The Southern Illinois University Plastic Surgery Program.
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Academic Medical Centers↗
Biomedical subjects
E G Zook
Publications and source records attributed to E G Zook.
Experimental evaluation of free-tissue transfer to promote healing of infected wounds in dogs.
An experimental model was designed to evaluate the course of healing and the changes in bacterial concentrations of infected forelimb wounds with devascularized bone in dogs. Infected leg wounds were allowed to heal by secondary intention or were covered with a full-thickness or split-thickness skin graft, an epigastric skin/fat flap, or a gracilis musculocutaneous flap. All skin grafts failed. Gracilis muscle flaps were superior to epigastric skin/fat flaps in decreasing soft-tissue bacterial concentrations. Quantitative bone cultures, however, were positive at reexploration 6 weeks later in 33% of all legs covered with a flap. X-ray films were successful in predicting the presence or absence of bone infection in 70% of all legs. Postmortem arteriograms of legs covered with muscle flaps showed neovascularity to bone. This study suggests muscle flap coverage of wounds debrided of contaminated, necrotic, or infected bone and soft tissue to be an excellent method of providing well-vascularized soft tissue promoting healing and resolution of infection.
Animals↗
A comparative study of free and pedicle flaps for lower extremity wounds.
Sixty-four flaps were used to treat wounds in 58 patients over a 5-year period. In this series there was a high incidence of healing of both tibial fractures and chronic osteomyelitis when covered with muscle. Better contour is achieved with muscle covered with meshed skin grafts than with musculocutaneous flaps. The survival rate for free flaps was 93% and for pedicle flaps, 100%. Complication rates were higher for pedicle flaps (45%) than for free flaps (30%), although major complications for free flaps (14%) were higher than for pedicled flaps (9%).
Adolescent↗
The growth potential of small arteries repaired by microsurgical technique.
A study to determine the growth potential of immature microvessels was carried out using rat femoral arteries. Immature rat arteries repaired with interrupted 10-0 nylon sutures grew in proportion to the animal. There were no areas of stenosis at repair sites, which in some animals appeared slightly dilated compared with control vessels. The ultrastructure of repaired arteries after growth was mildly altered in the internal and external elastic membrane layers while the intima and media appear normal. Neovascularization around anastomoses may explain an apparent increased blood flow velocity at repair sites and does not correspond to arterial narrowing in this model.
Animals↗
Successful treatment of acute head and neck dog bite wounds without antibiotics.
Dog bites continue to be the most common bite injury in the United States. We previously reported a series of 61 patients with 215 dog bite wounds. Of these, 55 patients had 188 dog bite wounds of the head and neck area which were treated with copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic coverage, wound closure, and close postoperative monitoring. A wound infection rate of .53% and a patient infection rate of 1.8% were obtained using this protocol. Our present study uses the same protocol with the exclusion of antibiotic coverage. Our series of 49 patients with 145 head and neck wounds reveals a wound infection rate of 1.4% and a patient infection rate of 4%. This is not statistically significantly different from the outcome of the previous study.
Acute Disease↗
Polyglycolic acid tubing as a conduit for nerve regeneration.
Rabbit common peroneal nerves will regenerate across a 1-cm gap inside polyglycolic acid tubing. Regenerated nerves are separated histologically into "minifascicles," which persist in distal segments. The conduction velocities and evoked action potential amplitudes following this type of regeneration are inferior to those seen in nerves repaired directly or by interpositional grafting. The strength of reinnervated muscles is equal following direct nerve suture, interpositional grafting, or polyglycolic acid conduit repairs.
Animals↗
Free microneurovascular gracilis muscle transfer in the dog for enterostomal sphincter construction and control: an experimental study.
Hundreds of thousands of individuals struggle today with the morbidity of an abdominal wall enterostoma. This study explored two ways of constructing abdominal wall sphincter mechanisms in dogs using gracilis muscles transferred by free microneurovascular technique. Transferred muscles successfully generated pressures greater than the normal external anal sphincter but could not maintain this level of contraction for tonic sphincter closure. Other transferred muscles were designed to straighten the course of stomas continent at rest. They provided strong linear pull uncoiling the stomas but simultaneously pinched off the orifices during contraction. This opening model shows promise if the muscle attachments around the stoma orifices could be made less constricting.
Abdominal Muscles↗
Fournier's gangrene of the penis: a report of two cases.
Fournier's gangrene is a rare disease involving the scrotum and penis with occasional extension up the abdominal wall. Both of our cases were unusual in that only the penis was involved. In addition, the occurrence of squamous cell carcinoma in an area previously affected by Fournier's gangrene has never been reported. The usual organism is an anaerobic streptococcus synergistic with some second organism. Early therapy is key, including debridement of the entire shaft of the penis distal to the devastated area, intravenous broad-spectrum antibiotics, and skin grafting.
Carcinoma, Squamous Cell↗
Experimental evaluation of tissue revascularization using a transferred muscular-vascular pedicle.
