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Biomedical subjects

F D Burstein

Publications and source records attributed to F D Burstein.

52 records · Page 3Linked to original sources
PubMed1994

Surgical correction of severe scaphocephalic deformities.

Sagittal synostosis may result in severe skull deformities. Characteristic components of the deformity include extreme elongation, frontal and occipital bossing, temporal pinching, and angulatory apical skull deformation. Conventional strip craniectomy often fails to correct these complex problems completely in severe early or late cases of sagittal synostosis. Techniques for total calvarial vault reconstruction have previously been reported, but a single large series has not been presented. Eighteen consecutive patients ranging in age from 3 months to 5 years (mean = 12 months) with severe early and late scaphocephalic skull deformities underwent total calvarial vault reshaping. All children required transfusions ranging from 250 to 1,100 mL. Operative times averaged 6 hours, and hospital stay ranged from 4 to 7 days. There was no perioperative mortality. Two patients experienced transient syndrome of inappropriate secretion of antidiuretic hormone, which responded to fluid restriction. One patient was noted to have a 2-cm parietal craniectomy defect 9 months after operation. Microscrews, which were used in all 18 patients, had to be removed in 2 patients when they became palpable. Excellent aesthetic results were noted in all 18 patients up to 36 months of follow-up.

Child, Preschool↗
PubMed1993

Total calvarial reconstruction for sagittal synostosis in older infants and children.

Premature closure of the sagittal suture is the most common form of craniosynostosis, but this condition occasionally goes unrecognized until the child is too old to undergo procedures that depend upon continued calvarial growth for success. As the entire calvaria is affected and thus misshapen by sagittal synostosis, late correction involves total calvarial reconstruction. The extensive nature of this undertaking has precluded its utilization despite the presence of significant deformities. Adapting the techniques and experience gained from craniofacial surgery, the authors performed total calvarial reconstruction on nine children with sagittal synostosis and subsequent scaphocephaly diagnosed after the age of 1 year. In each case the goals of shortening the anteroposterior length, widening the biparietal diameter, and reducing frontal and occipital deformities were met. Morbidity consisted of acute blood loss, postoperative hyponatremia, and in one case a residual skull defect. The rationale for this procedure and the techniques utilized are discussed.

Blood Loss, Surgical↗
PubMed1990

Extensive wounds of the spine: a comprehensive approach to debridement and reconstruction.

Extensive wounds involving the spine (greater than three vertebral segments exposed) may threaten its indispensable roles of biomechanical support and vital neurologic function. Although there have been select reports of specific flap applications in this body region in the reconstructive surgical literature, there has been a paucity of comprehensive descriptions of pertinent anatomy, pathophysiology, and the perioperative care of such patients--including the degree to which the spine is suited to aggressive debridement. Four patients with complex spine wounds involving greater than three vertebral segments were treated by the authors from 1986 through 1988. These patients ranged from 28 to 80 years of age. They were all found to have multiple risk factors, including neoplasm (4), severe nutritional depletion (3), advanced age (2), wound sepsis (2), and multiple other general medical problems (4). All patients underwent wide bony and soft-tissue debridement. A new clinically essential four-pillar concept of spinal support predicted spinal instability in two of the four patients. These patients could thus be protected from neurologic compromise with internal stabilization (1) or external orthotic support (1). Wound closure was achieved with skin graft (1) or traditional or extended musculocutaneous flap coverage (3). With 7 to 20 months of follow-up, wound healing has been complete in all patients despite a 100 percent complication rate and one late postoperative death. Multisegment spine wounds tend to arise in the setting of multiple medical problems or risk factors. Despite these risk factors and a high postoperative complication rate, gratifying results may be achieved in these patients with a comprehensive understanding of regional surgical anatomy and a multidisciplinary approach to their care.

Adult↗
PubMed1989

Scanning electron microscopy and gel electrophoresis of vascularized periosteal autografts.

