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Biomedical subjects

E K Manders

Publications and source records attributed to E K Manders.

At least 37 records · Page 2Linked to original sources
PubMed1996

Experimental study of allogeneically vascularized prefabricated flaps.

The authors fashioned vascularized island flaps using cryopreserved allogeneic vascular bundles as the vascular pedicles in rabbits. Auricular vessels of 8 cm in length were harvested and cryopreserved in liquid nitrogen for 30 days. The allovascular bundles were anastomosed into the recipients' native auricular vessels. Dorsal flaps (6 x 6 cm) in the recipient were raised on the implanted allovascular bundle. Eight days later, the flaps were elevated as vascular island flaps nourished by the allovascular bundle. Computed microangiography demonstrated the anastomoses between the vasculatures of the implanted vessels and the recipient sites 8 days after vascular implantation in the dorsal flap. Flap survival estimation, which was done 1 week after flap elevation, showed flap viability. Allogeneic vascular bundles proved their potential utility as vascular pedicles of autologous tissue transfer.

Anastomosis, Surgical↗
PubMed1996

Repositioning the stoma of the cervical esophagostomy.

The stoma created with a diverting cervical esophagostomy is often an unsightly inconvenience for the patient because of the high incidence of leakage from the collecting appliance. Secure attachment of a collection device at the base of the neck is difficult. The stoma of the cervical esophagostomy may be moved away from the base of the neck using a tubed skin flap modeled after that originally described by Wookey. Such a procedure has the advantages of removing the appliance from an area of high visibility and providing a flatter base that decreases leakage and soiling. We advocate this simple procedure in patients who desire to rid themselves of a cervical appliance, but who are poor operative candidates for a more extensive procedure replacing the entire esophagus.

Esophagostomy↗
PubMed1996

Assessing the role of presuturing on wound closure.

The efficacy of presuturing was tested by quantitating the tissue gains for standardized wounds in a white swine piglet (9 to 11-kg) model. Also measured were the changes in wound closure tension for the wounds. Measurements were carried out at 1, 4, 17, 24, 48, and 72 hours in a total of 20 piglets. Presuturing was carried out on one of the flanks and the opposite flank served as the control. Presuturing achieved a modest tissue gain, amounting to 67 mm at 4 hours and a maximum of 1.4 cm at 48 and 72 hours, for a 4-cm defect. The encouraging tissue gain was unfortunately not paralleled by a decrease in the tension required to approximate the wound edges. At 4 hours, the tension to close the wound was 1.2 N (only 120 g) less than the control wound. This initial small reduction in wound-closing tension was diminished thereafter, and at 72 hours the wounds were stiffer and harder to close than the control. This appeared to be due to tissue edema and was confirmed by an increase in measurable tissue water with increasing time. In this model, presuturing produces a minimal tissue advancement and even less reduction in wound-closing tension. It is concluded, from this work and from previously published work, that undermining will prove generally to be a more useful technique in closing broad defects.

Animals↗
PubMed1996

Ventral hernia repair with simultaneous panniculectomy.

The repair of a ventral hernia in an obese patient presents an interesting clinical challenge. We retrospectively reviewed the charts of 55 patients who, over a 12-year period from 1983 to 1995, concomitantly underwent both ventral herniorrhaphy and panniculectomy or abdominoplasty. In six of 55 patients, the hernia was recurrent. Forty-six patients had primary abdominal wall hernias or diastasis recti. Nineteen of 55 patients had weight greater than 200 lbs. This last subset of patients had a significantly higher incidence of complications, such as seroma, cellulitis, and persistent wound drainage. In our 55 patients, we experienced only two hernia recurrences (3.6%) during an average patient follow-up of 53 weeks. From this experience, we believe that simultaneous ventral hernia repair and panniculectomy is a safe and efficacious approach to these two problems so commonly found in the obese patient. Patients with a preoperative weight greater than 200 lbs can be expected to have a greater risk of wound complications. In all cases, the wounds eventually healed with no long-term sequelae.

Adipose Tissue↗
PubMed1996

Obesity.

