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Biomedical subjects

S Asko-Seljavaara

Publications and source records attributed to S Asko-Seljavaara.

At least 73 records · Page 4Linked to original sources
PubMed1995

Use of ultrasonography to evaluate muscle thickness and blood flow in free flaps.

The purpose of this study was to investigate the common belief that a microvascular transfer of a non-innervated free muscle flap loses muscle bulk over time. Sixteen patients (latissimus dorsi = 8, rectus abdominis = 7, and gracilis muscle = 1) were evaluated an average of 41 months after free flap transfer. Latissimus dorsi and lower extremity flaps displayed significantly more swelling than the other flaps. Flap bulk was measured by ultrasound. The mean thickness of upper extremity flaps was 10.3 +/- 1.8 mm (control muscles 11.8 +/- 2.8), lower-extremity 14.5 +/- 3.7 mm (control muscles 10.9 +/- 0.7), latissimus dorsi 14.3 +/- 2.2 mm (control muscles 10.3 +/- 0.8, P = 0.018), and rectus abdominis 11.2 +/- 1.2 mm (control muscles 12.4 +/- 1.9). Color Doppler ultrasonography was used to detect the pedicles of the free flaps and also to measure the peak velocity of blood flow intramuscularly and in the pedicles. In the upper extremities (n = 5) the pedicles could be found in only 20% of cases whereas in the lower extremities (n = 11) 91% of pedicles were located. (P = 0.013). Peak flow within the free flaps was significantly higher in the lower extremity (50% of the peak flow of the common femoral artery) than in the upper extremity (5% of the peak flow of the common femoral artery, P = 0.013). This study demonstrated that non-innervated free muscle flaps in the extremities maintain the original muscle thickness, although lower extremity and latissimus dorsi flaps have a trend to be thicker. Most pedicles of free muscle flaps in the upper extremities could not be located by ultrasound. However, flaps in the lower extremities most often have patent pedicles and also more vigorous intramuscular blood flow.

Adolescent↗
PubMed1995

A cytogenetic study of malignant fibrous histiocytoma.

We report the results of cytogenetic analysis of malignant fibrous histiocytoma of soft tissue (MFH). Seven of 12 successfully cultured MFHs had complex clonal aberrations, including translocations, deletions, and unidentifiable marker chromosomes. Telomeric associations were observed in five and the double minute phenomenon in four of seven MFHs with abnormal karyotypes. In one case (a storiform-pleomorphic MFH, grade IV) with a complex polyploid karyotype, two clonal ring chromosomes were present, one interpreted as r(19)(p13q13), one unidentified. In two tumors, clonal structural rearrangements of chromosome 1 were seen: del(1)(q21) in a storiform-pleomorphic MFH, grade IV, and add (1)(q21 or q32), t(1;10)(p22;q22) in a myxoid MFH, grade I. The remaining five MFHs had normal karyotypes, but in two of them nonclonal, structural aberrations were found. The modal chromosome number in the studied MFHs varied widely, but the majority of tumors with abnormal karyotypes had polyploid chromosome complements (five of seven cases). Our results confirm many of the previous findings and indicate that double minutes (dmins) may be more frequent in MFH than previously reported.

Adolescent↗
PubMed1995

Perioperative plasma endothelin-1 concentrations and vasoconstriction during prolonged plastic surgical procedures.

The role of endothelin-1, a potent vasoconstrictor released by vascular endothelium, in the vasoconstriction that develops after prolonged operations is not clear. This study was performed in order to determine if there was any relationship between endothelin-1 and the degree of vasoconstriction during prolonged plastic surgery. Plasma concentrations of endothelin-1, skin-forearm temperature gradient (Tgrad), rectal temperature, mean arterial pressure (MAP) and heart rate (HR) were measured at nine predetermined times before, during and after operation in nine women undergoing breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap. Development of cutaneous or fat necrosis of the flap was assessed clinically and with ultrasound. Concentrations of endothelin-1 before induction were increased (median 8.9 (25-75% quartiles 5.5-12.5) pg ml-1). During operation they were approximately 3 pg ml-1 and after operation approximately 5 pg ml-1. Tgrad was approximately 4 degrees C before induction and after operation, indicating marked vasoconstriction; during operation it was about zero, indicating vasodilatation. There was a statistically significant correlation between endothelin-1 concentrations and Tgrad (Spearman non-linear correlation) (r = 0.32, P = 0.004) and between endothelin-1 and MAP (r = 0.25, P = 0.02), but not between endothelin-1 and HR or development of minor cutaneous or fat necrosis of the flap (five patients). We conclude that increased plasma concentration of endothelin-1 is associated with the extent of peripheral vasoconstriction.

