Search PubMed⌕ Search

Biomedical subjects

A M Feller

Publications and source records attributed to A M Feller.

At least 37 records · Page 2Linked to original sources
PubMed1990

The transverse rectus abdominis musculocutaneous free flap: a reliable alternative for delayed autologous tissue breast reconstruction.

The use of the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap has been established world-wide for breast reconstruction. Until now, application of a TRAM free flap, however, has only taken place in special circumstances. The advantages of a TRAM free flap (such as better and more vigorous perfusion than with a pedicled TRAM flap and greater freedom in reconstruction, as well as a lower incidence of weakening within the abdominal wall) are so conclusive that it has become our preferred procedure for breast reconstruction. Twenty-five patients have successfully undergone this procedure at our division. In 6 patients, the arterial or venous microanastomosis, or both, required revision without experiencing, however, total flap loss. Partial flap loss occurred in only 1 patient. All patients (including those having undergone revision) were satisfied with their reconstructed breast form. This satisfaction can be directly attributed to the fact that with this procedure, a desired breast form and volume can almost always be achieved.

Abdominal Muscles↗
PubMed1990

[Tissue protection by elimination of oxygen free radicals in the post-ischemic reperfusion phase].

Prolonged ischemia decreases the chances for a successful pedicled or free tissue transfer as well as for major limb replantation. Skeletal muscle is especially sensitive to periods of prolonged ischemia and reperfusion. It is now hypothesized that tissue injury occurs during reperfusion due to the formation of toxic oxygen-free radicals. A replantation model, using the rabbit hind limb tibialis anterior muscle, was developed, to assess muscle function and histological appearance following ischemic intervals of five and eight hours. Muscle strength five weeks after injury was used as a functional measurement of tissue damage. The effects of the superoxide free radical scavenger superoxide dismutase (SOD), the hydroxide radical scavenger dimethylsulfoxide (DMSO) and the xanthine-oxidase inhibitor allopurinol (ALLO), administered systemically just before reperfusion, were studied.

Allopurinol↗
PubMed1990

[Aggressive debridement and early soft tissue coverage of 3d degree open tibial fractures].

93 patients with grade III open tibial fractures were treated without a treatment protocol from 1980 to 1982. This group is compared to 147 pts. managed between 1983 to 1986 according to a standardized prospectively designed protocol with aggressive debridement augmented by pulsatile Jet-lavage. Serial debridement were performed at 48-hour intervales until early soft-tissue coverage were obtained using local or free muscle-flaps. The mean follow-up was 80 months respectively 44 months. --The aggressive regimen led to a statistically significant decrease in infection (30% vs 12%), nonunion (16% vs 6%), amputation (18% vs 6%) and combined hospitalization-periods (137 vs 74 days) [all p less than 0.001]. The aggressively treated groups showed a trend toward early fracture-healing (30 vs 23 weeks) although this was not statistically significant.

Adolescent↗
PubMed1989

Experimental evaluation of oxygen free radical scavengers in the prevention of reperfusion injury to skeletal muscle.

A prolonged preoperative ischemic interval decreases the chances for successful replantation of an amputated limb. Skeletal muscle is especially sensitive to periods of prolonged ischemia. It is now hypothesized that significant tissue injury occurs during reperfusion, when oxygen-rich blood contacts anaerobic metabolites forming toxic oxygen free radicals. A replantation model, using the rabbit hind limb tibialis anterior muscle, was developed to assess muscle function and histological appearance following ischemic intervals of five and eight hours. Muscle strength five weeks after injury was used as a functional measurement of tissue damage. The effects of the superoxide free radical scavenger superoxide dismutase (SOD) and the hydroxyl radical scavenger dimethylsulfoxide (DMSO), administered systemically just before reperfusion, were studied. Muscle treated with SOD following five hours of ischemia had essentially normal strength and histological appearance; however, there was no protective effect after eight hours. DMSO treatment had no beneficial effects after five hours of ischemia, but after eight hours DMSO-treated muscle had significantly better function than untreated muscle. Histological examination confirmed the functional results. Clinical treatment of ischemic limbs with free radical scavengers before revascularization may aid in avoiding reperfusion injury and may improve survival and later muscle function.

Animals↗
PubMed1989

[Reconstructive possibilities after burns of the female breast].

Reconstruction of the adolescent female breast after full-thickness burns differs from that of the mature female breast. Whereas a final correction is aspired to in the adult, the operative procedure should be adjusted to the evolution of the breast in the adolescent. Our therapeutic guidelines as well as the advantages and disadvantages of the different procedures are discussed.

Adolescent↗
PubMed1989

[Corrective possibilities of burn contractures of the large joints].

Major joint movement is frequently limited following full-thickness burns of the extremities due to scar contractures. After operative correction of the contractures physical therapy is absolutely necessary. Skin contractures are treated with Z-plasty, skin graft, local flaps, pedicled flaps and free tissue transfer. The advantages and disadvantages of those procedures are described.

Burns↗
PubMed1989

[Autologous injection of fatty tissue following liposuction--not a method for breast augmentation].

In recent years autologous fat transplantation employing liposuction has become an established method for correction of small soft tissue defects and irregularities of skin contour. Only a small amount of fat may be used because fat cells will be nourished by perifusion alone until neovascularisation occurs. Transplantation of a large amount of fat will result in fat necrosis. The inappropriate use of fat for breast augmentation after liposuction is described in a case report.

Adipose Tissue↗
PubMed1989

[Post-traumatic soft tissue defects of the heel].

Trauma induced soft tissue defects of the heel are likely to develop recurrent ulcerations along with osteitis of the calcaneus even after years of conservative treatment. Biomechanical as well as plastic surgical, traumatological and orthopedical shoe device problems which must be taken into consideration to manage the functional demands, are discussed.

