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Biomedical subjects

E A Luce

Publications and source records attributed to E A Luce.

69 records · Page 4Linked to original sources
PubMed1982

Closure of myelorachischisis defects with reverse latissimus dorsi myocutaneous flaps.

The closure of myelorachischisis defects has been difficult and at times complicated. Over the past 2 decades, the use of rotational advancement flaps has been increasingly popular, but can be attended by instances of skin ischemia and necrosis. The development of the myocutaneous and muscle flap concept has aided reconstructive surgery. Extensive experience with the useful latissimus dorsi flap with and without overlying skin has been obtained for the reconstruction of a variety of truncal defects. We describe the use of bilateral "reverse" latissimus dorsi muscle flaps based on the paraspinal perforators for the closure of myelorachischisis defects in two patients. Coverage was uneventful in both instances. A 2-year follow-up revealed no compromise of upper extremity function due to sacrifice of the latissimus dorsi muscles. We offer an approach to the problem of closure of large myelorachischisis defects: bilateral reverse latissimus dorsi muscle flaps and delayed skin coverage. This approach seems to offer a good muscle layer over the dural closure and to provide long-standing durable coverage without apparent compromise of upper extremity function.

Follow-Up Studies↗
PubMed1981

Treatment of impending nipple necrosis following reduction mammaplasty.

Despite careful preoperative planning and accurate surgery, nipple necrosis may follow reduction mammaplasty. Impending nipple necrosis developed following translocation of the nipple and areola on a dermal pedicle in two patients. An excellent result was obtained by converting the nipple-areola complex to a full-thickness graft and removing the avascular portion of the breast. We recommend this technique to the surgeon whose patients develop impending nipple necrosis after reduction mammaplasty.

Adult↗
PubMed1980

Naso-ethmoid-orbital fractures.

This report reviews the experience with naso-ethmoid-orbital fractures at a major medical center. Thirty-three patients were treated between 1 October 1976 and 1 January 1979, who met our definition of naso-ethmoid-orbital fractures. The majority sustained trauma in a motor vehicle accident and 60% of the patients had associated nonfacial injuries. All patients had other facial injuries and fractures; orbital rim or floor, 94%; complex maxillary (LeForte II-III), 72%; and mandible fractures, 25%. Slightly over one half of the group of naso-ethmoid fractures were open; the remainder were closed injuries. Traumatic telecanthus was noted in 70% of the patients on initial examination. Cerebrospinal fluid rhinorrhea was evident in 40%, and frontal sinus fractures were detected in 25% of the group. Severe ocular injury with initial or subsequent loss of sight occurred in an alarming 30% of the patients. In addition, nasolacrimal duct system lacerations occurred in 20%. One patient developed a large carotid artery-cavernous sinus fistula 1 month postinjury. The severity of these injuries and the potential for deformity and dysfunction have not been properly emphasized in the past. Our experience has defined several diagnostic and therapeutic guidelines. For example, vastly improved results were obtained with an open reduction and internal fixation procedure. A multidisciplinary approach by a neurosurgeon, ophthalmologist, and plastic surgeon is mandatory.

Adolescent↗
PubMed1979

Review of 1,000 major facial fractures and associated injuries.

The records of 1,020 major facial fractures were reviewed, and it was found that the occurrence of life-threatening associated injuries was highly predictable on the basis of the pattern of facial fractures and the circumstances of the injury. Certain groups of patients have a high probability of associated serious injuries of the central nervous system, the trunk, or the extremities. Probably these patients should be primarily under the care of a surgeon who is capable of the diagnosis and emergency therapy of these associated injuries, as well as the facial injuries, so that appropriate priorities can be established and put in effect.

Abdominal Injuries↗
PubMed1978

Shotgun injuries of the upper extremity.

