Biomedical subjects
J W May
Publications and source records attributed to J W May.
Palm of hand free flap for forearm length preservation in nonreplantable forearm amputation: a case report.
In traumatic forearm amputation, if replantation is not indicated or possible, then adequate forearm length preservation is desirable to allow use of a below-elbow prosthesis. A case is presented in which forearm replantation was not done, but forearm length was preserved by use of a palmar skin free microvascular flap.
Simultaneous microstructure repair in replantation surgery.
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The water-skier seer syndrome.
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Preoperative magnification angiography of donor and recipient sites for clinical free transfer of flaps or digits.
Based on the 14 free flap transfers we present with full survival, we recommend peroperative magnification angiography of both the recipient and donor sites. In our hands, this type of preoperative assessment seems to increase the margin of safety.
Color preference for black and white by infants and young children.
The purpose of this study was to determine whether a preference for the color white was present in infants and young children. A color preference test was administered to 160 subjects who ranged in age from 6 mo. to 4.5 yr. Data were obtained from a 120-item test in which 12 different pairs of toys were presented to each subject. The toys in each pair were identical except that one was black and the other was white. The toy the subject selected was considered the subject's preference and the color of that toy was recorded. Statistical analysis did not support existing literature, refuting the published idea that white preference is a general quality in all human beings.
Management of supracondylar fracture with brachial artery thrombosis in a child: case report and literature review.
Brachial artery thrombosis following prompt reduction of a supracondylar fracture of the humerus in a 7-year old is described. Persisting absence of the distal pulses in a viable extremity may herald the insidious development of Volkmann's ischemia. Pulse volume recordings provide a safe, objective means of evaluation. Arteriography by direct open technique avoids the hazards of percutaneous puncture in children.
Angiography-friend or foe of free flaps?
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Amputation: injury to replantation.
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The no-reflow phenomenon in experimental free flaps.
The no-reflow phenomenon was studied following reconstitution of blood flow by microvascular anastomosis in an ischemic and denervated free epigastric flap in the rabbit. Microscopic, histological, angiographic, and hematological studies demonstrated the progressive nature of this obstruction to the peripheral blood flow after increasing periods of ischemia. This obstruction reached a point of irreversibility after 12 hours of ischemia, leading to ultimate death of these flaps. These results are consistent with the hypothesis that an ischemia-induced no-reflow phenomenon is caused by cellular swelling, intravascular aggregation, and the leakage of intravascular fluid into the interstitial space. Similarities between these experimental findings and human observations are made. The clinical importance of early diagnosis and treatment of ischemic tissues is emphasized.
The effects of the perfusion of various solutions on the no-reflow phenomenon in experimental free flaps.
The effects of solution perfusion in the free epigastric flap of the rabbit, after normothermic ischemic periods of 8 hours or 12 hours, have been examined by operative microscopic and histological methods. A smaller group of animals was also studied in which the perfusion was done before the ischemic insult. An ischemia-related obstruction to the peripheral blood flow occurred in the absence of stagnant ischemic blood in this model. Although the 3 perfusion fluids studied were shown to penetrate to all levels of a flap after such an ischemic period, none of them had a beneficial effect on skin survival. However, the solution containing mannitol did have a protective effect on fat survival. Analogies between these experimental findings and the clinical situation are made, and the importance of the early diagnosis and treatment of ischemia in a flap is emphasized.
The medial gastrocnemius myocutaneous flap.
Our experience with the medial gastrocnemius myocutaneous flap is presented. We have found it to be a reliable flap which can be transferred in one stage to solve difficult coverage problems about the knee and upper leg.
Free flaps: an overview.
The free flap represents a dramatic one-stage procedure for distant transfer of skin flaps. The operative technique consists of: identification of healthy recipient vessels; isolation of viable island skin flap; distant transfer followed by revascularization via microvascular anastomoses. New techniques warrant classification of free tissue transfers into single tissue transfers (skin, muscle, bone, nerve) and compound tissue transfers (osteocutaneous, musculocutaneous). When compared to conventional techniques, free flap transfers offer shorter hospitalization and immobilization as well as a greater reconstructive potential. However, their utilization mandates extensive experience in multiple microvascular techniques and clinical microsurgery.
Great toe to hand free tissue transfer.
Thumb reconstruction is a complex subject and the method selected for each patient deserves individual consideration. The method of free toe-to-hand transfer for thumb replacement should be chosen only when the surgeon is familiar with all alternative methods of thumb reconstruction and feels that this technique represents the most reasonable method available. For the surgeon a clear understanding of the anatomic similarities and differences between the normal thumb and great toe are mandatory. In well selected adults and children the failure rate for free toe-to-hand transfer should be very small. The advantages of a single staged thumb replacement from tissue of similar character and quality without local tissue sacrifice are tremendous. With improvement in techniques, experience and case selectiion, much free tissue transfers will actively compete with well established methods of thumb reconstruction. Surely the free toe-to-hand transfer for thumb replacement of today is a forerunner of thumb and hand transplantation of tomorrow.
Free neurovascular flap from the first web of the foot in hand reconstruction.
To identify an anatomically reliable and functionally acceptable neurovascular free flap for use in hand reconstruction, 50 fresh cadaver feet were dissected under the operating microscope, with particular attention paid to the anatomy of the first web area. A distal communicating artery was seen in 100% of dissections, allowing either dorsal or plantar donor artery inflow to nourish the entire flap area. Because of the ease of dissection, the first dorsal metatarsal or dorsalis pedis is suggested as the donor artery, and a dorsal branch of the greater saphenous venous system is suggested as the donor vein. The deep peroneal nerve was seen to consistently innervate the first web and, along with the plantar digital nerves, is suggested as an anatomically identifiable donor nerve. Either part of the foot first web may be used alone or together as a free flap. When indicated further dorsal skin may be incorporated into the web flap to expand its application. Two-point discrimination studies of the lateral plantar surface of the great toe in 50 normal individuals showed an average of 11.2 mm. This was significantly better as a potential donor flap than the medial dorsum of the foot where the average was 32 mm. A single case demonstrating the application of this flap in hand reconstruction is presented.
When to delay the dorsalis pedis flap?
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Successful clinical replantation of an amputated penis by microneurovascular repair. Case report.
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