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Biomedical subjects

D H Harrison

Publications and source records attributed to D H Harrison.

At least 55 records · Page 3Linked to original sources
PubMed1990

The island sensate ulnar artery flap for reconstruction around the elbow.

Elbow joint prostheses have now become reliable and provide stable movement. Some do have rather sharp edges on the ulnar component which, particularly in the rheumatoid arthritics and the elderly, may erode the skin, leading to exposure. Various flaps will provide cover to this area but do tend to re-ulcerate, probably due to inability to appreciate excess pressure. The ulnar artery flap, including the medial cutaneous nerve of the forearm, provides durable and sensitive cover, preventing re-exposure. Its successful use in two cases is described.

Adult↗
PubMed1990

Experience with upper extremity burns. The Mount Vernon experience.

History and clinical examination remain the mainstay in assessing burn depth. There is no satisfactory objective test for burn depth. Silicone oil in loose bags is the dressing of choice for the conservative management of superficial burns. Deep dermal burns of the dorsum of the hand should be shaved and grafted within the first 5 days. Full-thickness burns of the dorsum without exposure of deep structures should be excised and grafted within the first 5 days. K-wires may be used to stabilize metacarpophalangeal and PIP joints to prevent secondary deformity while grafts heal, but should not be left longer than 6 weeks. Flaps used to repair full-thickness burns with exposure of deep structures should be planned to permit elevation and movement. Primary reconstruction of extensor mechanisms should be performed at the time of flap cover.

Burn Units↗
PubMed1990

Current trends in the treatment of established unilateral facial palsy.

A unilateral facial palsy can be considered established and therefore unlikely to recover, if a year has passed since the injury which initiated it. Fascial slings and muscle transfers have still a place in maintaining static position and preventing the mouth swinging to the animated side on smiling. They do not, however, produce a smile responsive to emotion. Crossed facial nerve grafting is rather unreliable and rarely produces a symmetrical smile. Since the mid 1970s vascularised muscle grafts have been employed to compensate for the degeneration of the paralysed facial musculature. The pectoralis minor is a particularly suitable muscle for transplantation to the face because of size and shape. Experience with these techniques and the results of the first 30 cases using this muscle are presented.

Adult↗
PubMed1989

Impedance monitoring for subcutaneous free flap transfers.

The assessment of thoracic blood flow by electrical impedance is a well-established technique. In an application of this a small electrode array has been developed in which an alternating electric current is passed through a subcutaneous free flap and the induced voltage across a small volume measured. A graphical display of this changing voltage illustrates the pulsatile flow through the flap, allowing continuous assessment of perfusion on a beat by beat basis. The electrode array is such that it can be placed in close contact with muscle without interface problems and can assess its viability. It is non-invasive and easily removed. We have found this accurate, easily interpreted by inexperienced staff, and a considerable reassurance in the postoperative period.

Humans↗
PubMed1986

Reconstruction of the urethra for hypospadiac cripples by microvascular free flap transfers.

A proximal hypospadias, despite multiple procedures, may remain uncorrected either totally or because of multiple fistulae. In such circumstances there is often a severe shortage of skin on the ventral surface of the penis and scrotal skin may already have been used. The microvascular transfer of a radial forearm flap may then be used and, because of the thinness of the flap, a tube may be developed from it as well as covering skin. The long vascular pedicle ensures a good vascular input at the recipient site by anastomosis of the radial vessels to the femoral vessels. Two cases are presented which would have proved difficult to reconstruct by any other means.

Adolescent↗
PubMed1986

The osteocutaneous free fibular graft.

Free osteocutaneous fibular grafts, revascularised by microvascular anastomoses, have been used for one-stage reconstruction of extensive bone and skin loss in the lower leg in seven patients. The addition of an integral skin flap to a vascularised fibular graft makes reconstruction of bone defects with significant skin loss possible, and the technique for designing and raising such a flap is presented. The advantages of this transfer over other microvascular osteocutaneous flaps are the available length of straight cortical bone, the large thin skin flap, the good diameter of the vascular pedicle and the fact that dissection is carried out under a tourniquet.

