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Plast Reconstr Surg ; 80(5): 726-31, 1987 Nov.
Article En | MEDLINE | ID: mdl-2959974

An unusual case of neurofibrosarcoma of the cranio-orbital-maxillary region was resected by a combined neurosurgical and plastic surgical team. The resulting defect was reconstructed in one stage with a free rectus abdominis myocutaneous flap, obviating the need for subsequent prosthetic obturation of the maxillary defect. This reconstructive technique expedited the patient's convalescent period, allowing him to return to work 3 weeks following surgery. Wound healing was uneventful, and the cosmetic result was acceptable to the patient.

Neurofibromatosis 1/surgery , Orbital Neoplasms/surgery , Surgery, Plastic/methods , Surgical Flaps , Abdominal Muscles/surgery , Adult , Facial Bones/surgery , Humans , Male , Orbit/surgery
Plast Reconstr Surg ; 79(6): 968-73, 1987 Jun.
Article En | MEDLINE | ID: mdl-3295914

A traumatic below-knee amputation with extensive soft-tissue loss and tibial bone exposure was salvaged by employing microsurgical free-tissue transfer to obtain stable soft-tissue coverage. The free flap covering the bony stump and knee function have done well with over 1 year follow-up.

Amputation, Traumatic/surgery , Knee/surgery , Surgical Flaps , Back , Humans , Locomotion , Muscles/transplantation , Skin Transplantation
Plast Reconstr Surg ; 79(5): 697-700, 1987 May.
Article En | MEDLINE | ID: mdl-3575516

A modification of the hemitongue advancement flap is presented which provides greater extensibility to the base of the tongue. This technique allows for reconstruction of T2 tumor defects of the midlateral tongue ranging from 4 to 6 cm in length. Mobility of the tongue is minimally compromised, preserving good speech and deglutition. Excessive bulk is not present to impinge on the mandibular alveololingual sulcus, thus allowing early use of lower dentures without the need for adjustment and relining.

Carcinoma, Squamous Cell/surgery , Surgical Flaps , Tongue Neoplasms/surgery , Humans , Tongue/surgery
Ann Plast Surg ; 18(3): 230-7, 1987 Mar.
Article En | MEDLINE | ID: mdl-2954503

The pathophysiology and treatment of hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp, which constitute the follicular occlusion triad, are reviewed. The unusual occurrence of all three components in a single patient resistant to medical management is presented with a review of the literature. This patient's course was complicated by multiple synchronous squamous cell carcinomas developing in a localized area where his acne conglobata was most pronounced. Although one lesion was clinically obvious, the majority were less suspicious for cancer. Occult cancer should be considered in recalcitrant cases of acne conglobata where isolated areas fail to respond to medical management, particularly when 13-cis-retinoic acid has been used.

Acne Vulgaris/complications , Cellulitis/complications , Scalp Dermatoses/complications , Sweat Gland Diseases/complications , Carcinoma, Squamous Cell/etiology , Humans , Male , Middle Aged , Neoplasms, Multiple Primary/etiology , Skin Neoplasms/etiology
Plast Reconstr Surg ; 79(2): 284-8, 1987 Feb.
Article En | MEDLINE | ID: mdl-3809277

A thoracic suspensory jacket has been used in four patients with recurring ischial pressure sores to transfer the site of skin pressure from the insensate ischial area to the sensory area over the rib cage. This modality is not an alternative to surgery, but rather an adjunct to prevent an early recurrence after an ischial pressure sore has been repaired with a proper surgical procedure.

Orthotic Devices , Paraplegia/surgery , Skin Ulcer/surgery , Surgical Flaps , Adult , Buttocks , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Paraplegia/physiopathology , Posture , Sensation , Skin Ulcer/prevention & control
Plast Reconstr Surg ; 78(3): 385-9, 1986 Sep.
Article En | MEDLINE | ID: mdl-3737763

A total amputation of an ear from an automobile accident was salvaged by suturing the fragments of the skeletonized auricular cartilage and reattaching it to its original position "sandwiched" in a platysma musculocutaneous flap. The anterior portion of this flap was subsequently removed to apply a skin graft to the thin platysma muscle left over the convolutions of the auricular cartilage. This technique represents the application of the principle of bringing blood supply to avascular tissue in order to salvage it.

Amputation, Traumatic/surgery , Ear, External/injuries , Replantation/methods , Surgical Flaps , Adult , Ear, External/surgery , Humans , Male
J Pediatr Surg ; 21(8): 706-10, 1986 Aug.
Article En | MEDLINE | ID: mdl-3746606

Pediatric microvascular surgery has received little attention in the literature until recently. The demonstrated feasibility with successful results represents a disproportionately small patient population when compared with adults. One reason for this delayed growth in pediatric revascularization and replantation appears to be a lack of awareness on the part of both referring physicians and microvascular surgeons as to its present indications and outcome. Several cases are presented along with a review of the current literature to clarify this issue. A protocol for managing these patients from a triage standpoint is also included.

