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Biomedical subjects

W Boeckx

Publications and source records attributed to W Boeckx.

At least 19 recordsLinked to original sources
PubMed2001

Silicones in the rehabilitation of burns: a review and overview.

This article gives an overview of the use of silicones in the treatment and prevention of hypertrophic (burn related) scars. Of all non-invasive treatment modalities the use of continuous pressure and occlusive contact media, e.g. silicones, seem to be generally accepted as the only ones that are able to manage hypertrophic scarring without significant side-effects. A summary of the current opinions of the assumed working mechanisms of pressure as well as silicones is given. The use of silicones, either alone or in combination with pressure, is discussed. The recent development of custom made silicone devices has led to combinations of both modalities. Some of these, including the inflatable silicone insert systems (ISIS), are shown and discussed.

Bandages↗
PubMed2001

Free flaps in burn reconstruction.

In this paper, we present our experience of free flap reconstructions in burned patients. It allows the preservation of otherwise unsalvageable deep burn injuries and secondary correction of contracted burn scars. We analyse the indications of different free flaps, according to different anatomic regions and defects: depth and width of the loss of tissue, different colour skin, texture and thickness of the receptor area, weight-bearing or not weight-bearing surface. Free flap reconstructions were successful in 50 of 53 cases (94%). They provide good aesthetic and functional results with low morbidity both in acute deep burn injuries as in delayed reconstructions.

Adolescent↗
PubMed2001

Reproducibility of repeated measurements on healthy skin with Minolta Chromameter CR-300.

BACKGROUND/AIMS: In this report the reproducibility of measurements with the Minolta Chromameter CR-300 on healthy skin was investigated. METHODS: Intra- and inter-rater reproducibility, reproducibility with two instruments and repeated measurements with a 1 week time lapse were examined on healthy skin of 30 volunteers by means of intra-class correlation coefficients (ICC) and standard error of measurements (SEM). RESULTS: Results showed excellent values for ICC in all the four conditions. CONCLUSIONS: On the basis of these results we concluded that the instrument provides reliable information and can be used in comparative clinical trials.

Adult↗
PubMed1998

Microsurgery for intra-abdominal testicular retention.

OBJECTIVES: In cases of high intra-abdominal retention of the testis a standard technique of cryptorchidy treatment will not be able to bring down the testis into the scrotum. In this study we wanted to evaluate the feasibility and reliability of the technical aspects of testicular autotransplantations in children under the age of 5 years. STUDY DESIGN: A series of 25 microsurgical autotranslantations of testes performed on 17 boys since July 1984 are reviewed. Emphasis was placed on the microvascular transplantation technique, the age of the patient and the long term viability of the autotransplants. An end-to-end microvascular anastomosis between the deep inferior epigastric artery and the testicular artery was performed in an end-to-end way using mattress stitches to accommodate the difference in diameter between the donor and recipient vessels. Also the testicular veins were anastomosed to the deep inferior epigastric veins. RESULTS: Of the 25 transplantations (96%) were successful after a mean follow up of 24 months, the one failure was ascribed arterial thrombosis. CONCLUSION: Our results show a 96% survival of the transplanted testes using the end-to-end vascular anastomosis as described here.

Abdomen↗
PubMed1996

Changes in donor site selection in lower limb free flap reconstructions.

Since 1973 we have performed over 1,000 free flap reconstructions mainly in head and neck, breast, and upper and lower limb surgery. In lower leg reconstructions, changing indications for flap selection were not only correlated to new anatomical developments, but mainly due to a better understanding of adaptability of known muscle or fascial free flaps. Reducing donor site morbidity and planning for saving donor sites for future reconstructions are important. Morbidity is reduced by selection of free flaps ideally adjusted to the shape of the defect. Innervated free flaps or functional muscle transplants are rarely indicated in the lower leg. In the early years of microsurgical free flaps, soft tissue reconstruction or bone coverage was the primary indication. Later improving the vascularity of the wound bed by free flap cover increased the indication to chronic infected leg ulcers, osteomyelitis, diabetes, or artheriosclerotic wound defects or pressure sores due to lack of sensibility. Reconstruction of the foot and restoring its weight-bearing capacity is one of the more challenging applications of free flap cover.

Adolescent↗
PubMed1996

Microsurgical vasoepididymostomy in the treatment of occlusive azoospermia.

