Biomedical subjects
D Serafin
Publications and source records attributed to D Serafin.
Routine clinical use of laser Doppler flowmeter to monitor free tissue transfer: preliminary results.
Preliminary results indicate that a new laser Doppler flowmeter is more easily understood by nursing personnel than other laser Doppler units currently available. This monitor has demonstrated its capability in identifying and predicting tissue ischemia before clinically determined failure. Further evaluation of the device is warranted to define its use more clearly in the clinical setting.
Increased survival of skin flaps by scavengers of superoxide radical.
Elevation of rat abdominal skin flaps, followed by ligation and division of the left inferior neurovascular pedicle, resulted in only a 40% survival of the area normally perfused by the ligated artery and vein. Superoxide dismutase (SOD) (EC 1.15.1.1) administered i.v. (20,000 U/kg) 30 min before flap elevation increased survival to 52%. SOD derivatized with polyethylene glycol, which increases circulating half-life, was more effective, increasing survival to 80%. This protective effect resulted from the catalytic activity of the derivatized enzyme because inactivation by treatment with H2O2 eliminated its effect on skin flap survival. An equimolar mixture of Desferal and MnCl2, which catalyzes the dismutation of O2- in vitro, improved survival to 72%. Desferal-Fe3+, which lacks in vitro SOD activity, or Mn2+ alone did not affect the survival of skin flaps, but Desferal alone was nearly as effective as the Desferal-Mn2+ mixture. This effect of Desferal may result from acquisition of and subsequent removal of iron in vivo. These results support the view that the superoxide radical or a product derived from it plays a role in limiting the survival of island skin flaps.
Reduced cell death in skin flaps in rats treated with difluoromethylornithine.
The beneficial effects of alpha-difluoromethylornithine (DFMO) were assessed in a model of peripheral ischemia. DFMO is an irreversible inhibitor of ornithine decarboxylase (ODC), the initial enzyme in the production of polyamines. A 7 x 7 cm rat abdominal skin flap was surgically raised based on two inferior epigastric nerve, artery, and vein pedicles. One of the pedicles was then ligated and the skin was sutured back in place. Necrosis of skin was assessed 2 and 7 days after surgery. The rats were divided into four groups: control, DFMO, DFMO + polyamines, and polyamines alone. DFMO was administered in drinking water at 0.2%. Polyamines (putrescine, spermidine, and spermine) were each administered by daily i.p. injection at a dose of 10 mg/kg. The percentage of necrosis of the area of skin at risk in controls was 65 +/- 2% (mean +/- SEM). Necrosis was significantly reduced with DFMO (19 +/- 1%), with DFMO plus polyamines (37 +/- 3%), or with polyamines alone (41 +/- 2%). Protein synthesis and ornithine decarboxylase activity in the skin were both significantly decreased by DFMO. These studies demonstrate that DFMO protects skin from ischemic damage at least in part through actions on polyamine metabolism.
The orticochea pharyngoplasty and primary palatoplasty: an evaluation.
A primary Orticochea pharyngoplasty with a primary palatoplasty was studied in 15 children with cleft palates. Although all children demonstrated velopharyngeal competence, radiographic, endoscopic, and oral examinations suggested that 54% of the children studied would not have needed a pharyngoplasty. In addition, 27% of the children demonstrated aberrant speech patterns associated with velopharyngeal incompetence. Emphasis is placed on the difficulty in identifying which cleft palate patients will have residual velopharyngeal incompetence and the need for continued study and development of techniques for more accurate prediction of which patients would benefit from a primary pharyngoplasty.
A rationale for modifying the site of insertion of the orticochea pharyngoplasty.
A modification of the insertion level of Orticochea flaps is proposed. The purpose of the modification is to place the pharyngoplasty at a higher site, in the area of attempted velopharyngeal contact. The site of velopharyngeal contact can be identified using lateral radiographic techniques. A success rate of 93 percent was achieved in improved oral-nasal resonance balance when the pharyngoplasty was placed at a site in the nasopharynx.
Breast reconstruction following mastectomy.
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Reconstruction of the lower extremity. Microsurgical composite tissue transplantation.
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Factitious vesicocutaneous fistula: an enigma in diagnosis and treatment.
A case report of a patient with a recurrent factitial vesicocutaneous and a tensor fasciae latae musculocutaneous flap were employed in reconstruction. Difficulty in diagnosis and treatment of this patient with factitial disease is emphasized. Excessive hospitalization and cost reflect these difficulties. A life-threatening disease was modified by planned reconstruction coordinated with antidepressant medication and psychotherapy. Treatment centered on avoiding insight and maintaining denial ASA defense mechanism. The transference of self-mutilation in the suprapubic region to the donor thigh was most important in this patient's survival.
Subcutaneous mastectomy: an evolution of concept and technique.
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Nipple-areola reconstruction after mastectomy.
Hypopigmentation, fibrosis, and the risk of autotransplantation of malignant cells have resulted in diminished enthusiasm for preserving the nipple-areolar complex after mastectomy. Adequate color match for areola reconstruction can be obtained with a full-thickness medial groin graft after breast mound symmetry has been achieved. Both a single-stage and a two-stage technique are described for nipple reconstruction. These techniques use existing approaches with some modification, and provide nipple-areolar complexes that are symmetrical, have satisfactory color match, and provide good nipple projection. Most important, the contralateral nipple-areolar complex is not violated. It can be dealt with as deemed best in terms of cancer prophylaxis.
