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Biomedical subjects

L Scott Levin

Publications and source records attributed to L Scott Levin.

47 records · Page 3Linked to original sources
PubMed2003

The thoracodorsal artery perforator flap: anatomic basis and clinical application.

Based on the dissection of 20 fresh cadavers, the authors have detailed further the vascular anatomy of the thoracodorsal artery and its cutaneous perforator vessels. The thoracodorsal artery showed a constant bifurcation into a horizontal branch and a lateral branch, located on the deep surface of the latissimus dorsi muscle 4 cm (range, 3-6 cm) distal to the inferior scapular border and 2.5 cm (range, 1-4 cm) medial to the lateral free margin of the muscle. In 20 specimens there was a total of 64 musculocutaneous perforators larger than 0.5 mm. Thirty-six perforators (56%) originated from the lateral branch and 28 perforators (44%) originated from the horizontal branch. All perforators originated within a distance of 8 cm from the neurovascular hilus and ran in proximity with the horizontal or lateral branches. In 11 dissections (55%) there was also a direct cutaneous branch originating from the extramuscular course of the thoracodorsal artery before the neurovascular hilus. This cutaneous branch did not pierce the latissimus muscle but rounded the lateral muscle edge and supplied the overlying subcutaneous tissue and skin. It is hoped that the constant anatomy will encourage surgeons in the future to use the thoracodorsal artery perforator flap more often.

Adult↗
PubMed2003

Musculoskeletal sepsis: principles of treatment.

Musculoskeletal sepsis is infection of bone, joints, muscles, and skin and often occurs after open fractures. Thus, the main objective in the treatment of open fractures in restoration of function and prevention of infection. It is important to consider all open fracture wounds as contaminated. The principles of open fracture treatment include taking appropriate cultures, instituting immediate systemic antibiotic therapy, surgical débridement and wound management, stabilizing the fracture, and early bone grafting when indicated. The open tibial fracture, classified according to Gustilo and Anderson, serves as an exemplary model for musculoskeletal sepsis because this type of injury is described extensively in the literature. Early diagnosis and effective surgical and antibiotic management can control musculoskeletal sepsis, and the suppression of infection may last a lifetime.

Anti-Bacterial Agents↗
PubMed2002

Microsurgical free flap transfer to amputation sites: indications and results.

A series of microsurgical free flap reconstructions to amputation stumps of the upper as well as the lower extremities was reviewed in 7 male and 2 female patients. Indications included preservation of length after trauma in 6 patients and cure of local infection in 2 patients. In 1 patient an extensive defect after resection of a recurrent shoulder sarcoma required use of a complete arm fillet free flap for tumor reconstruction. Microvascular free flaps used included four scapular flaps, two fillet flaps from the amputated extremity, one anterolateral thigh flap, and one lateral arm flap. Seven of 9 patients were fitted with a prosthesis and underwent occupational therapy resulting in ambulatory and improved functional status. Microvascular reconstruction is indicated in emergency settings as well as for elective reconstruction of amputation sites. Using uninjured "spare parts" of the amputated extremity should be considered. Elective reconstruction is performed preferably with free flaps based on the subscapular vascular system.

Adolescent↗
PubMed2002

Endoscopic access to the extremities: the principle of fascial clefts.

Technology for endoscopic surgery has developed rapidly during the last decade. Applications of endoscopic techniques to orthopaedic surgery have been made possible by the use of balloon dissectors. Balloon dissectors create an optical cavity by separating fascial layers of a constant anatomic plane called the fascial cleft. The optical cavity can be maintained with either carbon dioxide (CO2) insufflation or manual retractors. The authors of the present study have developed a safe, reliable technique using a balloon dissector to create such optical cavities in the extremities, pelvis, and acetabulum to facilitate minimally invasive surgery in these areas. The authors' clinical work and fresh cadaver dissection confirms that the fascial cleft is a universal anatomic constant. It can be accessed quickly to facilitate endoscopic procedures, such as bone grafting for delayed unions, tissue expansion for reconstructive surgery, sural nerve harvesting for nerve cable grafting, and microvascular tissue transfer harvesting and flap prefabrication for extremity reconstruction. Twenty-five cases, each with an average follow-up of 34 months, are presented. Indications, results, and complications of balloon-assisted endoscopic surgery are described.

Bones of Upper Extremity↗
PubMed2002

Endoscopic-assisted, minimally invasive anterior pelvic ring stabilization: a new technique and case report.

