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Biomedical subjects

S W Parry

Publications and source records attributed to S W Parry.

At least 19 recordsLinked to original sources
PubMed1992

Use of the biceps femoris following failed inferior gluteal flap transfer. Case report.

Considering the high recurrence rate of pressure ulceration in paraplegic patients, flap procedures to reconstruct a defect should not be at the expense of another possible future flap. The posterior thigh fasciocutaneous flap is useful for the coverage of ischial and trochanteric pressure sores; the biceps femoris musculocutaneous flap is a useful choice for deep ischial defects. However, the cutaneous portions of these two flaps is nearly identical. The previous transfer of the biceps flap excludes the further use of the posterior thigh flap. In contrast, use of the posterior thigh flap still permits the employment of a biceps V-Y advancement flap. Even if the donor site of the previous posterior thigh flap must be skin-grafted, the graft will remain viable on its muscular bed and function as the cutaneous portion of the flap; thus stable coverage is provided, despite previous use of 'first line' flaps. We demonstrate how careful planning of the stages of flap procedures can allow the most economic use of donor areas in this difficult patient group.

Adult↗
PubMed1991

Indications for surgical débridement in 125 human bites to the hand.

Indications for operative intervention following human bites to the hand were determined based on physical examination and time elapsed since injury. One hundred twenty-four patients admitted to Charity Hospital of New Orleans, La, were stratified according to time elapsed from injury to treatment (early, less than 24 hours; delayed, 1 to 7 days; and late, greater than 7 days). Patients in the early group were mainly treated with conservative wound care, consisting of local wound exploration and irrigation in the emergency department, while those in the late group underwent surgical débridement. Patients in the delayed group either received conservative wound care or underwent débridement in the operating room. The early and late groups recovered excellent hand function while results within the delayed group were variable with improved results depending on rapid surgical débridement or drainage.

Adolescent↗
PubMed1991

The great auricular nerve revisited: pertinent anatomy for SMAS-platysma rhytidectomy.

Aesthetic platysma surgery during rhytidectomy has gained popularity for contour restoration of the jaw line, cervicomental angle, as well as anterior neck defects. The superficial musculoaponeurotic system-platysma flap is elevated and suspended in a cephaloposterior direction by suturing to the investing fascia overlying the sternocleidomastoid muscle and the mastoid bone. This procedure is usually performed without total visualization of the great auricular nerve, possibly placing this nerve at risk during suspension. Anatomical dissections of the great auricular nerve were performed bilaterally on 10 cadavers to delineate its course in the superior neck and identify anatomy pertinent to the elevation of flaps and placement of sutures during superficial musculoaponeurotic system-platysma suspension.

Cadaver↗
PubMed1989

Blood supply of the upper extremity muscles as related to functional tendon transfers.

For a given function to be restored, we feel that a "low risk" muscle should be employed in preference to a "high risk" muscle. If a "high risk" muscle must be used, a knowledge of its segmental blood supply should lead one to proceed with careful dissection (even under magnification), wider exposure, and preservation of every possible distal pedicle. We would strongly discourage blind "stripping" of the muscle belly in "high risk" muscles. This technique could be employed almost with impunity in the "low risk" muscles. We realize that this is a static, purely anatomic study with a new, theoretical viewpoint of tendon transfer techniques. Other factors must be considered (expendability, muscle strength, synergism, and amplitude). However, we feel that results may be improved through application of these detailed anatomic data. We have attempted to better delineate the blood supply to the muscles of the upper extremity. This knowledge may help improve our results in functional tendon transfer procedures.

Arm↗
PubMed1989

Reconstruction of the burned hand.

Several basic principles of burned hand care must be kept in mind at all times. Intervention should be early and aggressive, small splints should be placed within 24 hours, and early tangential excision of the burn should be done within 72 hours. Hemostasis should be absolutely meticulous prior to grafting. Depending upon the availability of donor site skin, full-thickness skin grafts, split-thickness grafts, or meshed split-thickness grafts (expanded or not expanded) are preferred. I have found the functional and cosmetic results to decrease with use in exactly the order stated. The skin graft should be placed with stent or bolster dressings and observed for "take" early. Light active range of motion is usually begun on the tenth postoperative day. Escharotomy or fasciotomy should be performed for any signs of ischemia. In order to control edema, one should be meticulous in the positioning of burned hands, emphasizing elevation, and early range of motion exercises. Pressure garments may be employed when the wound is stable and should continue for 6 to 12 months to control hypertrophic scar formation. Linear scars should not cross any hand joints; Z-plasties are employed over the web spaces. Whenever possible, flaps should be employed to preserve all web spaces and skin grafts used to cover the remainder of the hand. I am aggressive in releasing and reconstructing late deformities such as extension contractures of the wrist, the metacarpal hand, absence of the thumb, finger contractures, and burn syndactyly. These are listed in order of treatment priority. Only in this manner can the patient be returned to "normal life." Patient self-esteem will thus be increased markedly, as will quality of life. It is strongly urged that the surgeon be "captain of the team." The key person in this treatment regimen is the hand therapist, who uses appropriate splints, range of motion exercises, and desensitization programs. I encourage the use of multiple personnel on the "burn team." This may include psychotherapists and, in children, teachers with extraordinary qualities.

