Biomedical subjects

J J Pribaz

Publications and source records attributed to J J Pribaz.

At least 37 records · Page 2Linked to original sources

PubMed1996

Traumatic avulsion and reconstruction of the midface.

Traumatic loss of midface soft tissue and supporting structures may result in communication between the oral and nasal cavities. Reconstruction requires both oral and nasal lining, as well as supporting structures. The need for multilaminar tissue, as well as the paucity of local tissue, creates a reconstructive challenge. This case report describes the reconstruction of a traumatic defect of the alveolus, hard palate, inferior orbits, and local soft tissues. An intraoperative alginate mold facilitated a three-dimensional understanding of the wound, and allowed translation of an osseomyocutaneous groin flap to reconstruct the defect in one stage.

Adult↗

PubMed1995

Use of the innervated platysma flap in facial reanimation.

The innervated platysma musculocutaneous flap replaces facial tissue with like tissue. The thinness of the flap, the color match, and the presence of functional subcutaneous muscle are unmatched by any other flap that does not originate on the face. The superior blood supply is reliably provided by the submental branch of the facial artery, creating a reliable axial flap. Rotation of the muscle into the cheek aligns the fibers of the platysma muscle to provide upward pull on the oral commissure to assist with facial animation. Three cases of innervated platysma flap rotation to reconstruct the contour of the cheek and assist with facial animation are reported. All the patients achieved an improved facial contour and all flaps demonstrated noticeable contraction, augmenting facial animation.

Adult↗

PubMed1995

Anterolateral thigh free flap.

The descending branch of the lateral femoral circumflex artery is a large-caliber artery that passes obliquely across the upper third of the thigh and descends between the vastus lateralis and rectus femoris muscles. It sends perforators through the septum between these muscles and through the vastus lateralis muscle and supplies a large area of skin on the anterolateral aspect of the thigh. We report our experience with our first 44 consecutive anterolateral thigh flaps, which were used for a variety of soft-tissue deficits. Twenty-five of these flaps were used for lower extremity reconstruction. 10 were used in the upper extremity, and 9 were used in the head and neck. The overall success rate was 96%. Six flaps required reoperation; of these, 2 flaps were lost, one from a venous thrombosis and the other from arterial thrombosis, both of which were in the lower extremity. In approximately one third of cases, the flap was raised as a septofasciocutaneous flap, but in two thirds it was necessary to include a small segment of vastus lateralis muscle as well as fascia with the flap. The flap has been particularly useful for lower extremity reconstruction, and in patients who are not fit for general anesthesia, it is possible to perform the flap transfer with epidural anesthesia. The flap has the advantage of a long vascular pedicle with large-caliber vessels and thus is suitable as a flow-through flap. It may also be sensate and has provided a versatile soft-tissue coverage option with minimal long-term donor-site complications.

Adolescent↗

PubMed1994

Prelamination: defining the prefabricated flap--a case report and review.

Modification of flaps prior to local or distant transfer has gained wide acceptance. The term prefabricated has been used to describe all possible modifications. In this article we introduce the term prelamination to refer to the implantation of tissue or other devices into a flap prior to transfer and suggest that prefabrication be restricted to the implantation of vascular pedicles. A case is presented illustrating these concepts.

Adult↗

PubMed1994

Manipulating prefabricated flaps: an experimental study examining flap viability.

As flap prefabrication becomes a more commonly used clinical tool, it is necessary to investigate the limitations of this technique. Reconstructive procedures of the face often require "custom fitted" flaps to satisfy esthetic demands. This study examines and compares the safety of manipulating thin prefabricated skin flaps versus established axial pattern skin flaps. Twenty-seven New Zealand white rabbits were used to determine if prefabricated flaps can be folded 180 degrees around the edge of the rabbits' ears. The survival of these folded prefabricated flaps was compared with the survival of axial pattern flaps sutured into an identically recipient site. In addition, flaps prefabricated in the same manner were sutured onto a straight recipient bed to evaluate the viability of the newly vascularized tissue. The folded prefabricated flaps had reduced survival (56%) compared to equivalent folded axial pattern flaps (85%), P < 0.005. The nonmanipulated prefabricated flaps and axial pattern flaps survived completely.

Animals↗

PubMed1994

Flap prefabrication using the "vascular crane" principle: an experimental study and clinical application.

Techniques for tissue transfer have continued to evolve. Free flap prefabrication represents a further progression of well known plastic surgery principles in the arena of tissue transfer. This report presents an experimental study demonstrating that the repeated use of a vascular pedicle to prefabricate flaps in the rabbit is possible. There is a decrease in flap viability with the second transfer. A clinical case using this repeated transfer or "crane" principle is also reported. We conclude that the repeated use of a vascular pedicle to prefabricate multiple flaps is a viable option in selected cases.

Adult↗

PubMed1994

The value of the delay phenomenon in flap prefabrication: an experimental study in rabbits.

