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Biomedical subjects

H W Neale

Publications and source records attributed to H W Neale.

At least 37 records · Page 2Linked to original sources
PubMed1985

Management of perioral burn scarring in the child and adolescent.

The experience gained in the treatment of 116 patients with perioral burn scarring is presented. Important considerations are the choice of unit release or simple release, the choice of donor site to match the prevailing skin of the remainder of the face, and the timing of the reconstruction. Delaying the reconstructive procedure with the routine use of pressure appliances until the scar was mature produced a more pleasing final result. In addition, we found that modifying the traditional aesthetic unit excised to include darts when there was severe burning of the surrounding facial cheek skin with loss of natural nasolabial folds improved the final result and reduced the need for secondary revision.

Adolescent↗
PubMed1985

Use of i.v. fentanyl in the outpatient treatment of pediatric facial trauma.

Fentanyl, a synthetic analgesic narcotic, was used in 2,000 cases of pediatric facial trauma between 1981 and 1984. A dose of 2 to 3 micrograms per kilogram of body weight was administered slowly intravenously to provide sedation and analgesia to facilitate the repair. The drug has advantages ideal for outpatient use, namely rapid onset, brief duration, and short recovery time. The major possible complication is that of apnea, which requires that resuscitation equipment be available. Three apneic episodes occurred in this series and all were successfully reversed with naloxone with no untoward effects.

Ambulatory Surgical Procedures↗
PubMed1984

Acute management of severe hand injuries.

Mutilating hand injuries are extraordinarily complex, involving all structures of the hand. Immediate treatment priorities are described, and planning for staged reconstruction is formulated, based on the most reasonable and realistic goals involved in restoration of use for the patient.

Amputation, Surgical↗
PubMed1983

Established hand infections: a controlled, prospective study.

A randomized, prospective study of 200 consecutive established hand infections was designed to compare the efficacy of two antibiotics, cefamandole and nafcillin. Bacteriologic data revealed 63.5% of the patients grew multiple organisms (2.3 organisms per culture) and 26% of the patients had anaerobic infections. Complications were noted in 13% of all patients--26% in patients who grew aerobes and anaerobes and 9.8% in patients who grew aerobes alone (p less than 0.05). Despite the fact that 95% of all organisms were sensitive in vitro to cefamandole whereas only 67% of organisms were sensitive to nafcillin (p less than 0.01), complications occurred more frequently in patients treated with cefamandole. We conclude that the empirical selection of a broad-spectrum antibiotic is reasonable based on in vitro sensitivity studies; however, other factors such as treatment delay, initial extent of infection, anatomic location of infection, cause of infection, and extent of surgical debridement are important in the development of complications.

Adolescent↗
PubMed1983

Early joint and tendon reconstruction for a degloving injury to the dorsum of the hand.

Primary insertion of inert material into an open wound to expedite joint and tendon reconstruction can be safely accomplished if the wound is thoroughly debrided and the material is covered with a well-vascularized flap. In this case, metacarpophalangeal mobility and extensor tendon function were largely preserved by early insertion of silicone spacers and rods in the reconstruction of a severe degloving injury to the dorsum of the hand.

Adult↗
PubMed1983

Complications of muscle-flap transposition for traumatic defects of the leg.

A careful study of 95 consecutive muscle-flap procedures performed on 71 patients with traumatic soft-tissue defects of the leg was carried out. Although there were only 5 cases of total muscle-flap necrosis, major and minor complications were found in 31 patients, requiring additional surgery for coverage. Technical errors resulted in partial split-thickness skin-graft loss or hematoma and were responsible for the 10 minor complications. Inadequate debridement of necrotic soft tissue and bone, the use of diseased or traumatized muscle, and unrealistic objectives for the muscle-flap coverage were the source of 21 major complications. We feel fewer complications would result with more careful preoperative evaluation and surgical planning, adequate debridement of bone and soft tissue, and the transfer of healthy, nontraumatized muscle.

Adult↗
PubMed1983

Functional reconstruction of an extremity by free tissue transfer of the latissimus dorsi.

Fifteen lower extremities with large traumatic defects in the soft tissues were resurfaced by free microvascular transfer of the latissimus dorsi muscle and overlying skin. This procedure was particularly useful in four patients in whom a portion of the extremity had been acutely denuded of its soft-tissue sleeve, leaving exposed bone, joint, or tendon. It was also effective in eleven patients with chronic lesions who required additional reconstructive procedures (arthrodesis, internal fixation, bone-grafting, or tendon-grafting), and in the treatment of chronic osteomyelitis when infected bone and soft tissue had to be liberally debrided. In the eleven patients who had chronic osteomyelitis at the time of the transfer (five with infected, unstable tibial fractures), no subsequent drainage was evident at an average of twenty-two months' follow-up.

