Compression of the median nerve proximal to the carpal tunnel in scleroderma.
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Adult↗
Biomedical subjects
N F Jones
Publications and source records attributed to N F Jones.
Microsurgical reconstruction of the head and neck: interdisciplinary collaboration between head and neck surgeons and plastic surgeons in 305 cases.
Three hundred five microsurgical free flaps have been performed for defects of the head and neck by a team of two head and neck surgeons and two plastic surgeons over a 9-year period, with a success rate of 91.2%. The most common flaps used were the jejunum (89), radial forearm (57), rectus abdominis (48), latissimus dorsi (40), scapular (32), fibula (15), and iliac crest (11). Thirty-three flaps required reexploration for anastomotic thrombosis or hematoma (10.8%), of which 18 flaps were salvaged (54.5%). Thirteen flap failures occurred in 113 patients who had received preoperative irradiation (11.5%), but this was not statistically significant. Seven flaps failed in 20 patients who required an interposition vein graft (35%) and this was statistically significant. Ninety patients (31.5%) developed a major complication other than anastomotic thrombosis or death. Despite postoperative intensive care nursing and monitoring, 18 patients died postoperatively in the hospital (6.3%). The average hospital stay was 21.1 days with a range from 5 to 95 days. During this 9-year time period, various free flaps have evolved as the preferred choice for free flap reconstruction of a specific defect of the head and neck. The latissimus dorsal muscle flap surfaced with a nonmeshed split-thickness skin graft is the optimal free flap for reconstruction of the scalp and skull, whereas a multiple-paddle latissimus dorsi musculocutaneous flap is the best flap for reconstruction of complex defects of the middle third of the face and maxilla. The radial forearm flap and free jejunal transfer have become the preferred choices for intraoral reconstruction and pharyngo-esophageal reconstruction, respectively. There still remains no universally accepted flap for mandibular reconstruction, but the fibular osteocutaneous flap and a reconstruction plate protected by a radial forearm flap have largely superseded the iliac crest and scapular osteocutaneous flaps. Radical resection of tumors of the head and neck with immediate reconstruction by microsurgical free tissue transfer followed by adjuvant radiation therapy provides the best possible chance for cure and functional and social rehabilitation of the patient.
Adolescent↗
Rejection of the component tissues of limb allografts in rats immunosuppressed with FK-506 and cyclosporine.
One-hundred and fourteen limb transplantations have been performed across a major histoincompatibility barrier between donor ACI (RT1a) and recipient Lewis (RT1l) rats immunosuppressed with various dosages of FK-506 and cyclosporine. Three-hundred and thirty biopsy specimens from 64 animals have been evaluated histologically for signs of rejection. A new histologic grading system is introduced to classify the process of rejection in the component tissues (skin, muscle, bone, and articular cartilage) of a limb allograft. The results indicate that FK-506 is a more potent immunosuppressive agent than cyclosporine in preventing the rejection of the skin component of a limb transplant. With twice-weekly intermittent immunosuppression with FK-506, the rejection of muscle, bone, and cartilage can be prevented for an indefinite time, although all long-term surviving animals died at around 300 days, probably of graft-versus-host disease. Based on the histologic stages of rejection in the different tissues at the same point in time, it is evident that each component tissue of a limb transplant rejects over a different time period. This probably reflects a hierarchy of antigenicity, with skin being most antigenic, muscle being intermediate in antigenicity, and bone and cartilage being least antigenic. Although this grading system is not the ultimate solution, it may allow a more objective comparison of experimental limb transplantation in the future.
Analysis of Variance↗
Reliability of the fibular osteocutaneous flap for mandibular reconstruction: anatomical and surgical confirmation.
There is ongoing controversy regarding the reliability of the skin island associated with the fibular osteocutaneous flap for mandibular reconstruction. Anatomical dissections and a clinical series of mandibular reconstructions using the fibular osteocutaneous flap have demonstrated unequivocally that a skin flap can be reliably harvested with the fibula based purely on the septal perforators, without needing to incorporate portions of the soleus or flexor hallucis longus muscles or to perform any intramuscular dissection or anastomosis of the muscle perforators. However, the skin island should be designed more distally over the distal third of the lower leg at the junction of the middle and distal thirds of the fibula. A fibular osteocutaneous flap was designed over the distal third of the fibula in 60 fresh cadavers, and each flap was completely isolated on the septum and all muscle perforators were ligated before dye injection. A major perforator through the soleus muscle or flexor hallucis muscle was identified in 41 of 60 dissections (67 percent) and discrete septal perforators were identified under loupe magnification in 45 dissections (75 percent). All 60 flaps demonstrated 100 percent reliable perfusion of the skin island after injection of the proximal peroneal artery with methylene blue or red latex. This anatomical study was corroborated with 100 percent survival of 34 fibular osteocutaneous flaps for mandibular reconstruction with the skin island designed over the distal third of the lower leg and based only on septal perforators without incorporating the soleus or flexor hallucis muscles. Reliability of this fibular osteocutaneous flap for mandibular reconstruction is attributed to (1) design of the skin island more distally over the distal third of the lower leg, (2) preoperative precision Doppler mapping of the perforators, and (3) design of the closing wedge osteotomies of the fibula to protect the septocutaneous perforators transversing through the posterior periosteum of the fibula.
