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Biomedical subjects

F C Wei

Publications and source records attributed to F C Wei.

At least 145 records · Page 8Linked to original sources
PubMed1996

A new strategy to prevent the sequelae of severe Volkmann's ischemia.

This paper compares two treatment strategies in severe Volkmann's ischemia that differ in the time of exploration and excision of the muscle infarct. Six patients underwent late exploration, more than 1.5 months after injury, and 5 patients underwent early exploration, within 3 weeks of injury. Functioning free-muscle transplantation was later performed on all 11 patients for functional restoration. Hand function was evaluated in each group to determine the degree of intrinsic muscle function and sensibility. In the late group, all patients had restricted hand function due to clawing, poor opposition, and sensory disturbance. In the early group, all patients had preserved metacarpophalangeal joint flexion and interphalangeal joint extension without clawing, and two had preserved opposition. Sensory disturbance was mild, and good hand function was achieved. In severe Volkmann's ischemia, we advocate early reexploration with excision of the infarcted muscle within 3 weeks of injury or fasciotomy. Early exploration is technically simple, and neurolysis is not necessary. It preserves hand intrinsic function and sensation by removing the ischemic environment and preventing fibrosis that adds to nerve compression and nerve damage.

Acute Disease↗
PubMed1996

Vascularized toe joint transfer to the hand.

From 1984 to 1993, 36 vascularized toe joints were transferred in 33 patients. The present study group excludes 3 toe joint transfers to elbow and temporomandibular joints and 4 toe joint to hand transfers lost to follow-up. The final study group includes 29 vascularized toe joint transfers in 27 patients, 21 males and 6 females. All were performed for posttraumatic reconstruction, except one transfer for congenital deformity. Follow-up averaged 32.4 months. Mean range of motion was 34 degrees in toe metatarsophalangeal joint to hand metacarpophalangeal joint transfers, 32 degrees in toe proximal interphalangeal joint to hand metacarpophalangeal joint transfers, and 24 degrees in toe proximal interphalangeal joint to hand proximal interphalangeal joint transfers. Although vascularized toe joint transfer is an alternative to arthrodesis, in order to have a greater range of motion than average, the patient must have well-functioning muscle and associated tendons effecting joint motion. Good results were obtained in two immediate free vascularized toe joint transfers to complex injuries involving loss of the metacarpophalangeal joint. We encourage toe joint transfer in selected complex hand injuries.

Adolescent↗
PubMed1996

Monitoring of plasma clozapine levels and its metabolites in refractory schizophrenic patients.

Plasma concentrations of clozapine and its metabolites desmethylclozapine and clozapine N-oxide were measured in 61 patients with refractory schizophrenia. Before the initiation of clozapine, each patient was given haloperidol (HL) up to 60 mg/day for at least 4 weeks without improvement. Patients were then given a fixed dose of clozapine 400 mg/day. Patients were assessed with the Brief Psychiatric Rating Scale (BPRS) at baseline before HL therapy, at the end of HL at 6 weeks, before clozapine, and after 6 weeks of clozapine therapy. Clozapine and its metabolites were measured by high-performance liquid chromatography with ultraviolet detection. The mean plasma concentrations of clozapine, desmethylclozapine, and clozapine N-oxide were 598 +/- 314, 281 +/- 140, and 90 +/- 29 ng/ml, respectively. The mean decrease in the total BPRS scores from baseline clozapine to the 6-week treatment period was 11 +/- 4. Clinical improvement was noted to occur in most patients with clozapine plasma levels > 300 ng/ml. Improvement diminished in patients with clozapine plasma levels > 700 ng/ml. The most common adverse effects were sedation and hypersalivation. Significant correlations between plasma clozapine concentrations and adverse side effects were not found.

Adult↗
PubMed1996

Toe-to-hand transfer. Current concepts, techniques, and research.

The current status of toe-to-hand transfer at the Chang Gung Memorial Hospital is presented. Various combinations of toe-to-hand transfers have been used routinely for reconstruction of lost digits as well as parts of the digits distal to the sublimis insertion. Early, one-stage reconstruction is recommended in patients with clean wounds when replantation is not feasible. The decision of which technique to be used in certain patients is highly individualized. Technical refinements have been introduced aimed at simplifying the technique of toe harvesting and improving the function and appearance of the reconstructed digits as well as donor sites. Aggressive motor rehabilitation and sensory re-education are essential for optimal functional recovery. Current research projects involve evaluation of patients using the computerized work simulator, gait analysis, and somatosensory evoked potentials. Morphometric studies of the digital nerves in the fingers and toes have been performed to determine the effect of neurotization upon the degree of sensory recovery.