OBJECTIVE: To evaluate the practice and outcome of the end-to-end and end-to-side techniques of vasoepididymostomy for the treatment of occlusive azoospermia. PATIENTS AND METHODS: This retrospective study comprised 31 unselected patients (mean age 32 years, range 22-59) operated on with one of two techniques, more usually a modified end-to-side technique. Sperm quality and paternity were assessed in 24 patients during a 2-year follow-up. RESULTS: Of the 15 patients in whom sperm were found at anastomosis, sperm were retrieved from 11. Of 24 patients, 11 had patent anastomoses and paternity was achieved in three cases. CONCLUSION: Although performed by a proficient microsurgeon the operative success rate was low, partly because the operation was technically demanding but largely because of the difficulty in assessing intraoperatively the level of occlusion and the quality of the sperm. Better techniques for the evaluation of sperm during the operation should be developed.

Adult↗
PubMed1996

Peritoneal healing after fibrin glue application: a comparative study in a rat model.

The influence of fibrin glue on adhesion formation and peritoneal healing is evaluated in a prospective, randomized, controlled study. In all, 20 Wistar rats underwent microsurgical suturing of two silicone sheets, one covered with a fibrin glue barrier, to the anterior peritoneum. Each animal thus served as its own control. After 10 days, adhesions and peritoneal healing were evaluated by a blinded observer through a second-look laparotomy. Adhesions were scored using a modification of the classification of Diamond. Tissue around the silicone sheet was examined histologically and by scanning electron microscopy to evaluate the inflammatory reaction and peritoneal healing (ingrowth of blood vessels and quality of peritoneal cells). Adhesion scores for treated and control sides were (mean +/- SD) 2.89 +/- 4.68 and 6.79 +/- 9.09 (P = 0.181) respectively, and the percentage of the sheet covered by peritoneum was 26.25 +/- 31.50 and 29.21 +/- 40.21 (P = 0.226) respectively. Using the paired Wilcoxon rank test, the P values for the ingrowth of blood vessels and peritoneal healing evaluated by histology and scanning electron microscopy were 0.842, 0.692 and 0.695 respectively. We conclude that although the mean adhesion score was reduced by > 50% by fibrin glue, there is no statistically significant difference concerning adhesion formation or peritoneal healing with the use of fibrin glue.

Animals↗
PubMed1995

No correlation between peritubal and mucosal adhesions in hydrosalpinges.

OBJECTIVE: To correlate the presence and extent of peritubal and mucosal adhesions in hydrosalpinges. DESIGN: Comparative study. SETTING: Tertiary centers with experience in tubal microsurgery. PATIENTS: Infertile women with complete distal tubal block. INTERVENTION: Salpingoneostomy. MAIN OUTCOME MEASURE: Presence and extent of adhesions. RESULTS: Peritubal adhesions occur more frequently than mucosal adhesions in hydrosalpinges. Of 7 hydrosalpinges without peritubal adhesions, 1 showed mucosal adhesions but of 83 hydrosalpinges with peritubal adhesions, 31 (37%) showed no mucosal adhesions. CONCLUSION: Accurate endoscopic assessment of the ampullary mucosa is recommended in hydrosalpinx to select the appropriate patient for surgery.

Body Fluids↗
PubMed1995

Prospective study of tubal mucosal lesions and fertility in hydrosalpinges.

The relationship of abnormalities of the Fallopian tubes in patients with tubal infertility due to hydrosalpinges and fertility outcome after salpingoneostomy was studied in a prospective multicentric project. Hydrosalpinges of infertile patients were evaluated macroscopically and microscopically at the time of salpingoneostomy and the results were analysed with regard to the fertility outcome. Peritubal adhesions, the diameter and the quality of the mucosa were scored at the time of surgery and biopsies from representative areas were evaluated by scanning electron and light microscopy in 50 patients with bilateral hydrosalpinges or a hydrosalpinx of a single tube. Analysis of the different factors for fertility outcome was performed using the Cox proportional hazards model. No intrauterine pregnancy occurred in the thick-walled hydrosalpinges group (n = 13). In the thin-walled hydrosalpinx group (n = 37), 15 intrauterine and two tubal pregnancies occurred. The aspect of the mucosa as evaluated by an operating microscope was the most important factor in determining the fertility outcome; > 50% abnormal mucosa was associated with an intrauterine pregnancy rate of 7% which increased significantly to 50 and 69% when the mucosa was > 50 and 75% normal respectively. The pregnancy rate was not influenced by the presence or extent of peritubal adhesions but small sized (< 1 cm) hydrosalpinx had a better prognosis than medium (1-2 cm) and large sized (> 2 cm) hydrosalpinx. When mucosal adhesions were present (n = 19), the intrauterine pregnancy rate was 22% which increased significantly to 58% when adhesions were absent (n = 18). Both tubal pregnancies occurred in tubes with mucosal adhesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Experimental model for neoangiogenesis in adhesion formation.

