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Biomedical subjects

R M Pearl

Publications and source records attributed to R M Pearl.

At least 37 records · Page 2Linked to original sources
PubMed1989

Pathophysiology of cleft lip muscle.

Although attention has been focused for decades on the correction of cleft lip deformities, our knowledge about the etiology of such deformities has remained presumptive. Sixty-six muscle biopsy specimens from cleft lip infants were obtained at the time of primary closure. Histochemical stains, histographic analysis, and electron microscopy were performed. A nonneurogenic muscle atrophy was seen that varied in severity, with muscle fibers near the cleft being the most atrophic and disorganized. Muscle fibers stained with the modified Gomori trichrome technique also demonstrated "ragged red" fibers typical of a mitochondrial myopathy. Electron microscopy confirmed large accumulations of mitochondria distorting the fibrils. These mitochondria also were increased in size and densely packed with cristae. This study thus demonstrates that the muscles in cleft lip deformities are not normal. Instead, they reflect either myopathy in the facial mesenchymal mitochondrion or at least a delay in maturation. We hypothesize that some of the morphologic deformities associated with cleft lip may cause a failure of mesenchymal reinforcement of the facial processes at a critical time in development.

Cleft Lip↗
PubMed1989

A congenital orbital defect with periorbital-dural tissue adhesion.

This case demonstrates a previously unreported congenital orbital deformity. The patient was born with a unilateral exophthalmos. The etiology of the defect was demonstrated by CT scan as a convex bowing of the right superomedial orbital wall behind the axis of the eye. At surgery, this convexity was revealed to be a small bony defect through which the periorbital tissue and dura mater adhered. This sort of orbital deformity, although subtle, must be considered in the differential diagnosis of congenital unilateral exophthalmos.

Exophthalmos↗
PubMed1988

An approach to mandibular reconstruction.

Mandibular reconstruction requires the restitution of both form and function. Proper preoperative planning, vascularized bone grafts, rigid fixation, flexibility of donor site choices, and restoration of labial, buccal, and lingual sulci lead to optimal reconstruction. We have used this approach in 38 patients; bony survival resulted in 37 and primary union in 35. A main limiting factor exists with individuals who have lost extensive amounts of soft tissue and muscle at the time of tumor resection or trauma. Only by attention to details in the preoperative, intraoperative, and postoperative phases can the best functional and aesthetic results be achieved.

Adult↗
PubMed1987

Hand reconstruction following avulsion of all dorsal soft tissues. A cutaneo-tendinous free tissue transfer.

Restoration of function following mutilating injuries to the extensor surface of the hand has traditionally involved staged reconstruction with distant pedicle flaps, followed by tendon grafting. Advances in microsurgery now permit the transfer, in one operation, of vascularized composite tissues such as skin and muscle, or skin and bone. For dorsal hand reconstruction a composite flap of skin, tendons and nerves from the dorsum of the foot was transferred in one stage soon after injury, avoiding unnecessary disabling scar formation, prolonged hospitalization and resulting in the rapid restoration of near normal function and appearance of the hand. Donor site morbidity was minimal.

Accidents, Traffic↗
PubMed1987

Application of free tissue transfers to the foot.

During the past five years we have used three sources of free tissue transfers in 26 patients to reconstruct defects of the ankle and dorsum, hind, mid- and forefoot, defects poorly or unamenable to traditional reconstructive methods. These included free muscle transfers covered with a skin graft, temporoparietal fascia also covered with a graft, and radial forearm skin or fascia. In addition, six complex defects were reconstructed with composite tissue free transfers, usually tendinocutaneous flaps. There was one partial flap loss. All were successful in both healing the defect and in providing functional restoration, except in the forefoot. From an analysis of these cases, we have developed indications for various transfers based on the functional needs of the area involved and donor site requirements.

Fascia↗
PubMed1987

Surgical management of volumetric changes in the bony orbit.

This article demonstrates that the periorbital fat, instead of being continuous and freely flowing, is encased within 3 compartments: 1 anterior to the extraocular muscles, 1 external to the extraocular muscles, and 1 deep to the extraocular muscles. In addition, the study establishes that fat loss anterior to the axis of the globe does not affect the anteroposterior location of the eye itself. Only fractures located posterior to the axis produce enophthalmos, and only operative procedures that create bony enlargement and fatty displacement behind this axis correct exophthalmos. Furthermore, only adding volume behind the axis of the globe can correct enophthamos. Finally, if there is sufficient space between the top of the globe and the bony roof, volume additions at the axis of the globe can correct vertical dystopia without producing exophthalmos.

Adipose Tissue↗
PubMed1987

The radial forearm flap: a versatile source of composite tissue.

