Biomedical subjects

F C Wei

Publications and source records attributed to F C Wei.

At least 163 records · Page 9Linked to original sources

PubMed1995

Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers.

During the 5-year period between 1987 and 1991, 99 patients with total root or upper root (C5, C6, or C7) injuries were treated by nerve transfer to obtain shoulder abduction. More than eight different combinations of coaptation between donor nerves (intercostal nerves, phrenic nerve, spinal accessory nerve, ipsilateral C7, or cervical motor nerves) and recipient nerves (suprascapular nerve, axillary nerve, and upper trunk or C5) were applied. All patients had at least 2 years of follow-up. Different results were obtained in each category. Simultaneous neurotization of the suprascapular and axillary nerves with the phrenic and spinal accessory nerves obtained much better and more reliable shoulder abduction. Neurotization of the C5 spinal nerve by multiple nerve transfers was another good option that yielded good shoulder abduction in a single patient. If the phrenic nerve was traumatized, neurotization of the suprascapular nerve solely with the spinal accessory nerve was still capable of achieving an acceptable range of shoulder abduction.

Adolescent↗

PubMed1995

Pulp plasty after toe-to-hand transplantation.

Pulp plasty is a simple procedure that is used to debulk the bulbous-appearing pulp of a transplanted digit after toe-to-hand transplantation. A retrospective review of the effect of pulp plasty on the appearance and function of the debulked digit was conducted of 82 digits on 51 patients. Pulp plasty was performed on average of 14 months after toe-to-hand transplantation; the average follow-up interval was 20 months. Subjective improvement in appearance and function was reported in 67.1 and 63.4 percent, respectively, of the debulked digits. Painful scarring was rare, and hypersensitivity was not reported. Sensation was not affected adversely by pulp plasty. The procedure was considered to be worthwhile in 87.8 percent of the cases. Pulp plasty is a simple and effective procedure after toe-to-hand transplantation that enhances the appearance and function of the transplanted digit. Patient satisfaction with the procedure is high.

Adolescent↗

PubMed1995

Reconstruction of below-knee stump using the salvaged foot fillet flap.

Three cases of below-knee stump reconstruction, using cross-legged, free sole flap, free foot filleted flap, and island pedicle sole flap, were reported. The variability of the flap size provided satisfactory coverage as needed in all cases. The causes of amputation were acute trauma and chronic osteomyelitis. The contour of the stump, the sensory recovery, the preserved range of motion of the knee joint, and the long-term durability were satisfactory in these patients. Some pitfalls of this procedure and criteria for evaluating the distal extremity soft tissue with respect to their suitability for use are discussed.

Adult↗

PubMed1995

Retrograde dissection of the vascular pedicle in toe harvest.

A retrograde approach to dissection of the vascular pedicle in toe-to-hand transfer is presented, along with a simplified view of the vascular anatomy of the first web space. This approach has several advantages. First, the dominant vascular supply to the toe is elucidated early in the procedure, allowing for less unnecessary dissection of an inadequate pedicle. This also eliminates the need for preoperative arteriography. Furthermore, in cases where a lengthy pedicle is not required, retrograde dissection dispenses with harvest of a proximal vessel, which will not be needed for the transfer, and destructive dissection of the foot can be minimized.

Arteries↗

PubMed1995

One rectus abdominis muscle for two separated soft-tissue reconstructions.

One rectus abdominis muscle flap, when based on superior and inferior pedicles, can be transferred simultaneously as two free-muscle flaps in two different configurations during the same operation. The two free flaps based on either pedicle are safe, reliable, and extremely well vascularized. Excellent functional and cosmetic results have been achieved in five patients with minimal donor-site morbidity. It has been our flap of choice for reconstructing the moderate- to large-sized defects at two separate sites of the upper and lower extremities.

Abdominal Muscles↗

PubMed1995

Free tissue transplantation in the 90's.

Free tissue transplantation is now a well-established discipline and a common phrase in the medical literature. Only as recent as two decades ago, free tissue transplantation with microvascular anastomosis was a daring venture attempted by a selected few. It was considered to be a heroic effort of last resort when other reconstructive options were exhausted. Reconstructive surgeons were limited by tissue availability before free tissue transplantation with microsurgical techniques. With pedicle flaps, patients were subjected to multiple operations and hospitalizations and long periods of immobilization. The possibility of moving a large block of tissue to another body location by anastomosing its vascular pedicle with local blood vessels was tantalizing to reconstructive surgeons. The ability to perform anastomosis on small vessels had to be mastered before such a dream could be realized.

Amputation, Traumatic↗

PubMed1994

Distal phalanx replantation.

