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Biomedical subjects

D G Dibbell

Publications and source records attributed to D G Dibbell.

At least 19 recordsLinked to original sources
PubMed2000

Hidradenitis suppurativa polyposa.

A case of severe chronic hidradenitis suppurativa of the perineum complicated by disfiguring fibrous, polypoid lesions is presented. The patient, a 41-year-old woman, had a long history of axillary hidradenitis which subsequently involved the perineum. Draining sinuses, scars and large pendulous masses of the vulva developed over 10 years. Cutaneous scars, ridges, papules and large fibrous polyps were present. Deep clefts, sinuses, dense fibrous scars and foci of chronic inflammation were seen. Rarely, large fibrous polyps may develop in chronic hidradenitis suppurativa and may be due to chronic local lymphedema. Careful pathologic examination is necessary to exclude squamous cell carcinoma.

Adult↗
PubMed2000

Constructing muscle flap coverage for vascular grafts in the groin.

Groin wound infections can jeopardize patency and function of vascular bypass grafts anastomosed to the femoral artery. Attempts to salvage vascular reconstructions threatened by perigraft infection often fail because of inadequate debridement of surrounding infected soft tissue or because of an inability to cover an exposed graft with sufficient healthy tissue. In selected circumstances, use of rotational myocutaneous flaps makes it possible to salvage vascular grafts threatened by localized wound infection.

Blood Vessel Prosthesis↗
PubMed1996

Advanced hidradenitis suppurativa presenting with bilateral vulvar masses.

Hidradenitis suppurativa is a chronic suppurative inflammatory disease of the apocrine sweat glands. It is more common in women and involves the genital region in half of all affected patients. An advanced case of hidradenitis suppurativa with bilateral vulvar masses is presented. Possible etiologies of the disease are discussed, as well as strategies for definitive therapy. Because the disease frequently affects the female external genitalia and therapy can require extensive surgical resection and reconstruction, the services of a gynecologic oncologist may be required. Adequate therapy based on an understanding of the pathophysiology of the disease can yield significant relief of symptoms.

Adult↗
PubMed1991

Abdominal wall reconstruction (the "mutton chop" flap).

Reconstruction of full-thickness abdominal wall defects can be a difficult surgical challenge. Reconstructing the epigastrium may be especially vexing. The use of prosthetic mesh has significant drawbacks, and the use of pedicled myofascial and myocutaneous flaps should be advantageous. We present 15 consecutive cases demonstrating highly successful reconstructions of massive abdominal wall defects using myofascial and myocutaneous flaps without prosthetic mesh. The extended rectus femoris flap, or "mutton chop" flap, which is capable of resurfacing the epigastrium, is described. Complications were minimal, and use of myofascial units, particularly the rectus femoris, should be considered as the technique of choice for reconstruction of major abdominal wall deficits.

Abdominal Muscles↗
PubMed1991

Intraoral reconstruction with a microvascular peritoneal flap.

The microvascular peritoneal flap offers a new reconstructive option for closure of intraoral defects. The flap is easy to raise, and donor-site morbidity is low. Unlike fascial flaps, in which the raw surface may take weeks to "mucosalize," the peritoneal surface heals primarily. Finally, the rectus muscle effectively covers all forms of mandibular reconstruction, and the reliable skin paddle makes possible the closure of substantial cutaneous defects.

Fistula↗
PubMed1989

Rotational muscle flaps: a new technique for covering infected vascular grafts.

Twenty-one patients with established localized infection of vascular bypass grafts were treated with aggressive debridement and rotational muscle flap coverage to control graft infection. There were six gram-positive, six gram-negative, four mixed, and three fungal graft infections. Graft material included Dacron, Gore-Tex (registered trademark of W. L. Gore Associates Inc., Elkton, Md.), Dacron and Gore-Tex in combination, and saphenous vein. Twenty of 21 patients had successful preservation of graft function, local wound healing, and control of infection. There were no amputations or deaths. The one failure was caused by incomplete debridement of an infected graft segment. Aggressive debridement and rotational muscle flap coverage is an effective means of treating locally infected vascular bypass grafts.