The radiovolar area of the forearm constitutes a versatile source of composite tissues for pedicle flap reconstruction of the hand and free-flap reconstruction for many areas of the body. The skin is thin and relatively hairless, and the vascular pedicle is long and of large caliber. The flap can be harvested to contain vascularized tendons and bone. The skin can be reliably reinnervated. The principal disadvantage, that this is a conspicuous donor site, has not been a source of concern for our patients. Nineteen of the 20 (95%) free flaps survived completely.

Adult↗
PubMed1987

Penile revascularization in the treatment of vasculogenic impotence.

Arterial insufficiency is the most common organic cause of impotence. The diagnosis can be established on a clinical basis through the use of Doppler probe evaluation of the penile pulses, penile blood pressure measuring, and nocturnal penile tumescence monitoring. The diagnosis may be confirmed by internal pudendal arteriography. Through microsurgical arterial revascularization, a 60 percent long-term success rate has been achieved. Two early and two late failures suggest the need for improved patient selection and confirm the progressive nature of the arteriosclerotic process.

Erectile Dysfunction↗
PubMed1986

Metastatic cervical teratoma of infancy.

The first case of a documented metastatic cervical teratoma of infancy is presented with a review of diagnostic considerations. Early biopsy of suspicious neonatal head and neck masses is recommended. Complete resection of the teratoma should be considered as soon as clinically possible.

Diagnosis, Differential↗
PubMed1985

A vascular approach to the prevention of infection.

This study demonstrates that both axial and musculocutaneous flaps are similar in their ability to reduce bacterial concentrations and that either is superior to a random flap. Moreover, when the vascular flow in a random flap is improved, so is its potential to diminish bacterial contamination. Clinical infection reflects an imbalance between vascular supply and bacterial contamination. This study implies that flap selection in contaminated areas should be based on vascular profusion and that approaches which preserve or augment blood flow are efficacious in avoiding bacterial proliferation.

Abdominal Muscles↗
PubMed1985

Breast reconstruction following lumpectomy and irradiation.

The traditional approach to breast cancer has been the surgical mastectomy. The cosmetic deformity resulting from this procedure has led to the development of our current methods of breast reconstruction. The inherent attraction of lumpectomy and radiotherapy has been its equation with improved cosmesis. This procedure may be an effective alternative to surgery from the cancer perspective and does produce, in the majority of patients, an acceptable cosmetic result. However, this paper demonstrates that it may produce a result that is less optimal than mastectomy with postoperative breast reconstruction. The etiology of the increased deformity can either be the localized lumpectomy with marked internal derangement of breast volume or the radiation therapy itself. In addition, those who develop a combination require a solution to both. We describe three patients who illustrate these problems and believe that a greater awareness of these potential complications should be available to aid patients in choosing their cancer treatment.

Adult↗
PubMed1985

Experience with the temporoparietal fascial free flap.

The temporoparietal fascia is an ideal tissue source for free transfer to distant sites where ultrathin coverage is either desirable or mandatory. The fascia's dependable vascular anatomy facilitates the technical aspects of microvascular transfer by means of its large vessels, ample pedicle, and ability to be grafted on either side. Furthermore, this highly vascular tissue is available in surprisingly large quantities, and its donor scar is hidden in the hair. The authors have found this flap useful (1) in covering exposed bone and tendon without adding unwanted bulk, (2) in providing thin flap coverage or lining in major facial reconstruction, (3) in covering vital structures such as exposed nerves and vessels, (4) in providing neovascularity both as a recipient graft bed and for control of chronic infection, and (5) in reestablishing gliding-tendon mechanisms. The authors have successfully employed this free flap in 15 cases which involved deformities of the ankle, foot, Achilles tendon, forearm, hand, nose, and contralateral ear and scalp. Seven cases are utilized to illustrate the broad application of this unique and versatile free flap.

Achilles Tendon↗
PubMed1985

Acquired ptosis: a reexamination of etiology and treatment.

The etiology of acquired ptosis is almost always disinsertion of the levator aponeurosis from the tarsal plate. As opposed to congenital ptosis, where levator resection is required to compensate for muscle weakness, acquired ptosis can be consistently treated with simple levator reattachment. This study examines both the diagnostic and anatomic etiology of acquired ptosis in 80 consecutive patients. Although dermatochalasis, trauma with orbital hematoma, orbital swelling, anophthalmos, and multiple other diverse clinical etiologies were responsible for this condition, the anatomic etiology was identical in 79 of the patients--levator disinsertion. Cadaver studies demonstrate that the levator aponeurosis inserts into the tarsal plate through multiple flimsy, fibrous attachments. Any condition that results in either excess weight to the eyelids or excess muscular pull can disrupt these fibers. A modification of the external approach is described that allows rapid identification of the levator aponeurosis and permits accurate repair. Complete repair was achieved in the majority of the cases, and there were no instances of overcorrection.

Adolescent↗