Biomedical subjects
B Sundell
Publications and source records attributed to B Sundell.
Microvascular free flaps in early reconstruction of burns in the hand and forearm. Case reports.
In the reconstructive plastic surgery a free flap provides a one-stage method to achieve an optimal functional an aesthetic result. We report five acute burns or early contractions of the hand and forearm with free-flap reconstruction. In each case an attempt was made to design the flap to restore missing tissue components. We used three different musculocutaneous free flaps and two free skin flaps: a latissimus dorsi, a rectus abdominis and a rectus femoris renervated musculocutaneous flap, as well as a dorsalis pedis and a horizontal fasciocutaneous upper arm flap. In all five cases, the hand and wrist showed early restoration of function.
[Microsurgery - reconstructive possibilities of injured extremities].
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Adriamycin extravasation: surgical treatment and possible prevention of skin and soft-tissue injuries.
In a material consisting of approximately 6,000 injections of Adriamycin during a 2-year period, eleven moderate and five severe extravasation injuries have been observed. Even a small leakage of the drug may cause a permanent lesion. The most serious injuries were caused by large doses and on the dorsum of the hand. Plastic surgical operations were successfully performed in the severe cases. An active surgical intervention after primary neutralization of the extravasated Adriamycin is recommended.
Latissimus dorsi musculocutaneous flap used as a pedicle or free microvascular graft.
In our experience with 28 latissimus dorsi (LD) island pedicle musculocutaneous flaps we found it to be the best method in breast, chest wall and axillary reconstructions. the flap can be also easily extended to the face and used reversed, to cover lumbar defects. In the series of 11 free microvascular composite tissue to vascularize and restore deep and extensive soft tissue defects in the lower extremity, in the forearm and in the face. If a neurosensory flap or reconstruction and reinnervation of muscles of the extremity is necessary other tissues than a LD flap should be chosen.
Repair of incisional hernias by F. Langenskiöld's operation.
One hundred and fifteen patients underwent the Fabian Langenskiöld repair of an incisional hernia. 81 patients were studied retrospectively in a physical examination by the authors. The follow-up period ranged from 12 months to 15 years, with a mean of 6 years and 2 months. Wound infection occurred in 35.8%. Small herniations and recurrencies were observed in 31%. Five patients had large recurrent hernias (6.2%) reaching preoperative size. Despite the high rate of recurrencies and infections this method was found valuable because it enables restoring of a firm abdominal wall even in large incisional hernias without implantation of foreign materials.
Implantational growth of adenocarcinoma after Kraske operation for rectal tubular adenoma.
A 55-year-old man underwent an operation for a rectal tubular adenoma 1.5 cm in diameter by posterior proctotomy (Kraske operation). Later two rectal tubular adenomas were excised by electrocoagulation. Eight years after the primary operation, a 12 x 8 x 5 cm large mucinous adenocarcinoma was discovered inside the gluteus maximus muscle extending under the subcutaneous region of the primary incisional scar. No other metastases could be detected. It is probable that implantation of malignant or potentially malignant cells during the first operation was responsible for the adenocarcinoma.
The burned hand. Early treatment and surgery of scars and contractions.
Hand burns are common injuries in which early accurate diagnosis of the severity of the injury and active surgical treatment can save it or diminish the permanent disability caused by the thermal trauma. During the four year period of 1976--1979 we treated 45 patients with acute hand burns; secondary surgery was performed in 29 scarred and contracted hands. Deep dermal or subdermal (III degree) burns were either immediately excised to the vital tissue (within 6 hr postburn) or early afterwards (within 1--7 days post injury). The reconstruction of the excised areas was made by free skin grafting in 43 hands. If deep structures were exposed, subsequent reconstructions were used: local, groin, or free flaps. The aims in treatment of scarred hands were to restore function and to repair unstable scars. The following secondary procedures, often combined in a one-stage operation, were performed: scar excision and regrafting, web space correction, groin flap reconstruction, digital joint arthrodesis or capsulectomy, tendon transfer, and spherical osteotomy.
[The treatment of soft tissue sarcomas (author's transl)].
The treatment of soft tissue sarcomas gives poor results. Two thirds of the patients die of the disease. In retrospective studies the histological grading of the sarcomas has been shown to be the best prognostic sign. Combination of the effective treatment modalities: surgery, radiotherapy and chemotherapy in the primary phase of the treatment as well as the concentration of all the cases in selected care units is recommended.
Transposition of muscle flaps for covering exposed bone in the leg.
A muscle transposition technique for reconstruction of soft tissue loss and skin defects with exposed bone in the leg is described. Reconstruction with muscle flaps and freee skin grafts is a reliable and convenient one-stage operation. The gastrocnemius and soleus muscles were used to cover the upper and middle third of the leg. The method was used in 13 patients, and there were 3 failures in the series because of the impaired vascularity of the injuried leg. In 7 cases, including one failure, the soft tissue injury was associated with compound fractures. No functional disability was observed in the leg, ankle or foot after successful transposition of the muscle flap.
[The management of soft tissue sarcomas].
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[Clinical experiences with xenografts].
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Severe growth retardation of the upper extremity resulting from burn contracture and its full recovery after release of the contracture.
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The effect of dextranomer (Debrisan) on hand burns. A preliminary report on a new method in the treatment of hand burns.
Dextranomer (Debrisan, Pharmacia, Uppsala, Sweden) is synthetized by cross-linking of dextran chains with epichlorohydrin. It is an insoluble hydrophilic substance which is suitable for topical treatment of secreting wounds, such as burns. Thirteen patients with 17 burned hands were treated. The result of the treatment - decrease in pain, healing time and improved hand function - was registered clinically. No crust was formed. The risk of permanent restriction in range of movements decreased, since the treated hands were soft and mobile throughout the entire period of treatment. All hands treated recovered full mobility. Physiotherapy could be performed daily. No infection appeared because exudate and bacteria were continuously removed from the treated area. Pain rapidly decreased. No side reactions were observed.
In memoriam: Per Erik Anton Aschan.
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Late complications of scalding in children: treatment and prevention.
Children between the ages 1 to 3 years are particularly prone to burns by their constant desire to pull down containers of hot fluids. The resulting burns produce serious complications such as hypertrophic scars and scar contractures, which can be severe enough to cause growth disturbances. A series of 31 cases of these accidents resulting in the above sequelae was investigated. These complications are however the end result of a chain of unfortunate events any or all of which could have been avoided. Usually the scald could have been prevented by greater vigilance on the part of the parents. Once late complications have developed, excision of the scar tissue and subsequent skin grafting or other reconstructive procedure should be performed. However, in spite of satisfactory results, these complications have a tendency to recur during the growth period.