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Biomedical subjects

F C Wei

Publications and source records attributed to F C Wei.

At least 91 records · Page 5Linked to original sources
PubMed1998

Reconstruction of scalp defects with free flaps in 30 cases.

29 consecutive patients treated for reconstruction of various scalp defects with 30 free flaps were reviewed. The scalp defects resulted from accidents (13), electric burns (4), tumour excision (8), chronic osteomyelitis (1), and osteoradionecrosis (1). Secondary reconstructions for cosmetic improvement were performed in 2 patients. The defects involved scalp with bone exposure in 21 patients, and both scalp and calvarium in 8 patients. The average extent of the defects was 130 cm2 (23-420 cm2). Free flaps employed for reconstruction included radial forearm flaps (15), latissimus dorsi muscle flaps (10), medial arm flaps (2), juri flap (1), rectus abdominis muscle flap (1), and scapular flap (1). In 6 cases bone grafts were used for skull reconstruction. Three patients required dura repair. There were two flap failures. Donor-site morbidity was negligible. No local recurrence occurred in 7 tumour cases who are still alive. Secondary procedures (tissue expansion, debulking) were performed in 6 patients. The authors recommend selection of reconstructive options for scalp defects according to their aetiology, localisation, and duration of treatment, whereas the size of the defect dose not seem to be the most important determinant. They conclude that a free flap procedure is appropriate for scalp reconstruction in trauma, osteomylitis, and osteoradionecrosis cases, and following radical resection of malignant tumours.

Accidents↗
PubMed1998

Clinical evaluation of C7 spinal nerve transection: 21 patients with at least 2 years' follow-up.

We have performed C7 spinal nerve transfer to treat root injury of the brachial plexus since 1989. Out of a total of 43 patients, 21 have been followed up for at least 2 years. Evaluation of the effect of C7 transection included clinical examination, intraoperative C7 stimulation, LIDO Workset machine and electrophysiological studies to test C7 innervated muscles, and histochemical analysis of the anterior and posterior division of the upper trunk using acetylcholinesterase stain. Nearly half of the study group (48%) reported no significant sensory changes and most patients (81%) did not notice any weakness of the limb following C7 transection. Some patients did experience sensory and motor abnormalities which were most frequent during the first postoperative month, improved during the 2nd month and in most cases resolved in the 3rd postoperative month. The only longer persistent abnormality was the triceps reflex, which becomes weak or absent. We also found that intraoperative C7 stimulation was a useful predictor of possible post-transection morbidity. Subclinical deficits, detected by the LIDO workset machine and by electro-physiological studies, were quite common. Histochemical analysis revealed that the posterior division of C7 had more motor fibres than the anterior division.

Adolescent↗
PubMed1998

Pseudoxanthoma elasticum. Case report.

Pseudoxanthoma elasticum is an uncommon disorder of elastin with characteristic skin laxity. Rhytidectomy of the excessive redundant skin is necessary for cosmetic improvement, and reports of surgical management are rare. We report a case of pseudoxanthoma elasticum with involvement of neck, axillae, breasts, abdomen, thighs, and perineum, together with angioid streaking of fundi. Rhytidectomy of the lax cervical skin was undertaken with satisfactory results after a 13 month follow-up. We have reviewed other published reports to obtain a better understanding of the genetics, histopathology, vascular and ophthalmological manifestations, and also the surgical implications of pseudoxanthoma elasticum.

Adult↗
PubMed1998

Bilateral facial lipoatrophy secondary to connective tissue panniculitis treated with two microsurgically transplanted latissimus dorsi muscles.

A case of bilateral facial atrophy diagnosed as atrophic connective tissue panniculitis is presented. Reconstruction of both cheeks was performed with two staged latissimus dorsi muscle flaps. The initial good result on the right cheek deteriorated as the disease continued to progress after surgery. The good result on the left cheek, however, remained stable. Detailed clinical examinations, laboratory analysis, and deep biopsies from the affected areas are important for accurate diagnosis. Reconstructive procedures should be delayed while the disease is still active.

