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Biomedical subjects

N R McLean

Publications and source records attributed to N R McLean.

At least 73 records · Page 4Linked to original sources
PubMed1993

Early postoperative brachytherapy following free flap reconstruction.

Brachytherapy delivered within the early postoperative period has been associated with delayed wound healing and wound breakdown. The objective of this study was to determine whether reconstruction with a microvascular free flap reduced the incidence of wound breakdown in the presence of early postoperative brachytherapy following wide excision of soft tissue sarcomas and head and neck carcinomas. Ten patients with malignant tumours underwent wide excision and free flap reconstruction. Brachytherapy was administered using Iridium-192 wires in the early postoperative period via tubes inserted intra-operatively. In 9 of the 10 patients the wounds healed uneventfully, demonstrating that brachytherapy can be delivered in the early postoperative period following free flap reconstruction without an increase in the frequency of wound breakdown.

Adult↗
PubMed1993

Management of extensive facial basal cell carcinoma by excision and microvascular tissue transfer.

Management of large or recurrent basal cell carcinomas (BCCs) on the face can be difficult, especially where radiotherapy has been the primary treatment. Free tissue transfer using microvascular surgery permits wide excision margins ensuring clearance of the tumour without being compromised by concern over closure, since the free flap can be designed after the excision of the tumour and its size and composition can thus be custom made. Age alone should not be a contraindication to this major procedure.

Age Factors↗
PubMed1992

Intramuscular haemangioma of the orbicularis oris muscle.

The intramuscular haemangioma is a relatively uncommon benign vascular tumour which accounts for less than 1% of all haemangiomas. It is a rare lesion in the orofacial muscles. A case is reported arising in the orbicularis oris muscle presenting in a 9-month-old child.

Diagnosis, Differential↗
PubMed1992

Free microvascular tissue transfer in Newcastle upon Tyne.

One hundred and eleven cases of free tissue transfer were reviewed to assess the indications for, and results of, such procedures. More than 90% of cases were seen after treatment of tumour or trauma, with the most utilized flaps being the radial forearm, jejunum and latissimus dorsi. Fifteen per cent of cases required re-exploration of the anastomosis, of which more than 75% were salvaged. Haematoma formation and venous thrombosis were the commonest problems and were more successfully treated than arterial occlusion. The overall success rate was 92%. Free microvascular tissue transfer is a useful and reliable technique, especially in the management of head and neck tumours and limb trauma. The most important factors relating to flap survival are the experience of the surgical team and the integrity of the anastomosis.

Female↗
PubMed1989

Fine needle aspiration cytology in the head and neck region.

Although needle aspiration diagnosis was described over 50 years ago, many patients with neck swellings are still subjected to hazardous and unnecessary open diagnostic surgical biopsy. In a six-month period, over 200 fine needle aspirates were performed on tumours from the head and neck region, 44% of which were positive for cancer. The technique of aspiration, its advantage for the patient, clinician and cytopathologist, and the results of the study will be discussed. Close cooperation between the clinician and the cytopathologist is essential.

Adolescent↗
PubMed1989

How does sepsis promote thrombosis in microvascular anastomoses?

This study on 100 rats, divided into five equal groups, has shown that chronic distant sepsis promotes occlusion of microvascular anastomoses to a significantly greater extent than aseptic inflammation, transient bacteraemia and even local infection. This may be related to the significant increase in the number of platelets in the group with distant sepsis.

Abscess↗
PubMed1988

Reconstruction after excision of soft tissue sarcomas of the limbs and trunk.

From a retrospective analysis of 180 surgical interventions for soft tissue sarcoma of the limbs and trunk, it was concluded that complete excision of the tumour can usually be achieved without sacrifice of major artery, vein, nerve or bone. In this series five major arteries were resected but only one required reconstruction. None of six resected major veins or seven resected nerves were reconstructed. Bone resection in the limb required plating in only two of eleven patients who had limb-sparing resection (there were nine amputations). Both in the limbs and the thorax, resection of bone often involved such a wide excision of the superficial soft tissues as to require a flap repair: four were used in the limbs and three in five chest wall resections. In the majority of operations (140/180) primary wound closure was possible. After 15 procedures for tumour predominantly involving the superficial tissues, split skin grafts were used. These were generally successful (13/15), even occasionally when high-dose radiotherapy had been given. In 16 cases earlier radiotherapy influenced the decision to use a flap repair. A total of 18 flap repairs were performed. In various situations Mersiline mesh (Ethicon, Ltd., UK), Silastic implants and omental swings were used. Wound breakdown in heavily irradiated tissues presented a major challenge for reconstruction. Although major reconstruction was required in only 27 operations (15 per cent), a thorough knowledge of the available methods of reconstruction and repair is essential to allow uninhibited resection with an optimal aesthetic and functional result.

Arm↗
PubMed1988

An ingenious mucus trap.

This brief report describes how, with commendable insight, a patient recently treated in our Unit adopted a very simple device to collect the excess mucus issuing from his tracheostomy tube.

Equipment Design↗