Adult↗
PubMed1982

Latissimus dorsi musculocutaneous flap for elbow flexion.

A technique is described for the simultaneous restoration of traumatic loss of elbow flexors and overlying skin by transferring the latissimus dorsi muscle on its neurovascular pedicle with an island of overlying soft tissue. The procedure is safe and is performed in a single stage, thereby accelerating rehabilitation time. It provides bulk, contour, and coverage for the vital structures in the brachium and results in minimal donor morbidity.

Adult↗
PubMed1982

Breast reconstruction in the burned adolescent female (an 11-year, 157 patient experience).

The experience accumulated after reconstruction of 157 burned breast patients has led to the development of surgical principles and techniques tailored to this problem. Most important among these principles is that the surgeon recognize and preserve viable breast bud tissue in the debridement phase of the acute burn. Reconstruction should begin when the burned breast envelope is insufficient and restricts normal growth. Best results are obtained if contracture release is complete, if defects are covered by thick split-thickness skin grafts, and if nipple-areola reconstruction is obtained from a normal opposite breast if present. Postoperative management should continue until wounds are mature and should include techniques to prevent contracture recurrence.

Adolescent↗
PubMed1981

Complete sternectomy for chronic osteomyelitis with reconstruction using a rectus abdominis myocutaneous island flap.

We believe the rectus abdominis myocutaneous island flap offers a reliable alternative method of midchest reconstruction in selected cases of chronic osteomyelitis of the sternum, in conjunction with complete resection of injected sternal bone and cartilage. This single-stage procedure provides an en bloc unit of muscle with overlying skin and soft tissue, reaching from the xiphoid to the sternal notch. Three successful cases demonstrating the method are presented, with follow-up ranging from two months to two years.

Aged↗
PubMed1980

Melanin containing clear cell sarcoma in a fingertip. Case report and review of the literature.

A case is described of a clear cell sarcoma with ultrastructural evidence of melanin production. The tumour appeared on the distal portion of the index finger of a thirteen-year-old girl and showed little change in size over seven years of observation by the patient. At age twenty she required hospital admission at which time clinical evidence of metastases to axillary nodes, lungs and bone was found and the patient died within two months. The previous cases reported in the literature are discussed.

Adolescent↗
PubMed1980

Microvascular free groin flap for soft-tissue coverage of the extremities.

Six cases of microvascular free flap, composite tissue transfer are presented. The advantages of utilizing this modality of tissue coverage are that it is a direct one-stage procedure which, in experienced hands and using a two-team approach, can solve complex reconstructive problems with a minimal hospital stay and minimal morbidity.

Adolescent↗
PubMed1979

A new surgical procedure for correction of lip deformity in cranio-carpo-tarsal dysplasia (whistling face syndrome).

A child with cranio-carpo-tarsal dysplasia or whistling face syndrome is described together with a new surgical procedure for the correction of the mouth deformity. The syndrome is rare; only approximately 40 cases have been described in the literature since 1938. Correction of the facial appearance is of great importance to the affected individuals because of emotional problems they may develop as a reaction of their anomalies. Although the majority of cases have been sporadic, the syndrome can be transmitted as an autosomal dominant trait. Therefore, genetic counseling for affected persons should be offered.

Carpal Bones↗
PubMed1979

Two-year review of hand infections at a municipal hospital.

Although an unromantic topic, the management of hand infection can tax the patience and skill of the modern day surgeon. The addition of antibiotics to the surgeon's armamentarium have made the job easier than in the days of Kanavel and Koch but has not altered the basic surgical principles of elevation, immobilization and properly planned drainage. Awareness of hand anatomy in relation to infection and awareness of special categories of problems are necessary in preventing crippling deformities in one of our most precious possessions--the hand.

Animals↗
PubMed1977

Eyebrow reconstruction in the burn patient.

Eyebrow reconstruction in burn patients has been effectively performed in nine eyebrows in six burn patients. The results were excellent in seven of the eyebrows and satisfactory in the remaining two. In the authors' experience, the free hair transplants have had marginal results because of the scarred recipient site, and we recommend the island pedicle graft as an alternative, in selected cases, for facial burn reconstruction. Case summaries, details of the operative procedure, and illustrations are presented.

Adolescent↗
PubMed1976

Surgical management of chronic hidradenitis suppurativa of the perineum.

Two cases of chronic hidradenitis suppurativa of the perineum are presented. Both patients suffered through many years of discomfort and social isolation, undergoing multiple temporizing procedures. The treatment course pursued is described in detail. It is hoped that a greater appreciation of the disabling nature of this disease will lead to earlier, definitive therapy.

Adult↗