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Biomedical subjects

S H Kahler

Publications and source records attributed to S H Kahler.

7 recordsLinked to original sources

Sensibility of finger fillet flaps on late follow-up evaluation.

Though the use of fillet flaps salvaged from damaged digits is a well-established technique to obtain soft tissue coverage for the badly injured hand, the sensibility of these flaps has not been evaluated. We examined a series of four patients who underwent digital fillet flaps following hand trauma. Static two-point discrimination measurements of the injured hand and the contralateral hand showed that all four patients retained sensibility in the fillet flap that was equal to or better than the intact skin surrounding the flap. In some cases, the sensibility of the flap was equal to the sensibility in the corresponding contralateral fingertips. No patients had complaints regarding the function of their fillet flaps as sensate coverage of major soft tissue defects.

Adult

Pre-reconstruction tattooing eliminates the need for skin grafting in nipple areolar reconstruction.

Tattooing the skin of the reconstructed breast as a prelude to reconstruction of the nipple provides a nipple areolar reconstruction that has a uniform color. There is no requirement for a skin graft donor site. Tedious tattooing of the nipple papule is avoided. It is much easier to tattoo a flat surface than a projecting papule, and this technique gives a more uniform color. We believe that this approach to nipple areolar reconstruction provides a simpler, dependable technique.

Female

Tissue expansion of sensate skin for pressure sores.

The surgical treatment of pressure sores has improved with the development of many techniques to provide coverage of these defects. Few deliver sensate coverage. This report describes tissue expansion of back skin to provide definitive sensate coverage of a pressure sore, thereby preventing its recurrence. Follow-up of 5.5 years is presented with a review of the literature.

Adult

Planned angle osteotomy.

An improved method for performing angle osteotomies is described. An angle-osteotomy nomogram has been constructed allowing calculation of the width of a wedge osteotomy from the known thickness of the bone and the desired final degree of angulation. Use of the nomogram will speed operating time, improve technical precision, and minimize the chance of inadvertent injury to a vascularized bone graft that might occur in the event of repeated saw cuts.

Humans

Soft-tissue expansion in lower extremity reconstruction.

Soft-tissue expansion in the lower extremities is typically well tolerated. The more proximal one is--that is, the closer to the thigh and buttocks--the easier and less complication prone the expansion will be. It is another valuable technique for resurfacing the lower extremity and for reconstructing defects in contour and in skin character. There are limitations to this technique, which generally is most useful in late reconstructions. Intraoperative expansion has no place in lower extremity reconstruction. Soft-tissue expansion may be limited by an unsuitable geometry or the sheer size of defects. It should not be used next to open wounds. Soft-tissue expansion offers significant advantage in that the coverage of a defect will be replaced with tissue like that lost. Seldom does one see necrosis of advanced flaps, so that there is little risk of tissue loss in using this modality. There is an excellent vascularity to the flaps and an excellent character to the skin. In addition, in this cost-conscious era, soft-tissue expansion is quite cost effective, and in many cases the procedures can be conducted on an outpatient basis with a minimum of hospitalization, if any. With care to select patients properly, design carefully, and conduct expansion in a leisurely fashion, soft-tissue expansion offers a valuable means of reconstructing both large and small lower extremity defects.

Adult