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Biomedical subjects

R D Goldner

Publications and source records attributed to R D Goldner.

At least 55 records · Page 3Linked to original sources
PubMed1987

The wraparound procedure for thumb and finger reconstruction.

Nineteen thumb and finger reconstructions were performed using the wraparound procedure; there were five early arterial failures. Thirteen of the 14 successful digital reconstructions were reviewed at an average of 26 months after surgery. There were complications related to the upper limb in seven patients, several of whom had more than one problem; these included radial skin breakdown (2), malrotation (2), and infection (2). One patient underwent late deletion for chronic infection following corrective osteotomy. Time until toe donor site healing averaged 2 months. We considered that cosmesis and function were good. Pinch grip averaged 48% of normal; sensibility returned in all patients--four regained protective sensation and the others attained two-point discrimination (average 9 mm). The wraparound procedure provides a cosmetically and functionally excellent method of thumb reconstruction for amputation distal to the metacarpophalangeal joint.

Adolescent↗
PubMed1987

Demographics and replantation.

We reviewed demographic data on 761 patients who had one or more amputated parts replanted at Duke University Medical Center between 1972 and 1984 to learn more about the population that sustained amputation and replantation. Ninety-four percent were from North Carolina and its border states. Persons between ages 21 and 30 years were the most frequently injured. Eighty-five percent of patients were men. Seventy-eight percent of amputations occurred between 6:00 AM and 6:00 PM. No significant difference in the number of replantations was noted at various months of the year. Fifty-eight percent of amputations were job related, and laceration was the most frequent type of amputation. Time between injury and operation averaged 5 hours 50 minutes. Average operating time was 6 1/2 hours. Thumbs were replanted most frequently, the index and small finger least frequently. Length of hospital stay averaged 9 days. Time out of work averaged 3 months. This data suggest that efforts directed toward employee education, safety, and prevention of injury on the job have the potential of decreasing the largest single cause of amputations in the upper extremities of patients in our area of the United States.

Accidents, Occupational↗
PubMed1987

Arterial stump pressure: a determinant of arterial patency?

Twenty-seven patients with acute injuries to the radial or ulnar arteries had arterial repairs using microvascular techniques. No patient had an ischemic hand secondary to his arterial injury. The overall patency rate for all repaired vessels was 56%. For sharp, clean lacerations, the success rate for repairs was 55%. Repairs of acute, sharp lacerations yielded no better results than delayed reconstructions. The average distal end arterial stump pressure for patent arteries was 66% of mean, while for thrombosed vessels it was 76% of mean; this was not a statistically significant difference (p = 0.9). There was no statistical correlation between forearm arterial patency, age, sex, vessel injured, mechanism of injury, time of repair, or clinically measured distal arterial stump pressure. At the present time, it does not appear to be possible to predict arterial patency by measuring arterial stump pressure at the time of definitive repair.

Arteries↗
PubMed1987

Longitudinal epiphyseal growth after replantation and transplantation in children.

Previous investigators have shown that epiphyses are unlikely to grow after free grafting although there have been rare reports of good and even normal growth. However, growth has usually continued whenever the epiphyseal vascular supply has been maintained by microanastomosis. Of 25 growing epiphyses in our series that were transferred, 17 by replantation and eight by free tissue transfer supported by microvascular anastomosis, over an interval varying from 27 to 81 months, average length attained was 89% of normal in elective transfer, 93% of normal in replanted digits, and 92% overall. Maximum growth attained in any digit in our series was 102% of the length of the normal contralateral digit; the minimum attained was 70%.

Amputation, Traumatic↗
PubMed1987

Skeletal fixation in digital replantation. Use of the "H" plate.