Microsurgical replantation has been attempted in the distal phalanx of the digits. Twenty-three complete, single digit amputations are reviewed. The patients' ages ranged from 9 months to 48 years. Viability was 78%. Sensory recovery averaged 7 mm static two-point discrimination. Range of motion in the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb averaged 64 and 51 degrees, respectively. Eight of the 17 successfully replanted digits had mild to moderate atrophy. Eighty-two percent of patients were able to use the replanted digit successfully in their daily work. We feel that distal digital replantation is rewarding. In successful cases, it always preserves acceptable function and good appearance at a price of an average of 2.3 months off work.

Adolescent↗

PubMed1994

Fibula osteoseptocutaneous flap for mandible reconstruction.

The fibula free flap has become an established flap for mandible reconstruction when vascularized bone is desirable. Recreating mandibular contour, providing soft tissue coverage, and restoring masticatory function are equally important in mandible reconstruction, and these can be provided by the fibula osteoseptocutaneous flap. This article is a summary of the anatomy, indications, and operative technique of the fibula osteoseptocutaneous flap accumulated from 49 consecutive mandible reconstructions.

Ameloblastoma↗

PubMed1994

Replantation of amputated facial tissues with microvascular anastomosis.

A challenge to the microsurgeon is perfecting the technique of replantation of small pieces of facial tissue, mainly because of the extremely small size of the arteries as well as a lack of suitable veins for drainage. In the past 4 years, we have had seven cases of facial amputations, which included one scalp, two nasal tips, two ears, one lower lip, and one eyebrow. All of these patients were replanted/revascularized by microvascular anastomosis. Only two of the cases had suitable veins for anastomosis. Alternative techniques used for improving venous outflow were arterio-venous fistula, chemical leeches, and pin pricks. Four of the cases were completely successful, two cases had partial loss of the replant, and one case failed due to absence of venous drainage. In facial amputation, an aggressive microsurgical attempt will result in more tissue surviving and a better cosmetic outcome than in any other reconstructive procedures.

Adult↗

PubMed1994

Technical considerations in two-stage functioning free muscle transplantation reconstruction of both flexor and extensor functions of the forearm.

We report on two patients with severe injuries of the forearm who were reconstructed using functioning free muscle transplantation (FFMT) for individual replacement of flexor and extensor function. In both cases a two-stage procedure was performed: The extensor reconstruction preceded the flexor reconstruction by 4-6 months. The extensor digitorum communis and flexor digitorum profundus were successfully reconstructed in both cases using bilateral gracilis FFMT. In one case the flexor pollicis longus and extensor pollicis longus were also reconstructed using the adductor longus in addition to the gracilis. Clinical follow-up was a minimum of 2 years. Both patients achieved wrist control, excellent finger flexion, and metacarpophalangeal joint extension. One patient also had good interphalangeal finger extension, but the other developed a persistent claw deformity due to the lack of recovery of ulnar nerve function. Performing the extensor reconstruction prior to the flexor reconstruction theoretically allows a more rapid return of function and a shorter rehabilitation period than using the converse sequence.

Adult↗

PubMed1994

Pattern assembly--an aid to flap design during oral microsurgical reconstruction.

Surgical ablation of tumors within the oral cavity results in a three-dimensional defect and a potential puzzle for the reconstructive surgeon. Although a myriad of papers discussing the relative advantages and disadvantages of various methods of reconstruction are readily available for consultation, very few publications have provided the surgeon with a guide either to visualization of the defect or to how to reconstruct a three-dimensional defect with an essentially two-dimensional flap. Our intention is not to provide the answer for every oral reconstructive problem--after all, no two patients are alike--but we will demonstrate that an appreciation of the defect in three-dimensions, together with an understanding of oral function, provides a template for flap design and inset. This is achieved by simplifying the complex anatomical shape of the oral cavity into a geometric form from which a series of simple, easily recognisable shapes can be derived and assembled as necessary into a pattern that reproduces the defect, providing a template for flap design and inset.

Humans↗

PubMed1994

Fibula osteoseptocutaneous free flap in maxillary reconstruction.

The skin paddle in the fibula osteoseptocutaneous flap is thin, soft, and pliable, and it can be used for external skin coverage and intraoral linings. The flexibility of the fibula in three-dimensional positioning after multiple osteotomies is desirable in complex spatial skeletal reconstruction. The fibula osteoseptocutaneous flap is suitable for one-stage reconstruction of composite maxillary defects. The unique characteristics of the fibula osteoseptocutaneous flap and its application in the one-stage composite maxillary defect are discussed.

Adult↗

PubMed1994

Selection of recipient vessels for free flaps to the distal leg and foot following trauma.