This report describes the technique of endoscopic-assisted reduction and stabilization of the anterior pelvic ring with endoscopic visualization of all critical bone and soft tissue structures. Compared with the conventional ilioinguinal approach of Letournel, the endoscopic technique facilitates a reliable internal fixation of anterior pelvic ring fractures with minimal soft tissue trauma. Thus, the use of the endoscope enables us to apply the concept of minimal invasive plate osteosynthesis to the pelvis. We recommend the described technique for complex anterior pelvic ring fractures, in which the anterior stabilization has to be achieved with a plate from the symphyseal region to the iliac wing.

Adult↗
PubMed2002

Digital replantation including postoperative care.

Digital replantation first became a reality in the 1960s with the advent of microsurgical techniques. Indications for replantation have evolved over the ensuing years and currently include 1) thumb amputations, 2) multiple digit amputations, and 3) amputations in children. Crush and avulsion injuries and amputations of a single digit proximal to the flexor digitorum superficialis insertion remain relative contraindications. Good communication between the replantation center microsurgeon and the referring physician is paramount to achieving appropriate and timely referrals and correct transport of amputated parts. Communication with patients is also important: possible candidates for replantation must be informed of the likely outcomes of replantation and revision amputation procedures, and the different postoperative regimens for each. For patients who choose revision amputation or whose replants do not survive, there are a variety of reconstructive options available, if necessary, such as toe-to-hand transfer. The techniques to perform such elective free tissue transfers have been perfected during the last 30 years largely from experience gained through digital replantation.

Journal Article↗
PubMed2002

Alternatives to thumb replantation.

LEARNING OBJECTIVES: After studying this article, the participant should: 1. Have a variety of options for thumb reconstruction. 2. Know the advantages and disadvantages of the nonmicrosurgical and microsurgical techniques for thumb reconstruction. 3. Understand the decision making from the variety of thumb reconstruction techniques based on patient needs. 4. Have a basic understanding of the various thumb reconstruction techniques discussed. The traumatic amputation of the thumb is an absolute indication for attempted replantation. The profound disability of the hand resulting from absence of the thumb, with loss of pinch and grasp, obliges the surgeon to make every attempt to replant the amputated thumb and preserve hand function. However, not all attempts at replantation result in survival of the amputated portion, and unreconstructable damage to or complete loss of the amputated part may preclude attempted replantation. In such situations, the surgeon must have alternative methods of dealing with the sequelae of thumb loss. This article will discuss nonmicrosurgical and microsurgical techniques for thumb reconstruction.

Amputation, Traumatic↗
PubMedDate not supplied

Proportionality in Asian and North American Caucasian faces using neoclassical facial canons as criteria.

Nine projective linear measurements were taken to determine morphometric differences of the face among healthy young adult Chinese, Vietnamese, and Thais (60 in each group) and to assess the validity of six neoclassical facial canons in these populations. In addition, the findings in the Asian ethnic groups were compared to the data of 60 North American Caucasians. The canons served as criteria for determining the differences between the Asians and Caucasians. In neither Asian nor Caucasian subjects were the three sections of the facial profile equal. The validity of the five other facial canons was more frequent in Caucasians (range: 16.7-36.7%) than in Asians (range: 1.7-26.7%). Horizontal measurement results were significantly greater in the faces of the Asians (en-en, al-al, zy-zy) than in their white counterparts; as a result, the variation between the classical proportions and the actual measurements was significantly higher among Asians (range: 90-100%) than Caucasians (range: 13.3-48%). The dominant characteristics of the Asian face were a wider intercanthal distance in relation to a shorter palpebral fissure, a much wider soft nose within wide facial contours, a smaller mouth width, and a lower face smaller than the forehead height. In the absence of valid anthropometric norms of craniofacial measurements and proportion indices, our results, based on quantitative analysis of the main vertical and horizontal measurements of the face, offers surgeons guidance in judging the faces of Asian patients in preparation for corrective surgery.

Adolescent↗
PubMedDate not supplied

Treatment of deep infections of the shoulder with pedicled myocutaneous flaps.

Infection after reconstruction of the shoulder can lead to significant morbidity and possible destruction of the glenohumeral joint. Often, seemingly small wound problems mask underlying soft-tissue deficiency and instability. We have reviewed our experience with deep infections of the shoulder that have been treated with pedicled myocutaneous flaps. Patients in this series had been treated by a variety of local measures including debridement and attempts at reclosure, often unsuccessfully. The ability to import well-vascularized tissue that can treat dead space as well as reestablish a new cutaneous envelope around the shoulder is desirable and indicated for these difficult cases. Surprisingly, even with exposure of the humeral head in the wound, the shoulder joint can be salvaged by use of the techniques described in this article.

Adult↗