Accidents, Traffic↗
PubMed1985

Surgical approaches to block dissection of the inguinal lymph nodes.

Block dissection of the inguinal lymph nodes is associated with a high incidence of complications, the most frequent of which are related to wound healing. To determine the optimal surgical approach, a review of our experience over the last 10 years was undertaken. Fifty inguinal lymph node dissections are presented. The patients were divided into four groups according to the surgical incision used. The duration of hospital stay and incidence of complications were compared. We conclude that the optimal surgical approach is an elliptical incision removing a 4 cm width of skin over the inguinal nodes. Incisions that did not sacrifice at least a 4 cm width of skin had an inordinately high complication rate and a prolonged hospital stay. Approaches to wound closure, the management of bulky disease and primary lesions in continuity with the groin, and the use of adjunctive measures to reduce morbidity are discussed.

Adult↗
PubMed1985

The pectoralis minor vascularized muscle graft for the treatment of unilateral facial palsy.

A series of 10 pectoralis minor vascularized muscle transfers to reanimate the face in unilateral facial palsy are presented. The procedure is carried out in two stages. The first stage constitutes a nerve graft from the functional contralateral facial nerve to the preauricular region of the paralyzed side. Six months later, the pectoralis minor is transferred to the denervated side of the face with restoration of its neurovascular pedicle. The muscle is well suited to its new position with respect to length and bulk, as well as its fanlike shape. The diameter of its vascular pedicle is comparable with the facial vessels. The results demonstrate function in 8 of the 10 grafts, the two failures relating to early vascular thrombosis rather than an inability to reinnervate the muscle grafts.

Adolescent↗
PubMed1983

Myocutaneous flaps.

Explore the source record for details and available documents.

Carcinoma, Papillary↗
PubMed1982

Crystal structure and anti herpes simplex virus activity of 2,2'-anhydro-1-beta-D-arabinofuranosylthymine.

1-beta-D-Arabinofuranosylthymine (aThy; ara-T) is a potent selective anti herpes simplex virus drug. Its anhydro analogue, 2,2'-anhydro-aThy, was shown to be 9-fold less active and at least 3-fold less toxic than aThy. This compound was relatively stable at physiological pH and in strong acid but was rapidly hydrolyzed in base with a half-life of 18.3 min. The three-dimensional crystal structure of 2,2'-anhydro-aThy revealed a rigid structure with the arabinose ring in the unusual O1' endo, pucker, conformation. The trans-gauche conformation along the C4'-C5' bond permits only intermolecular hydrogen bonding of the 5'-hydroxy and O3'.

Antiviral Agents↗
PubMed1982

Private and public initiatives in health maintenance organizations.

Public policy controversies about the cost-containing potential of HMOs and the failures of many plans should not overshadow the fact that HMOs will be forces in the health care sector in the 1980s, largely as the result of increasing private investment. There is a large, stable segment of the prepaid industry that developed as a result of private sector and community concern long before the federal HMO Act of 1973, and it is their initiatives along with increasing investment activity by insurance companies and management companies in particular, that will serve as a base for consolidation and growth of HMO plans. HMOs have not proved to be the miraculous cost-containing mechanism of the future, but their impact will be felt even more for the changes they stimulate in the customary organizational forms, in financing, and in the role of business in health care.

Capital Financing↗
PubMed1981

Free microvascular and microneural transfer of the extensor digitorum brevis muscle for the treatment of unilateral facial palsy.

The operation of transfer of the extensor digitorum brevis muscle to the face in the treatment of unilateral facial palsy (Thompson and Gustavson, 1976) has been further modified by immediate anastomosis of its vascular pedicle to the superficial temporal vessels. Six of our ten patients showed some new movement but in only three did this approach symmetry with the other side. Long term follow-up showed that improvement can be expected for up to two years after transfer. Our technique is assessed critically and suggestions are made for further improvement.

Adult↗