Biomedical subjects
Publications and source records attributed to W E Floyd.
Common and rare benign cartilaginous neoplasms and diseases of multiple cartilaginous lesions are discussed. Particular attention is paid to patient demographics, physical and radiographic findings, pathology, and treatment.
Trauma to the upper extremity can be a cause of significant morbidity and disability to otherwise productive people. Traumatic amputation can be particularly devastating, but many of these extremities can be saved by replanatation of the amputated parts. We reviewed the upper extremity replantations performed at the Medical Center of Central Georgia in the 6-year period from September 1987 to August 1993. A total of 48 replantations in 39 patients (33 male, six female) were studied: 36 fingers, seven thumbs, two transmetacarpals, one wrist, one forearm, and one brachium. Average patient age was 32.7 years, with a range of 4 to 69 years. All seven thumbs, two transmetacarpals, and three proximal replants survived. Viability of replanted fingers was 56 per cent; however, sharp injuries fared better than crush injuries (62% vs 50%). The success rate improved with experience of the surgeon (85% after 1990). Leeches were used effectively for venous congestion in nine of 13 cases (70%). Results were comparable with those of large academic medical institutions. Replantation of traumatic amputations can be performed with reasonable success at a regional medical center if a qualified surgeon and appropriate ancillary care are available. Results improve with experience of the surgeon and careful patient selection. Successful replantation significantly reduces the morbidity of upper extremity amputations and will continue to be important in the management of the trauma patient.
Degloving injuries of the upper extremity may require extensive soft tissue coverage. Free tissue transfer is often useful in the management of these injuries. We describe the use of an extended rectus abdominis myofasciocutaneous vascularized free flap in the management of a massive longitudinal upper extremity traumatic soft tissue defect.
Epiphyseal transplantation has long been a goal of orthopaedic surgeons. While microvascular surgery has raised hopes that this goal could be achieved, factors other than blood supply also appear capable of affecting the function of the epiphysis. Basic research into the biology of the epiphysis appears to be required. This would be facilitated with a model of epiphyseal transplantation using a small mammal. The purpose of this experiment was to develop such a model in the mouse. Developing CD1 mouse or Lewis rat limb tissue was used to replace knee tissue that had been resected from CD1 postnatal mouse hosts. Donor tissue ranged from 14-day embryonic mouse to 9-day postnatal mouse or 18- and 19-day fetal rat, which has a gestation similar to the mouse. The murine tissue is known to be avascular prior to the sixth postnatal day. The limbs were analyzed radiographically and histologically. The results show that epiphyseal replacement could be studied using developing tissue donors in a murine model. The results suggest that donor tissue prior to vascularization and tissue combinations with the least developmental time mismatch (the least heterochronicity) produced relatively the best, although still abnormal epiphyses.
Thirteen patients had thumb metacarpophalangeal (MP) capsulodesis in conjunction with basal joint arthroplasty. The indication for capsulodesis was an MP hyperextension deformity of at least 30 degrees. The minimum follow-up period was 12 months, and the average follow-up was 39 months. Nine patients had an excellent result, three had a good result, and one patient had a result that was rated as fair. Ten patients had complete correction of the MP hyperextension deformity. The average increase in pinch strength was 50%. This procedure enhances the result of a basal point arthroplasty by improving the transmission of force along the thumb ray and by correcting the metacarpal collapse, which produces dorsal subluxation stress on the metacarpotrapezial joint.
Two cases of intra-articular median nerve entrapment after reduction of elbow dislocations in children are described. The diagnosis of median nerve entrapment is often delayed. A proximal median nerve deficit, limited passive elbow motion, and an associated medial epicondyle avulsion after reduction of a child's posterior elbow dislocation should alert the surgeon to the possibility of nerve entrapment. Optimal management of this problem consists of early surgical exploration and nerve release.
Although the formation of a secondary center of ossification is often compared with that of the primary center, there are striking differences between these processes. In the formation of the primary center, vascular invasion is always associated with the maturation of chondrocytes, whereas vascularization of the epiphysis can proceed in two different ways. In some species, the epiphysis is vascularized by cartilage canals before the appearance of the secondary center. However, in the mouse, the distal femoral epiphysis is vascularized by peripheral vascular invasion without pre-existing cartilage canals. Histological study of serial sections and studies of vascularization by injection with India ink demonstrated the relationship between hypertrophic chondrocyte formation, vascular invasion, and the formation of the secondary center of ossification in the murine distal femoral epiphysis.
We are reporting four cases of extensive, localized bone resorption adjacent to a rigidly anchored, cemented total hip replacement. None of these hips showed evidence of infection on clinical, bacteriological, or pathological evaluation. The tissue from the regions of osteolysis showed sheets of macrophages and foreign-body giant cells invading the femoral cortices. Abundant methylmethacrylate particulate debris was present in the tissues, but polyethylene wear debris was absent. The histological appearance of this tissue resembled that reported about loosened total hip implants with the exception of the synovial-like layer at the cement surface. The cases reported here show that aggressive bone lysis may occur around stable cemented total hip arthroplasties without the presence of sepsis or malignant disease.
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A case of an unusual cause of chromomycosis of the hand is described. Follow-up at 2 months revealed a complete recovery following removal of the mass, without treatment with antifungal therapy. A review of the different disease entities of the chromomycoses and a brief generic classification of the dematiacious fungi are presented.
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