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Biomedical subjects

R A Hardesty

Publications and source records attributed to R A Hardesty.

32 records · Page 2Linked to original sources
PubMed1993

Rotation-advancement repair of the unilateral cleft lip. One center's perspective.

Most surgeons agree that the Millard rotation-advancement is the procedure of choice for treatment of the incomplete cleft lip and milder complete cleft forms. It has been found to be an effective procedure for essentially all cleft cases, regardless of width, when the staged approach described is employed. To reach the goal of establishing near-perfect anatomy and function, a protocol, which capitalizes on the strengths of Millard's repair while minimizing its weaknesses, has been adopted. Three aspects of the protocol are emphasized in this article: (1) presurgical manipulation of the maxillary alveolar segments via passive molding appliances; (2) a staged approach to lip repair for wide complete clefts, which includes preliminary lip adhesion; and (3) adherence to a standardized technique, which will allow for a long-term clinical study.

Adolescent↗
PubMed1993

Prospectives in cleft lip and palate repair.

A recent focus on fetal surgery has raised the possibility of fetal cleft lip and palate repairs. Because of the fetus's marked plasticity, fetal repairs may have results that more closely approximate normality. Furthermore, the impact on cost management could be dramatic with a decreased need for extensive postoperative care, orthodontia, and speech therapy. This article considers the future prospects of intrauterine cleft lip repair as the next generation of surgical advances.

Animals↗
PubMed1992

Fetal kleeblattschädel cranium: morphologic, radiographic, and histologic analysis.

The kleeblattschädel deformity is a rare craniofacial condition typified by its trilobed, cloverleaf skull. The pathophysiology of this process is controversial. The morphologic, radiographic, and histologic abnormalities identified in the cranial base of an 18-gestational-week fetus with kleeblattschädel skull have not been described previously. Recently, the intrauterine diagnosis of kleeblattschädel was established by serial ultrasonography and, based on this evidence, the fetus was aborted. The fetus was studied extensively. Standard radiographs and high-resolution CT scans were obtained. Three-dimensional, reformatted contour surface images were constructed from the CT scan data. The cranial base was examined grossly, radiographically, and histologically. Histologic microanatomic study concentrated on structures of the mid-sagittal cranial base from the occiput to the mid maxilla. The distorted cranial architecture in kleeblattschädel deformity has, in the past, been attributed largely to the cranial base deformity which secondarily distorts the developing brain. Our study, however, suggests that the calvarium itself may be the primary focus of abnormal events leading to synostosis. The findings in this study seem to be inconsistent with earlier theories about the abnormal development of craniodysostoses.

Adult↗
PubMed1992

A new method for microvascular anastomosis: report of experimental and clinical research.

Principles of microvascular anastomotic surgery are uncertain in contrast to the standardized suture methods for the repair of large arteries. Complications of early thromboses or late stricture at the microvascular anastomotic line can be related to the inherent biologic response of these delicate tissues to penetrating needle and suture. A new method for microvascular reconstruction based on the principle of flanged, nonpenetrated, intimal approximation by an arcuate-legged clip has proven biologically and technically superior to the penetrating microsuture. These conclusions are based on extensive testing in multiple surgical laboratories of the following parameters: long- and short-term patency, morphology of wound repair, and burst and tensile strength. Details of the new surgical system and experimental studies are described.

Anastomosis, Surgical↗
PubMed1992

Tissue reconstruction with nonpenetrating arcuate-legged clips. Potential endoscopic applications.

A new system for tissue approximation consisting of a nonpenetrating arcuate-legged clip applied to everted tissue edges to form an elastomeric flanged joint is described. The flanged joint has unusual physical and morphologic properties. Novel systems for tissue eversion, clip application and clip removal have been tested at the micro scale in blood vessels and the rat vas deferens (vasovasostomy). Human applications have been successful (cerebrovascular reconstruction, free-flap transfer, skin grafting, A-V access). The system is biologically and technically equivalent to or superior to the needle-and-suture technique. Avoidance of intimal or mucosal penetration or intraluminal foreign body is associated with prompt wound healing and the reconstitution of tubular integrity. The system is readily adaptable for endoscopic surgical reconstructions, providing the surgeon with enhanced reconstructive abilities.

Anastomosis, Surgical↗
PubMed1992

Secondary craniomaxillofacial deformities. Current principles of management.

This article focuses on secondary reconstruction of naso-orbital frontal injuries. Pertinent clinical anatomy, physical examination/documentation, and radiographic imaging are examined first. Pretreatment planning, operative exposures, and case examples are discussed in the second part of the article.

Adult↗
PubMed1991

Unicoronal synostosis. A surgical intervention.

Computer-assisted medical imaging technology provides useful tools for the in vivo study of congenital craniofacial deformities. Using these tools, a standardized operation for infants with nonsyndromal unicoronal synostosis has been shown to consistently normalize orbital dimensions and decrease exocranial base angulation. Normalization of endocranial base angulation is less consistent. The plasticity of the infant's cranial base after cranial vault surgery suggests a locus of the primary pathology at a site other than the cranial base.

Craniosynostoses↗
PubMed1990

Craniofacial onlay bone grafting: a prospective evaluation of graft morphology, orientation, and embryonic origin.

