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Biomedical subjects

T R Hester

Publications and source records attributed to T R Hester.

At least 37 records · Page 2Linked to original sources
PubMed1988

Manofluorography of deglutition after total laryngopharyngectomy.

Manofluorography is a new technique for the evaluation of swallowing that provides simultaneous display of manometry and videofluoroscopy on one video screen. Data are presented from a study of deglutition in 10 patients who had prior total laryngopharyngectomy with replacement by either jejunal graft or gastric pull-up. Factors that enhance bolus passage are the presence of a widely patent graft and an intact swallowing reflex. Factors that impair bolus transit include stricture, jejunal peristalsis, impaired lingual coordination, and stenosis at the anastomotic site. The swallowing patterns of these patients serve as models of the open and closed cavity swallow and illustrate principles of manofluorographic interpretation.

Anastomosis, Surgical↗
PubMed1988

The superiorly based rectus abdominis flap: predicting and enhancing its blood supply based on an anatomic and clinical study.

A detailed investigation of the blood supply of the superiorly based rectus abdominis muscle flap and the transverse rectus abdominis musculocutaneous flap was done to improve the understanding of variations in flap viability and to explain the survival of the flap after internal mammary artery division and radiation. The study involved dissections of the internal mammary and superior epigastric systems, evaluation of pertinent angiograms, and impressions from observations of the vascular anatomy correlated with flap survival in over 600 clinical dissections. There is a diffuse intrathoracic collateral network involving the internal mammary system, with multiple branches and intercommunications on the same side, as well as across the midline. This enhances flap predictability and survival in some patients with internal mammary artery division or compromise. There is also a laterally based blood supply to the flap from the costomarginal artery at the costal margin which is sometimes well developed and may prevent flap compromise if preserved.

Abdominal Muscles↗
PubMed1988

A 5-year experience with polyurethane-covered mammary prostheses for treatment of capsular contracture, primary augmentation mammoplasty, and breast reconstruction.

This paper reviews a 5-year experience using polyurethane-covered mammary prostheses in the treatment of capsular contracture following placement of smooth-walled devices, primary augmentation mammoplasty, and breast reconstruction after mastectomy. The rate of occurrence of clinically significant capsular contracture has been reduced in all patient groups. Results in terms of aesthetic and functional improvement have been excellent. Major complications have been rare.

Breast↗
PubMed1988

Central breast pedicle and "free-hand" technique for alteration of volume and skin envelope of the breast.

We have found the central pedicle, free-hand technique applicable across the spectrum of surgical endeavors that seek to alter breast volume and revise the skin envelope for aesthetic and functional improvement. The rate of occurrence of significant complications has been low. The primary advantages of this approach are that (1) excellent pedicle vascularity has virtually eliminated the need for free nipple-areolar grafting in major reductions and correction of severe ptosis, and (2) in addition to its application in a wide variety of standard breast pathology, the technique allows individualization of volume change and skin brassiere alteration, which has significantly improved aesthetic results in more difficult cases such as the severe asymmetries presented.

Adult↗
PubMed1987

Ten years experience with the free jejunal autograft.

Retrospective analysis by chart review, personal interview, and physical examination identified 88 patients who received 96 jejunal free flaps over a 10 year period. Seventy-nine of these patients had cancer. There were 13 operative failures (13.5 percent) in 10 patients. Failures were attributed to arterial thrombosis in four instances, venous anastomotic problems in four instances, fistula and infection in the neck in one instance, carotid blowout in one instance, psychosis with avulsion in one instance, and an unknown cause in two instances. Seven second attempts at salvage of jejunal flaps were performed with five successes. There were five deaths in the perioperative period (6 percent). Of these, one was directly attributed to graft failure. The following eight abdominal complications required operation: wound dehiscence (four instances), small bowel obstruction (one instance), Mallory-Weiss tear (one instance), gastrostomy tube leak (one instance), and acute gastric dilatation (one instance). Complications in the neck included infection (six instances), infection requiring operation (three instances), hematoma (three instances), and suture line dehiscence (one instance). Fistulas developed in 28 patients (32 percent), 12 of whom required operative closure (43 percent). Significant stenosis developed in six patients, two of whom required operative revision. Of 79 patients treated for cancer, 34 died from progression of disease which recurred an average of 9.7 months postoperatively. Death ensued an average of 16.7 months postoperatively. Ten patients died with no evidence of disease. At last follow-up, 28 patients were alive without apparent disease. Twenty-six of these patients have good swallowing function. Significant palliation and a high rate of restoration of function are possible with the free jejunal autograft. Careful patient selection should markedly decrease operative morbidity and mortality.

