Biomedical subjects

H S Matloub

Publications and source records attributed to H S Matloub.

At least 37 records · Page 2Linked to original sources

PubMed1996

Biomechanics of the intact and surgically repaired proximal interphalangeal joint collateral ligaments.

Collateral ligament injuries to the proximal interphalangeal joint are common. When the collateral ligament is completely ruptured, surgical repair may be required. The strength of the lateral collateral ligaments of the proximal interphalangeal joint was examined using axial distraction on an electrohydraulic testing apparatus. Eighty-five fresh human adult cadaver fingers were assessed; 38 intact ligaments were first examined. The strength of the native ligament was 162.5 N. Forty-seven ligament repair preparations were tested: suture repair (27.8 N), pull-out wire repair (35.9 N), and repair using a Mitek suture anchor (38.4 N). The breaking strength of the intact ligaments was significantly greater than that of any repair. All repaired ligaments failed at the site of the repair. The ligaments repaired by the pull-out wire and Mitek anchor technique were significantly stronger than those repaired with the suture technique.

Adult↗

PubMed1996

Magnetic resonance imaging scanning in the diagnosis of zone II flexor tendon rupture.

This study was undertaken to determine the usefulness of magnetic resonance imaging (MRI) in the diagnosis of flexor tendon rupture in patients who had prior surgery. Magnetic resonance imaging scans were performed on 11 digits (16 tendons) with the clinical diagnosis of flexor tendon rupture. Clinical suspicion correlated with MRI and surgical findings. Clinical examination yielded a 60% accuracy in diagnosis. MRI differentiated rupture from adhesions with a 100% accuracy rate. The MRI scan is a valuable tool in diagnosing tendon ruptures and may help reduce the incidence of unnecessary tendon explorations.

Adolescent↗

PubMed1996

Complications and salvage of an ectopically replanted thumb.

The ectopic replantation of a thumb is described after a mutilating hand injury. The case was followed by a series of complications and surgical procedures to treat these complications. Through perseverance and multiple microsurgical procedures the patient attained a functional hand. The patient's psychological and physical course is described.

Accidents, Occupational↗

PubMed1995

Combination latissimus dorsi and groin free flap with double microvascular transfer.

A combined free tissue transfer using the skin and muscle supplied by the thoracodorsal artery and the superficial circumflex iliac artery (groin flap) was transferred to reconstruct a large lower extremity soft-tissue defect. The combination of these two flaps allowed coverage of a large tissue defect, more reliable coverage than either of these flaps alone, and direct donor site closure.

Adult↗

PubMed1995

Tissue humoral response to intact and ruptured silicone gel-filled prostheses.

Biopsies of the fibrous capsule in 31 women undergoing explanation of gel-filled breast prostheses and in 3 women with silicone gel-associated granulomas were tested for the presence of IgG, IgM, IgA, C3 complement, and fibrin using fluorescent antisera. Of a total of 41 prostheses removed, 9 were found to be ruptured but contained within the fibrous capsule or immediately adjacent to it. In the 3 women undergoing granuloma excision only, the sites were the arm (2) and the chest/axilla (1). In one patient, IgG, C3, and fibrin were detected in the capsule of an intact prosthesis. C3 and fibrin were present in the capsule surrounding one ruptured prosthesis. Fibrin was detected in the capsule of one other patient. Bilateral capsules surrounding intact prostheses removed from 4 patients with collage-vascular diseases were negative for C3, fibrin, and immunoglobulins, as were the 3 granulomas from distant sites. Hematoxylin and eosin stains revealed a typical foreign-body response to gel in almost all cases. Both T- and B-cell lymphocytes are present in the infiltrate surrounding silicone gel. In this study, chronic exposure to silicone gel-filled prostheses did not result in antibody deposition or complement activation in the fibrous capsule or in the tissue surrounding gel droplets.

Antibody Formation↗

PubMed1994

The effect of frostbite on the reconstructed ear.

A 17-year-old patient whose left ear was reconstructed using a lateral arm fascia and skin graft had done well until one episode of cold exposure approximately two years after the reconstruction. This thermal injury resulted in a localized area of composite tissue loss demonstrating that the reconstructed ear had a higher susceptibility to cold temperatures. The transferred fascia did, however, allow a stable base for granulation and reepithelialization, showing the continued vascularity and regenerative capacity of the transferred tissue. A discussion is provided regarding the susceptibility of free transferred fascia and its regenerative capacity.

Adolescent↗

PubMed1994

Revascularization of free mandibular reconstruction after early emergency arterial ligation.

