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Biomedical subjects

D W Furnas

Publications and source records attributed to D W Furnas.

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

Composite tissue (limb) allografts in rats. III. Development of donor-host lymphoid chimeras in long-term survivors.

Eight LEW rat recipients possessing long-term-surviving (206-701 days) LBN vascularized hind limb allografts (CTAs) were tested for donor-host lymphoid chimerism. The recipients received various cyclosporine (CsA) treatment protocols in order to induce indefinite CTA acceptance. Histological examination of long-term-surviving CTAs demonstrated normal-appearing bone marrow in the donor limb. Lymphocytes isolated from host hemopoietic tissues (peripheral blood and/or spleen) by ficoll-hypaque density gradient centrifugation were tested against LEW-anti-BN antisera. Comparisons were made to standard curves employing various known concentrations of LBN and LEW cell combinations. The level of lymphocyte agglutination (dependent variable) showed a significant (P less than 0.025-0.005) linear relationship to the concentration of LBN donor cells (independent variable) present. Lymphocyte suspensions isolated from long-term CTA host peripheral blood and/or spleen showed a mean of 19.7% (+/- 9.7-95% confidence interval) donor LBN mononuclear cells present. Thus, it appeared that lymphoid cells originated from, and/or were released from LBN donor bone marrow into the circulation, resulting in chimeric repopulation of hemopoietic tissues. The presence of donor immunocytes in these limb allograft recipients may have been beneficial, and thus could have helped contribute to the long-term CTA survival observed.

Animals↗
PubMed1985

Traditional craniotomies of the Kisii tribe of Kenya.

Our research team has reviewed the practice of traditional craniotomy by the ababari emetwe (craniotomists) of the Kisii tribe of Kenya through interviews with a number of craniotomists and their patients over a period of several years, and through observation of a number of the operations. Cultural background, rationale and indications, techniques and instrumentation, complications, and medical implications of this practice are examined. Our findings are recorded to preserve the details of a cultural phenomenon which is probably destined to disappear within this generation.

Craniocerebral Trauma↗
PubMed1985

Composite tissue (limb) allografts in rats. I. Dose-dependent increase in survival with cyclosporine.

The dose-response effect of cyclosporine on rat limb transplant prolongation was investigated across the LBN-to-LEW histocompatibility barrier. This composite tissue allograft model has been shown to represent a strong transplantation barrier. Median limb allograft survival times increased in a dose-dependent manner with low cyclosporine doses, and then reached a plateau at higher levels. The cyclosporine dose that produced half-maximal survival based on a 20-day treatment was only 3.7 mg/kg/day. Histopathology revealed that the rejection process was distinctly different in limb allografts treated with cyclosporine compared with non-cyclosporine-treated controls. Rejection appeared to be delayed or partly arrested in certain areas of cyclosporine-treated limb allografts. These studies represent an initial step in laying the experimental foundation for clinical transplantation of composite tissue allografts using cyclosporine-induced immune suppression.

Animals↗
PubMed1985

Composite tissue (limb) allografts in rats. II. Indefinite survival using low-dose cyclosporine.

Cyclosporine has reawakened interest in transplantation of peripheral composite tissue allografts (CTA) of skin, muscle, bone, vessel, and nerves. The purpose of this study was to examine whether cyclosporine could produce indefinite survival of CTA. Two groups of LEW recipients of LBN limb transplants were given different long-term treatments of cyclosporine. Tolerance was achieved in many of the animals. Several possibilities for the mechanism of this tolerance are discussed.

Animals↗
PubMed1985

Immunosurgery.

After being leaders in the field of transplantation, plastic surgeons became inactive in this field. Interest is reviving with the advent of the new immunosuppressant drug cyclosporine, as well as new knowledge of the immune mechanism. New generations of immunosuppressive drugs may allow allografting in patients with massive burns, limb transplants, and possibly even allografts of facial structures.

Antibodies↗
PubMed1985

Z-plasties and related procedures for the hand and upper limb.

The Z-plasty is a useful procedure in surgery of the upper limb for lengthening skin along a selected axis, for breaking up a straight line, and for obliterating webs. At least six geometric variables are considered in designing a conventional Z-plasty, and several modified designs must be considered. Geometrical models are useful guides in design, but biomechanical features are also important and must be incorporated in the plan.

Arm↗
PubMed1985

A pair of five-day flaps: early division of distant pedicles after serial cross-clamping and observation with oximetry and fluorometry.

In each of 2 recent patients with distant pedicles (one a groin flap and the other a cross-leg flap), we were able to perform the final division and detachment of the flap on the fifth postoperative day. Cross-clamping was used to create intermittent periods of ischemia. The periods of ischemia were progressively increased until the time of division. Fluorometry with intravenous fluorescein played a role in deciding when to divide the flap. The patients were discharged from the hospital on the sixth and seventh days, respectively. Trimming was done on an outpatient basis.

Adult↗
PubMed1984

Lateral cervical advancement flaps for the correction of webbed-neck deformity.

