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Biomedical subjects

H G Thomson

Publications and source records attributed to H G Thomson.

At least 19 recordsLinked to original sources
PubMed2001

The recurrent neurotrophic buttock ulcer in the meningomyelocele paraplegic: a sensate flap solution.

A large percentage of meningomyelocele paraplegic patients have a distal zone of sensation-bearing skin on their thighs. This sensate skin can be used as a fasciocutaneous flap to resurface a recidivistic ulcer after excision. In this study, because the transposition distance was significant, the flap length-width ratio was greater than normal and, therefore, required a 3-week elevation delay. This also permitted appraisal of the sensate flap after the first stage. The wound-healing was excellent after both stages. This reconstructive procedure was completed in four patients, with an average follow-up period of 13 years. These patients remain chronic sitters in administrative jobs and have been pressure sore-free after flap repair.

Adolescent↗
PubMed1999

First webspace deepening: comparing the four-flap and five-flap Z-plasty. Which gives the most gain?

A two-part investigation was undertaken to determine whether a four- or a five-flap Z-plasty gives the greatest increase in length (deepening) over the same radius of a web. In part A, flaps were designed on a model of a webspace made from a plastic frame and Speedo fabric; four types of flaps, three different central limb lengths, and three trials for each length gave a total of 36 observations. In part B, flaps were designed on the natural axillary webs of the pig; three Yorkshire pigs with one type of flap per axillary web gave a total of 12 observations. In part A, the stereometric elongation (percent deepening) produced by the five-flap Z-plasty was similar to that of a single 60-degree Z-plasty (4-cm central limb; five-flap versus a single Z procedure, 72.5+/-4.3 versus 75.0+/-2.5 percent). The 90-degree four-flap procedure gave a 1.59 times greater deepening than the five-flap procedure (4-cm central limb; 90-degree four flap technique, 114.2+/-1.4 percent). The 120-degree four-flap technique gave 2.0 and 1.26 times greater deepening than the five-flap and 90-degree four-flap procedures, respectively (4-cm central limb; 120-degree four-flap technique, 144.2+/-1.4 percent). In part B, the 90-degree four-flap Z-plasty again produced a significantly greater lengthening (1.57 times) than the five-flap procedure (132.7+/-6.4 versus 84.0+/-4.0 percent; p<0.05), and the percentage of elongation of the 120-degree four-flap procedure was 1.27 times greater than that of the 90-degree four-flap technique (167.3+/-7.0 versus 131.3+/-2.3 percent; p < 0.05). In conclusion, the four-flap Z-plasty produced greater webspace deepening than that of the five-flap Z-plasty. The 120-degree four-flap procedure gave the greatest percentage of elongation, but it was more difficult to design and close than the 90-degree four-flap Z-plasty.

Animals↗
PubMed1996

Electrical burns to the oral commissure: does splinting obviate the need for commissuroplasty?

Two groups of children who had sustained electrical burns to the oral commissure were compared. The first group (n = 20) underwent splinting of the commissure and the other group (n = 22) did not have splints as part of their treatment regimen. The mean age at the time of burn was 3 years in both groups. The need for commissuroplasty was significantly decreased in the splinted group (P = 0.0007 by Fisher's exact test). Further analysis of the duration of splinting in the splinted group (n = 20) revealed that all seven children who required commissuroplasty underwent splinting for less than 4 months while all 13 children who did not require surgery used their splints for more than 4 months (range 4-8 months).

Burns, Electric↗
PubMed1996

Is pharyngoplasty a risk in velocardiofacial syndrome? An assessment of medially displaced carotid arteries.

The association of medially positioned internal carotid arteries and velocardiofacial (Shprintzen) syndrome was first made in 1987. This is also the most common syndrome associated with facial clefting. The potentially dangerous implications in children with this syndrome requiring pharyngoplasty for velopharyngeal incompetence and stigmatized hypernasal speech involve potential damage to these vessels. This three-part study was undertaken to analyze this anatomic variant. First, a group of 25 children with velocardiofacial syndrome, velopharyngeal incompetence, and obvious posterior pharyngeal pulsations seen on nasendoscopy was studied by CT angiography to determine the degree of this abnormal vascular pattern. This technique, together with three-dimensional reconstructions, made it possible to determine the precise location of these abnormally positioned vessels. Second, our routine superiorly based pharyngeal flap was measured by lateral cervical x-ray to show the distal tip of the flap. The variance was minimal and demonstrated the tip of most flaps to be at the disk between the C2 and C3 vertebrae. By correlating this information with the CT angiography, the risk of surgery can be determined on strict anatomic grounds, allowing customized flap design in some unilateral cases. In this series of children, routine superiorly based pharyngoplasty would be safe in 52 percent, while in 28 percent a pharyngeal flap would be safe if custom designed, and in the remaining 20 percent surgery should not be attempted because the risk of damage to the carotid arteries is too great. Third, in a double-blind study, velocardiofacial children with obvious pulsations seen on nasendoscopy were grouped with other children with palatal dysfunction. When only endoral examination was performed by plastic surgeons and plastic surgical residents, no vascular pulsations were ever seen. This indicates another important role of nasendoscopy in the preoperative assessment of children for palatopharyngoplasty.