Adult↗
PubMed1995

Thermographic mapping of perforators and skin blood flow in the free transverse rectus abdominis musculocutaneous flap.

There is no ideal method for preoperative or intraoperative mapping of cutaneous perforators or for postoperative monitoring of blood flow in cutaneous flaps. To study the suitability of thermography for the mapping and monitoring of free transverse rectus abdominis musculocutaneous (TRAM) flaps for breast reconstruction, we performed thermography pre-, intra-, and postoperatively (eight patients). The temperature of the TRAM flap increased during the induction of anesthesia and was still higher than normal on the first and second postoperative days (p < 0.05). During the operation, the flap cooled, reaching its minimum temperature (3.62 +/- 0.6 degrees C below phase 2, p < 0.05) after ligation of both pedicles of the flap. When blood flow had been re-established, all parts of the flap warmed rapidly. The locations of perforators ("hot spots") could be seen before, during, and after the operation. However, induction and cutting of both pedicles made the flap isothermic, and the perforators disappeared temporarily. Thermography is a potential method of mapping cutaneous perforators pre-, intra-, and postoperatively and of monitoring the flaps at bedside. The method is easy to use and the outcome can be seen immediately. Our results also showed that the temperature (blood flow) in free TRAM flaps is higher than in the tissue in its original position.

Adult↗
PubMed1995

Free flap reconstructions of tibial fractures complicated after internal fixation.

The cases of 15 patients are presented where microvascular soft-tissue reconstructions became necessary after internal fixation of tibial fractures. Primarily, seven of the fractures were closed. Eleven fractures had originally been treated by open reduction and internal fixation using plates and screws, and four by intramedullary nailing. All of the patients suffered from postoperative complications leading to exposure of the bone or fixation material. The internal fixation material was removed and radical revision of dead and infected tissue was carried out in all cases. Soft tissue reconstruction was performed using a free microvascular muscle flap (11 latissimus dorsi, three rectus abdominis, and one gracilis). In eight cases the nonunion of the fracture indicated external fixation. The microvascular reconstruction was successful in all 15 patients. In one case the recurrence of deep infection finally indicated a below-knee amputation. In another case, chronic infection with fistulation recurred postoperatively. After a mean follow-up of 26 months the soft tissue coverage was good in all the remaining 13 cases. All the fractures united. Microvascular free muscle flap reconstruction of the leg is regarded as a reliable method for salvaging legs with large soft-tissue defects or defects in the distal leg. If after internal fixation of the tibial fracture the osteosynthesis material or fracture is exposed, reconstruction of the soft-tissue can successfully be performed by free flap transfer. By radical revision, external fixation, bone grafting, and a free flap the healing of the fracture can be achieved.

Adult↗
PubMed1995

Response of subcutaneous and cutaneous metastases of malignant melanoma to combined cytostatic plus interferon therapy.

A chemotherapy regimen consisting of dacarbazine (DTIC), vincristine, bleomycin and lomustine (CCNU) was combined with natural leucocyte interferon (IFN) in the treatment of 37 patients with cutaneous and subcutaneous metastases of malignant melanoma. Twenty-five also had concomitant lymph node, visceral, bone or brain metastases. Fifteen patients (41%) experienced complete response (CR) and 10 (27%) partial response (PR) of the superficial lesions. In addition, three patients were rendered surgically tumour-free after PR or disease stabilization during drug therapy. The median overall duration of response was 10.2 months (range 1-53 months). In disseminated disease, the combined therapy produced favourable results, particularly with regard to superficial lesions. It is also possible that this therapy may retard the growth of aggressive subcutaneous metastases in patients who have previously had multiple surgical procedures in an attempt to stabilize their disease. In a small proportion of patients, the long-term complete remission with the drug therapy alone, or in combination with surgery, suggests that this regimen might have been curative.

