Scrotal reconstruction in Fournier's gangrene--report of three cases.
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Adult↗
Biomedical subjects
F C Wei
Publications and source records attributed to F C Wei.
Basal joint reconstruction in a punch injury of the hand.
Severe hand trauma caused by an industrial accident resulted in composite tissue loss in the basal joint area of the right hand. The crushed metacarpal bone was replaced, and ligamentous and capsular reconstruction was performed with flexor carpi radialis tendon and additional tendon graft. We present our experience, with a follow-up of one year and eight months.
Accidents, Occupational↗
Simultaneous multiple toe transfers in hand reconstruction.
Our experience with simultaneous transfer of two or more toe units to the same hand where multiple digits were missing is presented. Forty-six toes from 38 feet were transferred to reconstruct 19 hands in 19 patients. The transfers consisted of 7 combined second and third toe units and 32 single toes. Three patients had a primary and 16 patients had a secondary reconstruction. There was one complete and one partial failure. The two-point discrimination ranged from 6 mm to protective sensation. Total active movement averaged 57 degrees in the thumb and 127, 93, 71, and 68 degrees, respectively, in the fingers reconstructed at middle phalanx, proximal phalanx, metacarpophalangeal joint, and metacarpal head. Pulp-to-pulp pinch averaged 2.4 kg in patients who had thumbs reconstructed and averaged 3.0 kg in patients who had normal thumbs. There was no cold intolerance, and no significantly disabled foot occurred except one with scissoring deformity. Simultaneous multiple toe transfer in hand reconstruction is feasible without increased complications both in primary and secondary wound conditions. It is time-effective and cost-effective.
Accidents, Occupational↗
Reconstruction of Achilles tendon and calcaneus defects with skin-aponeurosis-bone composite free tissue from the groin region.
Eight patients had reconstructive surgery for soft-tissue, associated Achilles tendon, and calcaneus defects on the posterior aspect of the ankle. In group A, those patients with skin, soft-tissue, and Achilles tendon loss were treated with free groin flaps that included sheets of the external oblique aponeurosis based on the superficial circumflex iliac vessel. The groin flap provided skin coverage, and the aponeurosis was rolled to form a tendon-like structure to replace the Achilles tendon. In group B, those patients with an additional calcaneus bone loss were treated with free iliac osteocutaneous flaps, together with the external oblique aponeurosis based on the deep circumflex iliac vessel. The iliac bone was then utilized to reconstruct the calcaneus defect. All composite free tissue transfers were successful, except in two group B patients who suffered partial skin loss. The advantages of this technique are (1) a single, one-stage procedure, (2) faster wound healing with fewer adhesions of the reconstructed Achilles tendon, and (3) good cosmesis and minimal morbidity at the donor site.
Achilles Tendon↗
Three successful digital replantations in a patient after 84, 86, and 94 hours of cold ischemia time.
Three successful digital replantations were performed on a patient after 84, 86, and 94 hours of prolonged cold ischemia time. Both the intraoperative and postoperative courses were smooth. Functional evaluation 8 months after operation revealed a normal speed of sensory recovery and nail growth. The atrophic changes in all three replants are mild. Total active movement was 45, 100, and 70 degrees in the replanted left thumb, left index finger, and right thumb, respectively. There is no cold intolerance. The overall functional result is satisfactory. Replantation of an amputated digit that is properly cooled immediately after injury should be attempted in selected patients even after prolonged ischemia time.
Adult↗
Reconstruction of the thumb with a trimmed-toe transfer technique.
The trimmed-toe transfer is a new modification of the existing great-toe transfer technique for thumb reconstruction. This procedure was devised to circumvent patient concerns regarding overly large reconstructed digits following total great-toe-to-hand transfer. This technique involves reduction of both the bony and soft-tissue elements along the medial aspect of the transferred great toe in order to produce a more normal sized thumb. Follow-up of the initial 20 patients from 1983 to 1986 demonstrates good stability, grip strength, and pinch strength. Although compared with total great-toe transfer a modest reduction in joint motion of trimmed toes has been observed, the overall appearance and usefulness of the reconstructed thumbs have been excellent.