Amputation, Traumatic↗
PubMed1996

A practical loading dose method for converting schizophrenic patients from oral to depot haloperidol therapy.

BACKGROUND: Haloperidol decanoate is a long-acting depot antipsychotic agent used for the treatment of schizophrenic patients. The decanoate formulation was developed to treat schizophrenics who have a history of noncompliance with oral medication. Studies of techniques to convert from oral to depot therapy have not utilized the pharmacokinetics of the decanoate formulation. This study is a prospective evaluation for converting patients from oral to depot treatment. METHOD: Twenty-one patients meeting DSM-III-R criteria for schizophrenia participated in the study. Patients were treated with oral haloperidol for 6 weeks and then were switched to decanoate. Haloperidol decanoate 100 mg was administered on a weekly basis for the first 4 weeks. Afterward, injection intervals were increased to every 2 weeks and then to every 4 weeks. Plasma haloperidol concentrations were obtained prior to the next injection and assayed by HPLC with electrochemical detection. Patients were monitored by the psychiatrists and nursing staff for symptoms of clinical deterioration. RESULTS: All patients completed the conversion trial during the first 4 weeks without any problems or adverse side effects. By the third week, mean plasma haloperidol concentrations from the decanoate injections were comparable with those of the 10-mg oral haloperidol treatment (7.95 +/- 4.94 ng/mL vs. 7.79 +/- 4.79 ng/mL). Steady-state conditions for the decanoate therapy were achieved by the fourth week. CONCLUSION: These findings suggest that schizophrenic patients can be easily converted from oral to depot therapy without problems. Further studies with haloperidol decanoate and its conversion from oral treatment utilizing plasma concentrations are needed.

Administration, Oral↗
PubMed1995

Effect of postischemic reperfusion on microcirculation and lipid metabolism of skeletal muscle.

To study the effect of ischemia reperfusion injury on microvascular reactivity and tissue metabolism in skeletal muscle, a Sprague-Dawley rat cremaster muscle was prepared as a tourniquet ischemia model and subjected to 2 hr ischemia followed by 1 hr reperfusion to simulate the timing of ischemia during microvascular surgery. The dose-response curve of arteriolar reactivity to norepinephrine, lipid peroxidation, and ultrastructure of capillaries was determined in both the control and postischemic reperfusion stages. Judging from the results, we summarize our observations as follows: (1) Postischemic reperfusion significantly increased arteriolar reactivity to norepinephrine, in which the EC50 for vasoconstriction decreased in all three orders of arterioles. These results suggest that reperfusion could have impaired the vasodilation control mechanism, possibly being endothelium dependent. (2) Lipid peroxidation increased sixfold in the reperfusion group, suggesting that oxygen free radicals have produced significant tissue damage under the created conditions. (3) Significant endothelial damage in the capillaries shown by electron microscope observation supports these studies, indicating that ischemia/reperfusion in clinically transplanted skeletal muscles could cause significant damage to the tissue microcirculation both physiologically and metabolically.

Animals↗
PubMed1995

Delayed sensory reeducation after toe-to-hand transfer.

The effect of a delayed program of sensory rehabilitation was evaluated in 13 patients with a total of 22 toe-to-hand transfers. Each patient was begun on a protocol of sensory reeducation at a mean of 38 months (range 13-98 months) after the transfer. Home rehabilitation, employing a Disk-Criminator (TM) program, was monitored at monthly intervals by the therapist for a mean of 3.3 months, at which time a final evaluation of sensibility was done. Each of the 22 toe transfers improved by an average of 7 mm in static and 6 mm in moving two-point discrimination. The improvement in two-point discrimination following delayed implementation of sensory reeducation was statistically significant at the P < 0.0001 level.

Adult↗
PubMed1995

Two immediate synchronous free flap transfers in a severe traumatic mid-hand defect: a case report.

A 66-year-old patient sustained a severe right hand injury resulting in a thumb pulp defect and unreplantable amputation of the index, long, and ring fingers at the metacarpophalangeal joint with joint exposure. There was also an 8 cm defect of the radial digital nerve of the little finger. Immediate one-stage total reconstruction of all of the defects was accomplished by a free groin flap and a free glabrous skin flap from the foot. Opposable function of the hand was thus preserved.

