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Biomedical subjects

A E Cram

Publications and source records attributed to A E Cram.

At least 19 recordsLinked to original sources
PubMed2000

Endoscopic plastic surgery.

This article discusses three of the most popular endoscopic procedures in plastic surgery. Brow lift, transaxillary breast augmentation, and abdominoplasty are all cosmetic procedures with a high demand on inconspicuous scars; however, many investigators are working on reconstructive endoscopically assisted procedures. The treatment of many facial fractures involving the upper third of the facial skeleton usually requires long bicoronal incisions similar to the incisions used in the traditional brow lift. Attempts are under way to use endoscopically assisted minimal-access techniques to reduce and fixate these fractures. Many flaps used in plastic surgery require long scars for harvest, as in the case of the latissimus dorsi muscle flap. A relatively long incision on the back is needed to gain access to the muscle so that it can be elevated from structures superficial and deep to it. Although it is unpopular, investigators have reported harvesting latissimus dorsi muscle flaps through fairly small incisions with the assistance of balloon dissectors and endoscopes. In the field of hand surgery, carpal tunnel release surgery has had more than one method proposed to transect the carpal ligament using endoscopes and special instrumentation. Although some reported series claim excellent results, many hand surgeons are reluctant to use endoscopes because of associated complications and a high recurrence rate of carpal tunnel syndrome. Plastic surgery has special demands that emphasize aesthetics in cosmetic and reconstructive procedures. Although the lack of natural optical cavities has slowed the incorporation of endoscopic surgery in the specialty, surgically created cavities are used to allow for minimal access incisions. The future of plastic surgery will include an ever-increasing number of endoscopically assisted procedures. Cosmetic and reconstructive procedures will benefit from this new technology.

Abdomen↗
PubMed1997

The effect of the delay phenomenon on the vascularity of rabbit abdominal cutaneous island flaps.

The beneficial effects of the delay phenomenon have been evaluated extensively and are widely known. However, no study has quantified the vascular changes seen in an abdominal cutaneous island flap following a surgical delay by vascular pedicle ligation. We evaluated the effect of unilateral superficial inferior epigastric and deep inferior epigastric pedicle ligation on the vascularity of a rabbit abdominal cutaneous island flap. Thirty rabbits underwent a left superficial inferior epigastric and deep inferior epigastric pedicle ligation as a delay procedure. A 19 x 15 cm abdominal cutaneous island flap was elevated at the time of sacrifice, based solely on the right superficial inferior epigastric pedicle. The flap vasculature was then evaluated by methylene blue injection and lead oxide microangiography at 0, 5, 10, 15, 21, and 27 days following the delay procedure. Methylene blue studies revealed perfusion of only the right (nonligated) side of the flap on day 0 and perfusion of the entire flap by day 15. This "capture" of the left (ligated) superficial inferior epigastric artery angiosome by day 15 could only have been achieved through enhanced cross-midline perfusion. Lead oxide microangiography revealed an increase in the number of vessels from day 0 to day 27 on both the ligated and nonligated sides in all the following: the number of large "choke" vessels (> 0.5 mm) crossing the flap midline, total number of vessels (all sizes) crossing the flap midline, and total number of vessels (all sizes) at the medial aspect of the right and left superficial inferior epigastric artery angiosomes. A statistically significant increase in these vessels was not seen until day 21. The effect of the delay phenomenon was significantly greater on the ligated side compared with the nonligated side. The areas of the flap that were relatively more ischemic following left superficial inferior epigastric pedicle ligation (medial aspect of the caudad half of the left superficial inferior epigastric artery angiosome) showed greater increases in vascularity with the delay procedure than did areas of lesser ischemia (medial aspect of the cephalad half of the right superficial inferior epigastric artery angiosome).

Abdominal Muscles↗
PubMed1997

The effect of the delay phenomenon on the vascularity of rabbit rectus abdominis muscles.