Adolescent↗
Scalp, skull, and dura reconstruction on an emergency basis.
Severe cranial trauma caused by an industrial accident resulted in loss of scalp, skull, dura, and brain tissue in the left frontal region of a 55-year-old man. Successful one-stage total reconstruction of the defect was accomplished using a patch of fascia lata, autogenous split rib graft, and a free forearm flap on an emergency basis. A ten-month follow-up showed uneventful recovery and a good cosmetic result.
Craniocerebral Trauma↗
Reconstruction of a hand, amputated at the metacarpophalangeal level, by means of combined second and third toes from each foot: a case report.
Reconstruction of all four fingers that were amputated at the metacarpophalangeal (MP) joints of the right hand of a 17-year-old male patient was performed by simultaneous transfer of the combined second and third toes from each foot at the level of the metatarsophalangeal joint. Fifteen-month follow-up showed acceptable cosmesis with satisfactory functional results. The patient had no foot discomfort, even after prolonged walking and running.
Adolescent↗
Fibular osteoseptocutaneous flap: anatomic study and clinical application.
The vascularized fibular graft has been expanded to an osteoseptocutaneous flap by including a cutaneous flap on the lateral aspect of the lower leg. The cutaneous flap can serve not only for postoperative monitoring of the grafted fibula, but also as extra skin coverage to replace substantial skin defects or prevent tight closure of the wound. From anatomic studies of 20 cadaver legs and 15 clinical cases, it has been possible to demonstrate adequate circulation to the skin of the lateral aspect of the lower leg from the septocutaneous branches of the peroneal artery alone. This finding has allowed the development of a new concept and technique to elevate the fibula as an osteoseptocutaneous flap for reconstruction which provides the following advantages: Elevation of the fibular osteoseptocutaneous unit is easy and fast. The cutaneous flap of the fibular osteoseptocutaneous unit can slide almost freely while attached to the paper-thin posterior crural septum without being tethered by a bulky muscle cuff, facilitating the setting of the fibular osteocutaneous flap when the bone and skin are widely separated. Intraoperatively, in a situation in which it is necessary to change from originally selected recipient vessels to ones more suitable, the thin posterior crural septum can be folded around the fibula allowing more flexibility in choice of recipient vessels. The fibular osteoseptocutaneous flap meets the criteria outlined for composite tissue reconstruction of defects of the extremities.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Ten-digit replantation.
A case is presented of replantation of 10 digits at the proximal phalangeal level. Seven digits survived. Osteotomies and flexor tenolysis were done on the right thumb, long, and ring fingers and left index and long fingers 11 months later. A toe-to-hand transfer was done to reconstruct the failed left thumb replantation. Functional and sensory recovery is satisfactory.
Accidents, Occupational↗
Microsurgical replantation of a completely amputated penis.
Replantation of a penis with microsurgical repair of vessels and nerves can restore normal genitourinary function. A case is presented of an amputated penis that was ischemic for sixteen hours before being microsurgically revascularized. The patient has at all times appreciated having an intact penis despite the fact that the injury was self-inflicted. Self-mutilation is not considered to be an absolute contraindication to replantation.
Adult↗
[Evaluation of functional recovery following digital replantation].
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Adolescent↗
The temporary stent technique: an easier method of micro-venous anastomosis.
The microvascular repair of small veins is technically difficult. A new method using a temporary "stent" has been studied experimentally in microvenous anastomoses of the femoral veins in twenty-four rats. The technique is described in detail. The results were evaluated by gross observation and by histological section. Improved patency rates were demonstrated and the advantages of the technique are discussed. The technique could be very useful in the anastomoses of small, fragile veins, particularly by the less experienced microsurgeon.
Animals↗
[Application of latissimus dorsi flaps in reconstructive surgery].
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Adolescent↗
Upper eyelid mycobacterial infection following Oriental blepharoplasty in a pulmonary tuberculosis patient.