A 70-year-old man with a squamous cell carcinoma involving the anterior arch and body of the mandible underwent resection and reconstruction with a 10-cm free vascularized iliac crest bone graft, preserving periosteum and minimal adjacent soft tissue. On postoperative day 12, he experienced bleeding from an orocutaneous fistula, requiring emergency ligation of the arterial pedicle to control hemorrhage. After ligation, continued bleeding was noted from the margin of the graft, with active filling of the venous pedicle. The 10-cm mandibular bone graft survived without appreciable resorption during a period of follow-up of 5 years. We believe that bone graft survival in the present case was due to early vascular communication between the periosteum and adjacent soft tissues of the graft with the recipient bed. This mechanism may serve to maintain bone graft viability after early arterial disruption, when repeat arterial anastomosis is believed to be contraindicated.

Aged↗

PubMed1994

The nasolabial fold: a photogrammetric analysis.

The nasolabial fold was analyzed by studying changes with aging in the nasolabial fold and adjacent soft-tissue features. Chronologic photographs were obtained from 19 older subjects, taken approximately every 10 years, from age 20 to their present age. In a separate phase of the study, facial portraits in repose and smiling were taken of young and old adult subjects with a mechanical frame used for setting an objective point of reference. Facial landmarks were identified and depth measurements were made in the anteroposterior direction. Relative lengths of selected points also were determined in the other dimensions (in the coronal plane) from photographs; these distances were normalized by using lower face length (distance from medial canthus to menton) for the vertical orientation and interpupillary distance to normalize horizontal dimensions. It was found that with aging there is anterior, lateral, and inferior displacement of the cheek mass with a resultant deepening of the nasolabial fold, while relationships between the upper lip and the fold itself remain constant. Also with age, the lateral commissure was found to move laterally, while the apparent angle of the nasolabial fold was decreased; this latter dimension was reflected by a decrease in the horizontal component of the fold length. These results support the theory that nasolabial fold deepening with age is caused by changes in the cheek mass and its support.

Adult↗

PubMed1994

Temporary ectopic implantation of an amputated penis.

A case of temporary ectopic implantation of an amputated penis to the forearm followed by subsequent return to its anatomic position is reported. The penis was amputated by a riding lawnmower, and massive contamination of the perineum and an extensive hematoma precluded immediate replantation. The penile vessels were attached to the radial artery and venae comitantes on the forearm, where it survived completely. After 4 weeks, the edema and hematoma of the perineum had resolved, and the penis was returned to its anatomic position by microsurgical technique. Arteries, veins, and nerves were repaired. The penis survived in its entirety. Return of sensation has been excellent. A urethrocutaneous fistula developed that required secondary closure with local flaps. Temporary ectopic replantation of the penis is a useful salvage procedure when the perineum is heavily contaminated or too extensively damaged for immediate replantation.

Adult↗

PubMed1994

The free-fillet flap for reconstruction of the upper extremity.

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wounds. However, in cases of complete extremity amputation, the transfer of pedicled flaps from the amputated part is not possible. In such instances, we have designed free-fillet flaps from the amputated limb to provide wound coverage when replantation of the amputated part was contraindicated. This technique allows immediate wound coverage and preservation of functional amputation stump length, without the morbidity of an additional donor site. We present three cases that demonstrate the utility of this technique as an additional reconstructive option in patients with unreplantable upper-extremity amputations.

Adult↗

PubMed1994

The brachioradialis forearm flap: anatomy and clinical application.

The blood supply to the brachioradialis muscle and the skin of the forearm was studied in latex-injected arms. The dominant perforator to the muscle arose from the brachial artery (27.3 percent), radial recurrent artery (33.3 percent), or radial artery (39.4 percent). In all cases, adequate perforators exist from the radial artery so that transfer as either a muscle or musculocutaneous free flap based on this vessel is possible. In 10 arms the septocutaneous perforators from the radial artery were dissected to determine the relationship between the forearm and brachioradialis flaps. Transfer of the brachioradialis muscle as a free flap or combined with the radial artery forearm flap based on the radial artery and either the venae comitantes and/or the cutaneous veins is feasible. Four clinical cases demonstrate the usefulness of this flap.

Adult↗

PubMed1994

Reconstruction of lower third of face with three simultaneous free flaps.

A case of massive osteoradionecrosis is presented that required angle-to-angle resection of the mandible and replacement of skin of the chin and neck as well as the entire floor of the mouth. In this heavily irradiated patient, three microvascular free flaps were transferred in one operation. A large radial forearm flap was used to reconstruct the floor of the mouth. A second large radial forearm flap was used to reconstruct the chin and neck defects and a fibular osseous flap was used to reconstruct the mandible. All wounds healed primarily. For extremely complicated and large defects, the transfer of multiple free flaps may provide the best reconstruction.

Female↗

PubMed1994

Soft-tissue reconstruction of the oral cavity.

