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Biomedical subjects

P D Hodgkinson

Publications and source records attributed to P D Hodgkinson.

13 recordsLinked to original sources
PubMed2003

Incidence and significance of microscopic pathological lesions found in pedicle and recipient vessels used in microsurgical breast reconstruction.

The purpose of this study was to assess the incidence of abnormal vascular histology and to determine whether or not this was correlated with the incidence of postoperative microvascular problems. The microvascular histology of both donor and recipient vessels was studied in 38 patients (40 flaps) undergoing breast reconstruction with free TRAM flaps. Preoperative risk factors were assessed and correlated with histological changes in vessels, and both were tested against anastomotic complications. Thrombosis of either the artery or the vein of the flap was seen in 6 cases (15%), and of these, two flaps failed completely and one suffered partial necrosis. The occlusion affected the arterial anastomosis in 3 patients, and the venous anastomosis in 2 patients, while both the artery and the vein were thrombosed in one case. Preoperative risk factors such as smoking, obesity, radiotherapy, and chemotherapy were not associated with a significantly higher incidence of thrombosis or with significant histological abnormalities in vessels (P value varied between 0.3-0.06). Microvascular histology showed variable degrees of pathological changes in six flaps (15%); nevertheless, in this group, only one flap suffered a venous thrombosis, which ended in total flap loss. Among those with one or more risk factors (24 patients), only 2 had some evidence of histological abnormality of the blood vessels used for the microvascular anastomosis (P = 0.2).

Adult↗
PubMed2003

Adverse events in plastic surgery.

Adverse events are a serious source of harm to patients and a large drain on the resources of healthcare providers. Retrospective studies have previously been carried out in the USA, Australia and the UK. In this study a prospective approach was employed, using similar methods to previous studies to detect the levels of adverse events over a period of one month. We also recorded the categories, causes and preventabilities of adverse events. We measured the degree of disability and the length of additional bed stay. Of the 537 patients treated in our department, 15 (2.8%) had adverse events; these patients were older than those who did not have adverse events, and were mainly emergency admissions. Most of the adverse events were operative and led to temporary disability. Overall, 139 extra bed stays were attributed to these adverse events. This report confirms the feasibility of conducting a prospective study of adverse events and of making preliminary estimates of their incidence and costs.

Adult↗
PubMed2003

Cranial-base surgery: a reconstructive algorithm.

Skull-base surgery is associated with a high risk of cerebrospinal fluid (CSF) leak, infection, and functional and aesthetic deformity. Appropriate reconstruction of cranial-base defects following surgery helps to prevent these complications. Between March 1998 and May 2000, 28 patients (age: 1-68 years) underwent reconstruction of the anterior and middle cranial fossae. The indications for surgery were tumours, trauma involving the anterior cranial fossa, midline dermoid cysts with intracranial extension, late post-traumatic CSF leak, craniofacial deformity and recurrent frontal mucocoele. We used local anteriorly based pericranial flaps (23 flaps, alone or in combination with other flaps), bipedicled galeal flaps (seven patients) and free flaps (nine patients; radial forearm fascial/fasciocutaneous flaps, rectus abdominis muscle flap and latissimus dorsi muscle flap). Follow-up has been 4-24 months. We had no deaths, no flap failure and no incidence of infection. Complications included two CSF leaks, three intracranial haematomas and one pulsatile enophthalmos. All patients had a very good aesthetic result. We present an algorithm for skull-base reconstruction and comment on the design and vascularity of the bipedicled galeal flap. The monitoring of intracranial flaps and the difficulties of perioperative management of free flaps in neurosurgical patients are also discussed.

Adolescent↗
PubMed2003

Microvascular histopathology in head and neck oncology.

A histological study of both recipient and flap vessels was performed in 30 patients with head and neck cancer, and relevant preoperative risk factors were assessed. A total of 35 free flaps were transferred in 30 patients; 16 patients had preoperative radiotherapy, 13 were smokers, eight had hypertension and six had peripheral vascular disease. No significant venous pathology was found in either the flap or the neck veins. However, over two-thirds of the neck arteries and one-half of the flap arteries were found to have microscopic arterial pathology. The only pre-existing factor significantly influencing vessel pathology was hypertension (P=0.007). All flaps survived, although in two there was some loss of the skin paddle. This study reveals that the majority of patients undergoing microsurgery in the head and neck region have pre-existing arterial damage in both the flap and the recipient arteries, but this does not have a significant effect on the overall patency of the microvascular anastomoses.