Bilateral upper blepharoplasty for the Oriental eyelid was performed in a 20-year-old female on antituberculous therapy for 3 months. The postoperative course was smooth and the patient was back to normal life. But unfortunately, at 3 months after the upper blepharoplasty, a spherical tumescence and red granuloma developed over the right upper eyelid. The granuloma was resected, and on pathological examination the specimen revealed epitheloid granuloma with Langhan's giant cells and a few acid-fast positive bacilli. The clinical events and pathological findings were suggestive of Mycobacterium tuberculosis rather than Mycobacterium chelonei as the possible cause of infection. Thus the patient was advised to continue antituberculous therapy and no antibiotic was prescribed. The eyelid swelling resolved gradually and was completely normal at the end of antituberculous therapy. Though it has been suggested that aesthetic surgery can be performed safely 3 months after antituberculous therapy in a patient with pulmonary tuberculosis, the remote risk of such a complication is always a possibility.
Adult↗
Evolution of the vertical reduction mammaplasty: the S approach.
The vertical reduction mammaplasty has been popularized over recent years. It always produces marked puckering of the excess skin and requires revision surgery for the persistent dog-ears that develop. Minor complications are often common. As a result, the evolution with S approach is developed. A series of 36 consecutive patients who underwent the S approach reduction mammaplasty is presented. The S approach can be described as having 1) superior dermoglandular pedicle, 2) simple and safe S-shaped skin marking, 3) suspension of the residual glandular tissues transversely to the periosteum of the 5th rib, and 4) short-scar closure. The surgical techniques are described in a step-by-step fashion. An analysis is made of the results obtained from these patients. The mean follow-up period of this study is 21 months. As a result of surgical operation, the symptoms of breast hypertrophy were markedly improved. According to patient assessment, neck, back, or chest pain decreased from 64% to 25%, shoulder grooving improved from 56% to 25%, stooped posture decreased from 42% to 14%, intetrigo improved from 36% to 8%, psychological embarrassment decreased from 33% to 8%. The postoperative complications included minimal areolar epidermolysis (11%), hypertrophic scar (8%), etc. All mammograms revealed hypertrophic patterns of the breast. The glandular tissues removed had a mean of 480 g from each breast. Two breasts (3%) had fibroadenomas. The sternal notch-nipple distance changed from a mean of 30.5 cm preoperatively to 20.5 cm, the length of infraareolar scar was 9 cm in average. Eighty-one percent of patients had minimal postoperative ptosis, and the sensitivity of nipple-areola complex was unchanged in 75% of patients. Nine patients (24%) retained the ability to lactate for more than 1 month postoperatively. Twenty-two patients (61%) were very satisfied with their operation, and eight (22%) were adequately satisfied. The technique presented is a simple and safe procedure that provides satisfactory results for patients with breast hypertrophy.
Female↗
Experience of 73 free groin flaps.
The free groin flap has gradually lost its popularity due to the disadvantages relating to the pedicle and the plethora of new donor sites. The purpose of this article is to re-evaluate this time-honoured free flap and to demonstrate its reliability and versatility through a review of 73 free groin flaps performed between 1985 and 1990. 7% of free transfers (total 1096 cases) in our institution were free groin flaps. The complication rate was 8% (three complete failures and three partial failures). This result is acceptable and not so high as other reports have described. The artery discrepancy is the main cause of the complication rate. Two special techniques to gain additional diameter of vessel size to overcome the pedicle disadvantages are stressed. The groin flap has proved to be useful and still deserves consideration in reconstructive procedures.
Adolescent↗
Current concepts of toe-to-hand transfer: surgery and rehabilitation.
Optimal functional recovery after toe-to-hand transfer depends on skillful surgery as well as aggressive motor and sensory rehabilitation. The patient should be well motivated and willing to incorporate the involved hand in daily living and carry out the rehabilitation program on a daily basis. This article presents the current recommendations for the different toe-to-hand transfers and their postoperative rehabilitation programs.
Finger Injuries↗