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Biomedical subjects

E H Rose

Publications and source records attributed to E H Rose.

35 records · Page 2Linked to original sources
PubMed1984

Reconstruction of central metacarpal ray defects of the hand with a free vascularized double metatarsal and metatarsophalangeal joint transfer.

A massive central hand defect in a 12-year-old boy was reconstructed with a free vascularized tissue block including the second and third metatarsal bones, second metatarsophalangeal joint, and common extensors of the second and third toes. Progressive bone growth has occurred and epiphyseal plates were still open at 12 months after transfer. Bone alignment and stabilization of the central hand were excellent. The foot is an excellent source of component spare parts for autogenous transfer to the hand.

Child↗
PubMed1983

Selective finger transposition and primary metacarpal ray resection in multidigit amputations of the hand.

In multidigit amputations parts with the most favorable prognosis (cleaner amputation, less crushed, short ischemia time) can be "selectively" replanted in positions most appropriate to providing useful function and cosmetic acceptability, regardless of their anatomic origin. Digits with poor prognosis are not reattached. These principles are applied in four selected cases involving multidigit amputations proximal to the proximal interphalangeal joints in which the least traumatized digits were selectively joined to the more ulnar metacarpal rays; intervening metacarpal shafts were primarily resected to clear the first web space of obstructing bony stumps. The narrowed palmar arch, although weaker, achieves wider palmar span grasp. Fingers in contiguity, although fewer in number, allow improved precision handling, chuck pinch, and cosmetic acceptability.

Adult↗
PubMed1983

Correction of bilateral breast hypoplasia and pectus excavatum with single-unit customized silicone implant.

The cosmetic defects of pectus excavatum and bilateral mammary hypoplasia can be corrected with a single-unit customized silicone implant. An extended pocket is made across the anterior chest wall through two inframammary incisions. It is then possible to insert and position the breast prostheses subpectorally and the sternal prosthesis subcutaneously using these incisions. A good cosmetic result can occur with minimal morbidity and scarring.

Adult↗
PubMed1983

Local arterialized island flap coverage of difficult hand defects preserving donor digit sensibility.

Small to moderate-sized defects of the hand overlying joint surfaces, flexor tendons, Silastic implants, and tactile surfaces require full-thickness skin and subcutaneous tissue either for primary coverage or in anticipation of secondary reconstruction. In this report, six difficult hand wounds are resurfaced with an arterialized island pedicle from the lateral surface of the nearby digit in lieu of multistage distant pedicle flaps. The Littler neurovascular island flap has been modified to include only the digital artery and venae comitantes at its pedicle, preserving digital nerve intact in the donor digit. Microsurgical separation of the digital artery from the digital nerve minimizes the sensory loss of the donor digit. Cortical reeducation at the recipient site is unnecessary. The lengthy pedicle allows an arc of coverage over the palm, dorsum of the hand, and adjacent digits. Results in six cases have been favorable. Flap survival has been 100 percent. Maximum flap size was 5.5 X 2.5 cm. Two-point discrimination of the donor defect averaged 4.5 mm. No significant donor morbidity was noted, with the exception of one case in which there was a mild degree of hypertrophic scarring across the volar aspect of the proximal interphalangeal joint. The one-stage procedure minimizes the number of hospitalizations and disability time. Its proximity to injury, versatility, and relative speed with which it can be raised encourages its usage for primary coverage (two cases in this series). Preservation of near normal two-point discrimination of the donor site allows either the radial or ulnar surface of the nearby digit to be used.

Adolescent↗
PubMed1981

Free transfer of a large sensory flap from the first web space and dorsum of the foot including the second toe for reconstruction of a mutilated hand.

