Biomedical subjects
Publications and source records attributed to B G Lamberty.
Three types of digitising device are described which may be used with a microcomputer for the measurement of such parameters as length, distance, area, angles and point counts. Some applications in plastic surgery research are considered.
This paper reports the results of an investigation into the blood supply of that portion of the distal radius which may be incorporated into the fasciocutaneous radial artery forearm flap. The findings demonstrate that when detached from its medullary blood supply, this segment of bone is supplied predominantly by two fascioperiosteal branches of the radial artery augmented by a musculoperiosteal plexus at the site of attachment of flexor pollicis longus.
We present two cases of small cell carcinoma of skin and review the evidence for the origin of these tumours from Merkel cells situated in the basal layers of the epidermis. The aggressive behaviour of these tumours makes their initial histological diagnosis important if careful follow-up is to be instituted and we suggest that more radical primary treatment might improve results. We emphasise the need to exclude an origin from other sites apart from skin and the role of electron microscopy and immunohistochemistry in identifying these tumours as being distinct from other poorly differentiated carcinomas.
Sixteen patients undergoing compression treatment for scar hypertrophy were included in a study to evaluate physical indices of scar maturity. The results show that while thermographic measurements of scar temperature were not clinically valuable, rising levels of transcutaneous oxygen tension in treated scars correlated well with a reduction in scar thickness assessed both clinically and by ultrasound. It is postulated that low levels of tcpO2 in immature scars result from low oxygen diffusibility through scar tissue rather than from rapid metabolic consumption of oxygen by scar tissue.
The pattern of blood supply to the integument of the thigh is reported. A new technique is described for analyzing the length, direction, and number of arterioles in specimens of cadaver skin and deep fascia. The information obtained from these studies adds to existing knowledge of the anatomic vascular basis of direct cutaneous and musculocutaneous flaps in this region and provides a scientific basis for the elevation of fasciocutaneous flaps in such a way as to aid the achievement of maximum length-to-breadth ratios.
In the conventional view of the arterial blood supply of skin, two systems of vessels are recognised; the direct cutaneous arteries and the musculocutaneous perforators. The existence of a third system consisting of fasciocutaneous perforators, is a relatively new concept. These vessels supply the skin by passing along the fascial septa between adjacent muscles. A particular feature of these fasciocutaneous perforators is that they spread out at the level of the deep fascia, forming a fascial plexus which often has a marked directionality. The locations of these perforators and the axiality of the fascial plexi are described. This knowledge is important for the elevation of pedicled fasciocutaneous flaps and the design of fasciocutaneous microvascular free tissue transfers.
The anatomical principles underlying fascio-cutaneous flaps in general are outlined. On the basis of their patterns of vascularisation such flaps are classified into four types. Examples are given of each of these types and some new, untried, flaps designed along these principles are postulated.
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The principles of the blood supply to the upper arm are described. Despite the large, fleshy nature of the biceps and the triceps, the blood supply to upper arm skin is not from the underlying muscles, but is by fasciocutaneous perforators emerging along the medial and lateral intermuscular septa. Fifty dissections of preserved cadavers have shown that on the lateral side the fasciocutaneous perforators consistently arise from the middle collateral artery. The available length of this vessel and its diameter have been measured and are reported. The design of a flap based on this vessel, in a manner analogous to the Chinese forearm flap on the radial artery, is described.
Various authors have reported different failure rates for the cervico-humeral flap. An attempt is made to explain these occurrences in the light of recent experimental and clinical work which has increased our knowledge of the detailed blood supply of the supraclavicular fossa and shoulder region. In particular, the role of a fascio-cutaneous vessel in the supply of a proximally based shoulder flap is stressed. Division of this vessel may occur during proximal mobilisation of the cervico-humeral flap. This fundamentally alters the nature of the flap and may be the key to the varying failure rates. The implications of this for fascio-cutaneous flaps in general are discussed.
The reliability of the axillary fascio-cutaneous flap recently described in this Journal was attributed to the presence of vessels in a fascial plexus. This paper describes the findings in anatomical studies of the vasculature in this region and highlights an important directional component in the fascial plexus at this site. Comparisons are made with other regions of the posterior trunk and the implications for pedicled fascio-cutaneous flaps elsewhere are discussed.
A clinical case is reported in which a fascio-cutaneous forearm pedicled flap was used. The flap was based on the previously described inferior cubital artery. Anatomical studies suggested that this vessel could be the basis for a fascio-cutaneous free flap possessing an exceptionally long vascular pedicle. This flap is described and its implications discussed in relation to the radial forearm (Chinese) flap.
The historical background of the literature on the cutaneous vascular territories of the forearm is reviewed. Further study of these territories has been undertaken using established anatomical techniques. Our findings differ from previous descriptions. The relevance of these findings is fundamental to the raising of fascio-cutaneous flaps. A previously undescribed fascio-cutaneous flap is postulated.
A new apparatus is described which facilitates the freeze fracturing of specimens under liquid nitrogen in preparation for scanning electron microscopy. The apparatus is simple and can be made by any competent engineering department.
An unusual case of pyoderma gangrenosum is reported that was not associated with any of the diseases it usually accompanies. Awareness of the rare possibility of pyoderma gangrenosum sui generis and the institution of adrenocorticosteroid therapy at an early stage of its development reduces morbidity.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.