Burns↗
PubMed1988

Vascular anatomy of the upper extremity muscles.

This study delineates the vascular anatomy of the upper extremity with particular attention toward the size, location, and number of vascular pedicles supplying each muscle. Ten cadaver upper extremities were dissected. A total of 440 muscles and 2209 pedicles were identified. The major "named" arterial source, number of pedicles, and pattern of perfusion for each muscle were delineated. Detailed description of the vascular anatomy of muscles commonly used for tendon transfer and local flaps is presented. The potential use of the coracobrachialis flap for contouring the infraclavicular area is elucidated. The anatomic bases of the anconeus and flexor carpi ulnaris flaps are confirmed. The radial and ulnar arteries may be used as microvascular donor or recipient vessels without compromising forearm muscle perfusion.

Adult↗
PubMed1988

Microvascular free-tissue transfer in children.

We have reviewed our experience with 22 microvascular free-tissue transfers in children. Ages range from 2 to 14 years; the success rate was 96 percent. Two patients underwent reexploration for postoperative hemorrhage, possibly due to treatment with low-molecular-weight dextran. No vessel spasm was observed, compared with a 28 percent incidence in our adult series of 154 patients. The vessels were in pristine condition. Operative time was shorter (6.1 hours) than in our adult series (9.7 hours). Average hospital stay was 10 days (compared to 23 days for adults). All children have resumed almost normal activity within 2 months (4 months for adults). Results of this study indicate that microvascular free-tissue transfer can be accomplished safely and expeditiously in children. Care should be taken in preoperative and postoperative planning, however, especially concerning immobilization.

Adolescent↗
PubMed1988

Acalculous hypersensitivity cholecystitis: hypothesis of a new clinicopathologic entity.

Acute acalculous cholecystitis is common, accounting for 5% to 10% of cases of acute cholecystitis. Although originally attributed to stasis and inspissated bile with subsequent obstruction of the cystic duct, acalculous cholecystitis has more recently been attributed to gallbladder ischemia from such conditions as hypotension or vasculitis. However, a significant number of cases of acute acalculous cholecystitis occur with no obvious cause. This report notes acute acalculous cholecystitis, diagnosed in 12 patients from 1982 to 1987, that was apparently precipitated by initiation of antibiotic therapy. Histologic sections of these gallbladders each disclosed a massive eosinophilic infiltrate. Two of the patients had identical signs, symptoms, and abnormal laboratory values during a previous course of erythromycin. These findings subsided when the antibiotic therapy was discontinued. We hypothesize that a significant cause of acute acalculous cholecystitis may be a hypersensitivity reaction to concurrent antibiotic therapy. Such patients should have antibiotic therapy halted or altered, which, it is hoped, will result in resolution of symptoms and avoidance of unnecessary laparotomy.

Acute Disease↗
PubMed1986

Restoration of the upper lip and nasolabial area by means of an intraoral approach.

Superomedial repositioning of the superficial musculoaponeurotic system (SMAS) in the upper lip is accomplished by means of intraoral incisions. The procedure reestablishes the convexity of the lateral vermilion border, elevates the upper lip, and restores a more youthful appearance to the upper-lip profile. Depth of the nasolabial folds are reduced. We have performed this procedure on 14 patients. Follow-up intervals range from 6 to 20 months, averaging 14 months. All patients received concomitant rhytidectomy; usual operative time was increased by 20 minutes. Results have been rated good to excellent by patients and surgeons. There have been no recurrences of nasolabial fold deepening or upper lip depression, and there have been no complications. In selected patients, this procedure, along with rhytidectomy, may provide a more youthful appearance.

Female↗
PubMed1986

Reconstruction of the burned nipple-areola complex.

Reconstructive results of 115 burned nipple-areola complexes in 84 female patients were reviewed. Results of nipple reconstruction using local quadrapod flaps (33 percent good, 45 percent fair, 22 percent poor) and composition grafts from the earlobe (20 percent good, 60 percent fair, 20 percent poor) were comparable, and both were superior to results obtained with the "double-bubble" technique (24 percent good, 35 percent fair, 41 percent poor). Differences in nipple reconstruction techniques were not appreciated until 1 year postoperatively. The early appearance of areola reconstruction with tattooing and split-thickness grafts was excellent. However, significant late hypopigmentation changes were observed with both techniques. Areola reconstruction with full-thickness skin grafts from the superomedial thigh (47 percent good, 33 percent fair, 20 percent poor) were superior to those obtained with tattooing (14 percent good, 35 percent fair, 51 percent poor) and split-thickness skin grafts from the contralateral unburned areola (21 percent good, 21 percent fair, 58 percent poor). We recommend employing local quadrapod flaps (for nipple), provided there is adequate surrounding dermis, and full-thickness skin grafts (for areola) in the reconstruction of the burned breast.