This study presents an animal model for the observation of adhesion formation, from a vascular viewpoint. In 60 Wistar rats, a 4 cm midline incision was made and a 0.5 cm square piece of silastic 0.2 mm thick was fixed on the right side of the peritoneum with two separate angular stitches of nylon 9/0. The rats were randomized in six groups of 10 animals and were operated on again on days 2, 4, 6, 8, 10 and 12 respectively. Biopsies for scanning electron microscopy were obtained by resecting a 2 x 2 cm square of parietal peritoneum around and covering the silastic patch. Foreign body reaction induced by the silastic patch and ischaemia caused by stitching are the stimuli for adhesion formation. The results showed a gradual progression in the type and tenacity of adhesion formation. The maximal degree of peritoneal reactive angiogenesis was noted between days 8 and 12, together with a decrease and a redistribution in the extent of adhesions. In the early stages, vascularization is part of the organization of adhesions while their extent is limited. Two parallel mechanisms take part in trauma healing: while omento-parietal adhesions are vascularized, new peritoneal tissue with its vascular network develops and covers the silastic surface and the traumatized area. This theory is supported by the presence of fibroblasts differentiating into mesothelial cells on day 8. Theoretically, a valid treatment in preventing adhesion formation should increase the peritoneal neoangiogenesis and the repair of peritoneal lesions, but at the same time prevent the vascularization of adhesions. The present model offers the possibility of testing the effect of any treatment or device for preventing post-operative adhesions in a relatively short time.

Animals↗
PubMed1995

Late results of breast reconstruction with free TRAM flaps: a prospective multicentric study.

When the free TRAM flap was introduced for breast reconstruction, it was supposed to have many advantages over the pedicled TRAM flap: good perfusion of all four zones, better mobility and easier shaping of the breast, lower incidence of abdominal-wall complications, and less restrictive selection of patients. However, we have experienced several complications after free TRAM flaps in our practice, including fat necrosis, partial and complete flap necrosis, abdominal-wall weakness, and hernias. In order to evaluate the incidence and types of complications, as well as the influence of preoperative risk factors (chemotherapy, radiotherapy, overweight, smoking habits, and abdominal scars), on complications, a multicentric prospective study including Bern (Switzerland), Leuven (Belgium), Stuttgart (Germany), and Verona (Italy) was designed. In 111 consecutive patients, operated on over a period of 18 months, 123 flaps were done; 99 flaps were unilateral and 24 bilateral, and 36 were used for primary and 87 for late reconstruction. There was no preoperative selection of patients. The follow-up period was from 8 to 24 months (average 19 months). A two-team operating approach was used. All four zones were always included in the flap, and the end-to-end anastomoses were done to the thoracodorsal, the circumflex scapular, or the internal mammary arteries. The total number of fat and flap necroses was 24 (19.5 percent), 6 (5 percent) minor and 4 (3 percent) major fat necroses, 2 (1.6 percent) minor and 6 (5 percent) major flap necroses, and 6 (5 percent) total flap necroses. Twenty-two (20 percent) patients had abdominal-wall complications. The results of this study show that the complication rate of free TRAM flaps is considerable. Preoperative risk factors did not play a major role in the development of complications and should not be considered as contraindications for free TRAM flap surgery. All total flap failures resulted from impaired arterial inflow to the flap, and the choice of recipient vessel did not influence the outcome. The incidence of total flap failures might be reduced by good postoperative flap monitoring and early revision of the anastomosis. Partial fat and flap necroses might be prevented by removing the fat under the scarpa fascia in zones 4 and 3 or by reducing zone 4. Sparingly harvesting the rectus muscle and its sheath as well as the use of mesh in the rectus sheath repair may reduce the abdominal-wall complications.

Breast Neoplasms↗
PubMed1994

Surgical management of the osteoradionecrotic mandible with free vascularised composite flaps.