This study was devised to investigate the morphologic and biochemical sequence of events occurring during early periosteal osteogenesis in vascularized periosteal flaps. A pleuroperiosteal flap based on the intercostal vessels was developed and rotated onto the chest wall in 12 adult dogs. Animals were sacrificed at intervals between 7 and 60 days, and the flaps were removed with the underlying muscular bed. Specimens were studied by tetracycline uptake, gel electrophoresis, light microscopy, and the scanning electron microscope. Osteoprogenitor cells were seen as early as 7 days after transfer. Collagen fiber deposition was vigorous and noted in all specimens with rapid mineralization by 9 to 15 days. There was no structural or vascular interaction between the flaps and the recipient muscular bed. Gel electrophoresis confirmed the presence of type I and III collagen, with an increase in type I collagen over time. The pattern of collagen deposition and the final bony architecture resembled that of woven bone.

Animals↗
PubMed1989

Elbow joint salvage with the transverse rectus island flap: a new application.

The transverse rectus island flap has gained wide acceptance in breast reconstruction. We introduce its use in reconstruction of extensive wounds of the elbow region. Three cases are presented. Its principal advantages over other methods are size, pedicle length, reliability, acceptable donor defect, and potential prevention of elbow and shoulder stiffness. Its disadvantages are bulk, weight, and required staged procedures.

Amputation, Surgical↗
PubMed1987

The pectoralis major myocutaneous flap. Use in surgery of the lower neck and superior mediastinum.

Surgery of the lower neck and superior mediastinum is most frequently performed for parastomal recurrence of laryngeal carcinoma. It has been associated with a high incidence of complications, often leading to fatal innominate artery rupture. The use of the pectoralis major myocutaneous flap has permitted wide en bloc resections of the superior mediastinum in ten patients without a major complication. Several technical innovations add versatility to the pectoralis major myocutaneous flap, including tailor fitting each skin paddle and incorporating the pectoralis minor into the muscular pedicle. Superior mediastinal resection should be performed in conjunction with laryngectomy and cervical lymph node dissection in patients who are at high risk for parastomal recurrence. We also recommend that patients with parastomal recurrence undergo this procedure for salvage.

Aged↗
PubMed1986

Composite hyoid-sternohyoid interposition graft revisited: UCLA experience 1974-1984.

The surgical correction of severe laryngotracheal stenosis remains a challenging problem. We report on a series of 20 patients treated with the composite hyoid-sternohyoid interposition graft (HSIG). They range in age from 1 to 66 years and all had severe subglottic stenosis refractory to dilatation and stenting procedures. The major cause of stenosis was prolonged endotracheal intubation (16/20); the majority of patients (13/20) had severe medical illness complicating their airway management. Postoperative results were judged on the basis of decannulation, voice strength, and quality as well as activity tolerance. Follow-up periods were over 24 months in all cases. Twelve patients were decannulated and three keep their tracheotomy tubes permanently plugged. All have socially acceptable voices and good activity tolerance. Seven patients who were aphonic had voice improvement. There were three complete failures; one secondary to infection, one due to severe scleroderma, and one because of graft displacement. Each patient underwent an average of four postoperative endoscopies for airway evaluation and removal of granulation tissue. CAT scanning was useful in diagnosing postoperative problems, especially graft displacement, which was impossible to diagnose by endoscopic examination. We conclude that the composite hyoid-sternohyoid interposition graft is a useful and reliable tool in the treatment of subglottic stenosis.

Adolescent↗
PubMed1985

Use of polytetrafluorinated ethylene compound in peripheral nerve grafting. An experimental study.

The suitability of polytetrafluorinated ethylene compound (Gore-tex) tubing in peripheral nerve grafting was studied using a rat sciatic nerve model. Thick-walled (0.36 mm) tubing was compared with thin-walled tubing (17 mm). Thin-walled tubing gave a favorable functional and microscopic result in five of seven animals, while thick-walled tubing gave a favorable graft result in three of six animals. The results achieved with the thin-walled tubing were comparable to those achieved using nerve grafts and vein interposition grafts.

Animals↗
PubMed1985

Osteogenesis in vascularized periosteum. Interactions with underlying bone.