Adult↗
PubMed1998

Economy of donor site incisions: multiple free flaps of the subscapular family for extensive extremity wounds and bilateral foot defects.

One of the most important goals of modern microsurgical reconstruction is to decrease donor site morbidity as much as possible. With free flaps for lower limb reconstruction, economy of donor sites was designed and performed in 39 patients. Among these 39 patients, 17 had multiple flaps raised from a single incision for reconstruction of multiple defects in one or both lower extremities. Microvascular reconstruction of multiple defects is a challenging problem, particularly if it is to be performed simultaneously. The patients were followed for more than 3 years. Immediate complications and long-term disabilities were analyzed. From the data we conclude that this method has the following advantages: (1) economy of donor site incisions, (2) less harvest time, and (3) availability of any composite tissue for transfer. Donor site morbidity can be reduced by good planning, careful dissection, meticulous hemostasis, and adequate postoperative management.

Adult↗
PubMed1998

Successful replantation of an avulsed middle finger.

In avulsion amputations of the digits, soft-tissue injuries are extensive and often require tendon, nerve, and vessel transfers or grafts. The functional results of such digital replantations are frequently less than ideal. Therefore, avulsion amputation of a single digit proximal to the insertion of the flexor digitorum superficialis has been a contraindication to replantation, because the anticipated poor functional result may interfere with overall hand function, and is not worth the sacrifice of a tendon, nerve, or vessel from another digit or transfer. The authors report a patient with avulsion amputation of the middle finger at the proximal interphalangeal joint. The digit was replanted successfully without any tissue transfers other than a radial digital artery from the ring finger. The functional results were good, and the authors believe that good functional and cosmetic results can be achieved in select patients with isolated digital avulsions, provided that an experienced hand microsurgeon and a skillful hand therapist are available for a compliant patient.

Amputation, Traumatic↗
PubMed1998

Value of routine angiography before traumatic lower-limb reconstruction with microvascular free tissue transplantation.

From November 1993 to June 1997, long-bone defects in 40 trauma patients were reconstructed with free osteoseptocutaneous fibula flaps. To determine the necessity of routine angiography in traumatized lower limbs before free flap transplantation, a prospective study was carried out. The study subjects were 34 patients, 25 males and 9 females, with an average age of 40.6 years. Reconstruction was performed primarily for bone defects after Gustillo type III b open fractures in 17 patients and secondarily for malunion and osteomyelitis in 17 patients. Reconstructed bone defects included 25 tibias and 9 femurs. Normal pedal pulses were palpable in 31 patients. Angiographic findings were abnormal in seven patients. In the three patients with abnormal pedal pulses, the particular nonpalpable pulses correlated with the vascular lesions shown in the angiograms (one in the tibial anterior artery and two in the tibial posterior artery). Four patients with either injury of the peroneal artery (three cases) or pseudoaneurysm of the tibial anterior artery (one case) had normal pedal pulses. In all patients, microvascular transplantations were performed successfully. Our study demonstrates the importance of thorough clinical evaluation. Preoperative angiography of the injured lower limbs did not provide relevant additional informations in this series. Familiarity with all available techniques makes it possible to cope with almost any difficult posttraumatic vascular condition. Routine recipient-site angiography before microsurgical reconstruction, therefore, seems unjustified.

Adult↗
PubMed1998

Posterior interosseous flap and its variations for coverage of hand wounds.

BACKGROUND: Conventional posterior interosseous flap has the disadvantage of partial or even complete necrosis of the flap when there is anatomical variation or contusion around its distal pedicle. To make it a more reliable flap, three types of auxiliary procedures were designed. METHODS: (1) When there is congestion after inset of the distally based flap, an additional venous anastomosis was carried out. (2) When there is anatomical variation so that a distally based flap could not be raised without compromising the nerve branches, or when contusion was found around the distal pedicle, the flap was changed into a free flap. This design is also indicated for coverage of the distal fingers. (3) When the patient is elderly with possible peripheral arterial disease, the flap was raised with a wide base, incorporating the branches of both the anterior and posterior interosseous arteries. There were eight, 36, and five patients in each group, respectively. RESULTS: There was only one failure in the free flap group. No partial necrosis of the flap was found. Other complications were analyzed. CONCLUSION: With these backup procedures, the posterior interosseous flap can be more widely used with safety. By combining various reconstructive armaments, the result of a conventional procedure can be improved.

