfer of a free muscle transplant is the procedure of choice for facial animation in a child with facial paralysis. One of the critical factors of this procedure is the selection of a motor nerve to innervate the transplanted muscle. METHODS: From 1989 to 1999, 166 free segmental gracilis muscle transfers were performed in 121 children for facial animation. The cross-face nerve graft was used in 70 procedures (cross-face nerve graft group) to innervate the muscle by branches of the seventh nerve for the normal side. The ipsilateral masseteric nerve was used in 94 procedures (50 patients, masseter group) and the ipsilateral accessory nerve was used in two procedures (one patient). To compare the operative procedures between the first two groups, all charts were reviewed. The extent of oral commissure movement was determined by measurements taken from the tragion to the oral commissure, both at rest and with full smile. In the cross-face nerve graft group (n = 20), the extents were measured on both the normal side and the reconstructed side; in the masseter group (n = 16), they were measured on the left and right sides. RESULTS: No significant difference was found between the two groups (p < 0.05) for the mean age at the time of muscle transplantation, for the total operation time for muscle transplantation, and for the length of the muscle used or for the fraction of circumference of the segment of gracilis muscle used. Although the operative variables were similar between two groups, the muscle excursion differed. Excursion in the cross-face nerve graft group was less than that on the right (p = 0.0006) or left (p = 0.0000) in the masseter group. It was also less than on the normal side (p = 0.0000) of the cross-face nerve graft group. Also, there was no significant difference between the left and right sides within the masseter group (p < 0.05). Furthermore, the extent of oral commissure movement in the masseter group was similar to that of the normal side in the cross-face nerve graft group (p = 0.35, p = 0.61). CONCLUSION: These results indicate that segmental gracilis muscle transplantation using the motor nerve to the masseter nerve for facial animation in children is a very reproducible operation and provides a commissure excursion in the range of normal.

Body Weights and Measures↗
PubMed2005

Anesthetic management of children with Moebius sequence.

BACKGROUND: Moebius sequence is a rare congenital absence of the sixth and seventh cranial nerves, although there may be additional congenital cranial neuropathies. Developmental delay, cardiac and musculoskeletal abnormalities may also co-exist. Oro-facial manifestations include bilateral facial nerve palsy resulting in a mask like facies, drooling, incomplete eye closure, and strabismus secondary to the extra-ocular muscle imbalance. This condition has multiple implications for anesthetic care. METHODS: We reviewed 111 anesthesia records of 46 patients with Moebius sequence for anesthesia technique and related complications. RESULTS: Facial nerve palsy was universally present and bilateral in 44 (93.6%) patients. Thirty-two (68%) had concomitant sixth nerve palsy. Oro-facial and limb abnormalities were present in 16 (35%) and 18 (39%) of patients respectively. Endotracheal intubation, when attempted, was easy in 76 of 106 cases. Tracheal intubation was consistently difficult in seven patients and intubation failure occurred in a single patient only. Statistically significant factors associated with difficult tracheal intubation included structural abnormalities of the mandible and palate and abnormalities of four cranial nerves (IX, X, XI, XII). CONCLUSION: We confirm that tracheal intubation may be difficult in patients with Moebius sequence. We identify disease features that might predict a difficult tracheal intubation and thus allow the anesthesiologist an opportunity to plan accordingly.

Abducens Nerve↗
PubMed2005

Congenital epulis.

Congenital epulis is a rare benign hamartoma of the alveolar ridge found in the newborn. The clinical characteristics of this lesion show some variability, and opinion of its pathogenesis lacks consensus. Congenital epulis can cause feeding or respiratory compromise. A case report and review of the literature is presented. The diagnosis, pathology, and treatment are reviewed.

Diagnosis, Differential↗
PubMed2005

Iatrogenic fetal injury.

BACKGROUND: Iatrogenic fetal injury during cesarean delivery is a serious but underreported complication. CASE: A distal iatrogenic amputation of a digit occurred during a cesarean delivery. CONCLUSION: Obstetricians should be aware of this potential complication.

Adult↗
PubMed2005

Treatment of congenital facial nevi.

The treatment of congenital facial nevi is often difficult and challenging. Previous authors have reported their techniques, results, and complications when treating these lesions. Our objectives are to simplify the treatment planning by subdividing the lesions with a new classification and using this to formulate a surgical algorithm. One hundred and two patients with congenital facial nevi were reviewed. All of these patients have had surgical excision for the lesions. We have subgrouped the lesions into three groups, according to size, number of aesthetic units involved, and number of reconstructive stages required. Group I included lesions 1 to 3 cm in maximal diameter, within one aesthetic unit, and requiring one or two reconstructive stages. This group included 29 patients. Group II included lesions 3 to 12 cm in maximal diameter, covering one or two aesthetic units, and requiring not more than two stages of reconstruction. This group had 41 patients. Group III consisted of extensive lesions, over 12 cm in maximal diameter, covering several aesthetic units, and requiring several stages of reconstruction. In this group, we had 32 patients. On the basis of our experience in treating congenital facial nevi in this series, we have developed a surgical algorithm for reconstruction. We are optimistic that this will assist the surgeon in surgical planning and treating this complex patient population. The algorithm is arranged according to the new classification of congenital facial nevi that is presented.

Adolescent↗
PubMed2003

The effects of gracilis muscle transplantation on speech in children with Moebius syndrome.

Speech and communication are major problems for children with Moebius syndrome, a congenital anomaly that includes facial and abducens nerve paralysis and, often, other cranial nerve deficits. In addition, these children frequently have severe functional problems such as drooling as well as poor self-esteem. The purpose of this study was to investigate the outcome of speech with bilateral gracilis muscle transplants innervated by the masseteric nerve in children with Moebius syndrome. The outcome of this two-stage procedure was investigated in 12 patients. Assessments were done before and after surgery, and additional data were collected from video records. After surgery, the children showed improved intelligibility of speech with a significantly lower frequency of all compensatory phonemes, including the sounds of /p/, /b/, /m/, /w/, "sh", /f/, and /v/. This procedure had evident positive impact in all problematic areas and is the procedure of choice for these unfortunate children.

Adolescent↗
PubMed2003

Congenital melanocytic nevi.

Congenital nevi are characterized by the appearance of pigmented areas that range in size, shape, surface texture, and hairiness. In most cases, the nevus remains stable and benign, but because of possible malignant transformation, nevi are often excised. In this case, a young boy was born with a hairy nevus below his lip extending inferiorly down the left side of his chin and upper neck. After two surgical excisions, the wound healing process was interrupted when his incision wound was split while jumping on his bed. With the professional assistance of occupational therapists, the scar should heal in an esthetically pleasing manner.

Child, Preschool↗