Collaboration is a strength and a key to the future.
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Forecasting↗
Biomedical subjects
V Bowen
Publications and source records attributed to V Bowen.
Tarsal tunnel syndrome: an unusual case resulting from an intraneural degenerative cyst.
Multiple local and systemic entities have been implicated as causes of tarsal tunnel syndrome. In this report, a 31-year-old man presented with medial plantar nerve compression caused by an intraneural degenerative cyst of the posterior tibial nerve. Removal of the cyst and decompression of the nerve relieved his symptoms. This is the first time that such an entity has been reported as a cause of tarsal tunnel syndrome.
Adult↗
Reconstructive surgery for lower limb salvage.
The authors review the principles of reconstructive surgery for lower limb salvage after severe lower limb trauma to determine factors that have been used as decision-making criteria for limb salvage or amputation in severe lower extremity injuries and the methods of reconstruction and their outcome. The use of scoring systems and their value in acute decision making (primary amputation or limb salvage) are described. Soft-tissue reconstructive techniques, with emphasis on the use of flaps and the importance of selecting the best technique and time for the reconstruction are reviewed. Skeletal reconstructive techniques are described, including available options and currently held views on indications and use of the best contemporary methods. It is essential for the physician to make a good initial decision on the need for primary amputation or limb salvage. A multidisciplinary approach is fundamental to successful salvage.
Amputation, Surgical↗
Factors associated with poor outcome following primary carpal tunnel release in non-diabetic patients.
A retrospective study was performed of 112 non-diabetic patients (133 hands) who had open surgical treatment for carpal tunnel syndrome, to determine the factors associated with poor outcome. None of the patients had a previous carpal tunnel release and all had a positive nerve conduction study to confirm the clinical diagnosis of carpal tunnel syndrome. Outcome was assessed at least 18 months after surgery and classified as excellent, good or poor. Outcome was deemed poor when symptoms were minimally improved, unchanged or worse after surgery. This occurred in 13.5% of treated hands. There was a higher chance of poor outcome in patients with physically strenuous work activities. All these heavy or repetitive manual workers were also involved in compensation and their poor outcome correlated with their inability to return to their original work. Other predisposing factors, associated hand conditions, duration of symptoms prior to surgery, the presence of bilateral or nocturnal symptoms, and the severity of the pre-operative nerve conduction deficit did not affect the final outcome after surgery.
Adult↗
Tuberculosis of the hand.
Three cases of tuberculosis of the hand are presented. There was a significant delay between the onset of symptoms and the correct diagnosis. Several observations are made to increase the awareness of this condition.
Adult↗
Reconstruction of a severe grinding injury to the medial malleolus and the deltoid ligament of the ankle using a free plantaris tendon graft and vascularized gracilis free muscle transfer: case report.
Whether or not to reconstruct deltoid ligament injuries of the ankle remains controversial. We present a case of deltoid ligament loss and an extensive overlying soft tissue defect from a grinding injury. The resultant gross medial ankle instability and soft tissue defect necessitated deltoid ligament reconstruction using a free plantaris tendon graft and soft tissue coverage using a free muscle transfer.
Adolescent↗
Wound-healing complications after soft-tissue sarcoma surgery.
One-hundred and eighty patients undergoing limb-salvage surgery for soft-tissue sarcoma from 1986 to 1991 were assessed retrospectively for risk factors associated with major wound-healing complications. Twenty-three of 137 patients (16 percent) treated with primary direct wound closure sustained complications. In univariate analysis, the cross-sectional area of tumor resection, the use of preoperative irradiation, the width of the skin excision, a history of smoking, and a history of diabetes and/or vascular disease were associated with wound failure. Multivariate analysis revealed that preoperative irradiation (p = 0.04) and resection diameter (p = 0.017) accounted for the risk of complications. Eighteen additional patients were treated empirically with distant vascularized tissue transfer following preoperative irradiation because of concerns regarding potential wound complications. The lower complication rate in this group suggested that vascularized tissue transfer may be beneficial in lowering wound complication rates.
Adolescent↗
Effect of pre-existing health conditions on the results of reconstructive microvascular surgery.
The effect of different pre-existing health conditions on the results of reconstructive microvascular surgery are reviewed. These conditions include: age, vital organ failure, diabetes, arterial and venous diseases, medications, smoking, wound healing disorders, epidermolysis bullosa, hematological diseases, multiple injury patients, pregnancy, and neuropsychiatric disease.
Age Factors↗
The medical leech: an old treatment revisited.
The treatment modality of choice for venous insufficiency after free tissue transfer or replantation remains surgical repair. When this is not technically possible, the use of medical leeches is a useful adjunct to treatment. This paper reviews the history of the use of leeches in medicine, the anatomy and physiology of Hirudo medicinalis, the techniques of leech therapy, and the complications and contraindications.