Obesity is a heterogeneous family of disorders with several overlapping contributory causes. It markedly increases morbidity and mortality from many different diseases, and affected patients are the targets of severe, negative social pressures. Physicians traditionally have been unsuccessful in treating obesity. The usual physician's office approach to obese persons is to conduct a good history and physical examination and then prescribe a 4200-J diet sheet and monthly or biomonthly office visits. This approach usually produces mild and ephemeral weight loss. Some patients quickly become disillusioned and manifest as appointment "no-shows." The doctor often bemoans the lack of will power of his or her ex-patient. Such patients and their physicians would be better served by referral to a professional weight management program, in which a coordinated team approach has proven effective and persistent in body weight control. "He that putteth his trust in the Lord shall be made fat."

Behavior Therapy↗
PubMed1996

Academic surgeons, take heart: the story of a student, his mentor, and the discovery of the etiology of angina pectoris.

Edward Jenner is renowned for developing a vaccination for smallpox. He trained as a surgeon and was an ardent anatomist and naturalist. Part of his formal training was directed by John Hunter, the father of scientific surgery. Jenner diagnosed Hunter as suffering from angina pectoris and correctly identified the cause of angina pectoris from a series of autopsies he conducted. After Hunter died during an altercation in committee, his postmortem examination proved Jenner correct. Jenner can be recognized as the first to correctly ascribe the etiology of angina pectoris to coronary atherosclerosis.

Angina Pectoris↗
PubMed1995

Sensibility of finger fillet flaps on late follow-up evaluation.

Though the use of fillet flaps salvaged from damaged digits is a well-established technique to obtain soft tissue coverage for the badly injured hand, the sensibility of these flaps has not been evaluated. We examined a series of four patients who underwent digital fillet flaps following hand trauma. Static two-point discrimination measurements of the injured hand and the contralateral hand showed that all four patients retained sensibility in the fillet flap that was equal to or better than the intact skin surrounding the flap. In some cases, the sensibility of the flap was equal to the sensibility in the corresponding contralateral fingertips. No patients had complaints regarding the function of their fillet flaps as sensate coverage of major soft tissue defects.

Adult↗
PubMed1994

Familial syndromes with skin tumor markers.

A number of interesting syndromes have been described in which skin tumors are markers of heritable disorders. In Cowden's disease, Muir-Torre's syndrome, and Gardner's syndrome, benign skin tumors accompany and sometimes precede the development of internal visceral malignancy. The association of skin cancers with other abnormalities is found in nevoid basal cell carcinoma syndrome, Bazex syndrome, Rombo syndrome, xeroderma pigmentosum, dysplastic nevus syndrome, and epidermodysplasia verruciformis. Other genetic syndromes in which benign skin tumors herald the existence of systemic diseases include neurofibromatosis, tuberous sclerosis, Haber's syndrome, and Buschke-Ollendorff syndrome. Diagnosis of one of these syndromes may be ascertained by taking a thorough family history. Recognition of the skin tumor may trigger the proper questions regarding family medical history. Diagnosis hinges upon the physician having a high enough index of suspicion to link the appearance of the skin lesions to the diverse manifestations accompanying these disorders. Recognition will also set the stage for appropriate genetic counseling.

Basal Cell Nevus Syndrome↗
PubMed1994

Supercharged latissimus dorsi muscle flap for coverage of the problem wound in the lower back.

Described is the "supercharging" of a latissimus dorsi muscle flap for coverage of an irradiated nonhealing wound of the lumbar area of the back. Nonhealing wounds of the lower back pose difficult management problems. In the face of radiation therapy, infection, and the presence of foreign materials, they can have the potential for disastrous outcomes. Exposed bone and prosthetic materials in an irradiated bed were covered by turning a latissimus dorsi muscle flap over its lower paraspinous origin and anastomosing the thoracodorsal artery and vein to the ipsilateral superior gluteal vessels. Postoperatively, the patient's wound healed without incident, and the muscle flap and skin graft provided a stable and durable reconstruction. Subsequent duplex Doppler imaging demonstrated a significant inflow to the flap from the superior gluteal artery and vein anastomosed to the thoracodorsal artery and vein of the muscle.

Back↗
PubMed1993

Pre-reconstruction tattooing eliminates the need for skin grafting in nipple areolar reconstruction.

Tattooing the skin of the reconstructed breast as a prelude to reconstruction of the nipple provides a nipple areolar reconstruction that has a uniform color. There is no requirement for a skin graft donor site. Tedious tattooing of the nipple papule is avoided. It is much easier to tattoo a flat surface than a projecting papule, and this technique gives a more uniform color. We believe that this approach to nipple areolar reconstruction provides a simpler, dependable technique.

