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Biomedical subjects

R J Spence

Publications and source records attributed to R J Spence.

31 records · Page 2Linked to original sources
PubMed1985

The combined use of the latissimus dorsi musculocutaneous free flap and split-rib grafts for cranial vault reconstruction.

The patient described in this article had a large skull defect under the scalp which had been irradiated during treatment of a malignant brain tumor. The patient desired reconstruction of her defect. To provide good soft-tissue coverage for the bony reconstruction, a free latissimus dorsi musculocutaneous flap was used. The bony defect was partially reconstructed with split-rib grafts. The two parts of the reconstruction were combined into one operation, since it was felt that the well-vascularized muscle would ensure viability of the bone grafts.

Adult↗
PubMed1985

The use of a free flap in homozygous sickle cell disease.

This paper describes what is thought to be the first reported use of a free flap in a patient with homozygous sickle cell disease. The utilization of a free flap in homozygous sickle cell disease should be questioned because the obligate period of ischemia to which the flap must be subjected during the transfer from donor to recipient sites might lead to intravascular sickling in the flap and flap failure. Review of the literature suggests that by reducing the level of sickle hemoglobin to the range of 25 to 40 percent, the risk of failure of a free flap is not significantly increased in the homozygous sickle cell patient. Furthermore, there is good evidence to suggest that a well-vascularized muscle flap provides optimal coverage, reversing the pathophysiologic cycle of the sickle cell ulcer. Thus in cases of multiply recurrent sickle cell ulcers in areas devoid of a local well-vascularized muscle flap, a free muscle flap is indicated, may be the procedure of choice, and can be performed successfully. We report a patient with a 4-year history of multiple recurrent sickle cell ulcers of the left ankle treated with a gracilis free flap. This patient has been followed for 2 years and continues to be free of recurrent ulceration.

Adult↗
PubMed1984

Symmastia: the problem of medial confluence of the breasts.

This paper presents the problem of medial confluence of the breasts producing a web across the midline. Significant references in the literature dealing with uncommon clinical problems are virtually nonexistent. The purpose of this paper is to stimulate discussion of this entity and its surgical management and to propose the term symmastia to facilitate retrieval of information about this entity in the future. Two cases that highlight the central problem but which differ in the specifics of the surgical approach are presented. In the first case, the medial web was corrected by elevating an inferiorly based triangular skin flap that was advanced superiorly in an inverted Y-V manner after the excess medial soft tissue was divided and sutured superiorly to the medial pectoralis fascia to create a brassiere-band sling effect. In the second case, a superiorly based medial flap containing both skin and soft tissue was elevated. The excess skin and soft tissue were then excised. The remaining flap was tailored to fit into a V-shaped defect in the inferior incision to place the scar in a less viable place inferior to the sternum. The relative advantages of the two surgical approaches are discussed and a third approach based on the strengths of the two approaches is suggested. This approach would consist of the vertical division and superior rotation of the excess subcutaneous tissue flaps and the elevation of a superiorly based skin flap inserted into a V-shaped defect in the inferior incision.

Adult↗
PubMed1979

The correlation of the computer quantitated treadmill exercise electrocardiogram with cinearteriographic assessment of coronary artery disease.

One hundred and twenty-five consecutive patients being submitted for coronary cinearteriography were subjected to preliminary graded exercise testing using a Quinton treadmill and ECG data computer. Patients with disease of the left main coronary artery are at particular risk during coronary arteriography and it was hoped that exercise testing might identify these patients. This hope was not realised. A satisfactory end point to the exercise test was either the attainment of 85% of the maximal heart rate assessed for age, or ST segment depression greater than 2 mm. Exercise induced angina also formed an end point to the test and was considered a positive result. Results were determined by McHenry's discriminant analysis. The sensitivity of the exercise test was 66, 88 and 92% for one, two and three vessel disease respectively. Specificity was at least 83%. Exercise induced ST segment elevation occurred in four patients all of whom had previous extensive anterior wall infarction. Exercise testing is without risk in patients with ischaemic heart disease provided well defined precautions are taken.

Cineangiography↗
PubMed1979

Traumatic renal arteriovenous fistula: case report and useful operative technique.

A patient with a traumatic extrarenal arteriovenous fistula underwent successful repair of the lesion. The reconstruction utilized a portion of renal vein to allow lateral repair of the renal artery. The patient's postoperative course was complicated by paradoxical hypertension and severe abdominal pain like that in the "post-coarctectomy syndrome." Satisfactory recovery has occurred and the patient remains normotensive.

