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Biomedical subjects

M Ninkovic

Publications and source records attributed to M Ninkovic.

At least 55 records · Page 3Linked to original sources
PubMed1997

Primary flap closure in complex limb injuries.

Free-tissue transfers enable surgeons to reconstruct or salvage limbs injured or amputated in high-energy traumas which result in extensive damage to soft tissue, bone, tendons, vessels and nerves. Primary free-tissue transfer is performed following debridement, bone fixation, and repair of injured structures within 24 hr after injury. Between 1987 and 1996, 57 patients who had complex extremity traumas were treated with primary free-tissue transfer, or free flaps. Long-term follow-up ranged from 4 months to 9 years (median: 4.5 years). No flap failure or serious wound-healing complication occurred using the protocol. Radical debridement and primary free-flap coverage in extensive extremity injuries can salvage limbs, provide improved functional and aesthetic results, and psychologically benefit patients through lowered morbidity. Other benefits include reduced incidence of free-flap failure, postoperative infection, secondary operative procedures, and invalidity, as well as shorter hospital stays, and lowered medical expenses.

Adult↗
PubMed1997

Free flap closure of recurrent palatal fistula in the cleft lip and palate patient.

Recurrent palatal fistulas present a particularly vexing problem for the cleft surgeon. In this setting, the cycle of repair followed by breakdown results in increasing scar formation with associated soft tissue contracture and a resultant increase in fistula size. This pernicious cycle of events renders random local tissue transfers obsolete. As such, the cleft surgeon must look to tongue flaps or local axial pattern flaps as a means of bringing well-vascularized, pliable tissue into the defect. Although this approach has been the standard of care for the last few decades, we believe that the modern-day success rates of free tissue transfers (95%) make them a viable, one-stage means of closing these defects. In this report we present our clinical experience with recurrent palatal fistulas and highlight the effective use of the dorsalis pedis-first dorsal metatarsal artery free flap as a means of repair.

Child↗
PubMed1997

Free neurovascular transfer of latissimus dorsi muscle to the bladder. I. Experimental studies.

OBJECTIVES: Experimental studies were undertaken to investigate the practicability of a microneurovascular transfer of latissimus dorsi muscle to the bladder, and to look for possible techniques enhancing evacuation of a reservoir such as the bladder by striated muscle. MATERIALS AND METHODS: Twelve dogs were used for the studies. They were divided into 3 groups. Group I: Evacuation proficiency of a re-configured latissimus dorsi under tension was hydrodynamically tested after 6 months. Group II: Microneurovascular latissimus dorsi transposition anastomosing thoracodorsal vessels and nerve to circumflexa ilium profunda vessels and a lumbar plexus motor nerve, respectively, was performed to cover the bladder devoid of up to 50% of the detrusor muscle. Group III: Microneurovascular latissimus dorsi transposition was used to reconstruct the bladder after supratrigonal cystectomy. Urodynamic and radiographic in vivo studies were done after 6 and 9 months. RESULTS: Stimulation of the thoracodorsal nerve of geometrically reconfigurated non-transposed latissimus dorsi reservoirs after 6 months yielded average intraluminar pressures of 190 cm. H2O at maximum capacity, and 35 cm. H2O at a minimum capacity of 10 to 15 cc. Stimulation of latissimus dorsi transposed to the bladder resulted in a visible and measurable contraction of the transplanted muscle after 9 months. Mean bladder volumes in group II animals pre- and postoperatively were 267.5 and 270 cc, respectively. During cystography the bladder outline was smooth both during filling and voiding. Light and electron microscopic examination confirmed viable, re-innervated muscle. CONCLUSIONS: The "tension-torsion" reconfiguration produced intraluminal pressures which should enable stimulated striated muscle to evacuate bladder-like reservoirs successfully. Microneurovascular free transfer of latissimus dorsi muscle resulted in reinnervated, functional muscle in the pelvis. Augmentation cystoplasty using the latissimus dorsi in conjunction with a free omental flap for substitution of an accompanying mucosal defect was unsuccessful. The concept of microneurovascular transfer of latissimus dorsi muscle to the pelvis may be used for complicated fistula of the lower urinary tract, and may be a possible solution for the therapy resistent acontractile bladder.

Animals↗
PubMed1996

[Plastic surgery treatment of extensive decubitus ulcers of the pelvic area].

Between 1980 and 1995, 207 patients with 219 extensive pelvic pressure sores underwent reconstructive surgery at our department. Eighty patients operated upon between 1992 and 1995 were followed up. The postoperative complication rate was 22% and the relapse rate 27%. Pre- and postoperative management has been standardized for the purposes of quality control. The value of preoperative management, choice of flap, operative procedure and postoperative care are discussed in this paper.

Adolescent↗
PubMed1996

A simple method of free-flap monitoring using a superficial vein.

A new, simple method for flap monitoring is presented. Dissecting a superficial flap vein, which is closed by an Acland clamp, and opening the clamp shortly thereafter, allows objective, postoperative flap monitoring. The surgical technique, advantages, and possible difficulties of the procedure are discussed.

Humans↗
PubMed1995

Emergency free tissue transfer for severe upper extremity injuries.