Adolescent↗
PubMed1985

The superficial musculoaponeurotic system in the upper lip: an anatomic study in cadavers.

Ten cadavers were employed to demonstrate the presence of the SMAS in the upper lip using macroscopic and microscopic techniques. The relationships and attachments of the SMAS to the dermis of the upper lip are described. In cadavers, medial traction on the SMAS in the upper lip in conjunction with superolateral traction on the SMAS in the cheek is found to decrease the depth of the nasolabial fold. Superior traction on the SMAS in the upper lip elevates the interlabial line, reestablishes the convexity of the lateral vermilion border, and partially increases concavity of the profile.

Adult↗
PubMed1985

Onlay cartilage graft of the alar lateral crus for cleft lip nasal deformities.

The onlay cartilage grafting technique is described for treatment of unilateral or bilateral cleft lip nasal deformities. The alar cartilage is exposed through rim and intercartilagenous incisions. The cephalic half of the alar cartilage is excised, similar to the technique of traditional tip rhinoplasty. The harvested cartilage is applied to the intact caudal cartilage in layered fashion and secured with absorbable sutures. If necessary, successive layers may be added. These grafts provide a sturdy, yet delicate framework for a more normal appearing alar rim. We have performed this procedure on 16 patients, ages 10 to 41. Follow-up intervals range from 13 to 40 months, with a mean of 19 months. Results have been rated good-to-excellent by patients and surgeons. There has been no recurrence of the deformity. The only complication has been one nasal vestibule synechia.

Adolescent↗
PubMed1985

Reconstruction of the eyebrow in the pediatric burn patient.

We have reviewed our experience with reconstruction of eyebrow alopecia secondary to thermal injury in the pediatric patient. Reconstruction was performed with free composite strip grafts or vascularized island pedicle flaps. The complication rates for eyebrows reconstructed with vascularized island pedicles with respect to loss of a significant portion of the flaps (30.8 percent) and malalignment of the grafts (23.1 percent) were significantly greater (p less than 0.001) than the significant tissue loss (10.6 percent) or graft malalignment (7.9 percent) observed for free composite grafts. Hair density was more predictably restored with the free composite graft technique (p = 0.0004). The patients reconstructed with composite grafts had 89.4 percent acceptable results in contrast to 38.5 percent acceptable results obtained with the island pedicle technique. Based on these findings, we reserve the use of the vascularized island pedicle technique for male patients with unilateral alopecia and heavy hair density in the remaining eyebrow and in cases where free composite grafts have failed. The remaining patients are initially treated with free composite grafts with acceptable results in the overwhelming majority of cases.

Adolescent↗
PubMed1985

Pollicization for thumb reconstruction in severe pediatric hand burns.

Our experience in pollicization of the index ray for severely burned hands in children is reviewed with attention to severity of burn, functional impairment, age at pollicization, procedure used, operative time, length of hospital stay, and long-term functional results. Fifteen pollicizations were performed in 11 patients with an average follow-up of over 5 years. Indication for pollicization was lack of prehension due to total loss of the thumb with the presence of a transposable index ray. The bipedicle flap method was used in two cases and the neurovascular pedicle technique was employed in all others. Skin grafts were necessary in all cases. Results were graded according to presence or absence of tip pinch, key pinch, grasp, and opposition. Significant functional improvement was seen in 14 of 15 cases (94 percent). Four patients (27 percent) developed complications requiring secondary procedures. In our experience, pollicization provides the most rapid and effective means of restoration of thumb function in the severe pediatric hand burn with multiple digit loss.

Adolescent↗
PubMed1985

Facial resurfacing at Shriners Burns Institute: a 16-year experience in young burned patients.

The records of 1,220 pediatric and adolescent patients admitted with a diagnosis of facial burns or facial burn scars were reviewed. Four hundred fifty patients underwent resurfacing of the face with skin grafts or flaps. One hundred ten patients underwent resurfacing performed in aesthetic units and were followed for an average of 5.75 years. Our experience in managing the patients in the latter group suggests that donor sites from above the clavicle give an optimum color and texture match regardless of whether grafting is full or split thickness.

Adolescent↗
PubMed1982

Bilateral gluteus maximus myocutaneous advancement flaps: sacral coverage for ambulatory patients.

The standard gluteus maximus myocutaneous flap, though an excellent procedure for coverage of sacral soft-tissue defects, has several disadvantages. It is usually quite bulky, and risks hip instability in the ambulatory patient. Bilateral gluteus maximus myocutaneous advancement flaps obviate these problems. The superior half of each gluteus maximus muscle, with overlying skin island, is released from its origin and insertion. The superior gluteal artery is identified and preserved. Each myocutaneous unit may be advanced to the midline. The line of cleavage between units preserves normal contour. Donor-site deformity is closed in the V-Y advancement fashion. Hip instability is thus avoided. This technique is useful in the management of sacral defects in the ambulatory patient.

Buttocks↗