Cadaver↗
Treatment of chronic pain by "wrapping" intact nerves with pedicle and free flaps.
Chronic pain due to scarred or devascularized but intact peripheral nerves may be potentially improved by neurolysis of the nerve, followed by the circumferential "wrapping" of the nerve with either the fascia, subcutaneous fat tissue, or muscle of either a pedicled or free flap. This procedure may cushion the nerve from external pressure on the overlying skin, insulate the nerve from traction forces of adjacent tendons, allow longitudinal gliding of the nerve, and potentially promote revascularization of the scarred nerve.
Brachial Plexus↗
Limb transplantation in rats: immunosuppression with FK-506.
The efficacy of a new immunosuppressive agent, FK-506, to prevent the rejection of limb transplants was investigated across a major histocompatibility barrier in rats and compared with Cyclosporine. We performed 129 limb transplants between donor ACI rats and recipient Lewis rats. The mean rejection time of the skin component of limb allografts without immunosuppression was 7 days. Animals receiving a 14-day course of Cyclosporine 25 mg/kg had a mean rejection time of 30 days. In contrast, animals receiving a 14-day course of FK506 1 mg/kg had a mean rejection time of 54 days and those receiving a 14-day course of FK-506 2 mg/kg had a mean rejection time of 122 days. Intermittent administration of FK-506 twice weekly further prolonged the mean rejection times to 149 days in animals receiving 1 mg/kg and to 296 days in animals receiving 2 mg/kg.
Animals↗
Magnetic resonance imaging findings in Secretan's disease.
Secretan's disease is defined as hyperplastic, recurring hard edema of the dorsal aspect of the hand. Its etiology, pathology and treatment are unclear. Magnetic resonance images and surgical findings are presented in three patients who fit the clinical findings of Secretan's disease. Magnetic resonance imaging scans with both T-1 weighted and T-2 weighted images showed soft tissue and tendon edema in combination with diffuse peritendonous fibrosis extending to the fascia of the dorsal interosseous muscles.
Adult↗
Stenosing tenosynovitis of the extensor carpi ulnaris.
Despite the paucity of reports in the literature, we have found extensor carpi ulnaris tenosynovitis to be relatively common in our practice. A retrospective review of charts revealed 15 patients treated over the last 4 years. Follow-up ranged from 10 to 14 months. All patients had ulnar-sided wrist pain and underwent conservative treatment consisting of splinting and steroid injection. In 7 of the 15 initial treatment failed and surgical release was required. Of these, 3 exhibited partially ruptured tendons from exposed bone and underwent reconstruction of the floor of the compartment. Preoperative x-ray films were helpful in identifying those with bone involvement. All but one patient had a good or excellent result. Stenosing tenosynovitis of the extensor carpi ulnaris may be more common than reported, and early intervention may prevent tendon damage in some patients.
Constriction, Pathologic↗
The four-poster halo vest for protection of a microvascular free-tissue transfer reconstruction of the scalp.
Use of a four-poster halo and corset jacket provides complete protection, access, and mobility for patients undergoing free-flap scalp reconstruction. This technique was used in a patient who required a total scalp reconstruction with a compound latissimus/serratus muscle free flap with good success. The case and technique are presented for review.
Aged↗
Peripheral nerve allotransplant immunosuppressed with FK 506: preliminary results.
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Animals↗
Peripheral nerve allograft transplantation with FK506: functional, histological, and immunological results before and after discontinuation of immunosuppression.
Two-centimeter nerve allografts were transplanted across a major histocompatibility barrier from donor ACI rats into a 0.5-cm gap in the sciatic nerve of recipient Lewis rats and immunosuppressed with FK506, 2 mg/kg per day for 3 months. One group of animals continued to receive intermittent immunosuppression with FK506, 2 mg/kg twice a week for another 2 months, whereas the second group of animals received no further immunosuppression in order to determine whether rejection of nerve allografts can still occur after immunosuppression is withdrawn, even after the axons have regenerated through the nerve graft. The sciatic function index improved from -76.3 at 3 months to -46.6 at 5 months in those animals continuing to receive intermittent immunosuppression, but only improved to -66.8 at 5 months when immunosuppression was discontinued. Similarly, somatosensory evoked potentials demonstrated an improvement in relative latency from 2.3 msec at 3 months to 0.34 msec at 5 months in animals continuing to receive intermittent immunosuppression, but only improved to 1.29 msec at 5 months when immunosuppression was discontinued. Nerve allografts continuing to receive intermittent immunosuppression showed no signs of rejection by light or electron microscopy and no significant difference compared with isografts, whereas nerve allografts whose immunosuppression had been stopped at 3 months showed mild signs of rejection, less regeneration, and a smaller number of nerve fibers.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Use of fluorescein to predict survival of a free jejunal transfer after disruption of the arterial pedicle on postoperative day 12.