Adult↗
PubMed1989

Internal hemipelvectomy as a treatment for end-stage pressure sores.

Internal hemipelvectomy was used to treat recalcitrant pressure sores in the absence of flap options following leg fillet. The bony hemipelvis was resected in the subperiosteal plane, resulting in the removal of the iliac wing, ischium, and pubic rami. This procedure creates enough mobile soft tissue to allow even large ulcer defects to be closed primarily. We have used the technique successfully in 5 patients; follow-up ranged from 4 to 30 months. Internal hemipelvectomy is a treatment option for end-stage pressure ulcers in lieu of hemicorporectomy.

Adolescent↗
PubMed1989

Coverage of acute vascular injuries of the axilla and groin with transposition muscle flaps: case reports.

Acute axillary or groin vascular injuries caused by farm machinery or shotgun blasts are often associated with extensive soft-tissue loss. Coverage of the repaired blood vessels with healthy tissue is necessary to avoid infection, desiccation, pseudoaneurysm, and rupture. Adjacent muscles are not always available to rotate for coverage, due to unacceptable functional loss, or injury to the principal vascular pedicle. We used proximally based trunk musculature with vascular pedicles out of the areas of injury to achieve coverage of four extensive axillary wounds and one extensive groin wound. Arterial repair only was performed in three axillary wounds. Combined arterial and venous repair were performed in one groin wound and one axillary wound. Followup ranging from 9 months to 5 years revealed no vascular failure or soft-tissue complications. We conclude that coverage of vascular repairs and soft-tissue defects with viable muscle is necessary in cases of extensive injury. Adjacent muscle is preferred for coverage, but when this is unavailable, coverage can still be achieved using more proximally pedicled muscles of the trunk.

Adolescent↗
PubMed1988

Accidental hand burns caused by operating room lights.

Three patients sustained burns of the hand in the operating room because of the lack of heat shields in the lights. A 54 degrees F increase in temperature in the operating field was noted when the heat shields were not in place.

Accidents↗
PubMed1988

Extravasation injury to the hand by intravenous phenytoin. Report of three cases.

Extravasation of intravenous phenytoin can result in serious soft-tissue complications. Three patients are presented, one of whom lost a hand. Assessment of circulation and early decompression fasciotomies may be necessary in such cases. Caution is recommended in the intravenous administration of phenytoin. Infusions at rates of less than 50 mg/min and education of nursing staff about this potential complication will decrease its incidence.

Amputation, Surgical↗
PubMed1985

Bilateral rectus femoris pedicle flaps for detrusor augmentation in the prune belly syndrome.

A 20-year-old patient with the prune belly syndrome presented with urinary retention and renal failure. In preparation for renal transplantation bladder rehabilitation, consisting of urethral dilation, reduction cystoplasty and detrusor augmentation with paired rectus femoris pedicle flaps, was undertaken. This procedure enabled the patient to empty the bladder totally by spontaneous voiding. Successful renal transplantation was performed subsequently and he has not required intermittent or continuous catheterization. The surgical approach and technique are described, and their application to other conditions of detrusor hypotonicity is discussed.

Abdominal Muscles↗
PubMed1984

The gastrocnemius myocutaneous flap in lower-extremity injuries.

Coverage of full-thickness lower extremity wounds has been the bane of surgeons who care for patients with skin and soft-tissue losses. A prolonged period of convalescence may be avoided by immediate coverage with a gastrocnemius myocutaneous flap. Case reports demonstrating the successful use of medial and lateral gastrocnemius myocutaneous flaps are presented. Advantages are that large amounts of tissue can be moved in one step, shortening hospitalization, and most are reliable because of their excellent blood supply. Care must be taken to preserve deep fascia and to dissect the fascia from the Achilles tendon. Fluorescein examination is recommended.

Adult↗