Skin and cartilage can be revascularized from a transferred muscular-vascular pedicle. Muscle vessels appear to connect with existing vessels in the subdermal plexus or perichondrium and determine the ultimate distribution of the skin or cartilage revascularized. The ideal timing for flap elevation following revascularization in this model is 21 to 28 days following transfer. Isolation of the muscular-vascular pedicle from underlying tissue by a silicone sheet does not appear to augment tissue revascularization. Delay procedures do not improve surviving flap length. Composite flaps of cartilage and skin can be revascularized using this technique.
Animals↗
Functional evaluation of latissimus dorsi donor site.
A study was undertaken to determine the cosmetic and functional problems associated with the latissimus dorsi muscle donor site. Twenty-four patients undergoing both free and pedicle muscle and myocutaneous flap procedures for a wide variety of reconstructive problems were studied. All patients had a contour defect at the donor site, a scar which varied with the patient's age and whether overlying skin had been taken with the muscle flap. Mild to moderate shoulder weakness and some loss of motion were noted in most patients which improved over the course of several months. An upper extremity disability in strength and shoulder motion should be anticipated following latissimus dorsi transfer, which in most cases is minimized by the recruitment of synergistic muscle units. Vigorous range-of-motion exercises following surgery should be encouraged to minimize adhesions and joint capsule stiffness. Social changes in occupation and daily living activities were noted which were not a problem for most patients. Twenty-three of 24 patients were pleased with the overall outcome of their surgery and would recommend the procedure to others. A prospective study before and after latissimus dorsi transfer followed by a second evaluation 2 to 3 years postoperatively would help to clarify the role synergistic muscle units play in "taking over" latissimus dorsi function.
Adolescent↗
Complications of the perionychium.
The anatomy and physiology of the perionychium are reviewed and complications secondary to trauma, to miscellaneous problems (such as neuroma, infections, and cysts), and to tumors are discussed.
Cysts↗
Extremity reconstruction using the free deltoid flap.
The deltoid fasciocutaneous flap is a thin, reliable flap that is easily dissected from the posterolateral arm. It has large-caliber vessels and is capable of sensory reinnervation to portions of the flap above the deltoid/triceps groove through the lateral brachial cutaneous nerve. There is little sensory return to the large vascular territory, which can be extended inferiorly below the deltoid triceps groove. The donor site can be closed primarily or skin grafted and when large may be objectionable to some patients. The flap is an excellent choice for extremity soft-tissue reconstruction on the plantar or palmar surfaces. Protective sensibility has returned to all reinnervated flaps. We present our experience in 10 patients with extremity problems.
Adult↗
Nail bed injuries.
The nail bed injury is common in mechanized societies. Appropriate early care is essential to good postsurgical results. The timing and techniques of this care are described.
Female↗
A study of nail bed injuries: causes, treatment, and prognosis.
Two hundred ninety-nine nail bed injuries were studied over a 5 1/2-year period. Methods of repair were described. Follow-up was obtained for 184 injuries. The injuries were defined, categorized, and analyzed according to defined result categories and results were graded from excellent to poor. Ninety percent of the repaired nail beds were graded good to excellent. Poorer results occurred with crush or avulsion injuries, with injuries of both nail bed and nail fold, and with associated infection.
Accidents↗
Cuffing techniques in microarterial surgery.
Four-stitch microarterial anastomoses reinforced with cuffs of artery, vein, or polyglycolic acid tubing were compared to standard eight-stitch repairs in the femoral arteries of 40 immature rats. The cuffing technique reduced the average repair time by 50% without compromising short- or long-term patency. Restricted vessel growth or anastomotic stenosis did not result from the presence of any of the cuffing materials. Polyglycolic acid tubing performed as well as autogenous cuffs. The cuffing technique helps minimize trauma to the vessel wall by reducing the number of sutures, and its application could significantly decrease the duration of ischemia in multiple digit replantations.
Animals↗
A biomechanical comparison of vascularized and conventional autogenous bone grafts.
Vascularized and conventional autogenous rib grafts were used to reconstruct 6-cm ulnar defects in the forelegs of the nine dogs. Each dog served as its own control. Biomechanical torsional testing of the grafted ulnas showed that vascularized grafts were 234 percent stronger than the conventional grafts. Bone toughness (energy absorbed) was 483 percent greater in the vascularized grafts, and elastic modulus and proportional limits were 263 and 246 percent greater, respectively. We conclude that vascularized bone grafts are significantly stronger than conventional autogenous bone grafts after 3 months of healing in the dog ulna model.
Animals↗
Heterotopic brain tissue in the scalp.
A hairy mass was excised from the occipital area of a 6-month-old girl. Pathology examination revealed microscopic characteristics of meningeal tissue and gliosis consistent with brain. The possible developmental possibilities are discussed.
Brain↗
Ulnar artery aneurysm in osteogenesis imperfecta.
A case of acute thrombosis of an ulnar artery aneurysm in a patient with osteogenesis imperfecta tarda is described. The pathophysiology of osteogenesis imperfecta is reviewed and the possible association of defective collagen maturation and aneurysm formation is postulated. Most ulnar artery aneurysms or thromboses should be surgically resected and the artery repaired by microsurgical technique with primary anastomosis if possible or a venous interpositional graft if direct repair is not possible without tension.
Adult↗