Aged↗
PubMed1995

The versatility of free rectus femoris muscle flap: an alternative flap.

In the 10-year period from June 1985 to December 1994, 54 free rectus femoris muscle or musculocutaneous flaps were performed at our hospital. It has been one of the most frequently used free muscle flaps in our institution and forms 2% of all free tissue transfers (total, 2,769 cases). In 26 patients, it was used for large wound coverage following debridement or tumor ablation, and in 27 patients, as a functioning free muscle transplantation for brachial plexus palsy or traumatic muscle loss. In one patient the components of the deep aponeurosis, muscle, and overlying skin were used for reconstruction of an abdominal wall defect after neurilemmoma excision. There were two complete failures, one due to diabetic foot infection and one due to venous occlusion. Four had superficial marginal skin necrosis. No significant disability of the donor limb was encountered. Easy approach, rapid harvest, large and reliable overlying skin flap, a single dominant neurovascular pedicle (with large vessel diameter and long motor nerve), easy primary closure of the donor site, and minimal donor site morbidity all make the rectus femoris flap a good alternative flap for free tissue transfer, in addition to the gracilis, rectus abdominis, and latissimus dorsi muscle flap.

Adult↗
PubMed1995

Recovery of sensation and somatosensory evoked potentials following toe-to-digit transplantation in man.

Recovery of digital nerve function in 21 patients with toe-to-digit transplantation was evaluated by clinical sensory tests and somatosensory evoked potentials (SEPs) to median and digital nerve stimulation. The mean interval between injury and surgery was 7 months, and that between surgery and study was 31 months. The transplanted toes achieved a satisfactory but incomplete recovery in temperature (warm and cold), pinprick, touch, vibration, and two-point discrimination in that order. The overall sensory status of the transplanted toes appeared to be closer to normal toes than to normal fingers. In SEPs from the transplanted side, median N9, N13, and N20 components had normal latency but reduced amplitude, whereas digital N9 component was usually absent, but N13 and N20 components had prolonged latency and reduced amplitude. Transplantation performed within 1 month after injury prevented amplitude reduction in median SEPs and latency prolongation in digital SEPs. The SEP data suggest that timing of surgery was critical in preventing retrograde effect on the median nerve, and that recovery of digital nerve function was incomplete correlating with clinical sensory findings.

Adolescent↗
PubMed1995

Irreversible muscle contracture after functioning free muscle transplantation using the ipsilateral facial nerve for reinnervation.

Four patients who underwent functioning free muscle transplantation (FFMT) for facial reconstruction developed a progressive disfiguring muscle contracture. This complication has not been previously reported. Three of the patients had longstanding facial paralysis and were reanimated by FFMT. The fourth patient had left hemifacial atrophy but without facial paralysis. She also underwent FFMT for augmentation. All four FFMTs were innervated by the ipsilateral facial nerve. Initially, they all had a normal facial appearance at rest during the first few months after FFMT. However, they all developed a progressive severe muscle contracture from 6 to 12 months after FFMT. Continuous spontaneous electrical impulse activity, which stimulated the transferred muscle day and night, may be responsible for the progressive muscle contracture. From the patients' reported sensations and from clinical evaluation, which included a local xylocaine injection test, over-reinnervation with a synkinesis effect of the transferred muscle is hypothetically the main cause, not over-tension of the muscle itself. This complication may possibly be avoided by limiting or decreasing the number of fascicles from the ipsilateral facial nerve or better by using a cross-facial nerve graft instead of the ipsilateral facial nerve as the innervating motor nerve. The outcome with a cross-facial nerve is likely to be more predictable and reliable.

Adolescent↗
PubMed1995

Secondary procedures to improve function after toe-to-hand transfers.

From August 1990 to December 1992, 139 toe-to-hand transfers were performed on 99 patients. Crush, avulsion, and combined crush and avulsion were the mechanisms of injury in 92.8% of the cases. Average duration of follow-up was 17 months (1 to 40 months). 133 transfers were successful, an overall survival rate of 95.7%. 19 transfers (14.3%) required secondary procedures for functional improvement. The incidence of secondary procedure on tendon, bone, joint and soft tissue was 9.0%, 1.5%, 2.3% and 3.0% respectively. Flexor tenolysis was the single most common secondary procedure (6.8%). The results of secondary procedures were satisfactory in all but one instance. Transient neurapraxia of an ulnar digital nerve after tenolysis was the only complication of the secondary procedures.