Adult↗
PubMed1985

Microsurgical replantation of the scalp.

Our 7-year experience with seven patients who had suffered avulsion of 30% or more of the scalp is reviewed. Six of the seven, who were candidates for microsurgical replantation, underwent successful replantation with 100% survival in five, and 50% survival in one. All had luxuriant regrowth of hair. The mechanisms of injury, emergency management, indications, and operative techniques are discussed. The role of interpositional vein grafts, and choice of vessels in contributing to this success is emphasized. The superiority of replantation over other methods of reconstruction of major scalp defects is demonstrated.

Accidents, Occupational↗
PubMed1985

Total reconstruction of the "end-stage" cleft lip and palate deformity.

The purpose of this paper is to present a 5-year experience using a comprehensive surgical approach to reconstruct what we have chosen to call the "end-stage cleft lip and palate deformity." The deformity consists of varying degrees of midface retrusion, malocclusion, nasal deformity, and lip deformity. Most of the patients afflicted had unacceptable upper lip anatomy characterized by tightness and lack of cupid's bow and bulk. All had severe palatal scarring with resulting arch collapse and severe malocclusion. Most had had multiple surgical attempts to improve nasal aesthetics using standard rhinoplasty techniques with little or no improvement. The procedure involves splitting the upper lip with incisions extending into the upper buccal sulcus and rim of the nose allowing wide skeletalization of the maxilla and osteocartilagenous nasal skeleton. LeFort I or II maxillary advancement, nasal reconstruction, and upper lip modification (with Abbé flap if indicated) are done. The jaws are placed in intermaxillary fixation for 6 to 8 weeks. This comprehensive approach has been used in 16 patients, aged 15 to 29 years, with follow-up of up to 5 years. Excellent functional and aesthetic improvement has occurred in all patients, and complications have been minimal.

Adolescent↗
PubMed1985

Breast reduction utilizing the maximally vascularized central breast pedicle.

Experience using a maximally vascularized central breast pedicle to nourish the nipple-areola is presented. The pedicle is designed to incorporate vascular contributions from the lateral thoracic artery, intercostal perforators, internal mammary perforators, and thoracoacromial artery by means of the pectoralis major muscle. The basic technique is as follows: First, the areola is incised and 2-cm-thick skin and subcutaneous flaps are dissected medially, laterally, and superiorly, freeing the entire central breast mound. Second, the breast is reduced in a "Christmas tree" manner, being careful not to narrow the base of the pedicle. Third, excess skin and subcutaneous tissue is excised inferomedially and laterally and the nipple is inset into proper locations. The advantages of this technique are (1) large and small reductions can be done, (2) pedicle length does not appear to be a problem, and (3) the central mound gives the forward projection needed for good contour and good aesthetic results. Sixty-five patients with follow-up to 4 years are presented.

Adult↗
PubMed1985

Double-pedicle transverse rectus abdominis myocutaneous flap for unilateral breast and chest-wall reconstruction.

Fifteen patients underwent unilateral breast and chest-wall reconstruction by a double-pedicle transverse rectus abdominis myocutaneous flap technique. Criteria for using both pedicles include (1) exceptionally large soft-tissue requirements, (2) prior abdominal operations compromising the vasculature to portions of the anterior abdominal wall, and (3) certain higher-risk patients with suspected microvascular pathology. Double pedicles allowed the transfer of the skin island as one unit or as two independent hemiellipses of tissue. Follow-up time ranges from 4 to 17 months. Complications included partial tissue loss in two patients, one abdominal flap seroma, and one patient with a hernia.

Abdominal Muscles↗
PubMed1984

The superficial inferior epigastric artery flap for coverage of hand and forearm defects.

Large wounds of the hand and upper extremity require secure closure for protection of the underlying structures. The skin of the lower abdomen can be raised in a lenticular fashion, supported by the superficial inferior epigastric artery and veins and applied as a flap to wounds of the distal upper extremity. The flap demonstrates versatility in positioning, and the donor site can be closed in a linear fashion. Viability of this superficial inferior epigastric artery flap is demonstrated by the case reports.

Abdomen↗
PubMed1984

Pharyngoesophageal stricture and fistula. Treatment by free jejunal graft.

