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Biomedical subjects

C Krag

Publications and source records attributed to C Krag.

28 records · Page 2Linked to original sources
PubMed1985

Experience with the latissimus dorsi flap.

A review of 65 applications of the latissimus dorsi flap based on the thoraco-dorsal vessels to recipient sites in the head and neck area (10), on the torso (22), in the upper extremity (9) and in the lower extremity (24) in 62 patients with malignancies (28) and congenital deformities (6) is presented. Thirty-five flaps were transplanted with microsurgical vascular technique, while 30 flaps were pedicled. Vascular thrombosis at the anastomotic site was seen in 4/35 free tissue transplants and was successfully managed in 3 cases with an overall survival rate of 97% in this group, while all pedicled flaps survived. Healing complications including haematomas and wound infections were related to the nature of the recipient site and most commonly seen in the lower leg after resection of infected bone. In 3 cases leg amputations were performed within 6 months after the reconstruction, while 6 patients had secondary operations for tibial pseudoarthroses. Donor site morbidity was insignificant, without permanent, functional losses. It is concluded, that the thoracodorsal unit is a versatile and safe flap for reconstructive purposes.

Adolescent↗
PubMed1985

Late patency of clinical microvascular anastomoses to free composite tissue transplants. I. Angiographical aspects.

In a series of sixty-five free composite tissue transplantations by means of microsurgical techniques, 37 transplantations were performed to recipient sites in the lower extremity in 34 patients. Twenty-eight of these patients with 31 composite transplants were examined by femoral arteriography to assess the patency of 33 arterial anastomotic lines 6-45 months, median 12 months, postoperatively. Angiography showed patency in 32 of 33 arterial anastomotic lines, one arteriography being inconclusive. The results suggest that microsurgical techniques in small vessel anastomosis (ext. diam, 3/4-3 1/2 mm) are essential prerequisites for long-term vascular patency.

Adolescent↗
PubMed1985

Late patency of clinical microvascular anastomoses to free composite tissue transplants. II. Hemodynamical aspects.

In a series of 37 free composite tissue transplantations performed to the lower extremity in 34 patients, skin islands were included in 35 cases, as a cutaneous island flap (3), as a musculocutaneous island flap (19), and as an osteocutaneous island flap (13). In a follow-up study which included 26 patients with 29 flaps 6-48 months postoperatively an estimate was made of the importance of the blood supply through the vascular pedicle relative to the collateral blood supply through the recipient bed. Using transcutaneous oxygen tension measurements a significant reduction in calculated relative skin blood flow averaging 70% (p much less than 0.01) was seen after digital occlusion of the vascular stalk, suggesting that patent microvascular anastomoses are important for the vascularity of the transplanted tissues, not only for immediate postoperative survival, but also on the longer view.

Adolescent↗
PubMed1985

Experience with transplantation of composite tissues by means of microsurgical vascular anastomoses. I. Indications, techniques and early results.

The clinical experience with 65 transplantations of composite tissues by means of microsurgical vascular anastomoses is reported with emphasis on indications, operative techniques, vascular complications and soft tissue healing. Donor tissues, comprising 28 latissimus dorsi flaps, 20 groin flaps, 2 saphenous flaps, 4 fibular flaps, 9 dorsalis pedis artery flaps and 2 second toes, were transplanted to recipient sites in the head and neck area (18), upper extremity (8), torso (2) and lower extremity (37) in sixty-two patients with defects caused by traumata (45), tumor excisions (16) or congenital malformations (1) in which on average 3 therapeutic attempts had been unsuccessful. The reconstruction failed in 3/65 (5%) cases due to vascular thrombosis at the anastomotic sites. Early circulatory impairment (less than 1 week postoperatively) in the transplanted tissues was seen in 16/65 (25%) cases, thirteen of which were successfully managed by evacuation of a haematoma (9) and/or by resection of the anastomotic site and reconstruction of vascular continuity (5). Late circulatory impairment (greater than 1 week postoperatively) secondary to local infection was seen on 2 occasions and resulted in total loss of one flap. In one case persistent posttraumatic ostitis resulted in partial loss of a flap necessitating further reconstructive attempts. Altogether the reconstructive attempt failed in the early postoperative period (less than 3 months) in 5 cases (8%). It is concluded, that difficult reconstructive problems may be solved in a single stage using microsurgical composite tissue transplantation in patients who otherwise would have faced prolonged multistaged reconstructions and/or major limb amputations. Microsurgical composite tissue transplantation has widened the possibilities of reconstructive surgery and seems to be a reliable method, at least as safe as conventional reconstructive flap procedures.

Adolescent↗
PubMed1985

Experience with transplantation of composite tissues by means of microsurgical vascular anastomoses. II. Late results and comments.

In a series of 65 composite tissue transplantations the results were evaluated 6-68 (median 28) months postoperatively. The donor tissues, comprising skin flaps (7), neurovascular skin flaps (2), musculocutaneous flaps (26), tendinocutaneous flaps (2), muscle flaps (2), osteocutaneous flaps (18), bone grafts (6), and digits (2), were transplanted to recipient sites in the head and neck area (18), upper extremity (8), torso (2) and lower extremity (37) in sixty-two patients with defects caused by traumata (45), tumor excisions (16) or congenital malformations (1) in which on average 3 therapeutic attempts had been unsuccessful. In 5 cases the reconstruction failed within the first two postoperative weeks while the reconstructed part was included in lower extremity amputations 6-24 months postoperatively in 3 cases. The intended purpose was achieved in 27/34 cases of soft tissue reconstruction, 3/3 cases of combined tendon and skin repair, 18/19 cases of combined skin coverage and bone reconstruction, 4/5 cases of segmental bone reconstruction, 2/2 cases of thumb reconstruction and in 2/2 cases of facial reanimation. In 21 cases of 37 lower extremity reconstructions a major amputation would have been the alternative. Four of these patients were in fact amputated above the knee (1) or below the knee (3). Altogether, the reconstructions were successful in 56/65 (= 86%) cases. It is concluded that difficult reconstructive problems, especially those related to head and neck surgery, orthopaedic surgery and hand surgery may be amenable to successful reconstruction using microsurgical composite tissue transplants with an expected success rate averaging 9 out of 10 cases.

Adolescent↗
PubMed1979

The effect of pulsed electromagnetic energy (Diapulse) on the survival of experimental skin flaps. A study on rats.

Experimental skin flaps in rats were treated with an active/non-active Diapulse unit in a double-blind trial to clarify whether or not pulsed electromagnetic energy had any effect on the surviving length of flaps. The observed differences in surviving flap areas between the Diapulse treated group and the untreated group as compared to the predicted survival by fluoresceine and/or vital capillary television microscopy were not statistically significant (p less than 0.10) in a set up, that on a significance level of 5%, would have detected an enhancement of flap survival of greater than or equal to 10% in 98% of trials.

Animals↗
PubMed1975

The neurovascular island flap for defective sensibility of the thumb.

In six patients with defective sensibility of the thumb the transfer of a neurovascular island flap was performed according to Littler's technique. This review one to eleven years later was mainly to determine if reorientation of the cortical representation of stimuli had developed and if tactile gnosis had persisted. The pick-up test was carried through by the three patients with a lesion of the dominant hand. All six patients referred pin-prick in the flap to the donor finger; all had absent two-point discrimination corresponding to the flap, although it had been present within normal limits a few months after operation; and all had better touch, pain and temperature sensibility in the flap than in the surrounding recipient area. All six reported functional improvement. For the best results an intelligent patient is required who has a lesion of the dominant hand and is prepared to use or exercise it regularly.

Adult↗