Biomedical subjects
Publications and source records attributed to G H Shepard.
Methods of treatment of nail bed avulsions, both historic and modern, are described. A description is given of the technical aspects of replacement of amputated parts, full and partial thickness nail matrix grafts, composite grafts, and rotation of nail matrix flaps. Results of treatment with currently available techniques are successful in minimizing nail deformities.
Monkey digits were used experimentally to demonstrate the pathologic anatomy of nail deformities and the results of treatment using full and partial thickness nail matrix grafts. Seventy-five human nail deformities were evaluated and treated. In both the experimental and clinical groups, microscopic hypertrophy of the superficial epithelial elements underlying the deformed nail existed. A follow-up of treatment of nail deformities indicated that nail matrix grafts, both full and partial thickness, are beneficial when the defect involves the sterile matrix and the proximal nail fold.
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An instrument is described for removing iliac crest cancellous bone grafts under local anesthesia. The device has widespread applications for plastic and orthopedic surgery. The convenience of obtaining bone grafts with this device broadens the use of bone-grafting techniques in patients in whom the need for bone graft is unexpected.
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Experimental studies with squirrel monkeys indicated the feasibility of split-thickness grafting of segments of the nail bed. Thin grafts, when taken from the nail bed, achieved excellent take over of the avulsed areas. Thirty-one patients with avulsion of segments of the nail bed were treated with split-thickness nail bed grafts. The injured nail bed had sufficient residual nail bed to serve as a donor site in 24 patients. The remaining seven patients required split-thickness grafts from the lateral one third of the great toe. Of the 31 treated nail beds, there was a total of five deformities in which there was either nonadherence of the nail or irregularity of the nail surface. Twenty-six had nails with no deformity. No deformities occurred in the graft donor area. The split-thickness nail bed graft offers the advantage of frequent availability of tissue on the same injured digit and the absence of donor site deformity, whether on the same injured digit or a donor great toe.
An operation is described that is based on anatomical studies showing the pattern of the fibrous septa and neurovascular bundles of the distal phalanx. Lateral V-Y advancement flaps are outlined with the dorsal incisions going sharply to the bone. With palmar retraction of each flap, dense fibrous bands on its underside are sharply divided. The palmar incision is made through skin only. The nerves, vessels, and adipose tissue of this pedicle are preserved while the fibrous septa are carefully divided. This technique permits 10 to 14 mm advancement of each flap. Complete division of the dorsal pedicle permits great mobility of the flap without functionally diminishing circulation or innervation. This procedure is particularly useful in traumatic fingertip amputations with the palmar and transverse oblique deformities. Elective remodeling of irregular fingertips has also been aided by this operation.
Four cases of forearm defects requiring reconstruction are presented to demonstrate the usefulness of muscle musculocutaneous and fasciocutaneous flaps in forearm reconstruction. The forearm is divided into four zones--cubitoolecranon, proximal and middle one-third, distal one-third, and wrist--for purposes of discussing the scope of these different flaps. Muscle flaps are useful for defects in all zones except the distal forearm, where fasciocutaneous flaps are available; however, the superficial forearm muscles and tendons should be included to prevent interference with fascial blood supply.
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A review is made of 42 close-range shotgun wounds. The massive injuries had many of the characteristics attributed to high-velocity missile wounding. Calculations of kinetic energy show magnitudes at muzzle velocity in the range of those generated by high-velocity rifle rounds. This is due to the very great mass. While emphasis has been placed in the literature on the factor of velocity, it is stressed that the mass is also very important since the equation for kinetic energy is the product of the square of velocity and mass. It is kinetic energy which relates to tissue injury. Medical writings should return velocity to its proper place as a factor and not an end-point of energy calculations.
Webbed penis as an isolated anomaly is rare, having been reported in 10 cases. A report is made of a 1-year-old child successfully repaired by a rectangular scrotal flap to close the penoscrotal junction and multiple W-plasty incisions for closure of the skin of the shaft of the penis.
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