This study is the first in a series of experiments undertaken to obtain basic information regarding the behavior of vascularized periosteum. Ten adult dogs were used and in each animal costal periosteum was alternatively placed in contact with normal (but previously detached) rib, and rib segments devitalized by autoclaving, decorticated, and isolated by means of a Silastic wrap. Specimens were harvested at 10, 20, 40, and 70 days and were evaluated grossly, histopathologically, and by tetracycline hydrochloride fluorescence studies. Periosteum in contact with intact bone became osteogenic within 20 days. Periosteum in contact with autoclaved and decorticated bone also became osteogenic but at a slower rate. Isolated periosteum failed to produce bone. These findings indicate that osteogenesis in transferred periosteum depends not only on maintenance of its vascular supply but also on its proximity to viable bone and its ability to interact with the recipient surface.

Animals↗
PubMed1985

Studies on the osteogenic potential of vascularized periosteum: behavior of periosteal flaps transferred onto soft tissues.

We investigated the basic properties of vascularized periosteal autografts. A pleuro-periosteal flap based on the intercostal vessels was developed in a canine model. Fourteen animals had vascularized periosteal flaps rotated onto the soft tissues of the chest wall. These animals were killed at intervals of 7 to 90 days and the flaps were studied by tetracycline labeling and light microscopy. Four other animals had similar flaps transplanted onto the soft tissues of the neck by microvascular techniques. All harvested flaps showed periosteal bone production, leading to the following observations: Osteogenesis begins as early as 7 days after grafting; the rate and extent of periosteal osteogenesis is proportional to the vascular supply; bone formation starts in small foci of active osteoblasts that grow and become confluent; and intimate bony periosteal contact is not necessary for periosteal osteogenesis to take place, but it appears to influence the rate and amount of bone formation.

Animals↗
PubMed1985

Supraglottic laryngectomy: series report and analysis of results.

Forty-one consecutive patients who underwent supraglottic laryngectomy at UCLA were reviewed. All of the operations were performed by or under the direct supervision of the same surgeon (T.C.). The majority (68%) had advanced squamous cell carcinoma (Stage III-IV). Approximately one half received radiation therapy as part of planned combined therapy. The overall tumor-free survival, with a two-year minimum follow-up period, was 90%. The most common site of tumor recurrence was neck metastasis. There were four laryngeal recurrences, three of which were salvaged with completion laryngectomy. There was only one completion laryngectomy for severe aspiration. The favorable results in this series are attributed to frozen section control of surgical margins, surgical or radiation therapy treatment of cervical lymph nodes at risk for metastatic disease, and the employment of surgical techniques designed to minimize aspiration.

Adult↗
PubMed1983

Restoration of physiologic vocal fold abduction with the ansa cervicalis nerve.

An attempt was made to restore physiologic abduction of the vocal fold using the ansa cervicalis nerve. In adult dogs, the ansa cervicalis nerve was anastomosed to the abductor branch of the recurrent laryngeal nerve. In the four surviving dogs, abduction of approximately 50% to 70% of normal was restored synchronous with inspiration. This technique seems to work almost as well as the phrenic nerve and is easier to perform.

Animals↗
PubMedDate not supplied

A dramatic complication of peroral fiberoptic endoscopy.

The advent of the flexible fiberoptic gastroscope has revolutionized clinical gastroenterology. The morbidity and mortality rates with flexible fiberoptic endoscopes are comparable to those associated with rigid and semirigid scopes. Insufflation devices are routinely used with flexible fiberoptic scopes. This may lead to complications, differing from those associated with rigid endoscopy. A case involving an insufflation injury to the piriform sinus is presented. The pathophysiology of insufflation injuries and their management are discussed.

Air↗
PubMedDate not supplied

Early structural changes in vascularized periosteal flaps studied in situ.

This study examines the very early stages of osteogenesis in vascularized periosteal flaps and completes a characterization of their behavior after decortication. Pleuroperiosteal flaps based on the intercostal artery were developed in nine dogs and studied in situ by histologic and tetracycline fluorescence methods over periods varying from 1 to 7 days. The earliest changes were noted at 72 hours and were characterized by cellular and capillary proliferation, osteoid deposition, and bright fluorescence. The potential function of retained osseous spiculae was investigated separately. It was concluded that microscopic fragments of mature bone trapped within the flaps appear to assist and consolidate new bone formation.

Animals↗