A 19-year-old man sustained a mutilating crush injury in August, 1978, in an 80-ton punch press. The injury resulted in transmetacarpal amputations of the index through little fingers. The thumb was revascularized by microvascular anastomoses. The replanted index to the little finger position failed. A free transfer of the patient's second toe to the fifth metacarpal was done to provide a post to oppose the thumb. The first web space of the toe was used in expanding the contracted single cleft of the hand. The innervated dorsal foot flap provided coverage for the dorsal surface of the hand. Anatomically, the entire composite transfer was supported by the dorsalis pedis artery anastomosed to the radial artery. The nerve sutures were between the plantar digital nerves and sensory fascicles of the median nerve and the deep peroneal to the dorsal branch of the radial. The extensor and flexor tendons were also repaired. This procedure differs from the neurovascular island transfer of the first web described by Strauch and Tsur by inclusion of the second toe in the free transfer.

Accidents, Occupational↗
PubMed1981

One-stage arterialized nasolabial island flap for floor of mouth reconstruction.

A one-stage nasolabial island flap isolated on the facial artery and vein is described for floor of mouth reconstruction. The donor site is closed primarily. The advantages of the procedure are that the one-stage procedure obviates the need for division and inset of a distant flap, the arterialized flap brings its own blood supply to the irradiated area; the donor site in elderly patients provides a large amount of redundant skin, which stretches easily across the midline or to the roof of the palate; and the donor defect is cosmetically acceptable. A disadvantage is that the procedure yields transient upper lip palsy and drooling that persists for several weeks.

Aged↗
PubMed1981

Primary toe-to-thumb transfer in the acutely avulsed thumb.

The case is presented of a primary toe-to-thumb transfer by microvascular anastomosis for reconstruction of an acute degloving amputation of the thumb. This approach is not recommended as the standard practice for this type injury, however, there were certain advantages in this patient: (1) one stage procedure, (2) restoration of length, sensibility, and cover, (3) cosmetic improvement, and (4) minimal length of hospitalization.

Adult↗
PubMed1980

Simultaneous transfer of the right and left second toes for reconstruction of amputated index and middle fingers in the same hand--Case report.

Simultaneous transfer of the second toes of the right and left feet was done to reconstruct the index and middle fingers in a 23-year-old man. A two-team microsurgical procedure approach was used. Technical aspects of the procedure are described. Long-term functional results have been good, both cosmetic and functional. Only one previous case of this type was described by Ohtsuka in 1977.

Adult↗
PubMed1980

Nailplasty utilizing a free composite graft from the helical rim of the ear.

A method of reconstruction of the nail and nail plate matrix and cuticle complex utilizing a free composite auricular graft from the helical rim is described. The advantages of the procedure are (1) good cosmetic results in most, (2) psychological improvement after the reconstruction, and (3) minimal donor deformity.

Accidents, Occupational↗
PubMed1979

Free toe-to-fingertip neurovascular flaps.

Six cases of free toe-to-fingertip neurovascular flaps are presented. The principal advantages of this procedure over rotation island flaps are (1) achievement of better two-point discrimination, (2) an acceptable donor defect, (3) no cortical reorientation is necessary, and (4) there is minimal tension on the nerve.

Adolescent↗
PubMed1978

A microarchitectural model of regional variations in hypodermal mobility in porcine and human skin.

In this paper, we focus on the hypodermal component of the integument and its functional contribution to properties of skin mobility. A specially designed mechanical apparatus was used to measure hypodermal extensibility in vivo of 6-mm "island" punches at selected anatomical sites in anesthetized pigs. Representative regional hypodermal force displacement curves were found to differ statistically in magnitude of acceleration, slope, and extensions at breaking point. A vertically oriented "lattice network" of hypodermal fibrous elements arranged in geometric subunits is consistently seen in sample specimens. Microarchitectural differences in network configuration, geometric unit size, fat infiltration, and intrinsic collagen fiber length can be correlated directly to the biomechanical data. These findings are corroborated by light microscopy, scanning electron microscopy, and quantitative hydroxyproline concentrations. A similar network is confirmed in human cadaver biopsies. Clinically, our data suggest that skin mobility is at least partially allowed by unfolding and stretching of the hypodermal vertical collagen network, and that regional variations in fibrous network architecture satisfy specific functional requisites (e.g., joint mobility, skin stabilization), as well as serving as an expansile retractile reservoir for the deposition and absorption of fat.

