Search PubMed⌕ Search

Biomedical subjects

R M Pearl

Publications and source records attributed to R M Pearl.

At least 55 records · Page 3Linked to original sources
PubMed1983

The vascular supply to the skin: an anatomical and physiological reappraisal--Part I.

We present a new concept of vascular anatomy, proposing that a complex subcutaneous vascular network, located between the dense and loose adipose tissue, connects the larger subcutaneous vessels, the vertical perforators, and the subdermal plexus. Knowledge of the location of these vessels helps determine optimal flap design and level of elevation. In this first of two articles, we describe the experimental portions of our study. The sequel describes the human experience and clinical implications.

Animals↗
PubMed1983

The vascular supply to the skin: an anatomical and physiological reappraisal--Part II.

The subcutaneous vascular system demonstrated in the first part of this study augments skin flap survival when included within human abdominal flaps. Flaps with larger subcutaneous vessels will survive to a greater length than flaps supplied solely by the subdermal plexus. Knowledge of the subcutaneous vascular system is applicable to breast reduction, subcutaneous mastectomy, and abdominal lipectomy.

Abdominal Muscles↗
PubMed1982

Irreplaceable free flaps in reconstructive surgery--part I.

Free flaps are increasingly being chosen to solve complex reconstruction problems. We describe a fascial sleeve approach to elevation of the donor flap which increases its safety and reliability. We report examples in which resultant revascularization of the recipient site causes the free flap to be irreplaceable for solving the particular clinical problem.

Adult↗
PubMed1982

Irreplaceable free flaps in reconstructive surgery--part II.

Recent advances in myocutaneous flap and free-flap surgery can be combined to solve difficult reconstructive problems. The unreliability and difficulty of dissecting subcutaneous axial free flaps, as well as problems associated with the small size of their donor vessels, have been obviated by the newer free flaps. Although microvascular tissue transfer should not be employed when a more simple and reliable reconstruction technique is available, the capacity of these flaps to revascularize the recipient site, plus their ability to provide skin, muscle, and bone, has increased the indications for their use. We prefer the fascial sleeve approach to free-flap elevation compared with direct dissection of the vascular pedicle. The free flap has become an important technique for the reconstructive surgeon.

Carcinoma, Squamous Cell↗
PubMed1981

A unifying theory of the delay phenomenon--recovery from the hyperadrenergic state.

Flap necrosis occurs from a combination of reduced blood supply--a result of transection of the feeding vessels--and vasoconstriction. The vasoconstriction is secondary to the hyperadrenergic state that follows transection of the sympathetic nerves accompanying the vascular supply to the flap. A flap that has undergone surgical delay has had its stored neurotransmitter, norepinephrine, released and cleared from the tissues. At the time of the flap transfer, therefore, the hyperadrenergic condition does not reappear and the vascular flow is greater than in an undelayed flap.

Abdominal Muscles↗
PubMed1981

Inflammation in a silicone-induced granuloma caused by a tuberculosis skin test.

We present a case report of a tuberculosis skin test causing a cellular immune type of response at both the injection site and at a distant site previously injected with liquid silicone. It is possible that the P.P.D. test is unrelated to the distant inflammation; initiated an antibody-mediated response; caused a specific cellular immune response; or caused a nonspecific cellular immune response. The most likely explanation is that it was a nonspecific cellular immune response. This report calls attention to the possibility to distant stimuli initiating episodes of inflammation at a site of liquid silicone injection. It may be that other agents that stimulate the cellular immune system are also responsible for causing inflammation at sites of silicone injection, and should therefore be avoided.

Adult↗
PubMed1981

Tensor fascia lata myocutaneous flap in lower abdominal wall reconstruction.

The tensor fascia lata myocutaneous flap provides a reliable autogenous building block for anatomical lower abdominal wall reconstruction. Preservation of innervation allows maintenance of voluntary motor control and protective sensation. The excellent blood supply of this flap is particularly helpful in reconstructing previously irradiated areas. A one-stage repair is possible, leaving minimal secondary defect. We describe 4 patients illustrating the uses and versatilty of this flap. Anatomy, operative procedures, and indications for delay are also discussed.

