Biomedical subjects
Publications and source records attributed to F R Heckler.
Carpal tunnel syndrome is the most common and best known of the compression neuropathies in the upper extremity. The authors review their clinical experiences in the diagnosis and management of this entity and survey the extensive literature on the subject. An operative approach for decompression of the median nerve in the carpal canal is described that has proved to be most efficacious and safe.
A rare and possibly the first case of a cartilaginous choristoma of the buccal mucosa is presented. Careful examination at follow-up for over 11 months has revealed no clinical evidence of any recurrence.
The lower eyelid skin-muscle flap is now widely used for cosmetic blepharoplasty, primarily because of the ease and speed of dissection it offers. We have used the same technique as a surgical approach in fractures of the orbital floor and rim. In a large clinical series seen over a three and a half-year period, no major complications were noted. This approach provides simple, extremely rapid exposure of the injured area and is an excellent alternative to other approaches to this site.
Angiolymphoid hyperplasia with eosinophilia is a rare, benign skin disease of unknown etiology. In the western hemisphere it occurs mostly in females and is located mostly in the head and neck. Microscopically, it is characterized by dermal and subcutaneous infiltration of chronic inflammatory cells, especially eosinophils; neocapillary formation; and lymphohistiocytic hyperplasia. Effective treatment requires total excision.
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Fresh cadaver nerves were examined by serial cross-sections and microdissection with the operating microscope. The findings are compared with those of previous authors, primarily Sydney Sunderland. Our study confirms and amplifies Sunderland's findings: although it is true that funicular prexus formation and interchange takes place in the nerves of the human forearm, these connections are not of such a degree as to preclude operative procedures such as intraneural neurolysis, fascicular nerve repair, and interfascicular nerve grafting. Individual branches and bundles can be identified and traced within the main nerve trunk for considerable distances without significant trauma to conducting fibers. This arrangement lends itself to the application of modern microneurosurgical techniques. Clinical applications of these findings in the repair, lysis, and grafting of the major nerves of the forearm are described. The possibility of using such branches as the dorsal cutaneous branch of the ulnar nerve(if irreparably damaged) as a donor nerve for grafting is noted.
Techniques for including muscle flaps and musculocutaneous flaps in the repair of difficult vesicocutaneous, urethrocutaneous, and vesicovaginal fistulas are described. These methods have been uniformly successful in 10 consecutive patients. The incorporation of such healthy, well-vascularized tissue into the standard techniques of urologic repair can be a major factor in the successful management of these problems.
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The main blood supply of the sternocleidomastoid muscle enters it above from branches of the superior thyroid, posterior auricular and occipital arteries. The lower third is supplied by a branch from the transverse cervical artery and at this level there are few if any musculocutaneous branches. Long skin flaps with or without the underlying muscle should be checked with fluorescein before transfer.
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Sickle cell disease presents an unusual challenge to the reconstructive surgeon. The interaction between the underlying hemoglobinopathy and the circulatory mechanics in pedicled flaps leads to a high incidence of flap necrosis in patients with this disease. We present 3 patients with sickle cell disease in whom the use of axial flaps allowed the repair of difficult reconstructive problems in one stage, without preoperative exchange transfusions. The rationale for this approach is discussed.
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