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Biomedical subjects

J W Futrell

Publications and source records attributed to J W Futrell.

At least 55 records · Page 3Linked to original sources
PubMed1986

Breast and pectoral muscle maldevelopment after anterolateral and posterolateral thoracotomies in children.

Anterolateral and posterolateral thoracotomies, involving an incision through the third and fourth intercostal space, have been used for the repair of congenital heart lesions in children during the past thirty years. We examined 28 patients who had undergone repair of atrial septal defect, patent ductus arteriosus, and coarctation of the aorta as children, through the anterolateral or posterolateral chest approach. Volumes of the breasts and pectoral muscles were obtained by a method using plaster molds, and linear dimensions of each chest side were measured. Questionnaires were completed that delineated the patients' perception of asymmetry of the chest. Infant breast tissue on cadavers was examined. We conclude that standard anterolateral thoracotomies result in a high frequency of breast or pectoral maldevelopment; 60% of our patients had a greater than 20% difference in volume between the two sides. We propose a modified operative approach that we believe will reduce the frequency of maldevelopment.

Adolescent↗
PubMed1986

Clinical anatomy of the internal oblique muscle.

In recent years microvascular free tissue transfer has become a well accepted reconstructive technique. The current trend in flap research seems to be the development of more refined flaps to meet specific needs with minimal donor site morbidity. The internal oblique muscle provides a broad, thin, well-vascularized flap which is ideally suited for restoration of contour with excellent aesthetic results. In addition, the iliac crest may be raised in continuity based on the same vascular pedicle, i.e. the deep circumflex iliac vessels. The purpose of this article is to describe the anatomic details necessary for the clinical application of this versatile flap. Thirty specimens of the internal oblique muscle flap were dissected and studied using Microfil injection techniques, including xerograms. In about 80 percent of the flaps, a single ascending branch of the deep circumflex iliac artery (DCIA) enters the undersurface of the muscle, arborizing within the muscle. In the remaining 20 percent, two or three branches enter the muscle separately, originating on the DCIA. The arc of rotation extends into the ipsilateral groin for coverage of exposed femoral vessels, along the pubis and the anterior perineum. The length of the vascular pedicle is to 6 to 7 cm and the vessel diameter is 2.0 to 3.0 mm, making the flap suitable for free tissue transfer.

Abdominal Muscles↗
PubMed1986

The influence of dexamethasone on the regrowth of surgically removed fat.

We investigated the interaction between long-term dexamethasone administration and lipectomy on regional fat deposits in the rat. Seven-week-old Sprague-Dawley rats (N = 24) were divided into 3 test groups. Group 1 (control) received 0.5 ml/kg of saline intramuscularly daily; group 2, 1 microgram dexamethasone intramuscularly; group 3, 5 micrograms dexamethasone intramuscularly. At week 9 a lipectomy of 4 regional fat deposits on the right side of the animal was done: inguinal, epididymal, interscapular, and perirenal. Injections continued for an additional 27 weeks, at which time a lipectomy was done removing left-sided depots in addition to any "regrown fat" on the previously dissected right side. Several conclusions can be made. First, rats receiving 5 micrograms/kg reaccumulated more fat than the controls in the inguinal, perirenal, and interscapular depots. Second, fat cell size in this model greatly influenced the ultimate size of each depot. Third, fat depots vary in their response to steroids and lipectomy because of local and systemic factors.

Adipose Tissue↗
PubMed1986

Studies on the nature of the flap/bed interaction in rodents--Part I: Flap survival under varying conditions.

A flap needs close contact with its bed for optimal flap survival. Using a rat dorsal flap model, flap/bed contact times were varied by use of a sterile polyethylene film. In addition, the flap was modified either by removing the panniculus carnosus or by converting the distal flap into a skin graft. Finally, the effect of using a dressing was assessed. Several observations were made: (1) The initial 6 to 12 hours of a flap's interaction with its bed is critical for optimal survival; (2) fluorescein accurately predicted flap survival upon polyethylene removal; (3) removing the panniculus carnosus increased flap and skin graft survival; (4) dressing allowed flaps and skin grafts to better withstand bed deprivation; and (5) distal flaps and skin grafts under various conditions responded differently to bed deprivation.

Animals↗
PubMed1986

Studies on the nature of the flap/bed interaction in rodents--Part II: Morphological and fluorescein kinetic data.

The current study in rats concerns two aspects of the flap/bed interaction: fluorescein kinetics and histological finding. In the control group of animals in the fluorescein kinetics experiment, flaps were raised and then reattached. In one experimental group, the flaps were raised and placed on a sterile polyethylene film. In two other groups, the flaps were raised and then the pedicle was cut, either immediately or at specific intervals. At intervals up to 24 hours several animals were injected with 5% fluorescein. In the control group fluorescein penetration increased with time, while it decreased in the polyethylene-film group. There was virtually no fluorescein staining in both cut-pedicle groups. To study histological events, the animals were divided into groups with flaps and groups in which the distal end of each flap was severed to form a contiguous skin graft. Other conditions were varied. All flaps were cultured, and biopsy specimens were obtained from three areas at several time intervals. Histological sections from the distal flap were markedly different from the corresponding skin grafts. These results corroborate previously noted survival rates.