Adolescent↗
PubMed1989

[Multi-sided free transplants for closure of multifocal tissue defects].

Recently microsurgical tissue transfer--especially to the distal lower leg--for coverage of big soft tissue defects has been found to yield better results than conservative methods. However, there is still a problem providing coverage for multiple defects with only one tissue transfer. One solution is to employ multiple transplants with only one nourishing pedicle. Six patients have been treated successfully with such transplants. The operative procedure and the postoperative results are presented with a case report.

Adult↗
PubMed1989

[Correction of the deformed hand in Parkinson disease].

The typical hand deformity of Parkinsonism consists of metacarpophalangeal joint flexion and interphalangeal joint extension. An unusual case of a claw hand deformity in a patient with Parkinson's disease is described with hyperextension in the metacarpophalangeal joints and flexion in the interphalangeal joints. The operative technique to improve the marked limitation in hand function is described.

Aged↗
PubMed1988

Experimental evaluation of the antibiotic carrying capacity of a muscle flap into a fibrotic cavity.

A study was undertaken to determine the antibiotic carrying capacity of a transferred muscle flap into a fibrotic cavity using a tissue cage model in rabbits. Blood and chamber fluid antibiotic levels were determined after intramuscular hindlimb gentamicin injection up to 56 days following muscle transfer. This study suggests that muscle flaps increase the concentration of antibiotics that can be achieved within a fibrotic cavity. The measurable peak level decreases with time, probably due to increased scarring around the muscle. This model should enable the study of many different classes of antibiotics with different protein binding and other administration schedules using multiple timed doses or a combination of agents.

Animals↗
PubMed1988

Experimental pretransfer expansion of free-flap donor sites: II. Physiology, histology, and clinical correlation.

There is a statistically significant increase in blood flow into expanded cutaneous and myocutaneous flaps in a pig model over controls. The vascular trees within flaps enlarge following expansion, and pronounced neovascularization is seen in the papillary dermis and capsular layers. Experimentally, there is differential thinning of all tissue layers except the epidermis. A successful clinical application of this technique, by free-tissue transfer of an expanded fasciocutaneous scapular flap, is described. The technique is applicable when altered flap size or contour is desired.

Adipose Tissue↗
PubMed1988

[Primary management and secondary reconstructive surgery of severe combined hand injuries].

Primary treatment and secondary reconstructive surgery of severe mutilating hand injuries are associated with challenging problems. Conventional and microneurovascular reconstructive methods must be integrated into the therapeutical rationale. The technical and tactical principles essential to obtain an optimal rehabilitational result are discussed. Simple sensitive grip tools will provide better functional long time results than modern prosthetic devices.

Adolescent↗
PubMed1987

[Bilateral obstruction of the ureters as a complication of iliac aneurysms].

A case of bilateral obstruction of the ureters secondary to iliac aneurysms is reported. While perianeurysmal fibrosis in so-called "inflammatory" aneurysms causes the obstruction in most cases, this is a report on a case of compression of both ureters by huge aneurysms without inflammatory reaction. Recurrent back pain of urinary type is the first symptom in 75% of the cases. Ultrasonography shows hydronephrosis and deviation of the ureters as well as the aneurysms. Intravenous pyelography, angiography and CT-scan are necessary to show the real size of the ureters and the aneurysm. Treatment of choice is resection of the aneurysm and replacement by a prosthesis. Ureterolysis may be necessary if the ureters are enveloped by perianeurysmal fibrosis.

Aneurysm↗
PubMed1987

[Cardiovascular manifestations of pseudoxanthoma elasticum (Grönblad-Strandberg syndrome)].

Pseudoxanthoma Elasticum (PXE) is a rare inherited disease with generalized degeneration of the elastic fibers. Typical changes occur in the skin and the eyes, but 25% of all cases present an involvement of the peripheral arteries. A typical case of familiar PXE is presented. Changes can occur in nearly all arteries, but involvement of the arteries of the leg, arm, foot and hand are most common. Usually, the symptoms are the same as in the peripheral arterial occlusive disease, but 70% of the patients are less than 35 years old. Angiography shows calcifications of the arteries with multiple stenoses and occlusions but also a very well developed system of collateral arteries. Involvement of abdominal arteries causes recurrent hemorrhage. Changes in the coronary artery system cause myocardial infarction and sudden death in children and young adults. Changes of the mitral, aortic and tricuspid valve and the endocard have been described. As the evolution of the disease is very slow and the system of collateral arteries is usually well developed, operation (i.e. femoro-popliteal bypass, aorto-coronary bypass) is in most cases not necessary.

Arterial Occlusive Diseases↗
PubMed1986

[Microsurgical bile duct anastomosis: animal experiment and clinical study].

In 10 Göttingen-minipigs an end-to-end anastomosis of the normal common bile duct was accomplished under the microscope with 11/0 Polygalactin-sutures. Biliary flow was controlled by serum concentration of alkaline phosphatase, by cholangiography and by dynamic hepato-biliary scintigraphy 2 weeks, and 3 and 6 months after the operation. Anastomoses were judged by macroscopic, microscopic and scanning electronmicroscopic examination 6 or 12 months postoperatively. The anastomoses presented no stenosis at all, only a light periductal fibrosis with intact luminal epithelium. Alkaline phosphatases and cholangiography showed a normal pattern, the scintigraphy presented dyskinesia after 2 weeks and normal flow at the later controls. After a microsurgical operation one patient showed a normal anastomosis after 6 months. A biliary anastomosis should be made by microscope in all patients with a long life span and unchanged bile duct wall in spite of the more difficult operation.

Adult↗