Biomedical subjects
Publications and source records attributed to G L Dockery.
The authors present an overview of the V-Y plasty technique with a discussion of the basic underlying principles and a description of the surgical technique. The variations available and the direct application of this procedure are discussed with reference to the foot and ankle. Consideration is given for design, location, survival, and postoperative care of the V-Y plasty.
A discussion of the design and use of the Z-skin plasty to revise scars and lengthen skin contractures of the lower extremities is presented. One of the most commonly used rotational flaps to alter scar direction or relieve tension on the existing scar or skin, the Z-plasty can also be the most difficult to perform and carries a high risk of flap loss if inaccurately planned or poorly placed. Several variations of the standard procedure and examples of common usage are presented.
The basic principles of a single-lobe flap are discussed along with the description of a modified slide-swing rotational flap. This rotation flap is called the Schrudde flap, and it has many applications in the treatment of skin defects of the foot and ankle. This rotation skin flap procedure provides excellent end results with high patient acceptance.
Scar formation is discussed along with definitions of the three most common types of scars: normal, hypertrophic, and keloid. Several current forms of therapy designed to reduce or eliminate scars are presented. The use of silicone gel sheeting is reviewed as a newer solution for the treatment of many types of lower extremity scars.
Iatrogenic and posttraumatic adhesive lesions of the ankle joint are rather common, although infrequently reported, clinical entities. Ankle arthroscopy has proved to be a valuable asset in the assessment and treatment of recalcitrant symptomatic cases of both localized adhesions and adhesive capsulitis. This article intends to broaden the reader's understanding of the clinical presentation and intra-articular derangements of these lesions.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Several types of agents used for intradermal and intralesional injection have been presented along with general discussion of technique and principles of use. We have a great deal of respect for the effectiveness of properly utilized injections in the treatment of various conditions, and we also know that if used improperly, these agents can do more harm than good. For this reason, we caution practitioners to use common sense and to refer to product information and specific sources for additional information before using any of the medications or drugs discussed here. Special attention should be given to systemic absorption and the use of these drugs in infants and children, pregnant and nursing females, and in patients with systemic illness. Each of the agents presented must be evaluated independently and information and experience gathered will aid in the longterm results of their use. We hope this report helps to describe intralesional injections for treatment of some of the more common lesions and that your patients will benefit from this technique.
This article presents an organized and relatively easy mechanism for the diagnosis of dermatologic problems by using an algorithmic flow sheet. Once this technique is understood, the practitioner may find it much easier to categorize, diagnose, and manage skin conditions of the lower extremities.
Vasospastic disease represents a group of diseases in which the common link is spasm. The causes of the individual disorders may differ slightly but a history of exacerbation of the symptoms by cold, emotional stimuli, or caffeine usually will be elicited. Ulceration and gangrene do not usually occur. Treatment involves patient education, reassurance, and the use of oral vasodilating agents.
Contact dermatitis of the lower extremity is reviewed in regard to symptoms, clinical manifestations, etiologic agents, and treatment. Examples of some of the clinical manifestations are presented pictorially.
Distinction must be made between tissue movability and tissue elasticity when considering tissue movement with the hope of predicting good results. Tissue movability is either inherent, as on the back of the thigh, or is created by undermining, back-cutting, or cutting out Bürow's triangles. The elasticity of skin is inherent everywhere and is difficult to accurately predict. Elastic tissue will gape when cut, whereas inelastic tissue will not. Finally, elastic tissue will rotate with little puckering but inelastic tissue will form large dog-ears when rotated. For these reasons, as soon as the decision has been made to use a flap it is important to "prethink" the dynamics of flap movement and decide which type of flap to use and what is to be accomplished. If consideration is given to which flap will best allow proper transfer of tissue and at the same time give the best cosmetic result, the task is usually simpler. By further considering the secondary movement of surrounding tissues (as well as the primary movement), the number of potential techniques and designs are greatly increased.
Flap survival variables are different for each type of flap and for each anatomic location. One must have sound knowledge concerning tissue survivability for all types of flaps. Otherwise, a high rate of failure may be experienced. A thorough knowledge of blood flow patterns of the foot and leg is paramount, as well as insight to the basic fundamental concepts concerning flap mechanics. These fundamentals include delay phenomenon, designing flaps, length-to-width ratios, and evaluation of flap vascularity. Successful and appropriate use of flaps in the lower extremity can be rewarding and provide the surgeon with a powerful tool to use in reconstructive procedures. Inappropriate or poorly performed flap procedures often create situations that are more difficult to manage than the original problem. According to Hoopes, "flaps are vicarious, mischievous, and frequently insubordinate reconstructive agents. They demand thorough understanding and meticulous attention for successful employment." Therefore, judicial use of these procedures is recommended.
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The perioperative management of children is important and the concepts should be reviewed regularly by all surgeons. This article emphasizes the overall aspects of physical and psychological care which begins at the first office visit and continues through the postoperative period. The podiatrist must assess the child's growth and development, emotional status, psychological needs, and the requirements of anesthesia and surgery.
Osteotomies designed to lift the metatarsal head dorsally on the sagittal plane are performed to alleviate painful plantar lesions beneath the metatarsal head. Correcting the position of the bone reduces the plantar pressure and stresses that are believed to cause the painful lesions. The authors found that resistant plantar lesions secondary to a plantarly depressed or long lesser metatarsal responded to a combination of plantar excision and modified cartilaginous articulation preservation osteotomy procedure.
A case of brachymetatarsia with congenital absence of all middle phalanges was presented. This is believed to be the first such case reported. Many surgical options are available for the correction of microdactyly. Satisfactory surgical results were achieved via bunionectomy, the implantation of a double-stemmed prosthetic joint in the fourth metatarsophalangeal joint and osteotomy of the second metatarsal bone.