Animals↗
PubMed1986

William Cowper.

William Cowper, now virtually forgotten, was the first of the surgeon-scientists of Great Britain. He was the first to bring the power of the experimental method to bear on practical surgical problems and to urge that the principles of surgery be drawn from an understanding of the "animal oeconomy." In these areas he anticipated the celebrated Hunterian school of surgery by more than half a century and by his example he actually set the foundation on which that school was built. Cowper was a scientist of a high order. He was the first to prove the existence of capillaries in higher mammals, to describe naturally occurring arteriovenous shunts in the lungs and spleen, to define the essential physiology of aortic valvular disease, and to recognize the nature and consequences of arteriosclerotic vascular disease. He was the author of two important anatomy books and the first English language treatise on general physiology available to surgeons. He was one of the first two surgeons ever honored by election to the prestigious Royal Society of London. An analysis of the works and doctrines of William Cowper appears to cast serious doubt on the common teaching that the idea of "scientific surgery" was the sole creation of John Hunter.

Anatomy↗
PubMed1985

The cutaneous blood supply of the neck: relevance to incision planning and surgical reconstruction.

Previous descriptions of the blood supply of the neck have been contradictory. Neck dissections were performed on 17 adult cadavers after perfusion with radio-opaque microfil silicone rubber compound. In four cadavers cervical incisions were created and flaps elevated prior to perfusion to help demonstrate vascular pathways. In all cadavers myocutaneous perforators were seen passing from the sternocleidomastoid, strap muscles, and trapezius to supply the dermal-subdermal plexus. Also, there were consistently identifiable branches of the superior thyroid, posterior auricular, occipital, facial and transverse cervical arteries, which supply both the platysmal vascular plexus and the overlying dermal-subdermal plexus. The dermal-subdermal plexus is continuous across the midline and this contralateral pathway is supplied chiefly from branches of the superior thyroid artery, facial artery, and myocutaneous perforators of the strap muscles. This information may be useful in the planning of cervical incisions and the design of platysma myocutaneous flaps.

Adult↗
PubMed1985

Topical acidification promotes healing of experimental deep partial thickness skin burns: a randomized double-blind preliminary study.

The effects of three buffered solutions with pH values of 3.5, 7.42 and 8.5, respectively, on the healing rate of deep partial skin thickness burns, was followed for 21 days in 16 guinea-pigs. Two symmetrical burns were inflicted on the back of each animal and then each individual wound was dressed with an irrigation disc dressing; solutions were coded (no. 1 to no. 3) and the animals were randomly divided and blindly treated as follows: Group A, solution no. 1 v. solution no. 2 (n = 4); Group B, solution no. 2 v. solution no. 3(n = 4); Group C, solution no. 1 v. solution no. 3(n = 4); Group D, non-irrigated disc dressings (n = 4). The solutions were applied to the surface of the burn wounds at a rate of 0.15 ml/cm2. Dressings were changed every 7 days to assess contraction and epithelialization by a sonic digitizer. On post-burn day 21 the newly formed scar tissue was measured in all wounds. After computation of the healing rate at the end of the study, the data were then related to the coded treating agent. Contraction did not differ in all test groups during the study. Epithelialization was significantly faster in the pH 3.5-treated burns than in the other treated wounds (P less than 0.001). The present study indicates that topical acidification of experimental deep partial skin thickness burns promoted healing. The precise mechanism should be elucidated.

Administration, Topical↗
PubMed1985

The salutary effects of the bed on the survival of experimental flaps.

The present study indicates that the distal, random segment of an axial pattern experimental flap can be partially salvaged by employing local pressure, which provides favorable contact with the bed. This portion of the flap could be considered as a composite skin graft. Serial India ink injections demonstrated that its physiological take resembles that of a split-thickness graft, dominantly depending on the blood vessels emerging from its bed, and to a lesser extent on those provided by its proximal segment and adjacent skin edges. Increasing the topical flap humidity hindered, rather than improved, its survival.

Animals↗
PubMed1985

The microcirculatory pattern of the transverse-abdominal flap: a cross-sectional xerographic and CAT scanning study.

Following unilateral iliac artery injection of radiopaque Microfil in cadavers, coronal sections of the anterior abdominal wall at 1-cm intervals were obtained employing computerized axial tomography of the intact specimen as well as xerography of frozen slices. Because they avoid the distortion and disruption of the vasculature induced by anatomical dissection, these studies clearly indicate that the arterial supply to zones 3 and 4 of the transverse rectus abdominis musculocutaneous flap is derived through the following systems: the subdermal plexus, and the superficial subcutaneous tissue crossover system. This study substantiates previous anatomical assumptions.