A prospective study using 46 young adult New Zealand rabbits was designed to evaluate onlay bone grafts to the craniofacial skeleton with respect to embryonic origin (membranous or endochondral), gross morphology (unicortical or bicortical), and orientation (cortex-to-bed relationship). Quantitative and qualitative data were analyzed and contrasted at both periods of evaluation (1.5 and 3.0 months). The embryonic origin of onlay bone grafts to the rabbit snout is significantly correlated with graft surface area, volume, weight, and recipient bed union for up to 3 months postoperatively. Over this interval, membranous bone (calvaria) grafts either persist in their entirety or increase, whereas endochondral bone (iliac) grafts resorb. Neither the number of cortices (unicortical or bicortical) nor the orientation of unicortical grafts (cortex-to-bed relationship) affected graft fate regardless of embryonic origin. Bone density remained unaltered during both resorption and deposition. Osteogenesis, demonstrated by serial fluorochrome markers, occurs in both membranous and endochondral bone grafts. Histologically, bone grafts of membranous and endochondral origin differ greatly in their cortical to cancellous diploe ratios and architectural configuration. We hypothesize that the differences found are related to the three-dimensional osseous architecture rather than to the embryonic origin of bone per se.

Animals↗
PubMed1988

Extensive and complex defects of the scalp, middle third of the face, and palate: the role of microsurgical reconstruction.

Twenty-one patients with gigantic defects of the scalp and middle third of the face and palate following excision of neglected or recurrent tumors, burns, and infections have undergone microsurgical reconstruction. Wide resection of the middle third of the face, orbit, and palate requires "complex" three-dimensional volume reconstruction, whereas extensive defects of the scalp and skull (exceeding 80 cm2) require coverage of the larger surface area soft-tissue defect and the exposed brain and dura. The latissimus dorsi free-muscle flap and split-thickness skin graft have become our methods of choice for extensive scalp and skull defects. The latissimus dorsi musculocutaneous free flap is preferable for reconstruction of complex palatal and external skin and orbital defects of the middle third of the face. Microsurgical free-tissue transfer reliably frees the oncologic surgeon from the constraints imposed by conventional reconstructive techniques and may therefore allow improved curative or at least palliative resection of these extensive tumors.

Adult↗
PubMed1987

Microsurgery for macrodefects: microvascular free-tissue transfer for massive defects of the head and neck.

Despite defect location and the fear of creating complex massive defects, coverage of large areas of soft tissue loss, with or without exposed calvaria, dura, and brain, can be reconstructed reliably with microvascular free tissue transfer. This technique permits separation of the oronasopharynyx from the intracranial contents, coverage of dural grafts, restoration of composite tissue loss, and achievement of superior aesthetic results in a single stage. When choosing vascular anastomotic sites, free-flap transfer permits a greater latitude in flap orientation, tailoring, and inset than is possible when using fixed pedicled rotation flaps. When confronted with a deeply invasive or gigantic malignancy, a multidisciplinary team approach is optimal. The risk associated with sophisticated ablative and reconstructive operative procedures is justified when dealing with potentially curable lesions. The success of these extensive procedures is related not only to the functional result and the aesthetic appearance, but most importantly to the resultant quality of life they allow.

Adult↗
PubMed1987

Upper limb salvage using a free radial forearm flap.

Microsurgical transfer of a skin flap salvaged from a nonreplantable upper extremity that would otherwise be discarded may provide essential soft-tissue coverage of the amputation stump, so maintaining a functional range of motion in the elbow joint. A radial forearm free flap measuring 24 cm long by 9 cm wide was salvaged from the degloved forearm skin of a patient who sustained a proximal forearm amputation that was considered unsuitable for replantation. This allowed coverage of the proximal radius and ulna, preservation of a functional elbow joint, and successful fitting of a below-elbow prosthesis.

Amputation Stumps↗
PubMed1984

Macrocephaly and minor congenital anomalies in children with learning problems.

To determine whether existing data which indicate a significant prevalence of abnormal head circumference and minor congenital anomalies in referred learning disabled populations could be replicated in a nonreferred population, 75 children enrolled in learning disabilities resource programs in an elementary school district were compared with a matched group of 73 children. Macrocephaly (occipitofrontal head circumference of 2 or more SD above the mean) was noted significantly more often in resource than in control children (12 versus 3) (p less than 0.05). Macrocephalic resource children had significantly lower achievement scores than either normocephalic resource or control children (p less than 0.05). There were no significant differences between resource and control children for mean number of anomalies per child, frequency of individual anomalies per group, or evidence of recurring anomaly patterns in the resource children. The macrocephalic resource children revealed the same prevalence of anomalies as normocephalic resource and control children, with no evidence of recurring anomaly patterns. Resource children with four or more anomalies did not differ from those with three or fewer anomalies on any psychometric parameters. Clinical, familial, radiological, and psychometric investigation of several macrocephalic resource children indicated similar patterns of learning deficits and documented evidence of familial macrocephaly but did not show any recognizable CNS abnormalities. This study confirms a significant prevalence of macrocephaly in children with learning problems. It indicates the need for further research into the prevalance and patterns of learning deficits in children with familial macrocephaly. The results add to recent concerns about the psychoeducational criteria of specific learning disabilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