Carotid Arteries↗
PubMed1995

Residual problems in chest donor sites after microtia reconstruction: a long-term study.

The rib cartilage has been the most popular autogenous tissue for microtia reconstruction. In this study, 88 chest donor sites were evaluated in 80 patients examined in the outpatient clinic at least 1 year after tissue removal. Microtia reconstruction usually was initiated between the ages of 2 and 3 years (42 percent), at which time an axial half of the sixth rib was harvested along with all of the seventh and eighth rib cartilages with their attached perichondrium. During this procedure, there were 19 uneventful pleural perforations (22 percent), and early in the series, 2 patients (2 percent) required a chest tube. Postoperative atelectasis without evidence of pneumothorax occurred in 7 patients (8 percent). Chest scars were classified by impartial observers as excellent (25 percent), good (33 percent), acceptable (28 percent), and poor (14 percent). Better scars were experienced in the cold-knife group than in incision by electrocutting. The younger group and the longer postoperative interval group showed better chest scars. Chest topography deformities were rated as normal (75 percent), mild retrusion (19 percent), and severe retrusion (6 percent). Costal margin contours improved as the postoperative interval lengthened.

Adolescent↗
PubMed1995

A long-term appraisal of the unilateral complete cleft lip repair: one surgeon's experience.

The authors reviewed 85 patients with unilateral complete cleft lip repaired with a low triangular flap technique. Clefts were classified into four categories, depending on the degree of deformity. The clinical results, as evidenced in standardized slides, were assessed by a professional panel using a weighted formula adapted from that devised by Williams. The Farkas-Lindsay anthropometric technique was also used to measure all dimensions of the lip and nose, with the results calculated as a ratio of the cleft to normal side. The findings demonstrated that the method of classification was consistent and reliable. As expected, the panel gave the postoperative results of the Simonart's and mild-degree clefts the highest ratings, with the severe clefts having the lowest. The consultant surgeons awarded the highest marks and the clinical fellows, the lowest. The residual nasal deformity continues to be the challenge rather than the lip defect, as evidenced by an average of 1.7 revisionary procedures on the nose compared with 0.7 on the lip. A combination of subjective and objective methods of evaluation has been incorporated into a critical clinical review of these patients.

Adolescent↗
PubMed1995

Nasal glioma: is dermis involvement significant?

Nasal gliomas are rare, benign, congenital masses more accurately referred to a sequestered glial tissue. Seven patients with nasal glioma treated by Hugh G. Thomson over the last 28 years are presented with special reference to tumor recurrence after excision and associated naso-ocular cleft. Three of our patients had an associated ipsilateral naso-ocular cleft, and three similar cases have been reported. This association is probably more frequent because a naso-ocular cleft can exist as a forme fruste and be easily overlooked. The first two tumors resected in our series recurred within 10 months; however, no recurrences were seen after a new treatment protocol was initiated in 1972. This consisted of total excision of the skin overlying the tumor if the skin adhered to the mass or if glial elements were seen within the dermis on frozen section. Deep resection margin was also assessed by frozen section of the nasal mucosa or fibrous stalk of the tumor. Accordingly, unnecessary intracranial procedures were avoided without increasing the risk of recurrence.

Abnormalities, Multiple↗
PubMed1994

Menkes' syndrome: wound healing in a long-term survivor.

A rare case of a long-term survivor of Menkes' syndrome who was treated early and had excision of bilateral axillary skin excess is presented. Primary wound healing was observed and skin histology showed fragmentation of the elastic fibers. Two years after surgery, the scars appeared atrophic with evidence of early recurrence of the skin excess. The relationship between Menkes' syndrome and the other copper-related syndromes (X-linked cutis laxa, occipital horn syndrome, and Ehlers-Danlos syndrome type 1X) is also described.

Adolescent↗
PubMed1993

Detection of laryngeal cancer--the case for early specialist assessment.