Adolescent↗
PubMed1998

A new evaluation system to predict the sequelae of late obstetric brachial plexus palsy.

Obstetric brachial plexus palsy has two distinct categories: (1) early obstetric brachial plexus palsy (or obstetric brachial plexus palsy in an infant) and (2) late obstetric brachial plexus palsy with deformity (or obstetric brachial plexus palsy in a child). Both early and late obstetric brachial plexus palsy lack a uniform evaluation system, and this makes correlation between them difficult. Clinical evaluation of obstetric brachial plexus palsy in infants is difficult, but in children it is easier. Here, we utilized a new evaluation system, called "Score of 10," to evaluate 121 late obstetric brachial plexus palsy patients based on patient's functional ability and surgeon's feasibility for reconstruction. "Score of 10" is a method combining the Erb and Klumpke scores. The Erb score gives points for upper plexus functions including shoulder abduction, shoulder external rotation, elbow flexion, elbow extension, forearm supination, forearm pronation, and trumpet sign. The Klumpke score gives points for lower plexus functions including wrist extension, wrist flexion, metacarpophalangeal joint extension, interphalangeal joint extension, finger flexion, thumb adduction, and thumb abduction. The aims of this evaluation system are to determine the relationships between early and late obstetric brachial plexus palsy, to predict the progressive changes that take place with aging, and to propose the possible operation procedures to reconstruct. However, this evaluation system may differ by time and may not be suitable for comparisons between pre- and postreconstruction.

Adolescent↗
PubMed1998

A new strategy of muscle transposition for treatment of shoulder deformity caused by obstetric brachial plexus palsy.

Cross-innervation (caused by misdirection of regenerated axons), muscular imbalance (caused by muscle paresis or earlier recovery), and growth are the three main causes of shoulder deformity due to obstetric brachial plexus palsy. If perioperative studies demonstrate the existence of muscle recovery by cross-innervation, a new strategy of muscle transposition to minimize the influence of cross-innervation is used. Release of antagonistic muscles (pectoralis major and teres major muscles) and augmentation of paretic muscles (transferring teres major to the infraspinatus muscle, reinserting both ends of the clavicular part of the pectoralis major muscle laterally) are performed for reconstruction. Since 1993, 29 patients having shoulder deformity caused by obstetric brachial plexus palsy underwent reconstruction utilizing this strategy of muscle transposition. The timing for the reconstruction was at an average of 8.5 years (range, 4 to 21 years). The average shoulder abduction following the muscle transposition was 151 degrees (i.e., average gain 104 percent, or 77 degrees) and that of external rotation was 72 degrees (average gain 200 percent, or 48 degrees). Compared with the patients who had no surgery for shoulder deformity caused by obstetric brachial plexus palsy and early nerve surgery for the infant obstetric brachial plexus palsy, the results of the strategy seem to be significantly impressive.

Adolescent↗
PubMed1998

Fibula osteoseptocutaneous flap for reconstruction of osteoradionecrosis of the mandible.

Osteoradionecrosis of the mandible poses formidable problems for treatment. In the last 6 years, the fibula osteoseptocutaneous free flap was used in 12 cases to replace mandibles with radionecrotic damage. The presence of a pathologic fracture, exposed necrotic bone, or a persistent fistula not responding to conservative treatment were the indications for such a radical approach. Mandible defects after resection were around 8.0 cm long, and in all cases intraoral mucosa, skin, or both were included with the bone excision. All vascularized fibula osteoseptocutaneous flaps transplanted were successful with good primary bone healing. Adequate facial symmetry and improvement in oral function was achieved. No evidence of osteoradionecrosis recurrence was observed after a mean follow-up period of 3 years and 9 months. The advantages of using the fibula osteoseptocutaneous flap for mandible reconstruction are numerous, and good aesthetic and functional results can be obtained when it is used for reconstruction after radical excision of osteoradionecrotic lesions.