29 patients with severe upper extremity injury were treated with 27 emergency free flap and three emergency toe-to-hand transfers, after radical débridement and primary reconstruction of all injured structures. There was no flap failure, and no infections or wound-healing complication were seen. Follow-up ranged from 3 months to 6.6 years with a mean of 3.2 years. 19 patients returned to work (14 to their original jobs), three were retired and another seven had no employment before injury. Operation time ranged from 2 hours 45 minutes to 18 hours 20 minutes with an average of 7 hours 45 minutes, depending upon the size of the defect and mechanism of injury. Long-term follow-up revealed successful functional and aesthetic results, decreased morbidity and invalidity, and reduced rates of free flap failure, post-operative infection, secondary operative procedures, hospital stay and medical expense.

Adolescent↗
PubMed1994

Mesalazine induced interstitial nephritis.

5-Aminosalicylic acid (5-ASA) has structural similarities to both phenacetin and aspirin, which are known to cause 'analgesic nephropathy'. Because of the increasing use of 5-ASA, this paper draws attention to two cases of severe interstitial nephritis resulting from 5-ASA and emphasises the importance of monitoring renal functions of patients with inflammatory bowel diseases who are receiving 5-ASA preparations.

Adult↗
PubMed1985

Opiate and histamine H1 receptors are present on some substance P-containing dorsal root ganglion cells.

Using combined immunohistochemical and receptor binding techniques, substance P-containing sensory neurones of rhesus monkey cervical dorsal root ganglia were examined for the presence of opiate or histamine (H1) receptors. Serial sets of three sections were examined sequentially for substance P-containing neurones, opiate receptors using [3H]etorphine binding and histamine (H1) receptors using [3H]mepyramine binding. Of 3484 dorsal root ganglion cells, 513 contained substance P. Of 30 randomly chosen substance P-positive neurones, 6 possessed opiate receptors and 7 histamine receptors, including 4 neurones with both sets of binding sites. The results are interpreted to suggest that both nociceptors and non-nociceptive sensory inputs may be biochemically heterogeneous and that a simple correlation between substance P content and a particular receptive field profile is unlikely.

Animals↗
PubMed1983

Alpha-bungarotoxin binding sites on sensory neurones and their axonal transport in sensory afferents.

The autoradiographic localization of [125I]alpha-bungarotoxin binding sites on primary sensory fibres was investigated. Nicotinic alpha-bungarotoxin binding sites were localized to a small sub-population of large dorsal root ganglion cells in the rat, monkey, cat and human dorsal root ganglia. Ligation of the sciatic nerve or dorsal root in the rat resulted in an anterograde accumulation of binding sites proximal to the dorsal root ganglion, and a small retrograde accumulation. Unilateral dorsal root section in the rat produced a loss of toxin binding sites mainly within lamina III of the dorsal horn. These results suggest that nicotinic alpha-bungarotoxin binding sites manufactured in large dorsal root ganglion cell bodies are transported both centrally to the spinal cord and also peripherally.

Afferent Pathways↗
PubMed1982

Localization of [3H]spiperone binding sites in the intermediate lobe of the rat pituitary gland.

[3H]Spiperone binding sites in all three lobes of the rat pituitary gland were studied using an in vitro autoradiographic technique. [3H]Spiperone binding was present throughout the pituitary gland but there was a much higher density of autoradiographic silver grains over the cells of the intermediate lobe than elsewhere. The density of spiperone binding sites in pars intermedia was comparable to that in sections of the rat corpus striatum. [3H]Spiperone binding was displaced by the specific dopamine agonist ADTN.

Animals↗
PubMed1982

Localization of opiate and histamine H1-receptors in the primate sensory ganglia and spinal cord.

The autoradiographic localizations of opiate and histamine H1-receptors were studied quantitatively and compared following dorsal root section in the primate spinal cord. High densities of opiate and H1-receptors were found in the superficial layers of the dorsal horn. Dorsal root section produced a 40-50% loss of both receptors types throughout layers I and II with no loss in deeper layers of the dorsal horn. "Bursts' of opiate and H1-receptor labelling was observed over a population of small diameter cells (35-45 micron or micrometer) in the primate dorsal root ganglion. These cells represented approximately 8% of the total cells present. Serial consecutive sections demonstrated a population of cells bearing both opiate and histamine H1-receptors.

Animals↗
PubMed1981

Effect of dorsal rhizotomy on the autoradiographic distribution of opiate and neurotensin receptors and neurotensin-like immunoreactivity within the rat spinal cord.

The distributions of neurotensin and opiate receptors within the dorsal horn of the rat spinal cord were studied with quantitative autoradiographic techniques and compared with the immunohistochemical localizations of neurotensin and methionine-enkephalin-like immunoreactivity in this region. High densities of both neurotensin and opiate receptors were found within the superficial layers of the spinal cord, paralleling the distribution of neurotensin and enkephalin-containing interneurons and nerve terminals. Dorsal root section produced a 40% loss of opiate receptors throughout layers I and II of the spinal cord whilst no change in neurotensin receptor density or distribution was found. At the electron microscopic level the presence of neurotensin-like immunoreactivity within vesicle-containing profiles in the dorsal horn was demonstrated; however, no interaction of these terminals with primary afferent boutons was seen.

Afferent Pathways↗
PubMed1981

The distribution of multiple opiate receptors in bovine brain.

The distribution of mu and delta opiate receptors in bovine brain has been investigated using the selective radioligands [3H]morphine and D-[3H]Ala2, D-Leu5-enkephalin. Their distributions were found to vary independently through different brain areas with up to a 10-fold difference between the ratio of mu to delta binding sites for the substantia nigra and the dentate gyrus of the hippocampus.

Animals↗