Neovascularisation of thin skin flaps after arteriovenous pedicle implantation (flap prefabrication) and the impact of the delay mechanism on the viability of these flaps were investigated. Twenty-four full thickness skin flaps were raised in twelve New Zealand white rabbits. Delay incisions were made at the lateral borders of the planned flaps at the same time as pedicle implantation, 1 week before pedicle implantation, or 1 week after pedicle implantation and the flaps based on the implanted vessels raised at 2 weeks after implantation. Flap survival assessed at 1 week was found to be improved when flap delay was performed 1 week before or after pedicle implantation. Angiographic studies demonstrated an increased density and linearity of the vascular pattern in these delay group flaps. The combination of the time-tested concept of delaying a flap with the newer technique of flap prefabrication appears to improve flap viability.

Angiography↗

PubMed1994

Local fasciocutaneous flaps for olecranon coverage.

In 1989 we began to treat soft-tissue defects around the olecranon process with local fasciocutaneous flaps as our preferred method of treatment. These soft-tissue defects are complications of bursitis, degenerative joint disease, and burns. They may also result from pressure necrosis over the olecranon in patients with impaired sensation. Because of the difficulty in treating these wounds a variety of local muscle, musculocutaneous, fasciocutaneous, distant, and free flaps have been described. Fasciocutaneous flaps have the advantage of using regional tissue in a single stage. Fasciocutaneous flaps around the elbow can be categorized as proximally or distally based. Proximally based flaps include the radial and ulnar forearm flaps as well as the posterior interosseous flap. Distally based flaps are based on upper elbow collaterals including the radial collateral artery, the middle collateral artery, and the anterior and posterior ulnar recurrent arteries. Eleven fasciocutaneous flaps were used in 10 patients with a follow-up of 1 to 3 years. All flaps survived and provided primary wound closure. Complications included 1 patient with recurrent ulceration after being healed for 6 months and 1 patient with a transient neuropraxia of the posterior interosseous nerve that resolved after 2 weeks. These flaps provide long-term stable coverage of olecranon wounds by using regional tissue with an acceptable donor site morbidity.

Adult↗

PubMed1994

Postmastectomy complications in breast reconstruction.

In a group of patients where breast reconstruction was performed at the time of mastectomy, the incidence of complications was studied. One hundred one consecutive patients had an autologous reconstruction using the transverse rectus abdominis musculocutaneous flap, and 115 consecutive patients had a prosthetic reconstruction with tissue expanders or with tissue expander and/or implant. One patient in the autologous reconstruction group had a cardiac arrhythmia requiring monitoring, but there were no other serious complications. Infection was more common in the group undergoing prosthetic reconstruction (5% compared with 3% in the autologous reconstruction group). A total of 8% of the patients in the group undergoing prosthetic reconstruction had to have their implants removed because of infection or exposure of the implant. Seven percent of the transverse rectus abdominis musculocutaneous flap patients had significant necrosis of a portion of the flap. Secondary surgical revision of the reconstructed breast was much more common (20%) in the prosthetic reconstruction group compared with 6% in the autologous reconstruction group.

Adult↗

PubMed1994

Reverse peroneal flaps: two surgical approaches.

The peroneal vascular pedicle supplies the posterolateral aspect of the lower limb and can be used in a reverse-flow manner to reliably cover wounds of the lower third of the leg and ankle. Two surgical approaches may be used, medial and lateral, to treat a variety of soft-tissue deficits. For the medial approach, the patient is positioned supine and the flexor hallucis longus muscle along with the peroneal vascular pedicle is raised. This easily covers medial malleolar or distal anterior tibial defects. For the lateral approach, the patient is positioned prone and a fasciocutaneous flap is dissected and can be used to cover soft-tissue defects down to the proximal foot and ankle. A total of 13 patients underwent reverse peroneal flaps with a follow-up of 6 months to 3 years. All patients healed their wounds, but there were minor wound complications in 4 patients. When used in a reverse-flow manner, the peroneal vascular system can allow for a wide variety of flap designs to treat selected patients.

Adult↗

PubMed1994

Use of previously burned skin in local fasciocutaneous flaps for upper extremity reconstruction.

Thermal injuries are characterized by varying degrees of damage to the skin and underlying structures. In the vast majority of patients, the initial thermal injury is limited to the skin and subcutaneous fat. The underlying fascia and its vasculature usually are spared. Flaps are required to cover nongraftable wounds (exposed tendon, bone, joints, and so on) and also are used to release joint and web space contractures. Contrary to frequent opinion, previously burned skin or skin-grafted fascia can safely be used as fasciocutaneous flaps when necessary. We present our series of burned patients in whom local flaps originating from within the burned area were used, avoiding the need for more distant or free flaps to accomplish appropriate wound coverage. This series consists of 40 fasciocutaneous flaps in 22 patients. The flaps included lateral arm (4), posterior interosseous (7), radial forearm (4), ulnar forearm (2), metacarpal (3), and digital (20).

Adolescent↗

PubMed1994

Early clinical experience in endoscopic-assisted muscle flap harvest.

