Biomedical subjects
Publications and source records attributed to A Sagi.
We present an uncommon case of large nonarticular chondromatosis of the hand. Some of the foci were found to cause compression of the median nerve, the ulnar artery, and also triggering of the third finger. The fourth lumbrical muscle was involved as well. A thorough, but not complete, excision with preservation of the median nerve and ulnar artery was performed. No recurrence was found during 5 years of follow-up.
A chemically treated bovine skin, Dermodress, is presented as a long-term skin substitute. Dermodress was applied over denuded surfaces of debrided deep burns and was kept in place up to 56 days. At this time it was totally replaced by autograft, so we have no idea yet of how much longer it could have remained. It adheres to all contours of the debrided area, has hemostatic effect, and does not present any sign of infection or rejection. Dermodress can be removed in stages according to the availability of autografts, which may be applied immediately, since the exposed areas are clean and suitable for immediate grafting. Our clinical experience shows that Dermodress has most of the required properties of a long-term temporary skin substitute.
A case of a full skin thickness burn after contact with a Hydrozoa, Millepora dichotoma, is described. The poison secreted by specialized cells on the spines of this marine animal is a strong local irritant. Deep burns due to this agent do not appear to have been described before.
Our experience with early tangential excision and grafting for burns of the hands is presented. The advantages of the early surgical approach are proven by comparing this technique with the 'old' conservative treatment in two different populations. It is clearly concluded that early excision and grafting, combined with adequate physiotherapy and pressure garments, offer favourable results for the burned hand. Early excision of the burn eschar, before the appearance of contamination, may prevent infection, long and unfavourable delay in healing, scar formation with its incapacitating sequellae and a non-aesthetic appearance. Such a delay was characteristic of the 'conservative period', which was dominated by 'fibroblast', 'good granulation tissue', and hypertrophic scarring. Early surgery, as described and advocated here, shortens the healing time, lessens the hospital stay, minimizes reconstructive surgery and leads to a good functioning hand with a reasonable aesthetic appearance, enabling the affected patient to return quickly to work and normal routine life.
Bilateral resection of the proximal femur, an orthopaedic procedure advocated in selected cases of infected hip joints, can be useful in the treatment of extensive pressure sores in paraplegics. It is especially indicated in those cases where a total thigh flap is considered with the advantage of saving the limb, and by shortening the leg providing more skin and soft tissue for closure of the pressure sores.
Vascular repairs using a combination of Vicryl rings to evert vessel edges and the Tisseel two-component fibrin adhesive system failed to achieve patent microanastomosis without using stay sutures. The bonding force of Tisseel alone was not sufficient to hold the cut ends of rat femoral arteries and veins together. All 10 arterial and 8 venous end-to-end anastomoses separated under normal intraluminal pressure immediately after the removal of microclamps. This method was found to be an unacceptable alternative to the conventional suturing method.
A simple, readily available, inexpensive device is presented that makes research of topically applied vasoactive drugs more accurate and reproducible. It is possible to recollect the drug or wash it away from the vessel. Reversal drugs can also be used in the immediate vicinity of the vessel wall.
A one-stage repair procedure is described for the reconstruction of small to medium-sized full-thickness alar rim defects with a hinged medially based nasolabial island flap. The operation is performed under local anesthesia as an office procedure and is indicated particularly in older patients. The hinged flap provides both the inner and outer layers of the alar rim. The donor site is closed primarily with no need to mobilize a large skin flap. The procedure leaves no conspicuous scars on the face. This method was found to be simple and safe, providing excellent tissue viability and yielding good color and texture match.
A rare case of dermatofibrosarcoma protuberans on the face of a 10-year-old boy is presented. The patient's young age and the localization of the tumor led to limited excisions that resulted in two local recurrences. Primary wide excision with 2.5 cm of free margins is recommended to avoid local recurrences that are otherwise frequent.
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Rat groin flaps were divided from their blood supply with and without cutting the epigastric nerve. Only small areas of the flaps were infrequently able to survive, probably as skin grafts. The intrinsic blood supply of the nerve did not contribute to the survival of these flaps.
A simplified technique for end-to-end microanastomosis is presented. It combines the advantages of the anterior and posterior wall techniques; it is especially suitable when only short vessel segments are available; it eliminates severe torsion of the vessels; and it is relatively easy to perform.
The extent to which rats self-mutilate was studied in 30 Sprague-Dawley rats. The experiment tested unilateral and bilateral sensate and denervated groin flaps, with statistically significant results obtained between the bilateral groups.
A new experimental model, the latissimus dorsi flap of the rabbit, was studied. This was found to be a relatively inexpensive research model. Its use is advocated for composite tissue transfer as transposition, island, or free myocutaneous flaps.
Perfusion of rat groin flaps after 10 and 11 hours of complete ischemia with superoxide dismutase, an oxygen free-radical scavenger, significantly improved the survival of these flaps. This finding provides further evidence for the important role that oxygen-derived free radicals play in ischemic injury. The study also demonstrates that while restoration of blood supply alone is not enough to ensure tissue survival after prolonged ischemia, chemical agents can be utilized to achieve viable flaps beyond what was believed to be "a point of no return".
"Dermodress" is a new temporary biological dressing (heterograft) composed of a pure neonatal bovine collagen I. The authors present their first trial with this skin substitute. Ten consecutive patients who required skin grafts were included in the pilot test group. The "Dermodress" was tested on their donor sites and compared with "Furacin" gauze. It was found that "Dermodress" provided a covering that adhered excellently to debrided surfaces, without disturbing the healing processes underneath, for up to three weeks after application. The results point to the potential value of the "Dermodress" for open wounds.
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