Adult↗
Complications and unsatisfactory results in the microsurgical reconstruction of lower extremities.
Complications and unsatisfactory results in the microsurgical reconstruction of lower extremities were reviewed in a chronological sequence. Perioperative complications were grouped into the following categories: improper patient or donor tissue selection, unsatisfactory choice of recipient site vessels, inadequate exposure of recipient site vessels, improper "insetting" of the free tissue transfer, extralumenal obstruction, and miscellaneous adverse factors. Vascular changes in the limb as a result of free tissue transfer are discussed. Discussion of late postoperative problems includes the long-term results of soft tissue and skeletal reconstruction.
Anastomosis, Surgical↗
Extremity transplantation: a review of its current state of development.
The discovery of a powerful immunosuppressive, cyclosporin A, together with the development of a microsurgical free tissue transfer technique, has brought extremity transplantation closer to being a realistic possibility. In this review the authors describe the history of laboratory research into extremity transplantation before immunosuppression, with early immunosuppressive agents, with cyclosporin A, and with FK-506, one of a new generation of immunosuppressives.
Animals↗
An operating table for hand surgery.
The construction details for an inexpensive, easy-to-build operating table for hand surgery have been described. The table was specifically designed according to the needs of those working with it. It has been in daily use for over 2 years and has proved to be a popular product with all staff members.
Hand↗
Tetanus--a continuing problem in minor injuries.
Tetanus is rare in North America because of highly effective specific immunization programs. Nevertheless, 15 patients with generalized tetanus were treated at the Vancouver General Hospital over a 20-year period; 10 of them were over 50 years of age. Two patients had no injury and 12 had suffered only minor wounds. None had received previous immunization and, even after wounding, prophylaxis was unsatisfactory in all cases. Nine patients required intensive care and two died. Positive cultures were obtained in only two cases. Four recommendations are made to prevent tetanus: (a) all wounds should be considered "tetanus-prone", (b) an accurate history of immunization should be obtained, (c) more attention should be given to prophylaxis at the time of injury and (d) patients should record vaccinations.
Adult↗
Microvascular distant transfer of a cervical axial-pattern skin flap in a dog.
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Animals↗
Boxer's fractures--conservative or operative management?
Sixty-three consecutive patients presented during an 18-month period with isolated closed fractures of the fifth metacarpal neck. Follow-up ranged from 3 to 20 months. Forty were recalled for study and divided into a conservative group (25 patients) and an operative group (15 patients). Both groups were statistically comparable. All patients obtained good results. Subjectively, no patient had long-term pain or dissatisfaction with the functional or cosmetic result. Objectively, all patients regained full joint motion and normal grip strength. Mild rotatory malalignment was present in both groups, but the conservative group had less extensor lag. The main difference between the two groups centered on residual dorsal angulation. This cosmetic deformity was considerably less in the operative group, although the cost of this improvement was significantly longer rehabilitation. Failure to correct dorsal angulation was not associated with functional disability.
Adult↗
Snowblower injuries to the hand.
A single heavy snowstorm in Saskatoon in late 1984 resulted in nine patients sustaining snowblower injuries to 19 digits. Factors leading to injury included rapid onset of colder temperatures, sudden reuse of snowblowers after storage for the summer, a heavy mid-week storm that created a sense of urgency to clear snow in dusky light conditions after a day at work, frustration as exit chutes became repeatedly clogged with heavy wet snow and limited operator education. The injuries themselves resembled low-velocity "missile" injuries. A practical preventive measure would be to encourage manufacturers to equip machines with remotely located spring-opening clutches.
Accidents, Home↗
Experimental free vascularized epiphyseal transplants.
Growth plates have been transferred both clinically and in experimental models since the end of the 19th century. Results have been unpredictable and frequently unsatisfactory due to postoperative ischemia. Modern microvascular techniques have minimized this problem and preservation of growth plate structure and function has been reported after replantation and free tissue transfers in children and immature animals. Experimental revascularized growth plate transplants were first reported in 1979. Viable orthotopic transfers are associated with rapid bony union, maintenance of radiological structure, and continued growth in length at near normal rates. Detailed studies have demonstrated a continuation of cell division, metabolic activities, and normal histology. Technetium bone scans have been a useful postoperative indicator of viability, and ischemic times of more than three hours can be tolerated. The behavior of heterotopic transplants has not yet been fully studied. Early attempts suggest that biomechanical problems may be troublesome.
Animals↗
Microsurgical management of tetralogy of Fallot in a cat.
A modified Blalock-Taussig shunt was performed on a cat with tetralogy of Fallot. Previous attempts at such palliative surgery in the cat have failed, due to small vessel size. The use of microvascular instrumentation and technique resulted in a patent shunt in this case.
Animals↗