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Biomedical subjects

E Santamaria

Publications and source records attributed to E Santamaria.

28 records · Page 2Linked to original sources
PubMed1998

Single versus double arterial anastomoses in combined second- and third-toe transplantation.

Combined second and third toe transplantation is one good option for reconstruction of multiple digit amputation. However, the use of one or two arteries for pedicle anastomoses, which may influence the vascular complication and success rate, has never been addressed in the literature. This study includes a retrospective review of 57 combined second and third toe transplantation in 54 patients performed from February of 1983 through December of 1996. Group I, composed of 41 transplantations, underwent one arterial anastomosis, and group II, composed of 16 transplantations, underwent double arterial anastomoses during surgery if there were two recipient arteries available or whenever the second and third toes showed inadequate blood perfusion after one arterial anastomosis. In group I, 10 transplantations (24.4 percent) required re-exploration with a success rate of 92.7 percent (38 out of 41 transplantations). In group II, only one transplantation (6.2 percent) required re-exploration with successful flap salvage. The success rate was 100 percent for group II. Because the re-exploration and success rates between groups I and II were not statistically significant according to two-tailed Fisher's exact test, the combined second and third toe transplantation is a reliable procedure using either single or double arterial anastomoses.

Adolescent↗
PubMed1997

The extended, pedicled rectus abdominis free tissue transfer for head and neck reconstruction.

The rectus abdominis musculocutaneous free tissue transfer has become a mainstay of reconstruction for large defects in the head and neck. The length of the deep inferior epigastric vessel is traditionally accepted to be 8 to 10 cm from its origin to its entrance into the rectus muscle. This pedicle is usually not long enough for reconstruction of the upper midface, forehead, and cranial base if vascular anastomosis to the neck vessels is necessary. Vein grafts have been recommended under these circumstances. We have been able to extend the length of the vascular pedicle by intramuscular dissection of the lateral branch of the deep inferior epigastric artery and veins in 26 clinical cases. The dissection is carried along the posterior surface of the muscle, up to the first tendonous inscription. Intraoperative measurements of the pedicle length before (6.9 +/- 1.0 cm) and after (13.7 +/- 2.0 cm) dissection, as well as in 17 fresh cadavers (34 muscles), demonstrate that the pedicle length can be increased safely from 7.8 +/- 0.5 cm to 17.7 +/- 0.52 cm (range, 15.8 to 19.1 cm). This long-pedicled flap has been used successfully in 26 patients for reconstruction of different types of defects in the head and neck, without using vein grafts.

Adolescent↗
PubMed1997

Effects of vasoactive medications on the blood flow of island musculocutaneous flaps in swine.

Pedicled flaps and microsurgical free tissue transfers are increasingly being used for reconstruction in the elderly and poorer risk patient. The use of systemically administered vasoactive agents to date has been avoided because of the fear that systemic levels of these agents perioperatively (particularly the vasopressors) might decrease blood flow and compromise the viability of the flap. There are no large-animal, real-time hemodynamic studies that support or disprove this belief. The objectives of this study were to (1) develop a musculocutaneous flap model in the pig that allows accurate, simultaneous monitoring of systemic and flap hemodynamic parameters such as flow and resistance and (2) identify the effects of commonly used vasoactive substances (dopamine, dobutamine, and phenylephrine) at clinically used levels on systemic and flap pressure/flow relationships. Vertically based rectus abdominis musculocutaneous flaps were raised in 8 anesthetized, 50- to 55-kg pigs, and a flow probe was placed around the artery. Catheters within the pulmonary artery and aorta were used to measure cardiac output and aortic root pressures. Measures of arterial blood pressure, cardiac output, and musculocutaneous flap flow were obtained at baseline and during the administration of varying doses of dopamine dobutamine and phenylephrine. Cardiac output increased significantly with low and high doses of dopamine and dobutamine, but decreased with increasing doses of phenylephrine. Flap flow, on the other hand, is increased only with dobutamine but remains unchanged with dopamine despite increased cardiac output. Flap flow decreases with high doses of phenylephrine. Flap flow also decreases relative to cardiac output with both dopamine and dobutamine. We conclude that (1) phenylephrine clearly affects flap flow adversely in a large-animal musculocutaneous model and therefore should be avoided, (2) dopamine does not affect total flap flow at either low or high doses despite increasing cardiac output, (3) dobutamine increases both flap flow and cardiac output, and (4) both dopamine and dobutamine should still be used with caution because the flap flow is not equally increased relative to total cardiac output. Possible changes in systemic and flap metabolic demand induced by these vasopressor drugs may therefore still be injurious to the flaps.

Abdominal Muscles↗
PubMed1997

Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants.

Insertion of osseointegrated dental implants several months after mandibular reconstruction using vascularized composite bone grafts has proved to be a successful method to achieve mastication and complete oral rehabilitation. Theoretically with primary placement of implants into the new mandible a better access to the bone is achieved, interdental relationships are easier to determine, and oral rehabilitation can be attained in a shorter period of time. Previous results describing this approach, however, are inconclusive and controversial. This review describes our experience with primary insertion of dental implants into fibular flaps used for mandibular reconstruction during ablative surgery. Adequate selection of patients for this combined procedure depends mainly on the pathological nature of the mandible and perioperative radiotherapy. Preoperative determination of soft-tissue and bone requirements, number of osteotomies, rigid fixation method, and familiarity with the use of osseointegrated implants are important factors that must be considered for adequate surgical planning and to achieve good results.

