Biomedical subjects

Scott D Lifchez

Publications and source records attributed to Scott D Lifchez.

7 recordsLinked to original sources

PubMed2005

Functional improvement with digital prosthesis use after multiple digit amputations.

PURPOSE: Patients who sustain traumatic amputation of multiple fingers suffer both a functional and psychologic loss. Previous studies of prosthesis use for finger amputees have focused primarily on the psychologic benefits. Clinically our group noticed a functional improvement on hand function tests when patients with multiple digit amputations used a prosthesis. Given the expense of multiple finger prostheses we sought to determine if they led to a consistent functional improvement in these patients. METHODS: Ten consecutive patients performed a battery of hand function tests and rated their ability to perform a variety of activities of daily living both with and without their prosthesis using the Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS: Our results show a significant improvement in 3-finger-pinch strength and grip strength and a trend of improvement of tip-pinch, lateral-pinch, and grip strength in dynamometer positions 1, 2, 3, and 4 in these patients when tested with and without their prostheses. Function in activities of daily living, as assessed by the Disabilities of the Arm, Shoulder, and Hand questionnaire, was improved globally with prosthesis use. In addition, significant improvement was noted in several specific activities including opening a jar, writing, and turning a key, among others. CONCLUSIONS: These results show that prosthesis use provides a functional benefit to these patients in multiple activities.

Activities of Daily Living↗

PubMed2005

Cortical adaptation to restoration of smiling after free muscle transfer innervated by the nerve to the masseter.

BACKGROUND: The child with Möbius syndrome presenting for facial reanimation presents a difficult challenge. When bilateral paralysis and paresis preclude use of the contralateral facial nerve, the authors' preferred donor nerve for reinnervation of free muscle transfer is a branch of the trigeminal nerve, the ipsilateral nerve to the masseter. METHODS: The authors have used a branch of the trigeminal nerve as a donor for three children with Möbius syndrome. RESULTS: Of three children with Möbius syndrome, two are now able to smile independently of jaw closure. One child is now 2.6 years past bilateral free gracilis transfers completed at age 13.2 years. The second child is 8.2 years past free gracilis transfer to the left side of the face performed at age 7.6 years. The third child is 5.6 years past bilateral facial reanimation with free latissimus and free gracilis flaps completed at age 13.4 years. This child is not able to smile independently of jaw closure. The two who are able to smile independently of jaw closure demonstrated maximum excursion of the lateral commissure on the affected sides when asked to smile without biting; however, they demonstrated minimal excursion of the lateral commissure on the affected sides when asked to bite without trying to smile. CONCLUSIONS: These findings indicate that smiling independently of jaw closure is attainable with reanimation to the masseteric branch, refuting previous speculations. Early age at operation and absence of complete bilateral paralysis in these two children may have contributed to cortical adaptation to smiling.

Adaptation, Physiological↗

PubMed2005

Serratus anterior in vivo contractile force study.

BACKGROUND: A major limitation of functional muscle transfer for facial and intrinsic hand reanimation is the inability to predict the force that will be generated by the transplanted muscle. METHODS: The authors studied the contractile force of the slips of the serratus anterior in situ in 10 patients and tested the gracilis muscle in four subjects as a control. RESULTS: Mean contractile force generated by each serratus slip was 0.178 pound (range, 0.019 to 0.797 pound). This compares favorably with the maximum force generated by smiling (0.307 pound). Muscle strength correlated strongly with age (r = -0.805, p = 0.005). The lowest slip generated less force than those above it (0.133 pound versus 0.191 pound); this difference did not reach statistical significance. When the strength of the lowest slip is compared with the more superior slips as a percentage of total force generated by the slips (to compensate for the effect of age on muscle strength), the lowest slip was significantly weaker (18.6 percent of total force versus 25.5 percent of total force, p = 0.013). Mean contractile force generated by the gracilis was 0.963 pound, significantly different from that generated by a serratus anterior slip (p = 0.009). CONCLUSIONS: Each serratus slip could potentially be used to generate a separate force vector for facial reanimation. Further separation of the flap along preexisting fascial planes may allow generation of up to 10 independent force vectors, making the serratus anterior muscle flap an attractive option for facial reanimation and possibly intrinsic hand muscle reconstruction.

Adolescent↗

PubMed2004

Transverse rectus sheath plication in abdominoplasty.

The standard abdominoplasty technique uses a wide, vertically oriented plication of the rectus sheath to narrow the waistline. This reduces the contribution of the rectus sheath to the anterior abdominal wall from more than 50 percent to 25 percent or less and creates an unnaturally flat appearance. No amount of exercise can restore the native form of the rectus sheath. For the past 3 years, the authors have performed a transverse plication of the rectus sheath, to address vertical laxity, complemented by a bilateral crescent-shaped plication of the external oblique fascia, to address waistline contour. Six consecutive patients who underwent the transverse rectus plication technique were compared with a similar group of patients who underwent vertical rectus plication. Comparison was made via preoperative and postoperative photographic analysis by two impartial judges. Although the overall result was excellent in both groups, the global score was significantly higher in the transverse plication group (4.5 versus 3.9, p = 0.044). Scores for anterior abdominal contour (4.7 versus 4.2, p = 0.029) and definition of the linea semilunaris (4.6 versus 3.7, p = 0.008) were also significantly higher for the transverse plication group. The difference for waistline contour (4.5 versus 3.8, p = 0.067), definition of the linea alba (4.4 versus 3.9, p = 0.067), and hip-waist transition (4.4 versus 3.7, p = 0.067) did not reach statistical significance. The outline of the rectus sheath is a significant portion of what is perceived as an aesthetic abdomen. Transverse plication of the rectus sheath with bilateral crescent-shaped plications of the external oblique fascia retains this native form. The result is improved anterior abdominal contour and definition of the rectus sheath with a comparable or better improvement in waistline contour and transition from the hips to the waist when compared with wide, vertical rectus plication.