Arm Injuries/surgery , Hand Injuries/surgery , Microsurgery , Replantation , Amputation, Traumatic/surgery , Brachial Artery/surgery , Child , Child, Preschool , Female , Humans , Infant, Newborn , Male , Organ Preservation
J Reconstr Microsurg ; 2(4): 221-8, 1986 Jul.
Article En | MEDLINE | ID: mdl-3761242

Microsurgical techniques have developed numerous territories suitable for free tissue transfer. However, the demand for thin cutaneous resurfacing limits the choice of flaps available to the reconstructive microsurgeon. The radial forearm flap is a thin, axial, fasciocutaneous flap, offering pliable cutaneous resurfacing, with or without sensation. We have used 15 flaps to reconstruct defects in the head and neck and lower extremity resulting from burns, blunt and avulsive trauma, radiation necrosis, and tumor ablation. Two flaps (15 percent) developed venous congestion and were salvaged by reoperation. One retrograde flap (7.5 percent) developed partial necrosis from arterial insufficiency. Neural re-innervation was successful in two out of three patients in whom it was attempted. Two patients (15 percent) sustained minor donor site skin graft loss that healed secondarily. In our series of predominantly older patients the donor sites have been relatively inconspicuous at one year follow-up. A functional restoration was achieved in all patients.

Forearm/surgery , Head/surgery , Leg/surgery , Microsurgery/methods , Neck/surgery , Surgical Flaps , Adult , Aged , Burns/surgery , Female , Humans , Male , Middle Aged , Neoplasms/surgery , Radiation Injuries/surgery , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/surgery
Plast Reconstr Surg ; 78(1): 94-101, 1986 Jul.
Article En | MEDLINE | ID: mdl-2873603

Resurfacing the sole of the foot is a unique and challenging problem. Many methods have been advocated in search of an ideal solution. When the entire surface requires reconstruction, alternatives have been limited, and their results have often been less than satisfactory. Free-flap transfer allows a single-stage reconstruction from a variety of donor sites. This report of a free neurosensory radial forearm flap to cover a complete plantar weight-bearing surface is an additional choice for reconstruction. This flap has the potential for sensory reinnervation by the medial antebrachial cutaneous nerve and when elevated without its fascia can provide improved adherency.

Foot Injuries , Surgical Flaps , Accidents, Occupational , Adult , Foot/surgery , Forearm , Humans , Male , Methods , Peripheral Nerves/surgery , Skin/innervation , Vascular Surgical Procedures
Head Neck Surg ; 8(5): 355-62, 1986.
Article En | MEDLINE | ID: mdl-3539875

A method to reconstruct visible cranioplasty defects involving the anterior cranium with the durability of bone and the exacting contours of the custom silicone implant is described. This technique is simple, quick, and does not require intraoperative assessment of subtle contours. The patient has a rigid underlying bony support with a perfectly contoured external surface. In patients with cranioplasty involving the cranium anterior to the hairline, we take advantage of both split rib grafts and a silicone prosthesis in one stage to obtain optimal results.

Bone Transplantation , Prostheses and Implants , Silicones , Skull/surgery , Surgery, Plastic/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Ribs
Plast Reconstr Surg ; 77(4): 577-85, 1986 Apr.
Article En | MEDLINE | ID: mdl-3952213

The free radial forearm flap provides a reliable single-stage method to cover difficult scalp and forehead defects where other local methods are unsuitable. Six patients have been successfully reconstructed utilizing seven free radial forearm flaps. A description of our surgical technique along with illustrative cases demonstrate the indications and advantages of this flap. Cranial soft-tissue deficits are primarily cutaneous; therefore, a more predictable reconstruction can be obtained utilizing a cutaneous flap with similar characteristics. Restoration of bony defects should be considered separately utilizing autogenous bone and/or alloplastic materials and not merely obliterated with a bulky soft-tissue flap. Therefore, if the local factors of a cranial wound require the utilization of a distant tissue transfer, we prefer the thin coverage of a well-vascularized free fasciocutaneous radial forearm flap over two-stage distant pedicle flaps or skin-grafted free flaps.

Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/surgery , Forehead/surgery , Scalp/surgery , Skin Neoplasms/surgery , Surgical Flaps , Aged , Female , Humans , Male , Middle Aged , Skull/surgery
J Hand Surg Am ; 11(2): 210-8, 1986 Mar.
Article En | MEDLINE | ID: mdl-3958449

Trauma to the hand can result in adhesions between the interosseous and lumbrical muscles with subsequent painful impingement on the deep transverse metacarpal ligament during intrinsic contraction. If these adhesions also develop between the intrinsic muscles and the deep transverse metacarpal ligaments or metacarpophalangeal capsule, discomfort may be produced by stretching of the intrinsic tendons. Release of these adhesions, partial resection of the ligament, and early mobilization can produce relief of the symptoms. Eighty-seven cases are reviewed with respect to causes, diagnosis, and treatment.