Adolescent↗
PubMed1995

An evaluation of velopharyngeal ring ligation in cleft palate repair.

PURPOSE: This article describes the details of the velopharyngeal ring ligation procedure (VPRL) and compares the results with those achieved with the von Langenbeck (VL) and pharyngeal flap procedures (PFP). PATIENTS AND METHODS: A random sample of 52 patients was evaluated postoperatively by phonation tests, measurement of oral pressure, pharyngeal fluoroscopy, and cineradiography. RESULTS: The results showed that the speech of the VPRL group was significantly better than that of the VL group. The velopharyngeal competence rate, the anteroposterior nasopharyngeal minimal diameter, the left-right nasopharyngeal minimal diameter (both in repose and on phonation), and the length of the soft palate were significantly different between VPRL and VL, and between VPRL and PFP. Differences in the velar angle were significant between VPRL and PFP and between PFP and VL, but there was no significant difference between VPRL and VL. CONCLUSIONS: VPRL is a better method for cleft palate repair than the VL or PFP procedures. It can reduce the nasopharyngeal space circumferentially, thus improving the patient's speech.

Adolescent↗
PubMed1995

Single third-toe transfer in hand reconstruction.

Eighteen third-toe transfers to the hand were performed from 1984 to 1993 in 15 patients. These patients had multiple amputations, and follow-up ranged from 5 to 78 months with an average of 27 months. Single third-toe-to-hand transfer was elected when (1) the second toe was not available or not suitable for transfer, (2) the second toe was located in the same foot where the great toe had been transferred to the thumb and the second toe was, therefore, spared for gait, or (3) the third toe was a better size match.

Adolescent↗
PubMed1995

Intraosseous wiring in toe-to-hand transplantation.

Although there are many reports on bony fixations in finger replantations, information pertaining to fixation methods in toe-to-hand transplantations is scarce. The results of intraosseous wiring were evaluated in 68 toe-to-hand transplantations in 47 patients. Clinical and radiological evaluation of bony union was conducted an average of 30 months after the procedure. There was no malunion. There was one painless pseudarthrosis, with an overall nonunion rate of 1.5%. Intraosseous wiring is a simple, quick, dependable, and consistent method of fixation in toe-to-hand transplantation.

Adolescent↗
PubMed1995

The composite groin fascial free flap.

Seven patients with extensive loss of soft tissue, extensor tendon, and exposure of bone and joint of dorsum of hand and foot were treated with free composite flaps from the groin area. To retard the adhesion by scarring, membrane interposition between tendon and bone was recommended. The groin flap, based on superficial circumflex iliac vessels, was combined with a well-vascularized external oblique aponeurosis. The groin skin flap provided skin coverage, and the aponeurosis was used simultaneously to create a gliding surface for reconstructed tendons in a single one-stage procedure. All composite free-tissue transfers were successful. The advantages of this technique are: (1) a single, one-stage procedure; (2) fewer adhesions of reconstructed tendons, and no need of secondary tenolysis; and (3) good cosmesis and minimal morbidity at donor site.

Adolescent↗
PubMed1995

Short gracilis myocutaneous flaps for vulvoperineal and inguinal reconstruction.

From October of 1990 to April of 1993, 16 short gracilis myocutaneous flaps and 1 short gracilis muscular flap were used to reconstruct vulvoperineal, inguinal, perineal, and ischial soft-tissue defects. Five of the 6 bilateral myocutaneous flaps were used for vulvoperineal reconstruction after radical vulvectomy combined with partial vaginectomy and one radical vulvectomy. Four unilateral myocutaneous flaps and one muscular flap were used for inguinal, suprapubic, ischial, and perineal reconstruction after release of contracted scar or excision of an ischial pressure sore. The immediate complications consisted of partial necrosis of the distal third of the cutaneous tissue in 6 patients, 1 superficial cutaneous necrosis, and superficial wound infection in 7 patients. The muscular portion of the flaps all survived. The follow-up period was from 6 to 27 months. The short gracilis flap has greater mobility than the classically described gracilis flap. On the basis of the functional and cosmetic results, the short gracilis flap is an excellent alternative to the more bulky classic gracilis flap.

Adolescent↗