In the webbed-neck deformity, a horizontal excess of cervical skin creates bilateral and often asymmetrical skin webs from the mastoid to the acromion. Hair extends laterally to the free edge on the posterior web surface, creating a wide nuchal hairline. A technique of correction is presented. Through an incision along or within the hairline, the glabrous anterior web surface is undermined with the platysma muscle into the anterior cervical triangle until posterosuperior traction will obliterate the web. The posterior hair-bearing web surface is also elevated, and an excess of scalp is excised anterior to the new hairline position determined by the surgeon. The anterior glabrous flap is advanced posteriorly to resurface the scalp defect and recreate a normal neck contour and symmetrical hairline. A Szymanowski triangle of scalp is excised to equalize wound margins creating two "lazy" Y incisions that join in the scalp midline on completion of the opposite neck web. All scars lie within or along the hairline or extend onto the posterolateral shoulder. The method allows precise control of bilateral neck contour and hairline position without intraoperative repositioning and avoids scars on the exposed anterolateral cervical surface. There has been no recurrence of the neck deformity after 2 years.

Child↗
PubMed1984

Straight-line closure: a preliminary to Millard closure in unilateral cleft lips (with a history of the straight-line closure, including the Mirault misunderstanding).

We have completed 25 SLC-RAC sequences for complete unilateral clefts of the lip, using the straight-line closure as a preliminary step to facilitate the definitive closure, which is done about 6 months later. Fourteen of the straight-line closures were done on newborn children with local anesthesia, and the rest were done at a later time under general anesthesia because of later referral or refuge/immigrant status, using general anesthesia. We have had no major complications such as lip dehiscence, major infection, respiratory problems, or bleeding. Since our original publication, we have increased the scope of the straight-line closure to include wider nasal undermining for better repositioning of the nasal structures, and we have adopted Millard's technique of lining the gap in the pyriform aperture with a vermilion flap (Millard's "L" flap). Our oldest patient is not yet in adolescence, so our study is incomplete, but our impression is that the preliminary straight-line closure has materially improved the results of surgery for complete unilateral cleft lips. The history of the straight-line closure forms a continuum from the 1st century A.D., and includes Malgaigne, Mirault, and Veau repairs as well as those of many others.

Child↗
PubMed1983

Gluteal thigh flap in reconstruction of complex pelvic wounds.

Nine flaps for reconstructing pelvic wounds were centered on the posterior portion of the thigh over the inferior gluteal artery and posterior cutaneous nerve of the thighs of seven patients. No flap necrosis occurred and all wounds healed (one hematoma and one partial wound separation). Three patients had radiation wounds and three had immediate reconstruction following tumor resection. This flap represents an important advance in pelvic reconstruction and should be considered the flap of choice for this area. Contributions to the procedure from this series include (1) use in vaginal reconstruction, (2) length of flap extended to the popliteal fossa, and (3) use of an air-fluidized bed for postoperative management.

Aged↗
PubMed1983

Microsurgical transfer of the great toe to the radius to provide prehension after partial avulsion of the hand.

Transfer of the great toe to the radius proved to be an effective means of gaining the function of grasp in a patient with an incomplete amputation of the hand in which all the digital flexor tendons had been avulsed. The remaining stump consisted of the carpal bones and fragments of the second, third, and fourth metacarpals. A long, oblique osteotomy of the first metatarsal was designed so that it would abut with the palmar face of the radius. Power was supplied to the great toe by the flexor carpi radialis and the brachioradialis tendons. Sensibility was supplied by the median nerve and circulation was furnished by the radial artery and the cephalic vein.

Adult↗
PubMed1983

Angular artery flap for total reconstruction of the lower eyelid.

An island flap of the skin and soft tissues of the nasojugal fold and lip can be based on the superior end of the angular artery. This flap, lined with mucous membrane, was a satisfactory means of reconstructing the lower eyelid in a patient with inadequate skin for a cheek flap. A disadvantage was the need to trim the bulkiness of the flap in subsequent stages.

Aged↗
PubMed1983

Microsurgery and the community-based plastic surgeon.

1. The majority of our residents who completed their training since 1974 use a microscope for nerve repairs. A majority of those doing microscopic nerve repairs also repair noncritical vessel injuries with the microscope. 2. Half of the respondents who completed training in 1974 or before do not use the microscope for any operative procedures. 3. Successful replantation or revascularization procedures are not uncommon early in the practice of a community-based plastic surgeon. The tendency is to do fewer of these procedures the longer the period of practice. 4. For most of the community-based plastic surgeons, the boundary line of community practice versus the University practice is at the level of replantation, revascularization, and free flaps. 5. This boundary was modified by the strategy of having a University microsurgeon (from the same respondent group) assist the community-based plastic surgeon on replants and free flaps in a community hospital. 6. All of the residents who completed training since 1978 used loupes on a frequent (daily or weekly) basis. 7. Only half of the residents who completed training before 1975 used loupes. 8. Other uses of the microscope in the community were vasectomy reversal, nailbed repair, individual transplantation of hairs for eyelashes, canaliculus repairs, and the prevention of traumatic tattoos. Otologic and laryngologic procedures were carried out under the microscope by two respondents who had had otorhinolaryngologic training prior to their plastic surgery residencies.

Amputation, Traumatic↗