Dental Implantation, Endosseous↗
PubMed1997

Preoperative ultrasound Doppler study and clinical correlation of free posterior interosseous flap.

BACKGROUND: Conventional pedicled posterior interosseous flap has a relatively high rate of partial flap loss which may result in ultimate failure to provide coverage of this important structure. The goal of this study was to delineate the posterior interosseous flap as a reliable free tissue transfer. METHODS: From 1991 to 1995, 34 patients undergoing free posterior interosseous flap had preoperative Doppler mapping to determine the point of emergence of the skin perforators of the posterior interosseous artery. This finding was correlated intraoperatively with the number of perforators nourishing the posterior interosseous flap. The anatomic variations in the posterior interosseous artery were also identified. RESULTS: These results showed (1) the main skin perforator was consistent and reliable in all of the posterior interosseous flaps both in the preoperative Doppler evaluation and intraoperative findings; (2) the main skin perforator arose from the posterior interosseous artery, the ascending interosseous recurrent artery or the common interosseous artery in 26 cases (76%), 6 cases (17.6%) or 2 cases (5.9%) respectively; (3) the success rate with the use of the free posterior interosseous flap was 97% without any partial flap loss. CONCLUSION: It is concluded that the free posterior interosseous flap is a reliable flap with adequate arterial flow from constant main skin perforators and large antegrade venous drainage. A less reliable distally based pedicle flap can be changed into a reliable free flap, with the aid of preoperative non-invasive Doppler evaluation. This principle could be applied in the design of other "free skin perforator flaps".

Arteries↗
PubMed1997

Modified reverse sural artery flap.

BACKGROUND: Reverse sural artery flap is a useful flap for defect reconstruction in the distal leg, ankle and heel. The major problem encountered with the reverse sural artery flap is its unreliability. It may be compromised by venous congestion and peripheral arterial insufficiency when the flap is transferred with its pedicle tunneled subcutaneously. METHODS: In this study we describe modifications of this procedure consisting of a wider pedicle during flap design and transferring it without passing the pedicle through a subcutaneous tunnel. The pedicle is then divided in a second-stage operation. Four patients with defects at various locations over the distal leg and heel had reconstruction with reverse sural artery flap in this fashion. RESULTS: No failure developed among these cases and the wounds healed without complication. These patients were satisfied with this procedure. CONCLUSION: Reverse flow flap vascularity is maintained and its viability is ensured with this technical modification.

Aged↗
PubMed1995

[Radiologic and skeletal-anatomical study of mummies at the Tourin Egyptian Museum].

The authors present a study performed on three Egyptian mummies, coming from the same inviolate grave belonging to the Necropolis of Gebelin. The grave bore no indications on the occupiers' identity and for that reason Schiaparelli identified it as "Tomb of the Unknown". The mummies and their funerary furniture are now exposed at the Egyptian Museum of Turin. Standard radiographies of the mummies have been taken in situ by means of a portable radiological equipment. It has also been possible to examine directly the anatomic aspect of one unbandaged skeletal mummy. The procedure was simple, reliable, not expensive and did not expose the mummies to damages due to an eventual transfer. Reliable data on the findings have been taken in that way: the three burials, one of them is likely a reburial, belong to three grown-up subjects, whose sex was male for two and probably female for the third. No bone pathology has been found. One of the cadavers seems to be dead due to a serious cranic injury, probably the effect of a heavy bladed weapon.

Adult↗
PubMed1987

Intraoperative use of pure perfluoropropane gas in the management of proliferative vitreoretinopathy.

A single-step technique for fluid-gas exchange with pure perfluoropropane gas in proliferative vitreoretinopathy (PVR) is described. The technique was used in 38 eyes of 38 patients. Permanent and total retinal reattachment, with a minimum follow-up of 6 months after gas disappearance, was achieved in 24 eyes (63%). The anatomical success rate was 80.9% (17/21 eyes) in PVR grade C and 41% (7/17 eyes) in PVR grade D. Twenty-two of the successful eyes (92%) underwent a single operation. Thirteen of the successful eyes (54%) obtained final visual acuities of 0.1 or better. Severe increase of intraocular pressure postoperatively, due to overestimation of the intraocular space available for gas expansion, is a potential risk of the technique. This risk should be avoided by means of preoperative evaluation of the vitreous cavity volume with A-scan ultrasonography and intraoperative measurement of the intraocular fluid volume displaced by scleral buckling.

Eye Diseases↗
PubMedDate not supplied

Anthropometry of the scapula: clinical and surgical considerations.

Anthropometric measurements were taken on 266 scapulas from the "G. Marro" Egyptian skeletal collection of the Department of Anthropology of the University of Turin in Italy to study the orthopaedic pathologic condition of the shoulder joints. Data were taken on the size and shape of the acromial arch in relation to the inclination and anatomic variants of the acromion. The rarity of the "hooked" form was confirmed, and two variants of the acromial vault (i.e., one predominantly osseous and the other predominantly fibrous) were recognized. The spatial location and biomechanical importance of the coracoid process were considered. Orientation of the glenoid fossa furnishes an osseous base for the stability of the scapulohumeral joint both anteroposteriorly and vertically. Observations on current practices of surgical intervention on the shoulder as reported in the literature and some anatomic skeletal basis of surgical access are discussed.

Acromion↗