Biomedical subjects
Publications and source records attributed to H Y Chiu.
We describe three cases of combined loss of skin and tendon on the dorsum of the finger that were reconstructed with venous flaps. The technique is feasible and offers a good treatment modality for the small but complex defect on the dorsum of the finger by a one-stage operation.
A technique for simultaneously replanting multiple digits amputated at Tamai's Zone V is described. Since these multiple amputated digits are connected together, they should be replanted as a single unit. The technique includes applying the pneumatic tourniquet first, debridement, bone shortening, and fixation of all the amputated digits, including tendon repairs, application of vascular clamps before releasing the tourniquet, followed by vascular anastomosis in one-by-one fashion for each digit. The disadvantage of this technique is the difficulty in keeping the digit cool. The advantages are it is a less time-consuming operation, there is reduced blood loss and contamination, and there is a better axial arrangement of the bony framework.
Measurement of orbital volume was conducted in 10 patients with blow-out fractures as well as in 20 controls. A bony orbital volume increase of up to 13.4+ +/- 6.0% was noted in the preoperative measurements. Proper reconstruction of the bony orbit in four patients reversed the volume change observed and achieved a satisfactory outcome. In the surgical techniques, we stress the importance of posterior floor restoration. Judicious analysis of the image and volume changes using computed tomography (CT) may offer great help in both pre- and postoperative assessments. An intimate correlation between the bony volume change and the observed degree of clinical enophthalmos has been confirmed. For a 1 mL increment in bony volume, there is a corresponding enophthalmos decrement of 1 mm on the Hertel exophthalmometer. In applying this information to clinical practice, we advocate that a bony volume change of over 8% (2 mL) usually implies a poor cosmetic outcome, thus indicating the need for surgical correction.
With the development of microsurgery, replantation surgery have become the method of choice in treating the digit amputations. Although better than 90% of successful rate can be achieved in replanting guillotine type amputation, the final functional recovery is the main goal. The indications include: (1) thumb amputations, (2) Zone I amputation, (3) multiple digits, (4) bilateral amputation, (5) hemi-hand amputations, (6) hand amputation at wrist to upper forearm, and (7) pediatric amputations. And the contraindications include: (1) life-threatening associated injuries, (2) technically impossible, and (3) self-inflicted injuries. As for condition which have been previously put in the contraindication categories, such as: (1) single finger amputation, (2) Zone II amputations, (3) severe crush or avulsion injuries, (4) geriatric amputations, and (5) lengthy ischemia time amputations, the decision of to replant or not to replant was not a straight forward one. The decisions are individualized to meet the needs of different patients.
Fournier's gangrene is defined classically as a fulminant, rapidly spreading infection of the scrotum that also involves the perineum, penis and abdominal wall. The pathologic findings are described as synergistic gangrene secondary to a polymicrobial flora with a poorly defined portal of entry. We report 3 cases of Fournier's gangrene. Case 1 was a 67 years old who was admitted with the chief complaint of scrotal swelling and necrosis. Case 2 was a 59 years old who was admitted with the problem of scrotal swelling and pain, he had sought other medical help without success, and was then transferred to our hospital. Case 3 was a 62 years old who was admitted with the chief complaint of scrotal swelling and pain for 2 days. These 3 patients were all found to have diabetes mellitus. All 3 patients required aggressive surgical debridement, broad-spectrum antibiotics and adjunctive measures. Blood cultures were usually negative and pus cultures were typically aerobic gram-negative rods and gram-positive cocci and anaerobic bacteria of various types, especially Bacteroids fragilis. Our pus cultures revealed Escherichia coli and Staphylococcus aureus in Case 1, Enterobacter cloacae in Case 2 and E. coli, B. fragilis and Pseudomonas aeruginosa in Case 3. This disease is no longer a disease of young men. After 1945, the average age in 119 reported cases was 51.3 years and the average age of our cases was 62.7 years. Before the era of antibiotics, scrotal gangrene was not a rarity. In these modern times, in spite of seeking medical attention early, patients still developed scrotal gangrene and the mortality rate is high.(ABSTRACT TRUNCATED AT 250 WORDS)
The hind limbs of young rats were transferred to adult rats to clarify the morphologic and growth changes of a young epiphyseal plate in an adult hormonal environment. The transplanted femur and tibia achieved about 70 percent of normal growth in length, or significantly less than normal control (p less than 0.001). Histologically, the thickness of the epiphyseal plate in the transplanted bone was significantly thinner than that of normal control (p less than 0.001), and earlier epiphyseal union was also noted. Hormonal alterations during adolescence are believed to have a marked effect on these findings. However, the circumferential growth of the femur and tibia was greatly affected by the loss of biomechanical stress, precluding an evaluation of the influence exerted by hormonal alterations.
A patient in whom a previously repaired flexor digitorum superficialis tendon was used for transfer to correct a claw deformity is described. I have found this to be possible under optimal conditions of tendon repair, thus providing the hand surgeon with another choice of donor material.
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When a functionally important digit is injured as part of a multiple digit injury, transpositional digital replantation is worth considering to preserve greater hand function and to avoid or minimize the necessity for secondary reconstructive procedures. We present two such cases with transpositional digital replantation. The indications for this technique are: 1) multiple digit injury, 2) severe crush injury, 3) the possibility of preserving more and better joints in some fingers, and 4) injury distal to Tamai's zone V (11). The benefits of this procedure are that function can be better with the more completely preserved digits replanted into the most useful positions and of similar lengths. Difficulties are encountered when there are large discrepancies in size of surviving digits, and problems with soft-tissue coverage, tendon repair, a 'step' at the fracture site after bone fixation, and with vessel anastomosis. Use of this procedure can result in preservation of hand function and fewer secondary reconstructive procedures.
Since January 1981, we have used the Exacon thermometer to monitor skin temperature of 180 completely amputated digits during and after replantation surgery. When skin temperature on the first day after surgery was above 32 degrees, 153 of 154 replanted digits survived. In contrast, when skin temperature was 32 degrees or lower, 22 of 26 replanted digits failed. Data were analyzed by the Probit model, which indicated that skin temperature monitoring with 32 degrees as critical temperature is significant at P = 0.01. Also, critical temperature was tested in the range of 31.0 degrees to 33 degrees at intervals of 0.1 degree. We found the probability of predicting the viability for replanted digits is highest when skin temperature is 32 degrees or higher.
A case of digits revascularized after 33 hours of warm ischemia time is described. Ischemic changes had occurred already with ultimate loss of the distal segments, but most of the fingers survived to provide the patient with adequate function. Although the commonly accepted limit of warm ischemia time has been reported to be within 6 to 12 hours, revascularization of digits can be attempted in selected cases even after an apparent prolonged warm ischemia time.
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