Although most reports of civilian gunshot injuries consist mainly of wounds inflicted by handguns, shotgun wounds deserve special consideration. Longrange shotgun wounds rarely pose a problem; however, medium- and close range wounds of the penetrating and perforating type may inflict substantial soft-tissue loss, bone defects and comminution, and loss of nerve and vessel continuity. Because of the complex and multiple system involvement by shotgun wounds, a greater challenge exists to obtain a successful, functional result. The challenge is most appropriately met by an aggressive approach of early operative exploration and debridement of the wound, internal stablization of the bony fragments, vascular repair when indicated, and exploration and identification of nerve deficits, followed by an early wound closure.

Adolescent↗
PubMed1978

Massive skin necrosis in Rocky Mountain spotted fever.

The occurrence of massive skin necrosis of approximately 50% of the body surface area in an 8-year-old girl with Rocky Mountain spotted fever is reported. Although the surgeon will not often be confronted with the management of Rocky Mountain spotted fever or its complications, certain therapeutic corollaries can be outlined, based upon the observed similarity between this particular complication of severe skin loss and the syndrome of purpura fulminans: (1) heparinization for the consumptive coagulopathy and disseminated intravascular clotting; (2) correction of hypovolemia and hypoproteinemia; (3) decompression by escharotomy and/or fasciotomy if indicated; (4) topical chemotherapeutic coverage of necrotic skin; (5) full-thickness eschar excision combined with biologic dressings directed toward autograft wound closure; and (6) appropriate extremity splinting and physiotherapy.

Child↗
PubMed1978

High tension electrical injury of the upper extremity.

A group of 18 patients received a high tension electrical injury of the upper extremity. The over-all results were dismal. Opportunity for improvement appears to lie in a regimen of rapid and complete removal of devitalized skin and muscle, avoidance of contamination and desication and the early provision of blood supply and wound coverage with pedicled flap coverage.

Arm Injuries↗
PubMed1977

Velopharyngeal insufficiency in hemifacial microsomia.

One-third of a group of 18 patients with hemifacial microsomia demonstrated velopharyngeal insufficiency of a significant degree. The ones with velopharyngeal insufficiency tended to have more severe soft tissue and skeletal deformities of the maxillary-malar complex, associated with a total unilateral palatal paralysis. Cinefluoroscopy was not helpful in diagnosing the velopharyngeal insufficiency. Fiberoptic nasopharyngoscopy, in contrast, proved to be an excellent diagnostic tool. We suggest that patients with hemifacial microsomia have a careful, periodic speech evaluation as an essential part of their overall management.

Endoscopy↗
PubMed1976

Alveolar-arterial oxygen gradient in the burn patient.

1)A presumptive diagnosis of inhalation injury by the occurrence of a "closed-space" burn and the presence of facial burns, singed nasal vibrissae, ronchi and wheezes as clinical criteria was often in error in our study group. 2) A-a O2 gradient and change in A-a gradient in our group of patients was of value in predicting the development of pulmonary dysfunction.

Adult↗
PubMed1976

Compression neuropathy following brachial arterial puncture in anticoagulated patients.

1) Seven patients were seen and treated over a 1-year span with forearm hematoma and median nerve neuropathy following brachial artery puncture. All seven were anticoagulated. 2) A careful examination established the diagnosis. Prompt operative intervention is recommended. 3) The brachial artery should be avoided as a source for arterial blood gas sampling in the anticoagulated patient.

Adult↗
PubMed1976

Long-term results of the island flap palatal pushback.

We analyzed all 104 island flap pushback palatal repairs done through our Facial Rehabilitation Clinic in the period from 1965 to 1971. The results were compared to those in a group of 109 standard pushback repairs. The island flap group had a higher incidence of operative complications, of velopharyngeal insufficiency, and of secondary procedures to correct the latter. (The differences between the two groups were not statistically significant, however.) In this group of patients the island flap repair offered no particular advantage over the V-Y or the Dorrance pushback; in fact, it may have been deleterious. A hypothetical explanation for these results is offered, based on possible continuing osteogenesis by the transplanted mucoperiosteum, to produce an inflexible and poorly functioning velum.

Child↗