The recipient vessels are of prime importance in free flap transfers to the lower limbs. To determine the incidence and pattern of vascular trauma, a study was carried out in 126 patients who had Gustillo Type III open fractures of the distal legs and feet that required free flaps for wound coverage. In comparison with the posterior tibial artery, the anterior tibial artery has a much higher incidence of injury with more extensive damage. It can be injured at a more proximal level than estimated from gross inspection during surgery. This should be borne in mind when the anterior tibial artery is selected as the recipient artery in order to prevent reexploration and failure of the flaps. However, the posterior tibial artery is much less vulnerable to damage in most injuries and is more reliable as the recipient artery. In this series there was no problem in finding proper recipient veins in the legs. A general principle is proposed for selecting recipient vessels in crushed legs, with a warning against the pitfalls that have been encountered.

Adolescent↗

PubMed1994

The sensate fibula osteoseptocutaneous flap: a preliminary report.

The ideal oromandibular reconstruction calls for restoration of intraoral sensation as well as tissue replacement because the loss of sensation in the oral cavity impairs oral function. The versatility and flexibility of the fibula osteoseptocutaneous flap in complex three dimensional spatial positioning lends itself to be desirable in composite oromandibular reconstruction. It falls short of being ideal because the skin paddle of the flap is usually insensate and thus oral sensation is not restored. The skin paddle of the fibula osteoseptocutaneous flap is innervated by the lateral sural cutaneous nerve and this nerve can be preserved and reinnervated to restore sensation to the skin paddle. The sensate fibula osteoseptocutaneous flap may be the ideal flap for one stage composite reconstruction of oromandibular defects. This is a preliminary report on the sensory return of the sensate fibula osteoseptocutaneous flap in oromandibular reconstruction.

Adult↗

PubMed1994

Reverse dorsometacarpal flap in digits and web-space reconstruction.

Skin defects in some areas of the digits are difficult to reconstruct, such as the ulnar aspect of the little or ring finger, radial aspect of the index, dorsal or volar aspect of fingers with proximal interphalangeal or metacarpophalangeal joint involvement, and proximal phalanx of the thumb. Moderate or severe contracture of the web space and multiple finger injuries without an available cross-finger flap are also a challenge to reconstructive surgeons. The reverse dorsometacarpal flap presents an option for reconstruction because of these difficulties. It is reliable and versatile in design. The donor site can be closed primarily provided the flap is less than 2 cm wide.

Adult↗

PubMed1994

Miniature plates and screws in acute complex hand injury.

Thirty-six patients with 72 metacarpal and phalangeal fractures with associated injuries to the neurovascular bundle, tendon, soft tissue, or bone following acute complex hand injury were treated with miniature plates and screws and reconstruction of the disrupted and missing structures. The results were judged according to the criteria of the American Society for Surgery of the Hand. The overall results were good in 46.3%, fair in 32.2%, and poor in 21.5%. Although traditional wiring techniques are certainly useful in complex hand injuries, internal osteosynthesis with miniature plates and screws has definite indications in cases requiring stable and rigid internal fixation.

Adult↗

PubMed1994

Microsurgical thumb reconstruction with toe transfer: selection of various techniques.

Microsurgical toe transfer is an established method for reconstruction of missing thumbs. However, there is little agreement on which of the various techniques represents the ideal transfer. Basically, selection of technique requires balancing the patient's functional needs, appearance of the reconstructed thumb, and donor-site cosmesis. Based on our experience with 103 toe-to-thumb transfers performed over the past 9 years, this paper attempts to provide guidelines for appropriate selection among the four most commonly employed toe transfer techniques (e.g., second toe, total great toe, great toe wrap-around, trimmed great toe) so that optimal results and patient's acceptance can both be achieved.

Adolescent↗

PubMed1994

Transposed replantation of fingers at forearm bones in severe segmental injuries across the hand and wrist.

There are situations in which amputated hands or fingers cannot be replanted directly back to their original positions. When there is severe segmental injury across the hand and wrist but one or several fingers are still healthy, the fingers can be selected to be replanted at the forearm bones to restore pinch function. This is different from the toe to antebrachial stump transplantation presented by Dr. Vilkki. From the results in four patients, the following conclusions are drawn: (1) When the fingers are replanted at the forearm bone(s), only pinch function can be obtained. There is no opposition. (2) Grip function is weak because the intrinsics are lost and only a few fingers are replanted. The forearm bones are often shortened, as are the flexors. (3) Of particular importance is the creation of a large web space between the radial digit and ulnar digit(s), because fingers are longer than toes. (4) The sensory recovery is not so good as in ordinary finger replantation. However, this is a salvage procedure. Regardless of these facts, the patients are still satisfied with the results out of such severe injuries. With good pinch function, not only are they independent in daily life, but they also can do a lot of work. It is a worthwhile procedure. A functional prosthesis can be added distally after this replantation.

Adult↗