Fifty-five patients with disorders of the pharynx or cervical esophagus requiring extensive ablative therapy were reconstructed by heterotopic autotransplantation of a segment of jejunum. Of these 55 patients, the overwhelming majority were treated for squamous cell carcinoma or the complications of combined radiation and operative therapy. There were six graft failures in the entire group of 55 patients for a transfer reliability of 90%. Three patients died in the perioperative period (5%). The purpose of this paper is to report on the treatment of a subset of these patients in whom fixed cicatricial stenosis of the gullet was the problem or in whom a radionecrotic cutaneous fistula existed. Fourteen such patients were treated, ten with stricture and four with fistula. Both patch grafts of on-lay segments and more routine circumferentially intact tubed segments of jejunum were used depending upon the nature of the defect. The youngest patient in this group was a 3-year-old juvenile diabetic with caustic stricture and the oldest was a 75-year-old man with fixed stricture following operation and radiation for cancer. Nine of ten and four of four anatomic reconstructions were successful in the stricture and fistula patients, respectively. All of these 13 patients with a neo- gullet of jejunum were able to handle secretions and liquids satisfactorily. Eleven patients were on a regular diet and had no discernible physiological impairment in alimentation. One patient had mild dysphagia and used a blenderized diet. One patient was able to swallow liquids only. In this patient the resection for tumor was so high and so extensive that the physiologic act of deglutition itself was impaired. There were no perioperative deaths, although one patient has succumbed to recurrent and metastatic carcinoma. When conventional treatment for stricture or fistula in the cervical alimentary tract has failed, reconstruction can be accomplished safely by free revascularized jejunal graft. Successful alimentation can be anticipated in all patients in whom the physiologic mechanism of deglutition itself is not drastically impaired.

Adolescent↗
PubMed1984

Radiation to the breast. Complications amenable to surgical treatment.

UNLABELLED: Major complications of radiation directed to the breast, axilla, and mediastinum were treated in 54 patients from 1974 to 1983. A classification of these complications facilitates both an understanding of the pattern of injury and the development of a treatment plan. CLASSIFICATION: I. Breast necrosis; II. Radionecrosis and Chest Wall Ulceration; III. Accelerated Coronary Atherosclerosis with Median Sternotomy Wound Failure After Coronary Revascularization; IV. Brachial Plexus Pain and Paresis; V. Lymphedema and Axillary Cicatrix; VI. Radiation-induced Neoplasia. The treatment has evolved during the 10-year study period to excision of the necrotic wound, including any tumor, and closure with a transposed muscle or musculocutaneous flap of latissimus dorsi (II, III, V) or rectus abdominis (I, II, VI). This strategy reflects a change from primary use of the omentum during the first years of the study. The vascularity, oxygen and antibiotic delivery of these muscle and musculocutaneous flaps promote wound healing, usually with one operation. The transfer of these muscles has not caused significant functional deficits.

Adult↗
PubMed1984

Blood supply of the abdomen revisited, with emphasis on the superficial inferior epigastric artery.

The key to understanding the blood supply of the anterior hemiabdomen is knowledge of the central superficial inferior epigastric artery system and the peripheral contribution of the epigastric, deep and superficial circumflex, and iliac arteries and external oblique perforators. These systems all feed into the subdermal plexus of the anterior abdominal wall. Angiographic confirmation of multiple communications between the superficial inferior epigastric artery and other major sources of abdominal wall blood supply has been obtained. Experience using the superficial inferior epigastric artery flap as a pedicled and microsurgical transfer has been described.

Abdomen↗
PubMed1984

Advanced applications of revascularized free jejunal flaps for difficult wounds of the head and neck.

The rationale, technique, and an example of full utilization of the jejunomesenteric free flap have been described as a means of reconstructing complex wounds of the head and neck. Not only jejunum, but also well-vascularized mesentery will protect vascular structures and intestinal anastomoses and, in addition, accept a skin graft. No additional muscular or other flaps are necessary to achieve these ends. Finally, no additional donor-site morbidity is incurred by harvesting the supplementary mesentery.

Craniocerebral Trauma↗
PubMed1984

Hypopharyngeal stenosis.

Hypopharyngeal stenosis after total laryngectomy is a relatively frequent complication. In our series we found that approximately 20% of total laryngectomies require treatment for hypopharyngeal stenosis. This presentation analyzed the factors that contribute to hypopharyngeal stenosis in a large series of patients treated at Emory University and affiliated hospitals. Analysis is presented on the effects of location of the cancer, extent of resection, radiation therapy, and methods of reconstruction. The highest incidence of hypopharyngeal stenosis was found in hypopharyngeal vs. endolaryngeal lesions. The surgical decision examined in this paper is whether a primary "tight closure" of the hypopharynx or a flap or graft reconstruction gives the best results with the lowest complication rate. The best treatment of hypopharyngeal stenosis is its prevention. This paper deals with the methods of identifying the surgical situation when one is most apt to have stenosis and suggest appropriate measures to prevent these complications.

Carcinoma, Squamous Cell↗