The transverse rectus abdominis muscle (TRAM) flap has become the "gold standard" for autogenous breast tissue reconstruction. Complications are reported in 10 to 40 percent of patients undergoing this procedure, and many are related to soft-tissue necrosis secondary to ischemia. Various methods have been proposed to improve TRAM flap survival, including surgical delay of the flap. The beneficial effects of the delay phenomenon have been well established in laboratory studies and clinical evaluations. Many investigators agree that the delay phenomenon will enhance arterial inflow and venous outflow from the TRAM flap. No study has quantified the changes seen in the rectus abdominis muscle following a delay procedure. In this prospective, controlled, and blinded experiment, we evaluate the effect of a unilateral superficial inferior epigastric and deep inferior epigastric artery and vein ligation on the vascularity of the rectus abdominis muscles in rabbits. Thirty-eight rabbits underwent a left superficial inferior epigastric and deep inferior epigastric pedicle ligation as a delay procedure. The rectus abdominis muscle vasculature was then evaluated by lead oxide microangiography at 0, 5, 10, 15, 21, and 27 days following the delay procedure. Magnification (x 2) was used to count the number of vessels at the periphery of the deep inferior epigastric artery angiosomes in the microangiograms. An increase in the number of vessels from day 0 to day 27 was seen on both the ligated and nonligated sides in all the following: the number of large (> 0.5 mm) "choke" vessels and total number of vessels (all sizes) crossing the abdominal wall midline and the total number of vessels (all sizes) at the medial, superior, and lateral aspects of the right and left deep inferior epigastric artery angiosomes. A statistically significant increase in these vessels was not seen until day 21. The effect of the delay phenomenon was significantly greater on the ligated side compared with the nonligated side. The areas of the rectus abdominis muscles that were relatively more ischemic following left deep inferior epigastric pedicle ligation (medial aspect of the left deep inferior epigastric artery angiosome) showed greater increases in vascularity with the delay procedure than did areas of lesser ischemia (lateral aspect of the right deep inferior epigastric artery angiosome).

Angiography↗
PubMed1996

The role of neovascularization in the survival of an arterialized venous flap.

This study compares survival of arterialized venous flaps placed on normal and impaired recipient beds in New Zealand White rabbit ear. Fasciocutanous flaps (4 x 5 cm) were perfused by an arteriovenous anastomosis; outflow was provided by one vein. In group 1, the arterialized venous flap was sutured into its bed on the ear; in group 2, a sheet of silicone was placed between the flap and the ear, providing an experimentally impaired recipient bed. Flap survival was expressed as a percentage of the total flap surface by means of a computerized image analysis system. Excellent survival (> or =95 percent) was noted in 16 of 21 arterialized venous flaps in group 1 versus 2 of 21 in group 2 (p < 0.01). Partial survival (50 to 94 percent) was observed in 2 of 21 arterialized venous flaps in group 1 and 15 of 21 in group 2. Poor survival (<50 percent) was noted in 3 of 21 in group 1 and in 4 of 21 in group 2. Microangiography was used to illustrate arteriovenous fistulas, the vascular network within the flaps, and neovessels in the periphery of the flaps. These data indicate that neovascularization is necessary for optimal survival of arterialized venous flaps in this experimental rabbit ear model.

Animals↗
PubMed1996

Reduction mammaplasty: the results of avoiding nipple-areolar amputation in cases of extreme hypertrophy.

In extreme cases of breast hypertrophy, amputation of the nipple-areolar complex and transplantation during reduction mammaplasty has been advocated to avoid nipple necrosis. We report our experience with 172 patients having inferior breast pedicle reduction without amputation of the nipple-areolar complex. Mean total weight of resected tissue was 1,946 g (548 to 5,100 g), with a mean nipple-areolar transposition of 10 cm (0.5 to 23 cm). Dividing patients into four groups by weight of resection, we compared complication rates. In this series, where nipple-areola amputation was avoided, there was a 99.6% survival rate of the nipple-areolar complex with 97.1% retention of nipple sensibility. Patients with extreme breast hypertrophy (3,000 g resected tissue) experienced no increase in complications when compared to smaller reductions. In most cases of gigantomastia, amputation of the nipple can be avoided using the inferior breast pedicle technique. Size of breast resection alone should not determine the fate of the nipple.

Adolescent↗
PubMed1995

Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous flap versus breast implant reconstruction.