Abdominal Injuries↗
PubMed1978

Failure of immunotherapy with neuraminidase-treated tumor cell vaccine in mice bearing established 3-methylcholanthrene-induced sarcomas.

C3H/HeJ mice bearing MC-80 fibrosarcomas were given immunotherapy consisting of multiple injections of a Vibrio cholerae neuraminidase (VCN)-treated tumor cell vaccine at a site remote from the established tumor. In five separate experiments we were unable to show either partial or complete tumor regression or prolongation of survival for vaccine-treated mice compared to appropriate controls. Further, the use of BCG in addition to VCN-treated tumor cells failed to show any therapeutic efficacy. We could not confirm the successful immunotherapy results reported by others despite multiple efforts of reproduce the immunotherapy model as carefully and precisely as possible.

Animals↗
PubMedDate not supplied

Laser Doppler flowmetry evaluation of burn wound depth.

Hypothesizing that reduced blood flow to various levels in thermally damaged dermis is related to the depth of burn, we studied 59 burns in 41 patients, with an age range of 18 months to 67 years, with improved laser Doppler blood flow technology to determine burn depth on admission. Two hundred and sixty-eight laser Doppler measurements were made in 59 burn wounds in 41 patients. Of the 129 burn wounds with laser Doppler readings of less than 1.4 on admission, 127 were classified ultimately through clinical observation as either deep second- or third-degree burns and required excision and closure. Therefore predictive value of a positive result (i.e., laser Doppler value less than 1.4) on admission was 98.4% using laser Doppler measurements. Clinical estimation did not correlate as well with the depth of injury.

Adolescent↗
PubMedDate not supplied

Psychologic factors involved in the decision to undergo reconstructive surgery after burn injury.

Burn injuries often result in permanent changes in physical appearance and function. Although reconstructive surgery is often considered to improve function or physical appearance, or a combination, variables that may predict use of surgery are relatively unknown. Burn survivors (N = 46; 48% male) were assessed at an evaluation for potential reconstructive surgery. Measures of adjustment, distress, and personality were administered. Several psychologic and demographic variables differed among those who did versus those who did not subsequently undergo surgery. Social, sexual, and family relationships were poorer among those who later used surgery, and surgery patients had higher scores on somatization. Subjects who had not returned to work, and individuals with private insurance or managed care, were significantly less likely to follow-up with reconstructive surgery. Contrary to hypothesized results, indexes of burn severity and the injury location were not significantly different between the two groups. Results suggest that interventions designed to aid adjustment after injury may result in the best surgical candidates completing reconstruction.

Adjustment Disorders↗
PubMedDate not supplied

A multicenter review of toxic epidermal necrolysis treated in U.S. burn centers at the end of the twentieth century.

Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care. The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, non-burn hospital and burn center treatment, and outcome. A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and non-burn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P < 0.05), prophylactic antibiotics (22 vs 37.9%, P < 0.05), corticosteroid use (22 vs 51%, P < 0.05), and wound management. Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and non-burn centers. Early transport to a burn unit is warranted to improve patient outcome.

APACHE↗
PubMedDate not supplied

Effect of early body image dissatisfaction on subsequent psychological and physical adjustment after disfiguring injury.

OBJECTIVE: The impact of body image dissatisfaction on quality of life after severe burn injury was investigated after controlling for other determinants of outcome (i.e., injury, distress, and preburn quality of life). METHODS: The postburn quality of life (2-months postdischarge) of groups with and without body image dissatisfaction was studied after controlling for preburn quality of life (measured 2-3 days postadmission). The patient population (N = 86) was 77.9% men, had an average total body surface area burned of 17.02%, and average full-thickness burn of 6.09%. Forty percent had facial injuries, 68.6% required surgery, most were injured by flame (39.5%), and 76.8% were employed. RESULTS: Multivariate analysis of covariance (covarying preburn level of Mental quality of life, facial injury, and size of burn) contrasting body image dissatisfaction groups found significantly lower psychosocial adjustment at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 3.61; p<.01). A second MANCOVA (covarying the preburn level of Physical quality of life and both facial injury and size of burn) found significantly lower physical functioning at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 2.78; p < .03). Adding two more covariates (depression and posttrauma distress) eliminated the effect of body image dissatisfaction on postburn Physical but not Mental adjustment. CONCLUSIONS: Body image dissatisfaction affects quality of life after severe burn injury. Distress moderates this impact on aspects of physical but not psychosocial health.

Adaptation, Psychological↗