Adult↗
PubMed1998

The distally based forearm island flap in hand reconstruction.

The distally based forearm island flap is vascularized by the perforators of the distal radial artery. The skin flap is along the axis of the radial artery, and the pivot point of its subcutaneous pedicle is about 2 to 4 cm above the radial styloid process. We have treated 12 patients with 12 flaps for soft-tissue defects of the hand. Of these recipient sites, seven were in dorsal hands, two were in thumbs, two were in forearms, and one was in the palmar area. The donor-tissue variants included eight skin flaps, two adipofascial flaps, and two sensate flaps. The sizes of the flaps ranged from 6 x 4 cm to 14 x 6 cm. The donor site wound could be closed primarily in five patients. Two sensate flaps, innervated by the lateral antebrachial cutaneous nerve, could provide sensation for thumb reconstruction. The advantage of this flap is its constant and reliable blood supply without sacrifice of the main radial artery. The elevation of the flap is simple and rapid. There is the potential that this flap can be used as an innervated flap, and there is no need of microsurgical technique.

Adult↗
PubMed1998

Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction.

Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time.

Adolescent↗
PubMed1998

Reliability of the venae comitantes in venous drainage of the free radial forearm flaps.

The radial venae comitantes are usually considered as an accessory venous outflow tract in the free radial forearm flap because of their smaller size and thinner structure when compared with those of the cephalic vein. To evaluate the reliability of the deep venous system, a single radial vena comitans anastomosis was performed to serve as the sole venous outflow tract in 94 consecutive radial forearm free flap transfers. The suprafascial dissection technique was used in flap elevation, which allowed preservation of the cephalic vein and the dorsal branch of the radial nerve. In all cases, the external diameter of at least one vena comitans was adequate (< or = 1.5 mm) to perform a smooth microvascular anastomosis; in none of the cases was a venous anastomosis failure detected. Preselected use of a single vena comitans for the venous drainage of radial forearm free flaps was proven to be reliable and was preferred because of the ease of flap dissection and better donor site appearance.

Adult↗
PubMed1998

Free transverse colon transplantation for functional reconstruction of intra-oral lining: a clinical and histologic study.

A variety of free-tissue transplantations are available for oropharyngeal (lining) reconstruction. The most commonly used flap, the radial forearm flap, is relatively thin, adaptable, and reliable but does not provide lubrication. In this study, the potential of the transverse colon to provide a lubricating tissue for replacement of oral lining was investigated. Eleven patients requiring replacement of oral lining received transverse colon flap transplantation between November of 1993 and December of 1995. There was one complete flap loss and one partial loss. Flap size used for reconstruction averaged 40.4 cm2, and average vessel length and diameter were 7 cm and 2.0 mm, respectively. In a follow-up period from 15 to 48 months, all colon flaps proved to be durable with continuous lubrication function. Histologic assessment of the transplanted colon flaps at various postoperative times showed an adequate amount of mucus-secreting goblet cells even after irradiation. There was no donor-site morbidity. The main disadvantage seemed a tendency to transplant too much tissue, which resulted in formation of redundant pockets affecting food handling. Thus, 8 out of 10 patients with flap survival required one to three debulking procedures. Given an accurate estimation of the area of mucosa defect and adequate trimming of the colon flaps, the transverse colon flap offers a good alternative for reconstruction of the oral lining, especially when lubrication is desirable in cases with large defects and preoperative or postoperative irradiation, or in case a radial forearm flap is not available.

Adult↗
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↗
PubMed1998

Tissue preservation in hand injury: the first step to toe-to-hand transplantation.

The recommendations outlined in this editorial for the initial management of nonreplantable amputation injuries emphasize tissue preservation. This facilitates future toe-to-hand transplantation in terms of reconstructive options, functional and aesthetic outcomes in the hand, and donor-site morbidity in the foot. It is hoped that surgeons involved in the emergency surgical care of such cases will find these guidelines useful. Although tissue conservation is the main goal at this stage of treatment, this should not be at the expense of tissue viability. If in doubt about management issues, advice should be sought from the reconstructive microsurgery unit.

Finger Injuries↗