Fingers , Muscular Diseases/surgery , Tissue Adhesions/surgery , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Muscles/pathology , Muscular Diseases/pathology , Tissue Adhesions/pathology
Plast Reconstr Surg ; 77(1): 50-9, 1986 Jan.
Article En | MEDLINE | ID: mdl-3941849

The management of costochondritis of the chest wall is reviewed and four illustrative cases presented. Adequate debridement is the single most important factor to ensure eradication of this disease. Well-vascularized tissue coverage reduces ischemic factors, resists secondary infection by contamination, and promotes rapid healing. The pectoralis major, latissimus dorsi, and rectus abdominis muscle flaps are the primary choices for pedicle-flap coverage. Antibiotic coverage was not extended beyond 3 weeks in these cases, and no recurrences have been noted over a 1- to 3-year follow-up.

Cartilage Diseases/surgery , Ribs , Actinomycosis/complications , Aged , Cartilage/anatomy & histology , Cartilage Diseases/diagnosis , Cartilage Diseases/etiology , Debridement , Female , Follow-Up Studies , Humans , Inflammation , Male , Middle Aged , Necrosis , Postoperative Complications , Surgical Flaps
J Trauma ; 26(1): 18-25, 1986 Jan.
Article En | MEDLINE | ID: mdl-3510302

Traditional teaching recommends major burn procedures be limited to successive 20% total body surface area (TBSA) excision and grafting procedures. This format theoretically reduces the surgical stress and limits the transfusion requirements to a level reasonably tolerated by patients. We have treated 14 patients with thermal burns involving greater than 30% TBSA. These patients underwent excisions ranging from 30 to 70% TBSA at the initial operative escharectomy. Tangential and fascial excisions were employed, depending upon the depth of injury, and autografts and/or allografts were utilized for wound closure. The results of this technique yielded an overall 71% survival. Time from burn to last autograft and hospital stay tended to be shortened or unchanged when compared to national averages. This series demonstrates the feasibility of performing early major escharectomy in a selected burn population without apparent increased surgical risk compared to patients treated by conventional staged excision. Although burn wound sepsis and mortality appeared favorably affected by this technique, the small population size was unsuitable for adequate statistical analysis.

Burns/surgery , Adolescent , Adult , Body Surface Area , Burns/mortality , Child, Preschool , Female , Humans , Length of Stay , Male , Methods , Sepsis/etiology , Sepsis/mortality , Skin Transplantation , Transplantation, Autologous , Transplantation, Homologous
Plast Reconstr Surg ; 76(1): 13-24, 1985 Jul.
Article En | MEDLINE | ID: mdl-4011767

The oromandibular limb hypogenesis syndrome is a group of anomalies affecting the mandible, tongue, and maxilla with or without reductive limb anomalies. Their genetic origin is uncertain, and no drug-induced teratogen has been clearly identified. Although many similarities exist on both an embryologic and clinical level, distinction between these entities is appropriate. A new classification system with these principles in mind is presented. Two cases are presented of glossopalatine ankylosis with hypodactyly representing the thirteenth and fourteenth cited in the world literature. One patient presented with a fatal pulmonary hypoplasia not previously reported in association with this syndrome. Three of the 14 cases with reductive limb anomalies reported have had fatal outcomes.

Abnormalities, Multiple/pathology , Mandible/abnormalities , Maxilla/abnormalities , Tongue/abnormalities , Abnormalities, Multiple/classification , Ankylosis/classification , Ankylosis/pathology , Arm/abnormalities , Female , Humans , Infant, Newborn , Leg/abnormalities , Male , Micrognathism/classification , Pierre Robin Syndrome/classification , Pierre Robin Syndrome/pathology , Syndrome
Plast Reconstr Surg ; 75(6): 882-7, 1985 Jun.
Article En | MEDLINE | ID: mdl-4001209

Use of muscle flap obliteration for bronchopleural fistulas appears to be indicated with (1) failure of a previous thoracoplasty, (2) anticipated failure of a thoracoplasty alone, and (3) the need to obviate a formal debilitating thoracoplasty. With the use of well-vascularized muscle flaps to fully obliterate the densely scarred cavities associated with persistent bronchopleural fistulas, we may hope to see improved healing in the bronchial stump and, in cases of residual infection, better resistance of the flap to necrosis, as well as improved delivery of chemotherapeutic agents to the local tissues. These factors may confer improved cure rates for bronchopleural fistulas similar to those seen in lower extremity salvage surgery for osteomyelitis following the introduction of vascularized pedicle and free muscle flaps. In this article we have described the versatility of the island pedicle latissimus dorsi muscle flap for closure of recalcitrant bronchopleural fistulas and associated empyema cavities. Utilizing either the dominant thoracodorsal or the minor paraspinal pedicle(s), it can reach any intrathoracic cavity by means of the appropriate thoracotomy incision.

Bronchial Fistula/surgery , Fistula/surgery , Pleural Diseases/surgery , Surgical Flaps , Aged , Child , Female , Humans , Male