Over 40,000 postmastectomy breast reconstructions are performed annually. In this study, we investigated the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous (TRAM) flap versus breast implant reconstruction. Thirty-three women who had undergone postmastectomy breast reconstruction were contacted by telephone and agreed to participate in the study. Twenty-two women completed the self-assessment questionnaires regarding their quality of life, psychological symptoms, functional status, body image, and global satisfaction. The TRAM and implant groups contained 8 and 14 patients, respectively. The groups were well matched for age, employment status, marital status, race, religion, and severity of medical and surgical illnesses. The average follow-up was 36 months. Statistical analysis of the responses revealed that women who had undergone TRAM flap reconstruction were more satisfied with how their reconstructed breast felt to the touch (p = .01), and there was a trend toward greater satisfaction with the appearance of their reconstructed breast (p = .08). However, these same patients identified more difficulties as far as functioning at work or school, performing vigorous physical activities, participating in community or religious activities, visiting with relatives, and interacting with male friends (p < .04). There were no statistically significant differences in body image or overall satisfaction. In this small cohort study, both the TRAM flap group and the implant group were satisfied with the results of their breast reconstruction, but the TRAM flap group was more satisfied with how their breast felt and tended to be more satisfied with the cosmetic result. The TRAM flap group reported greater psychological, social, and physical impairments as a result of their reconstruction.

Adult↗
PubMed1988

Skin preservation at 4 degrees C: a species comparison.

There are numerous experimental studies in the literature regarding skin storage and preservation. These studies are difficult to interpret due to the variety of storage techniques utilized and the number of different animal species used as skin donors. This study utilized a single cold storage protocol to test the effect of species variation on skin graft viability. Donor skin was obtained from five animal species and human surgical panniculectomy specimens. The skin was stored in modified Roswell Park Memorial Institute (RPMI) 1640 tissue culture media at 4 degrees C. Stored skin was transplanted to surgically created defects on athymic (nude) mice after specific storage intervals. Ten days after transplantation, the grafts were examined by gross and microscopic techniques. The viability of mouse, rat, and dog skin was significantly different from human skin, while stored rabbit and pig skin were similar to human skin. These results demonstrate the difficulty of applying the data of skin storage studies from nonhuman species to clinical practice. The data indicate that rabbit and pig skin may be used in laboratory studies of skin preservation at 4 degrees C with a strong likelihood that the results may be of clinical relevance in predicting the behavior of human skin under similar storage conditions.

Animals↗
PubMed1987

Role of an emergency helicopter transport service in rural trauma.

The records of 916 trauma victims transported by an emergency helicopter service were reviewed to evaluate its impact on patient outcome. According to strict criteria, the service was classified as essential, helpful, or "not a factor" in the preservation of life and/or limb in each case. The helicopter service was essential in 14.0%, helpful in 12.9%, and "not a factor" in 56.6% of patients. A fourth category included patients who, despite the delivery of maximal emergency medical care, died as a result of their injuries (16.5%). With the available initial information, it was impossible to determine prospectively which patients would benefit from air transport. We believe that the rapid evaluation of potentially serious injuries and the number of patients for whom the service proved beneficial justify its use, particularly in rural areas.

Adolescent↗
PubMed1987

Implantation of human keloid into athymic mice.

In the interest of developing an animal model for keloids, human keloid dermis was implanted in the subcutaneous tissues of athymic (nude) mice. Subsequent growth resulted in a lesion with histology similar to the original keloid. Fibroblasts were cultured from keloid dermis. When the fibroblasts alone were implanted in the subcutaneous tissues of nude mice, growth of a visible lesion was again produced. The fibroblasts had proliferated and deposited collagen in an abnormal fashion with the histology resembling the parent keloid. Further research could develop this into a reliable animal model to allow in vivo experimentation.

Adult↗
PubMed1985

Preservation of human skin: a study of two media using the athymic (nude) mouse model.

This study is part of an ongoing attempt to define the optimal conditions for short-term storage of viable human skin for auto- or homotransplantation. Roswell Park Memorial Institute 1640 (RPMI) media was more convenient to use than Eagle's Minimum Essential Medium with HEPES buffer (MEM-H) but functional skin viability was not statistically different in the two media. MEM without HEPES buffer did not preserve human skin at 20 days storage. The athymic (nude) mouse provides an excellent in vivo test of stored human skin functional viability.

Animals↗
PubMed1984

Rural trauma care: a study of trauma care in a rural emergency medical services region.

Motor vehicle-related trauma deaths in a 21-county rural emergency medical services (EMS) system are reviewed. Injury severity scores (ISS) and Glasgow coma scores (GCS) were recorded to provide baseline data for future comparison as the system progresses. The majority of deaths (67%) were related to CNS injuries. ISS in this series was similar to data reported from Orange County, California. The average GCS for all patients in this series was 5, indicating the high prevalence and severity of head injuries in motor vehicle deaths. Patients treated only in community hospitals had a low average ISS of 28.5. Those transferred from community hospitals to the regional tertiary care center had an average ISS of 36.2. Those admitted directly to the tertiary center had an ISS of 38.9. The data suggest that the rural trauma system might improve if there were training programs that promote recognition of significant injury, more aggressive resuscitation, and expeditious transfer of the injured patients.