Reconstruction with vascularized composite tissue in patients with excessive injury following surgery and irradiation.
The biological effects of a single high dose of radiation are examined. Both cellular injury and repair are reviewed during early, intermediate, and late phases. Anticipated composite tissue morbidity is detailed for therapeutic radiation doses administered to the head and neck, breast and thorax, and perineum. Patients who demonstrated excessive time-dose fractionation values were irradiated with lower x-ray energies. Those in whom there was an overlap of treatment fields presented a serious challenge to the reconstructive surgeon. Judicious selection of well-vascularized composite tissue outside the portals of irradiation, preferably with a long vascular pedicle, facilitated reconstruction. When possible, both donor and recipient vasculature should be outside the irradiated area to ensure uninterrupted blood flow to the transferred or transplanted tissue.
The lymphatics of the groin flap.
This communication briefly discusses lymph-draining potentials and problems of skin flaps; describes specifically the lymphatics of the groin flap, an axial pattern flap; gives examples of its clinical application as a lymphatic wick; and explains its partial success and failure. The concept of axial pattern flaps was developed when the groin flap was described in 1972 by McGregor and Jackson. Attempts were subsequently made to delineate the extent of the vascular territories of these axial vessels. Although the flap was initially used as a pedicle flap, transfer of its vascular territory based on the axial vessels was soon undertaken, producing the so-called free flap. One desirable characteristic of this axial pattern flap was the remarkable absence of edema following elevation and transfer or transplantation to the new site. This stimulated one of us (L.C.) to review the lymph-draining potential of this flap.
The free scapular flap.
We present our early experience with a flap that should become important to the microsurgeon. The scapular flap is based on the circumflex scapular branch of the subscapular artery and is a versatile, hardy, easily dissected flap. We have used it in 14 cases where a fairly thin flap was indicated. Four of the 14 patients developed complications. Two developed hematomas after removal of the drains. These were evacuated without any loss of the flap. One patient had to be returned to the operating room because of thrombosis of the venous anastomoses, but the flap eventually survived in its entirety. One flap was lost from progressive venous insufficiency.
Microsurgical composite tissue transplantation: indications and technical considerations in breast reconstruction following mastectomy.
Twenty-six patients are presented who underwent reconstruction of the breast and thorax following mastectomy. A successful result ensued in 96 percent of the patients. Indications for the use of microsurgical composite tissue transplantation in breast reconstruction following mastectomy include. 1. Inability to employ an island latissimus dorsi musculocutaneous flap 2. Previous failure of an island latissimus dorsi musculocutaneous flap 3. The restoration of form and contour with minimal secondary donor deformity The present series includes 12 patients who underwent reconstruction utilizing the vascularized groin flap and 14 utilizing the contralateral latissimus dorsi musculocutaneous flap. The advantages and disadvantages of the different donor tissues are presented and contrasted with other vascularized donor tissue also employed in breast reconstruction following mastectomy. Technical modifications correlating the limitations of the donor tissue to the complexities of the recipient site and contributing to successful transplantation are detailed. The authors wish to emphasize that microsurgical composite tissue transplantation for reconstruction of the breast following mastectomy has applicability in only a small carefully selected subgroup of patients--approximately 9 percent.
Transcutaneous PO2 monitoring for assessing viability and predicting survival of skin flaps: experimental and clinical correlations.
Rectangular skin flaps based on the right superficial epigastric vessels were designed on the groins of 36 rats. Preoperative control, intraoperative, and postoperative readings of oxygen tension (PO2) were made at proximal, central, and distal sites on the flaps with a transcutaneous PO2 (tcPO2) monitor under various conditions of oxygen inspiration. The results of this experimental work indicated that the tcPO2 monitor was useful in continuously and rapidly measuring changes in oxygen concentration in skin flaps in a noninvasive fashion. The monitoring demonstrated that the response time of the flaps to changes in the concentration of inspired oxygen was rapid (less than 15 seconds). The monitoring also was valuable in assessing viability of the flaps, in predicting flap survival, and in detecting any systemic factors influencing oxygen transport, such as pneumonia. As a result of the experimental series, tcPO2 monitoring was used clinically to evaluate 18 flaps in 16 patients. As in the experimental series, the clinical measurements were significant and reproducible. They demonstrated that the tcPO2 monitor provides safe, reliable monitoring of peripheral oxygenation in the microcirculation that is rapid, continuous, and totally noninvasive. It is concluded that simultaneous tcPO2 measurements at control and flap sites provides a continuous record of the status of a flap that can improve the postoperative management of the surgical patient.
A silent but lethal injury associated with facial trauma.
Without a careful evaluation of all patients with major facial injuries and a thorough search for possible associated injuries, traumatic transection of the aorta may be easily missed, if the patient survives the first 24 hours after injury. Any patient subjected to sudden deceleration injury, particularly following automobile or motorcycle accidents, should be evaluated carefully for traumatic aortic rupture. Patients with associated chest trauma should have chest x-rays in the emergency room, and repeat chest films several hours later should be obtained to identify subsequent development of a widening mediastinum. Proper management of possible aortic transection should include arteriograms when appropriate and prompt surgical intervention when indicated. All patients with major injuries should be thoroughly evaluated by a trauma team so that associated injuries may be quickly recognized and treated.
Twenty-five year evaluation of external halo fixation for severe maxillofacial injuries.
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