The first 300 patients referred from 11 participating general practices (GPs) to the Hoarse Voice Clinic, Queen Elizabeth Hospital, Birmingham, were studied prospectively to estimate the accuracy of GPs' diagnosis of laryngeal symptoms and to assess whether the provision of a direct referral immediate access service for the assessment of persistent laryngeal symptoms is an effective way of ensuring early referral and detection of laryngeal cancer. The GPs' assessment of laryngeal symptoms was inaccurate. Diagnosis after the initial clinic visit was accurate, predicting all histological cases of cancer. Laryngoscopy was possible in all patients at the first clinic visit. Disease requiring admission for direct laryngoscopy and biopsy was found in 39 patients (14%). Ten (3.3%) were found to have laryngeal cancer, of which eight were early lesions. When seen in the clinic 102 (34%) had normal voices and larynxes. A hoarse voice is a symptom requiring specialist assessment. By using the flexible fibreoptic nasendoscope all patients larynxes can be seen in clinic, an accurate diagnosis quickly made and the appropriate management instigated. It is feasible to offer this service without appointments to patients with persistent hoarseness.

Ambulatory Care↗
PubMed1993

Unilateral microtia reconstruction: is the position symmetrical?

A method of analyzing the head position of the reconstructed unilateral microtic ear relative to the normal side was developed and applied in the assessment of 78 microtic ear reconstructions. Two groups of patients were assessed. Group I included 58 unilateral microtia patients, some with no clinical evidence of lateral facial dysplasia and others with mild to moderate lateral facial dysplasia, as judged by three experienced clinical observers. Group II included 20 unilateral microtia patients with severe lateral facial dysplasia involvement. Of special interest was evidence of lateral facial dysplasia in 88 percent of the patients reviewed. A reproducible technique was developed to assess the position of the reconstructed ear. Three slides showing the normal ear, reconstructed ear, and anteroposterior views of each patient were projected onto a centimeter grid to provide life-size (5-cm) proportions. The normal side served as the control. Length, angulation, and height were compared between normal and reconstructed ears by using a clear film rhomboid pattern designed by choosing specific reproducible landmarks. In group I, the reconstructed ear was of acceptable length and angulation in 91 and 95 percent of the patients, respectively, and of proper height in 88 percent. The corresponding values in group II were 90, 95, and 90 percent. Efforts should be made at the time of original surgery to ensure that the reconstructed ear is not only aesthetically pleasing but also positioned correctly. The technique used by us is one example of an attempt to evaluate the resultant ear position in microtia reconstruction.

Ear, External↗
PubMed1990

Endoscopic evaluation and treatment of sleep-associated upper airway obstruction in infants and young children.

A method is described for observing the pharyngeal airway in children with proven sleep apnoea using a flexible nasendoscope during light anaesthesia. Fifteen children were referred for endoscopic evaluation and treatment. All had documented obstructive sleep apnoea. Flexible endoscopic assessment of the airway revealed the site of obstruction in all cases and allowed a rational and successful management plan. The mechanism of obstructive sleep apnoea in infants and young children is discussed and the findings at endoscopy and results of treatment are reported.

Adenoidectomy↗
PubMed1990

Common benign pediatric cutaneous tumors: timing and treatment.

This article has been a brief overview of some of the common cutaneous pediatric tumors. There are many that have been omitted, but these are relatively uncommon and, for them, consultation with your dermatologist and/or professional peers is always a good investment. This pays great dividends and increases the quality of health care, particularly in the uncommon lesions that are foreign to you but may have been seen on several occasions by one of your peers.

Child↗
PubMed1989

Cerebrospinal fluid in the rhinitis clinic.

The Rhinitis Clinic at the Royal National Throat Nose and Ear Hospital is a direct referral clinic dealing with approximately 300 new cases a year. Last year three cases of spontaneous CSF rhinorrhoea were diagnosed. In each case long term topical steroid sprays had been prescribed and the patients had been referred for further management of their 'rhinitis'. Spontaneous CSF rhinorrhoea is potentially life threatening as failure to recognize the problem may lead to the development of meningitis and possibly death. The diagnosis is simple and is based on a good clinical history which may be confirmed by chemical pathology. Radiology is often non-contributory, the site of the leak may have to be identified at surgery. Morbidity and mortality are reduced if an extracranial, trans-nasal/external ethmoid route for repair of the fistula is employed. Three case reports are presented and the diagnosis and management of CSF rhinorrhoea is reviewed.

Adult↗
PubMed1989

Reconstruction of cupid's bow: a quadrilateral flap technique.

The cupid's bow is an important feature of the normal upper lip, and every effort should be made to reconstruct it during initial cleft lip surgery or trauma repair. However, a secondary surgical procedure is often necessary to improve the appearance and symmetry in the cupid's bow area. For this purpose, the authors present a quadrilateral type of interposition flap that can be used in both unilateral and bilateral cupid's bow reconstruction. This procedure is applicable only when adequate vermilion is available.

Cleft Lip↗