Osteoradionecrosis (ORN) of the mandible is a serious sequel to radiotherapy administered for malignant neoplasms of the head and neck. In a retrospective/prospective study, 28 patients with mandibular defects due to ORN were reviewed. Monocortical and bicortical defects as well as pathological fractures were reconstructed by means of a free serratus anterior/rib (n = 8) or a vascularised iliac crest flap (n = 25). All the former survived; a pathological fracture, however, occurred postoperatively in 2 of the patients (25%). Five iliac crests were lost (20%). The remaining bone struts healed well. The donor site morbidity was very low. Clinical and radiological longterm follow-up showed that a very acceptable functional and cosmetic result was achieved in all cases. Progress of ORN was prevented in ca. 90% of all patients. The radiological follow-up was facilitated with the use of high-resolution CT-scans.

Adult↗
PubMed1992

Fibrin glue in the treatment of dorsal hand burns.

This paper analyses two groups of patients with only dorsal hand burns: groups I contains patients with a total of 15 burned hands and group II patients with 12 hand burns. The patients in group I were all treated by full sheet skin grafts using a two-component fibrin glue. Patients in group II underwent the traditional operative treatment without fibrin glue and the same postoperative physical therapy programme. After follow-up periods of 6-11 months (group I) and 12-21 months (group II), we investigated in both groups, grip strength, key pinch, mobility, two-point discrimination and with the Semmes-Weinstein monofilaments. Our results prove that after the respective follow-up periods group I patients developed far better results for two-point discrimination, touch recognition and mobility.

Adolescent↗
PubMed1992

Effect of cerium nitrate-silver sulphadiazine on deep dermal burns: a histological hypothesis.

Although there are excellent clinical results from using cerium nitrate plus silver sulphadiazine in the treatment of deep dermal burns in our burn centre, its mechanism of action remains unexplained. We set up a prospective study to establish a hypothesis which could explain the formation of the typical leathery crust. Burns treated with cerium nitrate plus silver sulphadiazine and silver sulphadiazine alone were compared histologically and metallurgically. Application of cerium nitrate plus silver sulphadiazine on deep dermal burns caused superficial connective tissue calcification with few deep dermal changes. Cerium penetration was low and silver was never detected intradermally. The precipitation of cerium and pyrophosphate destroys the calcification inhibitory function of the latter, creates multiple calcification nuclei and leads to superficial dermal calcification. No calcium was detectable in biopsies from silver sulphadiazine-treated wounds. No major toxicological side-effects were seen during this study. The clinical results were favourable, as have been reported previously.

Adolescent↗
PubMed1992

[Microsurgical reconstruction of the irradiated mandible with deep iliac circumflex flap].

From 1979 to 1988, 30 osteomuscular or osteomyocutaneous free flaps of the iliac crest (revascularized by the deep circumflex pedicle) were used to reconstruct 28 mandibles severely compromised by radiotherapy exceeding 66 Grays. In addition to a perfect graft raising and microsurgical technique, perfect closure of the mucosal plane appears to be an essential factor of success. Over the years, this iliac crest flap appears to improve the radiological appearance of the bone stumps on either side. The procedure therefore appears to be particularly useful in the treatment of advanced radiation osteonecrosis.

Head and Neck Neoplasms↗
PubMed1990

Analysis of the pressure perturbation due to the introduction of a measuring probe under an elastic garment.

Attention is drawn to the increase of the pressure on the skin due to the introduction of a measuring probe under an elastic garment. The increase of pressure is explained by looking at the force equilibrium on the transducer. Making some assumptions on the geometry and the conditions that actually prevail at the interface, this mechanical phenomenon is expressed mathematically. Expressions for estimating the order of magnitude of the relative pressure perturbation are derived both for the case of a cylindrical probe and for a thin plate probe with the same curvature as the limb. Thanks to the geometrical assumptions, these expressions are independent of the mechanical properties of the probe and the soft tissue. As in some of these formulas the magnitude of the indentation appears, a measurement is necessary for estimating the error. Other expressions, only taking in account the dimensions of the limb and the probe, give a rougher estimation of the error. It is shown through a few practical examples that the error cannot be disregarded and cannot be calculated precisely, which means that this measuring technique is unreliable. The same mathematical expressions are used to show that pressure paddings effectively increase the pressure. It is also shown that the introduction of an optical fibre under the garment, used in laser Doppler flowmetry, creates an important additional pressure on the skin.

Cicatrix↗