Search PubMed⌕ Search

Biomedical subjects

J Upton

Publications and source records attributed to J Upton.

At least 109 records · Page 6Linked to original sources
PubMed1983

Management of extensive doxorubicin hydrochloride extravasation injuries.

Forty patients with extensive doxorubicin hydrochloride extravasation injuries are reviewed. These injuries were located in critical anatomic areas such as the palmar aspect of the wrist, dorsum of the hand, and antecubital fossa. Contributing factors were related to local venous pathology, the mode of administration, and the lack of recognition of extravasation. Treatment of these injuries consisted of extensive debridement of all involved tissue and delayed closure by a variety of techniques. The complications and morbidity secondary to doxorubicin hydrochloride extravasation are often more disabling than the patient's primary disease. The degree of disability is related to the site of extravasation, patient's age, and delay before surgical complication. Early recognition and excision and delayed closure yield the most successful results.

Adolescent↗
PubMed1982

The evolution of techniques for reconstruction of full-thickness cheek defects.

Our experience with 20 full-thickness cheek reconstruction in 17 patients over the past 27 years is presented. The evolution of techniques for management of full-thickness cheek defects reflects our gradual appreciation of the longitudinal artery concept within axial and musculocutaneous flap units. During the 1950s, defects were managed by random flaps. Popularization of the forehead flap and introduction of the medially based deltopectoral flap during the 1960s heralded the current application of axial flaps. The 1970s saw an explosion of new techniques, including the musculocutaneous flaps and microvascular free tissue transfers, based on the longitudinal vessel concept. A method simultaneously employing the pectoralis major musculocutaneous flap for intraoral lining and the deltopectoral flap for external coverage has been described. A modification of the latissimus dorsi free flap to allow a one-stage watertight closure of large full-thickness cheek defects has been outlined. Our challenge for the 1980s lies in the improvement of techniques to reanimate the reconstructed cheek.

Adolescent↗
PubMed1981

Neocartilage derived from transplanted perichondrium: what is it?

The articular surfaces of rabbit patellae were completely eburnated and resurfaced with ear perichondrium or fascia lata or left unresurfaced. Both mature and immature animals were used and were sacrificed at 3, 6, and 12 months postoperatively. Only those joints resurfaced with perichondrium formed neocartilage. The neocartilage was composed of variable amounts of chondroitin sulfate; histologic appearances ranged from hyaline cartilage to fibrocartilage to fibrous tissue. Scanning electron microscopy revealed that the neocartilage surface was irregular, fibrillated, and disorganized. Biochemical analyses documented the variability of the neocartilage, one specimen being quite similar to normal articular cartilage. Cell-culture experiments with isolated rabbit periochondrocytes, chondrocytes, and fibroblasts were conducted to determine whether those cell types could produce cartilage matrix in vitro. The ability of sparse cultures of perichondrocytes to synthesize chondroitin sulfate under serum-free conditions is evidence that these cells are unlike fibroblasts and more like chondrocytes in their in vitro behavior. These in vitro and in vivo studies show that perichondrocytes are relatively differentiated cells with the potential to make cartilage. Elucidation of the factors contributing to the variable results of perichondral transplantation is essential before clinical applications will be predictably successful.

Animals↗
PubMed1980

Restoration of facial contour using free vascularized omental transfer.

Three cases are described in which free omental transfer was utilized for facial soft tissue augmentation. Dissections in 30 cadavers confirmed the five patterns of vascular distribution, the diameter of the omental vessels, and the fat distribution within the greater omentum. The versatile omentum offers many advantages over the "deepithelialized" groin flap: long pedicle, larger vessel size, less bulk, and tissue that can be layered upon itself. Retention of septae along the natural facial contour lines has improved the placement and minimized the late migration of transferred omental tissue.

Adolescent↗
PubMed1979

Primary care of the injured hand, part 1.

Because the hand is the most frequently injured part of the body, primary recognition of injured structures, careful assessment of damage, and appropriate treatment or referral by the primary care physician are critical. Most fingertip injuries heal with conservative care. Ideally, the healed wound should be covered with well-padded skin, be free of scar tissue, and not adhere to underlying bone. Crushing fingertip injuries associated with underlying fractures are often overlooked initially, with resultant infection, nonunion, and nail deformity. In the evaluation of flexor tendon injuries, recognition of the location of severed tendon is critical. Improved surgical techniques, when performed by an experienced hand surgeon, have yielded gratifying results, especially in the primary repair of tendon severance in the distal portion of the digit and palm. Mallet deformities at the distal interphalangeal joint are treated with extension splinting for minimum of six weeks without immobilization of the proximal interphalangeal joint. Open reduction is often required when an associated fracture involves more than 30% of the articular surface.

Amputation, Traumatic↗
PubMed1979

Primary care of the injured hand, part 2.

Nerve injuries in the forearm and hand are common, especially with concomitant tendon lacerations. The optimal time for repair of a clean sharp laceration is within the first 24 to 48 hours using magnification to achieve precise surgical reapproximation. Transfer to a facility equipped to perform replantation is indicated for multiple digit amputations, any thumb amputation, transmetacarpal amputation, wrist and arm amputation, and major amputations in children. Acute paronychial infections are treated with warm soaks, antibiotics, elevation, and immobilization. Surgical drainage is often indicated for a felon and should be done through a high midaxial incision. fractures of the hand are extremely common and require accurate diagnosis and precise anatomic reduction. Ensheathment syndromes--carpal tunnel syndrome, trigger finger, de Quervain's disease--are the most common nontraumatic disorders of the hand. If recognized and treated early they may resolve without need for surgery.

Abscess↗
PubMed1978

The spiral oblique retinacular ligament (SORL).

A procedure is described for reconstruction of the oblique retinacular ligament using a small tendon graft in a spiral fashion to act as a dynamic tenodesis to restore distal interphalangeal extension and to restrain proximal interphalangeal hyperextension. The method has been uniformly successful in the treatment of post-traumatic "swan-neck" or "mallet" deformity. Although the concept is simple, the procedure demands thorough understanding of digital anatomy for successful completion.

Adolescent↗
PubMed1978

Lengthening of the short columella associated with bilateral cleft lip.

Operations for lengthening the columella can be classified into three groups on the basis of source of material: lip, nose, or ear. When seen in profile, the middle of the lip provides one-fourth to one-third of the forward projection of the columella as compared with the level of the alar bases. Complete bilateral cleft lips usually benefit from columellar lengthening, but symmetrical, incomplete clefts rarely require it. Ancillary procedures, such as correction of a retruded maxilla by Le Fort I osteotomy or by contour build-up, can enhance the overall result. Our experience with advancement of skin from the floor of the nose and ala [15], skin from the alar margins at the tip [7], prolabial advancement flaps, fork flaps, and composite earlobe grafts is reported.

Adolescent↗
PubMed1977

Reconstruction of the breast after mastectomy.

We have described our techniques for reconstruction of the breast after a simple mastectomy, a modified radical mastectomy, and a radical mastectomy. Inadequate skin cover must be relieved, preferably by transposition of a thoracoepigastric flap. Not only must a mound be created, but also a nipple-areola complex. The areola can be constructed by nipple-sharing techniques from the opposite breast or by the use of the labia minora and/or the labia majora. However, we advise preservation and banking of the nipple-areola (or areola) by the ablative surgeon, when possible. The remaining breast usually requires some modification to match the reconstructed one.

Breast↗