Abdominal Muscles↗
PubMed1985

Internal oblique muscle pedicle flap for coverage of a major soft tissue defect of the groin.

We describe a new muscle flap, using the internal oblique muscle as a transposition flap based on the ascending branch of the deep circumflex iliac artery, for coverage of a groin defect with exposed femoral vessels. This muscle also has potential usefulness as a pedicle flap for coverage of the anterior perineum and midline lower abdominal defects. It is a thin, flat muscle with excellent vascularity and is safe and reliable to use. The donor site scar is well concealed. The disadvantages are a possibly bloody and tedious dissection, and the long-term potential for abdominal wall weakness or herniation. In the case reported, no abdominal wall laxity or herniation were noted at eight and one-half months. We believe that the internal oblique muscle flap is a useful technique that complements the already popular methods of reconstruction for groin defects.

Abdominal Muscles↗
PubMed1985

Surgical management of massive perianal hidradenitis suppurativa.

Hidradenitis suppurativa of the perineum and buttocks is a devastating disease often causing patients years of pain, discomfort, and eventual social isolation. The chronic form of the disease results from a lack of aggressive surgical intervention when the patient is first seen. It is characterized by a malodorous drainage from multiple sinus tracts encased in marked scarred and fibrotic tissue. In contrast to axillary involvement, the perianal form of hidradenitis suppurativa is associated with an increased frequency of anemia, fistulous communications with bowel and urinary tract, and the development of carcinomas. Several cases illustrating the debilitating nature of the disease and its optimal management are presented. This report illustrates that (1) a well-planned preoperative and postoperative bowel regimen can eliminate the need for a diverting colostomy, even in the most extensive forms of perianal disease, (2) radical excision is expedited and blood loss is minimized by the use of a Shaw hot knife (Oximetrix, Mountain View, CA), (3) the quilted application of meshed split-thickness skin grafts as a primary procedure provides rapid closure of the surgical defect and minimizes patient discomfort, and (4) aggressive surgical intervention in severe cases provides a chance for a rapid recovery from this crippling disease.

Adult↗
PubMed1985

Effect of Fluosol-DA (20%) on skin flap survival in rats.

This study evaluates the effect of increased oxygen-carrying capacity of blood with the oxygen-carrying blood substitute Fluosol-DA (20%) on skin flap survival in rats. A skin flap model as described by Finseth was used in male Sprague-Dawley rats. We found that Fluosol-DA (20%) alone or in conjunction with O2 does not augment survival of skin flaps in rats, while hemodilution enhances and hemoconcentration deteriorates skin flap survival. Systemic O2 does not enhance survival of skin flaps in rats.

Animals↗
PubMed1984

Primary carcinoma of Stensen's duct: recognition and management with literature review.

Primary carcinoma of Stensen's duct is a rare neoplasm with only 15 cases reported in the English literature since 1927. The authors present a recent additional patient and discuss their criteria for the determination of true primary ductal lesions based upon clinical presentation, operative findings, and tumor histology. This method of selection, most particularly involving electron microscopy in the reported case, is necessary to define whether the lesion originates from the ductal epithelium. All previously reported cases were reviewed, together with the actual pathologic slides in four available cases. Only ten were retained as primary ductal lesions. Most important, this analysis clarifies the natural history of these neoplasms and reinforces a recent theory of histogenesis of salivary gland tumors. In light of these findings, a rational treatment plan can be suggested.

Adult↗
PubMed1984

The disc dressing for local irrigation of experimental burn wounds.

The newly designed disc dressing permits the surface of experimental burn wounds to be irrigated with liquid therapeutic agents without the need for frequent dressing changes. This approach is simple to handle, reduces the risk of trauma or contamination of the wound, and is not time consuming.

Animals↗
PubMed1984

Limb allografts in rats immunosuppressed with cyclosporin A.

The role of cyclosporin A in transplantation of composite tissue for potential reconstructive purposes is examined in the rat hind limb transplant model. Two inbred rat strains were utilized. Brown ACI rat hind limbs were transferred to the dorsum of white Lewis rats with microvascular anastomoses. Twenty transplants were divided into four groups for postoperative immunosuppression: control, no cyclosporin; 7 days of cyclosporin; 21 days of cyclosporin; and continuous cyclosporin from 44-113 days. Hemagglutination and antibody titers were measured. Clinical evaluation and histologic examination at sacrifice were performed and rejection graded. Cyclosporin A has been successful in suppressing rejection in composite allograft transplant across defined major histocompatability barriers. Rats treated with cyclosporin A for a short period of time showed signs of rejection after discontinuation of therapy. Five animals treated continuously on cyclosporin A for up to 113 days showed no sign of rejection clinically, histologically, or immunologically.

Animals↗