In our early experience with head and neck reconstruction, we evaluated our results mainly by the final contour of the mandible. With further experience, the bony reconstruction has become more and more accurate, and it is the intraoral soft-tissue reconstruction that poses the continued challenge. Better preoperative and postoperative evaluation will improve our operative planning, and our results will continue to improve. We must be able to compare our cases with those of other centers by appropriately categorizing deficits into specific structures removed to allow relevant comparison of results. We should no longer accept the simple view of the oral cavity deficit as a uniform soft-tissue loss that requires nothing more than closure. Nor can we continue to accept the evaluation of postoperative results of head and neck reconstruction by a simple external photograph; rather, this must be combined with a true visual and functional assessment of the oral cavity. In this way, the combined effort of head and neck surgeons will help to advance the cause of oral cavity reconstruction as rapidly as has occurred with reconstruction of the mandible.

Humans↗

PubMed1994

The nasolabial fold: an anatomic and histologic reappraisal.

The nasolabial fold was analyzed by anatomic and histologic evaluation of the tissue planes that create and surround the fold. A fascial-fatty layer exists in the superficial subdermal space extending from the upper lip across the nasolabial fold to the cheek mass. The SMAS is present in the upper lip as the superficial portion of the orbicularis oris muscle. Traction on the SMAS or periosteum lateral to the nasolabial fold can deepen the fold, while traction on the fascial-fatty layer lessens the fold. The fascial-fatty layer and skin of the cheek mass are suggested as the primary ptotic elements responsible for facial aging.

Adipose Tissue↗

PubMed1993

A comparison of upper arm and forearm tourniquet tolerance.

This study examined the use of upper arm and forearm tourniquets for hand surgery. 40 subjects (20 males, 20 females) were randomly assigned to one of four groups: left upper arm, left forearm, right upper arm and right forearm. Tourniquets were applied to these areas. Subjects were asked to rate their discomfort at 10-minute intervals and the total time of tourniquet tolerance was recorded. The results of a three-factor ANOVA revealed no statistically significant differences in either pain rating or tourniquet tolerance between any of the groups. In addition, forearm tourniquets were used in 18 clinical cases. None of the individuals with tourniquet times less than 30 minutes required any medication in order to tolerate this procedure. Of the 13 patients with tourniquet times greater than 30 minutes, ten required medication in order to tolerate the procedure. We conclude that patients tolerate upper arm and forearm tourniquets equally.

Adult↗

PubMed1993

Spiral fracture fixation techniques. A biomechanical study.

The mechanical strengths of five common fixation techniques for spiral fractures have been tested. A total of 240 cadaver metacarpals and proximal phalanges were fractured and fixed by either crossed K-wires, interosseous loops, a dorsal mini-plate, a single compression screw or K-wire plus cerclage wire. Specimens were subjected to torsional and cantilever bending tests. A single compression screw provided the best overall fixation for the proximal phalanx. In addition, a single compression screw provided better fixation than any of the other techniques when proximal phalanges and metacarpals were subjected to torsional tests (P < 0.05). In apex dorsal bending tests of metacarpals, the screw provided fixation superior to interosseous wires, crossed K-wires, or dorsal mini-plates (P < 0.05). These results indicate that the use of a single compression screw provides the most satisfactory biomechanical advantage for spiral fracture fixation.

Biomechanical Phenomena↗

PubMed1993

The corkscrew sign in hypothenar hammer syndrome.

Arteriography of an adult manual labourer presenting with numbness and cold intolerance in the middle and ring fingers of the right hand demonstrated filling defects in the digital arteries of these two fingers associated with a corkscrew-like configuration of the ulnar artery in Guyon's canal. This arterial segment was subsequently excised revealing intramural necrosis and fibrosis and nonocclusive intraluminal thrombosis. An arteriogram performed 2 years previously for an unrelated condition revealed a similar but less pronounced corkscrew configuration of the artery, suggesting that this finding could be a marker for arterial injury which may eventually lead to embolization or thrombosis with accompanying ischaemic symptoms.

Adult↗

PubMed1993

The extrinsic blood supply of the ulnar nerve at the elbow: an anatomic study.

The extrinsic vasculature of the ulnar nerve as it relates to the treatment of cubital tunnel syndrome has not previously been described in detail. For a study of the anatomy, 18 fresh-frozen cadaver upper limbs were dissected after intra-arterial injection of latex. Two major pedicles were present in all 18 specimens--the superior ulnar collateral artery proximally and the posterior ulnar recurrent artery distally. A single minor pedicle, the inferior ulnar collateral artery, was present in 5 of 18 specimens. Total vessel length as well as distance to the medial epicondyle for the extrinsic arteries was measured. On the basis of these anatomic dissections, it is suggested that the extrinsic vascular supply can be preserved during anterior transposition of the ulnar nerve, even after extensive mobilization of the nerve.

Arteries↗