Many forms of bone fixation have been advocated for use in digital replantation, and successful series have been reported using such methods as intramedullary Kirschner-wire fixation, crossed Kirschner-wires, bone pegs, double-headed screws, and bone plates. Symptomatic nonunions have been rare with these various types of bone fixation. The functional results that have been reported are usually considered good; however, amputation of digits through the proximal phalanges is still a difficult area in which to obtain satisfactory function as measured by proximal interphalangeal joint motion. This may be related to a reluctance on the part of the surgeon to use early mobilization techniques for fear of disrupting marginally stabilized fractures. The "H" plate provided rigid fixation in six patients. This technique promotes earlier mobilization and shows promise of improved functional results.

Amputation, Traumatic↗
PubMed1985

Postoperative management.

Postoperative vascular compromise can result from a problem at the anastomotic site, including vessel damage, improperly placed sutures, trauma to the vessel, or atherosclerosis. Systemic factors include decreased blood flow, vascular spasm, and atherosclerosis. External compression such as hematoma, tight skin closure, or a large drain pressing on a vessel can compromise flow. In patients who are to undergo elective microsurgery, angiography at the recipient site is helpful to select healthy vessels. Anastomosis is performed outside the zone of injury, and a patency test is performed after anastomosis to substantiate adequate blood flow. If a healthy vessel is repaired with a technically satisfactory anastomosis, without tension, and if attention is given to meticulous hemostasis, careful skin closure, and nonconstricting dressings, postoperative management will be easy. Surgeons who are less conscientious in these matters will become more familiar with difficult postoperative management problems. With comprehensive postoperative care of the patient, including repeated monitoring with both clinical evaluation and monitoring devices, arterial or venous insufficiency can be detected early. If the cause of the vascular compromise is identified and corrected rapidly, the failing free tissue transfer can often be saved.

Anticoagulants↗
PubMed1985

Thumb reconstruction by the wrap-around method.

Reconstruction of a thumb amputated distal to the metacarpophalangeal joint can be accomplished by the "wrap-around" procedure. The operative procedure calls for an iliac crest graft to replace the bone of the amputated thumb. A flap from the great toe with innervation and circulation intact, including the toenail as well as sensory nerve, is wrapped around an iliac crest graft in a single-stage reconstruction of the thumb. This procedure allows a nice aesthetic result; the nail is transferred, sensibility is restored to the amputated thumb through the transferred neurovascularly intact flap, and the procedure is done at a single sitting. Results to date have been excellent in ten patients.

Amputation, Traumatic↗
PubMed1985

The results of replantation after amputation of a single finger.

We reviewed fifty-nine consecutive cases of patients who had replantation of a single finger (excluding the thumb) after traumatic amputation, with an average follow-up of fifty-three months. Fifty-one (86 per cent) of the replanted fingers survived. Survival was found to be affected by the age of the patient, the number of vessels that were anastomosed, and the replantation experience of the surgeons. The survival rate was not affected by the gender of the patient, the mechanism of injury, or which finger was amputated. As compared with survival only, the functional results were most dependent on the level of amputation. The proximal interphalangeal joint in amputated fingers that were replanted distal to the insertion of the flexor superficialis tendon had an average range of motion of 82 degrees after replantation, while those amputated proximal to the insertion had an average range of motion of only 35 degrees after replantation. The average operating time was six hours and ten minutes, and the average time until the patient returned to work was 2.3 months. Based on this experience, it is our opinion that replantation of a single finger that was amputated distal to the insertion of the flexor superficialis tendon is justified, but that replantation of a single finger that was amputated proximal to this insertion is seldom indicated.

Adolescent↗
PubMed1983

Cartilage as an interposition material to prevent transphyseal bone bridge formation: an experimental model.

A rabbit model modified from the one originally used by Osterman was used to test the effectiveness of interposition materials in the prevention of epiphyseal-metaphyseal bone bridge formation. Although fat was a moderately effective interposition material, cartilage was more effective in preventing growth retardation and angular deformity of the involved distal femur. None of the interposition materials, however, allowed for completely normal growth. It is theorized that the effectiveness of cartilage may be enhanced by the presence of a factor contained therein which inhibits bone formation.