Accidents, Traffic↗
PubMed1984

Evaluation of an emergency air transport service as a component of a rural EMS system.

The authors reviewed the records of 569 patients transported by an emergency helicopter service to evaluate its impact on the outcome of patients with multisystemic injuries. A Total Trauma Score for each patient was computed. A number of other factors were also considered, including the nature of the injury, number of systems injured, origin and duration of flight, resuscitative maneuvers, number of blood transfusions given and the timing of operations required to treat the injury. The service was then rated utilizing strict specific guidelines as either essential, helpful or not a factor, in the preservation of life and/or limb in each case. A fourth group was comprised of patients who expired as a result of their injuries. The air transport service was essential to 16.5% and helpful to 10.9% of patients. In spite of rapid evaluation and maximal intervention, 102 (17.9%) of the patients died. The group for which air transport was judged "not a factor" (54.7%) consisted of patients whose injuries would not have proven fatal had their transportation to the tertiary care center been delayed. Retrospective analysis of the data available to the tertiary care center at the time of the decision to transfer the patients by air revealed that it was not possible to differentiate those patients who did not benefit from the service from those for whom the service was judged essential or helpful. Even though 17.9% of the helicopter transported patients died at some time during their period of hospitalization, they did receive the benefit of prompt sophisticated evaluation and management of their injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Short-term preservation of human autografts.

Short-term storage of a patient's harvested skin is clinically desirable for numerous reasons. Previous experience in our center using a skin storage solution of saline with a high concentration of antibiotics resulted in poor graft viability and an unsatisfactory clinical outcome. This report defines an improved method of storage which allows longer storage time, yielding viable skin and results in subsequent graft acceptance on the patient. Split-thickness autografts from patients were stored in: 1) saline + 10(4) units/ml penicillin and 0.005 gm/ml streptomycin, or 2) RPMI-1640 + 25 units/ml penicillin and 25 mcg/ml streptomycin, at 4 degrees C. The pH range of the saline solution was 5.90-6.20, compared to 7.20-7.32 for the RPMI-1640 solution. The medium was changed every 3 to 4 days during the storage period. Before graft reapplication the autografts were rinsed with sterile saline. Previous clinical results using the saline-antibiotic storage solution resulted in poor graft viability and no graft survival was noted on patients after 5 days of skin storage. In contrast 11/16 autografts which had been stored in the RPMI-1640 solution for 5 to 22 days (median, 11 days) were successful takes when regrafted to patients. Graft loss was observed in five cases due to the following reasons: inability to immobilize graft (one); poor vascular bed (two); and bacterial infections (two). These data are in agreement with results reported in a separate paper, demonstrating the effectiveness of RPMI-1640 as a storage medium for maintaining viable human skin grafts which were subsequently transplanted to athymic nude mice.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

Human skin storage techniques: a study utilizing a nude mouse recipient.

The nude mouse model is an excellent technique for studying the viability of stored human skin. In this study Roswell Park Memorial Institute (RPMI) tissue culture medium provided reliable storage of viable human skin for 20 days. Antibiotic concentration plays a role in stored skin viability with low concentrations of penicillin and streptomycin providing adequate bacterial control and improved viability when compared to identical media with high concentrations of the same antibiotics. Addition of fetal calf serum to the storage medium did not improve human skin viability in this experiment.

Animals↗
PubMed1983

Duodenal trauma in the rural setting.

During the past 15 years, 21 patients with duodenal injuries were treated at the University of Iowa Hospitals and Clinics. The major cause of injury (66.6%) was blunt abdominal trauma. Eighteen patients (85.7%) underwent celiotomy. Only one patient (4.7%) had an isolated duodenal injury. In most cases, a careful exploration of the periduodenal area and lesser sac was necessary to diagnose and treat the injury. No one specific procedure was used in these patients. The use of Penrose drains did not prevent abscess formation in three of nine patients. Overall mortality was 23.8 per cent, but most deaths were related to other serious injuries. Only one death (4.7%) was directly related to the duodenal injury. In the rural setting, duodenal injuries are rare, but when they occur they are frequently the result of blunt trauma. These injuries are commonly associated with other obvious problems and may be easily overlooked. Because the preoperative diagnosis is difficult, careful intraoperative examination of the entire duodenum is mandatory.

Adult↗