Female↗
PubMed1993

The fate of dermal and dermal-fat grafts.

Histological changes in dermis and dermal-fat grafts have been hampered by the lack of a defined boundary to allow precise localization. We describe a model in which grafts of skin components were coated with india ink and implanted over the perichondrium of pigs' ears. Histological studies were then performed at 2-weekly intervals for 10 weeks. The survival of the grafts was also quantified. Skin adnexal structures found in dermal grafts survived with some changes. Grafts with an epithelial component produced an intense inflammatory infiltrate and formed inclusion cysts. Fat tended to disappear, a significant part of it being replaced by fibrous tissue. Dermis grafts implanted in the ears of growing pigs not only survived, but grew.

Adipose Tissue↗
PubMed1993

Diffusion versus iontophoresis in the transport of gentamicin in the burned rabbit ear model.

This experimental study demonstrates that iontophoresis can be used to transport biologically active gentamicin into auricular cartilage. Fifty female New Zealand White rabbits were divided into three groups: live controls with unburned ears, live animals with burn-injured ears (deep or partial-thickness), and euthanized animals with unburned ears. Each group was then divided into subgroups that received gentamicin transported by iontophoresis or diffusion. In ears subjected to iontophoresis, adequate gentamicin activity could be demonstrated only in the cartilage of euthanized animals with unburned ears and live animals with full-thickness burned ears. Diffusion did not transport a detectable level of gentamicin in any instance. Diffusion is ineffective in the transport of gentamicin and should not be used as a primary method of treatment for ear chondritis. Iontophoresis did not transport active gentamicin across partial-thickness burns, presumably because the migrating antibiotic molecules were dispersed throughout the body by the circulation. However, if the circulation is destroyed, as in a full-thickness burn, iontophoresis can move the biologically active gentamicin into the cartilage.

Animals↗
PubMed1992

Cutaneous scar at anterior hair line in mother and child with associated frontal bone defect in child.

A large frontal bone defect underlying a "V" shaped scar was noted in a newborn male whose mother had an identical "V" shaped scar at the same location in the anterior hairline. Both had hypertelorism and short palpebral fissures. The mother had no radiographic evidence of skull defect and neither mother nor child had other cutaneous or skeletal anomalies. Cranioplasty was performed on the child using the remaining frontal bones with an excellent cosmetic result. Biopsy performed at operation documented scar tissue extending through the dermis and underlain by thickened dura. Mother and child appear to have a variant form of aplasia cutis congenita, an autosomal dominant trait with wide variation in expression.

Abnormalities, Multiple↗
PubMed1992

Abdominoplasty combined with other intraabdominal procedures.

One hundred three patients underwent abdominoplasty combined with other intraabdominal procedures including 67 tubal ligations, 34 total abdominal hysterectomies and 2 cholecystectomies, from January 1983 to July 1991. The patients were divided into two groups, those undergoing the standard or total abdominoplasty and those undergoing limited abdominoplasty with or without liposuction in delimited areas. In this series of 103 patients, we found only two minor complications and only three patients were transfused with autologous units of blood. When performed by well-schooled surgical teams, abdominoplasty may be combined with intraabdominal procedures with gratifying results.

Abdominal Muscles↗
PubMed1992

Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery.

Aeromonas hydrophila infections are a recognized complication of postoperative leech application, and can occur with measurable frequency in populations of patients treated with leeches. We review 11 previously reported leech-related Aeromonas infections and analyze seven unreported cases. These infections range from minor wound complications to extensive tissue loss and sepsis. Often, these infections followed leech application to tissue with questionable arterial perfusion. Onset of clinical infection in these patients ranged from within 24 hours of leech application to 10 days or more after leech application. Late infections may represent bacterial invasion from colonized necrotic tissue. Based on these observations, we recommend that leech applications be restricted to tissue with arterial perfusion to minimize contamination of necrotic tissue. We also recommend that patients treated with leeches receive antibiotics effective against Aeromonas hydrophila before leech application. Patients treated with leeches and discharged with eschars or open wounds might benefit from oral antibiotic therapy until wound closure. These precautions may minimize or eliminate this complication of leech use.

Adolescent↗