Adipose Tissue↗
PubMed1978

Successful replantation of two avulsed scalps by microvascular anastomoses.

Two cases of immediate replantation of avulsed scalps by microvascular anastomosis are presented. This method of treatment seems to offer significant economic, social, and psychological advantages over split-skin grafting of the calvarium, or other presently used treatments. The need for secondary reconstructive procedures after a successful replantation is minimal, or nil. The mechanism of scalping is reviewed, and it is related anatomically to the structure of the galea aponeurotica. Specific recommendations are made regarding the immediate care of the avulsed scalp and the denuded calvarium, the value of a team approach in replantation, and various technical aspects of the procedure and postoperative management. The more frequent use of interpositional vein grafts is urged.

Adolescent↗
PubMed1977

The panniculus carnosus in the domestic pig.

The panniculus carnosus arises from the superficial fascia of the midlateral back, inserts into the medial skin of the forelimb, and fuses ventrally with the contralateral cutaneous muscle. In the midback, forelimb, thigh, and groin the panniculus carnosus is lacking; there, superficial fascia alone is present. Both the panniculus carnosus and the superficial fascia divide the panniculus adiposus into a superficial compact layer and a less compact deep layer. The firm attachment of the dermis to the panniculus carnosus, and of the panniculus carnosus to the deep fascia, makes pigskin a more suitable model for comparison with human integument than the usual laboratory animals with loosely draped skin. When using the pigskin model, however, care must be exercised to define the level of incisions and the location of flaps or grafts, with respect to the panniculus carnosus.

Animals↗
PubMed1977

Excisional wound biomechanics, skin tension lines, and elastic contraction.

Confusion surrounding the concept of Langer's lines can be reduced by careful distinction among the operational definitions of the phenomenon, the empirical descriptions, and the theoretical explanations. An experimental analysis of the mechanical parameters of excisional wounds in pigskin shows that the marginal retraction, the elastic modulus at the wound midline, and the closing tension are higher for wounds oriented at right angles to tension lines--but the elastic modulus of the terminal segment of the force displacement curve is independent of orientation. The regional distribution of these values shows two patterns. The modulus parameters and the closing tension share a common distribution related to the steepness of regional force-displacement curves, while retraction has a qualitatively different distribution. On the basis of similarities in the behavior of retracting wound margins and in the distortion of punch holes which define tension lines, we hypothesize that the same mechanism may be responsible in both cases.

Animals↗
PubMed1976

Skin tension lines in the domestic pig.

The skin tension lines of the domestic pig have been mapped. With a 6mm punch biopsy, local relative skin forces can be determined. The influence of various factors (such as age, fat deposition, gascial attachments, and previous scarring) on the direction of the skin tension lines is discussed.

Animals↗
PubMed1976

Evaluation of a prototype therapeutic system for prolonged, continuous topical delivery of homosulfanilamide in the management of Pseudomonas burn wound sepsis.

The ability of homosulfanilimide (HS) delivered from two different dressing vehicles to limit bacterial proliferation was evaluated in burned animals deliberately infected with virulent Pseudomonas organisms. Treatment consisted of once daily topical application of one of two vehicles: (1) an experimental prototype system that utilized micronized HS in a hydrophobic, bioerodible, polymeric matrix, impregnated on a fabric backing; or (2) a commercially available dressing that contained the same mass of drug in a hydrophilic cream base impregnated on the same backing. Wounds on control animals were covered with fabric backing with or without the bioerodible matrix. The experimental system was designed to maintain a finite local concentration of HS on the burn wound for at least 24 hours. It is known that the cream base presents a rapidly decreasing concentration of drug to the burn surface. HS delivered from the experimental system produced a significant reduction in deaths compared with the HS delivered from the cream base. In addition, the new method of delivering HS provided better control of local and systemic infection, and better wound hydration and also promoted earlier eschar separation. The experimental system was at least as convenient to apply as the cream and had an advantage with respect to inspection of the wound, since it could be removed and reapplied easily.

Administration, Topical↗