Abdominal Muscles↗

PubMed2004

Detailed neurovascular anatomy of the serratus anterior muscle: implications for a functional muscle flap with multiple independent force vectors.

A functional muscle free flap with multiple muscle segments that could be oriented independently to produce different force vectors would be beneficial in facial reanimation and upper extremity reconstruction. The serratus anterior muscle has this potential because two or more individual muscle slips can be transferred on a single vascular pedicle. Although serratus anterior muscular anatomy has been studied previously, little attention has been given to the intramuscular anatomy. Muscle slips 5 through 9 (and 10, if present) in 50 specimens from 27 cadavers were studied following intraarterial latex injection. Eight specimens were injected with a radiopaque material (latex/diatrizoate/lead mixture) for x-ray delineation of the intramuscular vascular pattern. Slips 5 through 9 are consistently supplied by a single dominant branch of the thoracodorsal artery and innervated by the long thoracic nerve. Dissection revealed that the long thoracic nerve and its branches invariably follow the artery and divide proximal to the corresponding arterial division. There is a consistent vascular pattern to each muscle slip, in which the serratus artery gives rise to common slip arteries, each of which supplies adjacent muscle slips. The mean length of a muscle slip from its origin on the rib periosteum to the division of the common slip artery is 9.6 cm. These findings imply that the slips may be separated to the level of these common slip arteries, with up to five slips transferred on a single neurovascular pedicle and each slip oriented independently to provide multiple muscle force vectors. With these possibilities, the reconstructive surgeon may be able to restore more natural facial animation and better intrinsic muscle function in the upper extremity.

Adolescent↗

PubMed2004

The serratus anterior subslip: anatomy and implications for facial and hand reanimation.

The ideal donor muscle for facial and hand reanimation has yet to be found. Donor muscles commonly used today, such as the gracilis and pectoralis minor, are limited by bulkiness and the number of force vectors they can provide. In the authors' study of 50 fresh cadaver serratus anterior muscles, they further describe neurovascular anatomy of the muscle slip (i.e., the portion of the muscle that inserts on a rib) and subslip (superficial or deep subdivision of the slip after division along a loose areolar plane). All 260 slips could be separated into a deep and a superficial subslip, yielding a total of 520 subslips. A branch of the serratus artery (a terminal branch of the thoracodorsal artery serving the lower five to seven slips of the muscle) and a branch of the long thoracic nerve were identified for each of these. Deep subslips were thinner than superficial subslips, both at the origin of the slip on the rib periosteum (2.4 mm versus 3.0 mm, p < 0.0001) and centrally at the serratus artery (3.3 mm versus 4.0 mm, p < 0.0001). In addition, the subslips of the most inferior slip were thinner than those of more superior slips, both at the origin of the slip (2.3 mm versus 2.8 mm, p < 0.0001) and at the serratus artery (3.0 mm versus 3.8 mm, p < 0.0001). Fine anastomosing vessels were present between the slips and the subslips. The average number of anastomosing vessels present between adjacent slips was 1.7, and 2.1 anastomosing vessels were present between the subslips of a given slip. Given the thinness of these vessels (all less than 0.2 mm) compared with those of the vascular pedicle of the subslip (mean, 0.7 mm; all greater than 0.4 mm), the authors believe these can be safely divided without compromising subslip vascularity. After division of these vessels, a mean length of 9.6 +/- 1.5 cm is available to allow independent orientation of each subslip. When the serratus muscle flap is separated into its component subslips, a maximum of 10 possible force vectors may be transferred on a single vascular pedicle. Subslips are significantly thinner than donor muscles commonly used today. These two advantages offer the potential for significant functional and aesthetic improvement when the serratus anterior muscle flap is used for face and hand reanimation. Mimetic muscles such as the orbicularis oculi and orbicularis oris could possibly be reconstructed in their proper anatomical positions.

Adolescent↗

PubMed2002

Pyoderma gangrenosum after reduction mammaplasty in an otherwise healthy patient.

Pyoderma gangrenosum (PG) is a rare postoperative complication of plastic surgery of the breast. Initial signs and symptoms resemble those of infection, and antimicrobial therapy is usually initiated and fails before considering PG as a diagnosis. Therapy consists of immune modulators, and use of corticosteroids is frequent, as is local wound care. Sufficiently small wounds are allowed to heal secondarily, but larger wounds require coverage with either skin grafts or flaps. Long-term (1 year or more) postoperative surveillance is necessary because late failure of the graft or flap can occur.

Adult↗