Abdominal Muscles↗
PubMed1981

Atypical mycobacterial cervical lymphadenitis--treatment with surgery and antibiotics.

Five patients, ages 2 to 5 years, were successfully treated for cervical lymphadenitis caused by the avium intercellulari complex of atypical bacteria. Preoperative treatment with standard antituberculosis therapy had been unsuccessful. Extensive surgery requiring a conservative radical neck dissection was sometimes required. Three patients had such extensive and progressive disease that immediate excision was impossible. These patients received a course of Amikacin with considerable improvement, permitting adequate excision and reconstruction. A fourth patient who received Amikacin did not respond, although sufficient excision was possible. This preliminary data indicates that a combined treatment of Amikacin and surgery in extensive cases may be useful in the treatment of cervical lymphadenitis due to atypical mycobacteria.

Amikacin↗
PubMed1981

Patent median artery as a cause of carpal tunnel syndrome.

Persistent median artery should be considered in the evaluation of patients with carpal tunnel syndrome. We present 5 instances of carpal tunnel syndrome caused by pressure from patent median arteries. The arteries caused bilateral carpal tunnel syndrome in 1 patient. Neuropraxia can be so severe that thenar muscle atrophy and complete loss of sensation occur. We review the embryonic development of the median nerve vascular supply and the reported incidence of persistent median artery. The use of Doppler examination is stressed in evaluating whether a median artery is present, and if it is essential to digital blood supply. In each instance, the neuropraxia resolved after the patent median artery was resected.

Adult↗
PubMed1980

Use of the medial upper arm skin as an arterialised flap.

The skin on the underside of the upper arm is supplied in part by the superior ulnar collateral artery, a direct cutaneous artery arising from the brachial artery four to six cm distal to the pectoralis major insertion. Two-thirds to three-quarters of the length of the medial arm skin can be reliably transferred as an arterialized undelayed pedicle flap. This skin provides excellent coverage for the opposite hand from a relatively inconspicuous donor site. Transfer of this flap is safe and patient discomfort is minimal. It is recommended for elective reconstruction and emergency procedures.

Adult↗
PubMed1980

An arterial medial arm flap--vascular anatomy and clinical applications.

We describe the vascular distribution to the skin of the arm as determined by cadaver dye injections and anatomical dissection. The superior ulnar collateral cutaneous artery provides a direct cutaneous branch that supplies the proximal two-thirds of the medial arm. An arterialized flap from the medial arm is very thin, elastic, and hairless--therefore excellent for hand resurfacing and facial reconstruction. Five examples of the use of arm skin from 21 patients using local and distant flaps are shown. The indications, methods, and anatomical bases for flap delay are detailed. The Doppler flow meter is used to determine artery position.

Adult↗
PubMed1978

Orbital blowout fractures: an approach to management.

Cadaver studies and clinical evidence are presented to suggest that medial wall fractures are often concomitant with orbital floor fractures. The medial wall fractures are located in the ethmoid bone midway between the medial canthus and the lesser wing of the sphenoid. These fractures may be the etiology of late enophthalmus. The discrepancy between the high frequency of occurrence of medial wall fractures in this study and the rarity of clinical diagnosis derives from the limitations of standard radiography. Computed tomography (CT scan) is useful in delineating these fractures. The operative approach is through an incision above the medial canthus. Surgical treatment includes reduction of the herniated periorbital fat and coverage of the defect with autogenous, homologous, or alloplastic materials.

Adult↗
PubMed1978

Uses of the rectus femoris myocutaneous flap.

The rectus femoris myocutaneous flap is quite useful for definitive immediate coverage of complex wounds within its territorial arc. We describe 4 cases to illustrate the capabilities of this flap. The indications for, the anatomy of, and the surgical technique for transfer, as well as the functional sequelae in two nonparaplegic patients are discussed.

Abdomen↗