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Biomedical subjects

C B Cuono

Publications and source records attributed to C B Cuono.

At least 37 records · Page 2Linked to original sources
PubMed1986

Selective aggressive burn excision for high mortality subgroups.

Traditional teaching recommends major burn procedures be limited to successive 20% total body surface area (TBSA) excision and grafting procedures. This format theoretically reduces the surgical stress and limits the transfusion requirements to a level reasonably tolerated by patients. We have treated 14 patients with thermal burns involving greater than 30% TBSA. These patients underwent excisions ranging from 30 to 70% TBSA at the initial operative escharectomy. Tangential and fascial excisions were employed, depending upon the depth of injury, and autografts and/or allografts were utilized for wound closure. The results of this technique yielded an overall 71% survival. Time from burn to last autograft and hospital stay tended to be shortened or unchanged when compared to national averages. This series demonstrates the feasibility of performing early major escharectomy in a selected burn population without apparent increased surgical risk compared to patients treated by conventional staged excision. Although burn wound sepsis and mortality appeared favorably affected by this technique, the small population size was unsuitable for adequate statistical analysis.

Adolescent↗
PubMed1986

Single-stage repair of complex scalp and cranial defects with the free radial forearm flap.

The free radial forearm flap provides a reliable single-stage method to cover difficult scalp and forehead defects where other local methods are unsuitable. Six patients have been successfully reconstructed utilizing seven free radial forearm flaps. A description of our surgical technique along with illustrative cases demonstrate the indications and advantages of this flap. Cranial soft-tissue deficits are primarily cutaneous; therefore, a more predictable reconstruction can be obtained utilizing a cutaneous flap with similar characteristics. Restoration of bony defects should be considered separately utilizing autogenous bone and/or alloplastic materials and not merely obliterated with a bulky soft-tissue flap. Therefore, if the local factors of a cranial wound require the utilization of a distant tissue transfer, we prefer the thin coverage of a well-vascularized free fasciocutaneous radial forearm flap over two-stage distant pedicle flaps or skin-grafted free flaps.

Aged↗
PubMed1985

Burn wound excision and local flap closure.

Eleven circumscribed, full-thickness burns were treated in 9 patients with immediate excision and primary closure of the defect or by using a variety of local random cutaneous and musculocutaneous flaps. The burns were located on the face, trunk, and extremities. In 2 patients this technique was used in the management of smaller burns on one surface of the body, thus facilitating skin grafting of larger wounds on the opposite surface. The cutaneous flaps utilized included advancement flaps, V-Y flaps, Moberg flaps, and S-plasties. The timing of the excision and closure varied from 2 hours to 2 weeks following thermal injury, with no postoperative wound infections. In selected cases primary excision of deep burns and closure by use of local tissue approach ideal treatment. With certainty of the depth of destruction, this procedure should be carried out regardless of locality when technically and anatomically feasible.

Adolescent↗
PubMed1985

Versatility and safety of flap coverage for wide excision of cutaneous melanomas.

This study is a retrospective analysis of a consecutive series of 85 patients with primary melanomas of the trunk (51 patients) and extremities (34 patients) treated by wide excision and flap repair. Both the standard rhombic flap (39 cases) and the double-Z rhomboid flap (46 cases) were used. Postoperative follow-up was 11 to 49 months, with a mean of 20 months. Major postoperative flap necrosis was encountered in one case (1.1 percent). There were no local recurrences and only one instance of intransit metastasis. As compared with skin grafts, flap repairs were found to be free of the classic contour defect. In this series, flap repair also permitted earlier mobilization and resulted in shorter hospital stays.

Humans↗
PubMed1984

Double Z-rhombic repair of both large and small defects of the upper extremity.

The use of single local flaps in the upper extremity to repair excisional defects together with direct repair of the flap donor region is limited by the potential for tension and joint contracture in the flap donor region. The double Z-rhomboid technique is a useful alternative to minimize these problems. The lesion is excised as a rhombus, and the defect is repaired with two opposing equilateral 60 degrees Z-plasties. The technique effects closure of the primary defect as well as of the two smaller donor defects. By borrowing half of the required skin from opposite sides of the defect, excessive tension is avoided in repairing donor regions, and the technique may be used more safely in closer proximity to mobile joints. The technique has been used successfully in a wide variety of defects 4 to 70 cm2 in size.

Arm Injuries↗
PubMed1984

Management of sclerodermal finger ulcers.

Ninety-three percent of 59 patients with scleroderma reviewed in this study presented with Raynaud's phenomenon at a mean age of 43 years; 65% of these developed fingertip ulcers within 4 years. Other common findings were sclerodactyly, distal phalangeal resorption, calcinosis cutis, and digital contractures. Medical management of the digital ulcers with systemic and regional vasodilating drugs was unsatisfactory. Sympathectomy, when performed early, temporarily relieved vasospastic pain but did not affect the course of the ulcers. Severe digital pain was the most incapacitating symptom resulting from vasospasm early in the course of the disease and irreversible arterial luminal narrowing later in the course. Conservative fingertip amputations for nonhealing ulcers constituted the management of choice to eradicate the ulcer, to reduce or eliminate the pain, and to return the hand to early useful function. A decision tree for the management of these ulcers is proposed.

Adolescent↗
PubMed1983

Double Z-plasty repair of large and small rhombic defects: the double-Z rhomboid.

An alternative method for the repair of rhombic skin defects utilizing opposing Z-plasties has been developed and applied clinically. The design, orientation, and execution of this method share the simplicity of the Z-plasty. The technique has been employed successfully in over 100 cases during the past 5 years to resurface defects as large as 150 cm2, and it obviates many of the inherent limitations of the Limberg flap.

Humans↗
PubMed1983

Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note.

The authors describe a double Z-rhomboid technique for the closure of large lumbosacral myelomeningocele defects. After the dorsally displaced neural tissue has been reduced into the vertebral canal and a watertight closure of the dura lining the sac has been achieved, the skin defect is surgically converted to the shape of a rhombus. Equilateral Z-plasty flaps are elevated at the sides of the rhombus and transposed across the defect to secure wound closure. A successful experience with 10 consecutive cases of lumbosacral myelomeningoceles repaired with this technique is reported.

Humans↗
PubMed1981

Improved reliability in tumor diagnosis by fine needle aspiration.

A simple but useful modification of sample preparation of fine needle aspirates of soft tissue masses is presented, in conjunction with its assessment by a controlled study. The modification, employing routine histologic techniques, reduces the requirement for cytopathologic expertise. The potential utility of fine needle aspiration is thereby significantly expanded. In addition, this modification allows the pathologist to use special tissue strains or electron microscopy as options, when necessary, to enhance diagnostic accuracy.

Adult↗
PubMed1980

Immediate reconstruction of a composite mandibular defect with a regional osteomusculocutaneous flap.

This is a report of an immediate reconstruction of a composite mandibular defect, using a pectoralis major osteomusculocutaneous flap incorporating a segment of the fifth rib. Viability of the transferred rib segment was established by tetracycline labeling at 2 weeks and technetium scanning at 3 months postoperatively. This clinical example supports the experimental observations of a vascular network interconnecting muscle, periosteum, and compact bone.

Bone Transplantation↗
PubMed1979

The carpal boss: surgical treatment and etiological considerations.

We report on 30 symptomatic cases of carpal boss which were treated surgically. The condition represents a highly localized degenerative arthritis at the base of the middle metacarpal, and is seen primarily in relatively young patients. Symptomatic relief was obtained by excision of degenerated tissue in all these patients.

Adolescent↗