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Biomedical subjects

T R Hester

Publications and source records attributed to T R Hester.

47 records · Page 3Linked to original sources
PubMed1981

Free jejunal grafts for reconstruction of pharynx and cervical esophagus.

Reconstruction of the pharynx and cervical esophagus is a surgical challenge associated with high complications, multiple-staged procedures, and prolonged hospitalizations. In a series of cases, single-stage transfer-free jejunal graft reconstructions had a 85% success rate with low complications in a series of patients who received preoperative, postoperative, and curative radiation treatment. There are advantages to this reconstruction procedure; however, there can also be complications.

Aged↗
PubMed1980

Infected median sternotomy wound. Successful treatment by muscle flaps.

The purpose of this paper is to present the experience at Emory University Hospital with the infected median sternotomy wound and to offer a treatment plan for those patients recalcitrant to the usual therapy of debridement and closed catheter irrigation with antimicrobial agents. When standard treatment fails, we proceed not only with the necessary thorough debridement to convert the wound to a relatively clean one but also concomitant closure by pectoralis major muscle flaps to completely obliterate dead space. Transposition flaps of rectus abdominus muscle or omentum are used when necessary to complete the closure. In the initial phase of this study, there were 3,239 patients who underwent open heart procedures through a median sternotomy approach in the years 1975 through 1978. In the 50 patients who had wound infections (1.54%), there were nine deaths. Three were thought to be unrelated to the sternal wound infection, four patients ruptured the ventricle or aorta, two patients died of generalized sepsis. Of these 50 patients, 22 responded to simple drainage; 28 had involvement of the mediastinum (0.86%). Of the 28 patients, 25 had debridement and closed mediastinal irrigation by catheter. Fourteen of these 25 did not respond. In these failing patients, 12 were treated by further debridement and closure by muscle flaps. Nine of these 12 were rescued. In the past nine months, an additional 1,052 patients had an open heart procedure. Of these, 11 had a median sternotomy infection. There have been no deaths in this latter group of patients, most of whom were treated by the muscle flap procedure. In addition to the improvement in mortality, morbidity has been reduced substantially. This procedure provides for a rational approach that we have found to permit salvage of a high percentage of patients who failed conventional closed irrigation techniques.

Anti-Bacterial Agents↗
PubMed1980

Avoiding the flat breast in reduction mammaplasty.

The reliance on retained superior breast tissue beneath the reduced skin envelope may not provide adequate breast projection in reduction mammaplasty. Placement of preserved inferior dermal-breast pedicle beneath the tailored skin envelope in this group of patients has allowed control of both breast projection and size, but there are alternatives in the management of the nipple--areola complex with the use of this technique.

Breast↗
PubMed1979

Experiences with the tensor fascia lata flap.

Our experience with 60 TFL flaps is reviewed. The anatomy and the arcs of rotation of this flap are described. Our clinical experience--particularly in reconstruction of the groin and abdominal wall, and in free flap transfers--has been detailed, including the use of a free osteomyocutaneous sensory TFL flap for reconstruction of the heel.

Abdominal Muscles↗