Adult↗
PubMed2001

Do intraoral radial forearm free flaps re-mucosalise and is candida infection relevant?

Eleven patients, with a mean age of 57 years, who had undergone radial forearm flap reconstruction following the excision of intraoral carcinoma, underwent flap biopsy at a mean of 45 months postoperatively. Seven of the patients had received postoperative radiotherapy. In eight patients the clinical appearance of the flap was similar in colour to that of adjacent normal oral mucosa; the remaining flaps retained the appearance of normal volar forearm skin. Histological examination of the flaps showed varying degrees of telangiectasia and mild chronic inflammation. In only two patients was superficial infection by candida hyphae identified. Intraoral free flaps, although clinically resembling oral mucosa, retain histological features of skin, at least within the period under study. The erythematous clinical appearance was not correlated with the presence of chronic fungal infection, but reflected the presence of vascular repair tissue, telangiectasia and mild residual chronic inflammation.

Adult↗
PubMed1995

New technique of levator lengthening for the retracted upper eyelid.

Retraction of the upper eyelid associated with shortening of the levator mechanism occurs most commonly in association with Graves' disease but occasionally arises as a complication of blepharoplasty or other surgical procedures. A new technique of a castellated type aponeurotomy of the levator aponeurosis is carried out to lengthen the levator. This procedure appears to give a predictable, stable and symmetrical result.

Aged↗
PubMed1994

Cross-leg free muscle flaps for reconstruction of open fractures of the tibia.

In two patients in whom the injured leg was not suitable for reconstruction using a routine free tissue transfer, a cross-leg free muscle flap was used, i.e. the vessels of a free muscle flap were anastomosed to donor vessels on the uninjured leg and the muscle flap used to reconstruct a defect on the opposite leg. Both operations were successful, with the transferred muscle becoming well vascularized from the recipient bed at the site of injury. In both cases, use of the uninjured leg to transfer the free flap caused minimal morbidity.

Adolescent↗
PubMed1994

The use of skeletal traction to correct the flexed PIP joint in Dupuytren's disease. A pilot study to assess the use of the Pipster.

The flexed PIP joint presents a particular problem in the treatment of advanced Dupuytren's disease. Following reports of the use of skeletal traction in the treatment of this condition, a simple device, the "Pipster" was developed to extend the PIP joint by skeletal traction before surgery. In seven fingers in five patients with severe contractures, there was a pre-operative improvement of at least 45 degrees in the flexion angle (measured as maximum achievable passive extension). The technique was effective in primary and recurrent disease. Subsequent surgery was facilitated and amputation avoided in five fingers. The optimum distraction technique was identified. The study continues with more patients.

Aged↗
PubMed1994

Ulnar nerve entrapment due to epitrochleo-anconeus muscle.

Two cases are described of ulnar nerve compression at the elbow due to an anomalous muscle--the epitrochleo-anconeus. In both cases the onset of symptoms may have been related to a period of excessive exercise of the upper limb. Both cases recovered rapidly and completely following medial epicondylectomy and excision of the abnormal muscle.

Adult↗
PubMed1986

Three-dimensional nasal morphology in adult bilateral cleft palate patients: a morphanalytic study.

The residual anomalies of the soft and hard tissues of the nose were studied in a group of adult bilateral cleft palate patients. Standard morphanalytic techniques were used to produce objective and accurate pictorial representations of the mean nasal deformities in three dimensions. The spatial positions of these mean outlines were tested statistically against normal means. Mean bilateral cleft nasal outlines were shown to have symmetric lateral and superior displacement of both alae with nasal blunting and retrusion and rounding of the nasal dorsum. The analytic techniques used indicated that the reduction in the depth of the external nose was confined to its posterior part. The presence of a palatal cleft in conjunction with the bilateral labial cleft only slightly increased the degree of deformity. In the case of asymmetrically incomplete bilateral clefts the nasal deformity in adulthood retained certain asymmetric features.

Adolescent↗