The arterial pedicle to a free jejunal transfer was inadvertently disrupted on the 12th postoperative day. Intravenous fluorescein indicated viability of the entire jejunal transfer except for a 2 cm diameter area on the antimesenteric border midway between the upper and lower enteric anastomoses. The entire jejunum survived except for the small area which failed to fluoresce; this area was converted to a controlled pharyngocutaneous fistula. Neovascularisation from surrounding, unirradiated tissue can allow survival of a free vascularised jejunal transfer after disruption of arterial inflow as early as 12 days postoperatively.
Aged↗
Intermittent occlusion of the ulnar artery.
Intermittent occlusion of the ulnar artery developed in a patient causing cramp in her right hand. Both flexion and extension of the wrist completely obstructed bloodflow in the ulnar artery, at a level just proximal to the wrist. At operation, a tight band of antebrachial fascia was found to be the cause of this intermittent arterial occlusion. Surgical release of this fascial band produced complete relief of her symptoms.
Adult↗
Oromandibular reconstruction using a keel-shaped modification of the radial forearm osteocutaneous flap.
The keel-shaped modification for harvest of the radial forearm osteocutaneous flap has been used to reconstruct 19 oromandibular defects in 18 patients. Fourteen men and 4 women ranging in age from 22 to 72 years have undergone composite mandibular reconstruction, with follow-up ranging from 3 to 36 months. Sixteen patients (17 reconstructions) had resection of advanced malignancies, and 2 patients sustained shotgun wounds. Twelve symphyseal and 7 lateral or posterior defects were reconstructed with donor radius bone ranging in length from 5 to 13.5 cm. Double osteotomies were performed in 7 patients. Two skin paddles were used in 4 patients to provide simultaneous intraoral lining and external skin coverage. The radial forearm osteocutaneous flap is still an excellent choice for oromandibular reconstruction. Anterior and lateral composite mandibular defects were satisfactorily reconstructed both aesthetically and functionally using the keel-shaped modification of the radial forearm flap. Donor-site problems were uncommon and minor, and long-term forearm function was minimally affected. Radius fracture occurred in only 1 patient.
Adult↗
Local full-thickness skin-graft coverage for the radial forearm flap donor site.
Closure of the radial forearm flap donor site has been achieved by triangulating the defect and using a full-thickness skin graft from the adjacent volar forearm. Coverage of the flexor carpi radialis tendon has been more robust, and the aesthetic results have been superior to split-thickness skin-graft coverage of the forearm flap donor site.
Bandages↗
The cervicopectoral rotation flap--a valuable technique for facial reconstruction.
Four cases of lower cheek reconstruction using the cervicopectoral rotation-advancement flap are reported. This fasciocutaneous flap can be raised quickly, provides excellent colour and texture match for the tissues of the face, and donor site morbidity is minimal. It is an especially useful method for lower cheek reconstruction following wide excision of melanomas of the cheek and for advanced parotid tumours where skin replacement is required following resection.
Carcinoma, Squamous Cell↗
Renal failure caused by leukaemic infiltration in chronic lymphocytic leukaemia.
A case of B-CLL which was complicated by chronic renal failure due to leukaemic infiltration of the kidney is reported. Treatment with chlorambucil, prednisolone, and renal bed irradiation resulted in a substantial improvement in renal function which persisted until the the patient's death from marrow failure some eight years later. The temporal association between treatments and response suggested that renal bed radiotherapy had contributed to the improvement in renal function. This case is one of only two reported cases in which chronic renal failure due to CLL has been treated with radiotherapy. It is unique in that the renal response was shown histologically. Leukaemic infiltration of the kidney is common in CLL but, characteristically, is not associated with renal impairment. An improvement in renal function has been described in two patients with acute renal failure after chemotherapy.
Chlorambucil↗
A Pain Rating Scale and a Pain Behavior Checklist for clinical use: development, norms, and the consistency score.
A Pain Rating Scale [PRS] and a Pain Behavior Checklist [PBC] were developed for use during a clinical pain interview. Norms were based on 395 chronic pain patients referred for pain management. The PRS obtained ratings of present pain, and worst and least pain during the previous 30 days. The PBC recorded 16 pain behaviors during the 45- to 60-min interview. Normative data were given for seven measures: (1) worst pain rating, past month; (2) least pain rating, past month; (3) present pain rating; (4) difference between worst and least pain ratings; (5) pain behavior score; (6) total pain score (based on Nos. 1, 2, 3, and 5), and (7) consistency score. The consistency score reflects the agreement (or discrepancy) between the pain behavior and present pain ratings. A moderate overall relationship was found between pain behavior and present pain ratings (r = 0.46, p < 0.001). The frequency of good agreement between pain behavior and present pain ratings was unaffected by sex, race, age, pain site, type of injury, duration of pain, legal representation, and evaluating psychologist; but it varied markedly with conscious symptom magnification. Patients seen as consciously exaggerating pain (n = 127) gave higher pain ratings (all p values < 0.001); and had frequent (64.6%) discrepancies between their pain report and pain behavior compared to others (14.2%). The report of present pain was unrelated to pain behavior for conscious exaggerators (r = 0.04, NS); in contrast there was a moderately high relationship for other patients (r = 0.68, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Activities of Daily Living↗