Animals↗
PubMed1982

The vascularized cutaneous scapular flap.

Five cases of cutaneous free tissue transfer using the cutaneous and circumflex scapular vessels are presented. The free scapular flap is an excellent choice when intermediate-sized (6 to 10 by 10 to 16 cm) uninnervated flap coverage is necessary and cannot be achieved by conventional methods. The flap is exposed easily and has a constant artery and venous system, 2- to 3-mm-diameter vessels, and a 4- to 6-cm vascular pedicle. The shoulder donor site can be closed primarily. Like all shoulder wounds, it has a tendency to spread, but not functional deficit exists at the shoulder or on the posterior chest wall.

Adolescent↗
PubMed1980

Outpatient meniscectomy of the knee.

This paper reviews 218 patients who had outpatient meniscectomy at the University of Virginia between January 1974 and June 1977. Only one patient (0.46%) returned before his scheduled visit. Three patients (1.4%) had superficial wound infections. One (0.46%) had a pulmonary embolus several weeks postoperatively. Twelve percent underwent knee aspiration at two weeks after operation and 3.8% at six weeks. Twenty-seven patients had two meniscectomies at the University of Virginia, and 23 had both procedures as outpatients. None who had the first as an outpatient chose admission for the second. The average hospital bill for meniscectomy performed at a private hospital in Virginia in 1978 was +1,238.99. This would have been reduced by about 50% if meniscectomy had been done on an outpatient basis. In selected patients, outpatient meniscectomy can be done with a low complication rate, at a decreased cost, and with satisfaction to the patient and doctor.

Adolescent↗
PubMed1977

The structure of mononuclear phagocytes differentiating in vivo. III. The effect of particulate foreign substances.

The response of mononuclear phagocytes to three inert particles--barium sulfate, talc, and thorium dioxide--was studied by correlated light and electron microscopy. All three particles induced maturation of the mononuclear phagocytes, which proceeded to the stage of the mature macrophage and required 7 to 9 days. Once established, maturation persisted as long as 45 days, as did the inert particles. The resultant lesions, dense aggregates of mature macrophages, were termed mature granulomas. The resultant maturation differed from that produced by digestible bacteria in tempo and extent but not in pattern.

Animals↗
PubMed1975

Ultrastructral effects of in virto experimentation on right ventricular papillary muscle from cats in hypovolemic shock (38487).

The present data demonstrate for the first time that repeated stimulation (2-3 hr in an oxygenated perfusate) of right ventricular papillary muscles from cats subjected to hypovolemic shock does not alter the ultrastructure of the shock lesions. Neither does the in vitro experimentation cause functional impairment as determined by the measured isometric twitch tension. The data also indicate that electron microscopy is important to the evaluation of papillary muscles from cats subjected to shock.

Animals↗
PubMed1975

Formation of myocardial zonal lesions.

Right ventricular papillary muscles from control cats and from cats subjected to hemorrhagic shock were studied by electron microscopy. Half of the muscles were fixed at the apex of their active length-tension curves following stimulation in a papillary muscle bath. The other half were also fixed under tension. The ultrastructure of each muscle was examined in detail. A series of stages in the formation of myocardial zonal lesions, ranging from minimal changes in the intercalated discs to severe lesions, were identified and interpreted as representing the sequential stages in the formation of zonal lesions. One of the earliest (least severe) changes in the formation of zonal lesions, the separations of actin filaments from the intercalated disc, may be critical to the subsequent development of cardiac failure in hypovolemic shock. Mitochondrial displacement was a late event in the formation of the lesions, occurring only after major alterations had taken place in the sarcomeres and intercalated discs. It was noted that the ultrastructure of mitochondria remained essentially normal, and that there was no cell swelling associated with zonal lesions. This serves as confirmatory evidence that myocardial zonal lesions are a unique form of myocyte injury, are potentially reversible, and are not caused by ischemia.

Actins↗