Two cases of endoscopic-assisted muscle harvest for lower extremity reconstruction are presented. Each case involved resurfacing the distal leg and dorsum of the foot with a split-thickness skin graft over a latissimus dorsi free flap. An endoscope with a video monitor and modified thoracoscopic instruments were used to assist in the muscle harvest. The principles of endoscopic muscle harvest include an incision long enough to remove the muscle, placed in the least conspicuous area that is within the reach of the instrumentation; retraction to optimize the optical cavity or visual working area; and use of video monitors to allow for coordinated assistance. The decrease in visible scarring is dramatic and represents the primary advantage over open techniques. We believe that the role of endoscopy will continue to expand as our experience increases and technology improves.

Adult↗

PubMed1994

Three-dimensional folded free-flap reconstruction of complex facial defects using intraoperative modeling.

Free-tissue transfer has emerged as the ideal way of reconstructing complex facial defects. Multifaceted free flaps are often needed, and we have developed a simple technique to determine both the volume of tissue required and the localization of the various epithelial surfaces, thereby simplifying these complex reconstructions. We report our experience in reconstructing 19 complex facial defects in which we have used an intraoperative alginate moulage that has provided an accurate three-dimensional model of the defect, helping to determine the volume of the flap required. The reconstruction was further simplified by converting this three-dimensional model into a two-dimensional pattern by wrapping the model with a piece of Esmarch bandage, thereby determining the locations and sizes of the epithelial surfaces. The pattern was then transferred to the donor site and the flap de-epithelialized and thinned in situ with complete confidence that the tissue was "tailor-made" for the defect.

Adolescent↗

PubMed1993

Flap prefabrication using an exteriorised vascular pedicle in a rabbit ear model.

We have developed a new model of thin flap prefabrication in the rabbit with an exteriorised vascular pedicle in a skin tube. Study of these prefabricated flaps after transfer demonstrated that distal flap survival improved as the interval between implantation and flap transfer increased. Exteriorising the pedicle minimises both donor deformity and pedicle trauma and allows easier experimental study of the neovascularisation process in flap prefabrication.

Animals↗

PubMed1993

Nasal reconstruction with auricular microvascular transplant.

A free flap derived from the ascending helix of the ear has been used to reconstruct an anatomically diverse set of defects of the distal nose in 6 patients. Our cadaver injection studies have demonstrated that the blood supply to the auricular flap is via small, consistent branches from the superficial temporal artery. The patients were carefully selected, and most had failed prior attempts at reconstruction. The auricular flaps were used to reconstruct the nasal tip, ala, columella, and sill. The donor vessels were anastomosed either to the facial artery and vein or to vessels in the neck, via vein grafts. The flaps survived in all cases, but all patients required minor subsequent revision. The auricular donor site was closed by rotation and advancement of local tissue. This flap is presented as a surgical option for selected patients with complex defects of the distal nose, where excellent match of color and contour, predictable outcome, and avoidance of central facial donor site are desired.

Adult↗

PubMed1993

Double fillet of foot free flaps for emergency leg and hand coverage with ultimate great toe to thumb transfer.

A 42-year-old woman presented with avulsion amputation of her right leg 14 cm below the knee joint and a hemihand amputation of the opposite hand. Two free flaps, taken from the amputated foot, were used to cover the injured extremities. The sole fillet flap was used to preserve length and cover the injured leg, while the dorsal fillet flap covered the injured hand and provided ectopic storage for the great toe. The great toe was later transferred on a pedicle for thumb reconstruction. Spare parts surgery is now a well-accepted technique. This case demonstrates maximum utilization of amputated parts for functional and aesthetic reconstruction.

Adult↗

PubMed1992

The interrupted-continuous microsurgical suture technique.

Interrupted microsurgical sutured anastomoses are the standard to which all new anastomotic techniques must be compared. In 1902, Alexis Carrel described a continuous suture technique for large vessels that initially triangulated the anastomosis with three stay sutures. Our technique is a modification of Carrel's original technique combined with other previously published microvascular methods. This is an attempt to address the inherent problems associated with the standard interrupted technique and previously described continuous suture techniques.

Anastomosis, Surgical↗

PubMed1992

Vascularization of skin following implantation of an arteriovenous pedicle: implications in flap prefabrication.

In a rat model, a skin flap was fabricated by implantation of a distally ligated arteriovenous pedicle. The femoral artery and vein were implanted as a unit beneath the abdominal skin, a portion of which was later raised as an island flap, based on these vessels. Percentage area of survival, tissue blood flow, and pattern of vascularity were compared in two groups of flaps. In group I, the pedicle to be implanted was dissected with a cuff of surrounding muscle still attached; in group II, the pedicle was skeletonized to the level of adventitia. Flap survival in the two groups was similar (73% vs. 77%), as was skin blood flow (5.4 vs. 5.7 ml/100 g/min). Angiography demonstrated two principal patterns of vascularization: connection between donor and recipient vessels (inoculation), and sprouting and arborization of new vessels. Strengths and limitations of this and other models of flap "prefabrication" are discussed.

Animals↗