Adult↗
PubMed1995

Morbidity of donor and recipient sites after free flap surgery. A prospective study.

Although free flap transfer is a routine procedure, we know of few studies about post-operative morbidity at recipient and donor sites. The strength of the shoulder extension after harvesting of a latissimus dorsi free flap (n = 12) and the patients' subjective opinions of morbidity at recipient and donor sites (n = 23) were assessed two and six weeks, and three,six, and nine months after transfer of free muscle flaps. The patients' subjective opinions were measured on a scale from 1 (normal) to 5 (very troublesome) and the strength of the shoulder was measured in N. The flaps used were latissimus dorsi (n = 18), rectus abdominis (n = 4), and gracilis (n = 1). All but one were transplanted to a lower extremity. The extension strength of the shoulder decreased from 105 N to 70 N immediately after the operation (p < 0.05), and strength did not improve during follow up. Subjectively assessed morbidity at the recipient site and cosmetic disability decreased from troublesome or very troublesome to moderate (p < 0.05). Swelling decreased from moderate at two weeks to normal or slight at nine months (p < 0.05). The subjective morbidity at the donor site decreased from slight at two weeks to normal at nine months for functional disability (p < 0.05). Cosmetic disability at the donor site was minimal during follow up. This study shows that shoulder extension strength deteriorated permanently after part of the latissimus dorsi muscle had been removed even though subjective morbidity was minimal. Morbidity at the recipient site decreased significantly with time. Subjective opinion of morbidity after latissimus dorsi transplantation did not differ from that after rectus abdominis transplantation.

Adolescent↗
PubMed1995

Return of sensibility and final outcome of breast reconstructions using free transverse rectus abdominis musculocutaneous flaps.

Thirty-nine patients who had had free transverse rectus abdominis musculocutaneous (TRAM) flaps were studied and interviewed 5 months to 2.3 years after the procedure. The main reason why the patients had wanted the reconstruction in the first place was difficulty with the external prosthesis. Thirty three of 39 would have had the operation again; three were hesitant, and three had regrets for reasons other than that the breast was not satisfactory. All patients considered that the symmetry of the breasts was good or satisfactory with bras; without bras, one patient thought that the symmetry was poor, and the physician thought that the symmetry was poor in nine patients. Two-point discrimination turned out to be too delicate for studying the sensitivity of the breast. When pressure sensitivity was studied with von Frey monofilaments, the threshold values were significantly lower on the lateral and medial side and under the reconstructed breast than on the opposite side. In 22 patients the lateral part, and in 23 the medial part, of the reconstructed breast was insensate. There was good or satisfactory pressure sensitivity on the lateral side in nine patients and on the medial side in eight. The return of sensitivity to the autogenous breast reconstruction was variable among the patients studied, but it did not affect their satisfaction with the reconstruction.

Abdominal Muscles↗
PubMed1995

Temporal artery island flap in reconstruction of the eyelid.

The temporal artery island flap, based on the anterior branch of the superficial temporal artery, was used in full thickness eyelid reconstructions of 11 patients (in four for both lids, in two for the upper lid and in five for extensive lower lid defects). The skin island was taken from the upper lateral frontal skin in front of the hairline to leave minimal scaring and create a long vascular pedicle. Mucosal or chondromucosal graft was used for the inner lining. In seven patients the arterial pedicle surrounded by a 0.5 cm wide band of subcutaneous tissue containing the corresponding veins, was tunnelled under the skin in a one stage procedure. In four cases, the pedicle was temporarily left above the skin to shorten the operating time. The temporal artery island flap is a reliable way of reconstructing both lids, or the lower lid in cases where the local flaps have been used in earlier operations. Because of the risk of bulging and for functional reasons, we do not recommend the flap for upper eyelid reconstructions.

Adenocarcinoma↗
PubMed1994

Mouse subrenal capsule assay chemosensitivity and DNA flow cytometry parameters of human melanoma metastases.

Chemosensitivity was analyzed by mouse subrenal capsule assay (SRCA) in 103 human melanoma metastases 79 of which were also analyzed by DNA flow cytometry. The most effective combination was dacarbazine, vincristine, and carmustine (DOB), followed by cisplatin plus etoposide (Plat-VP16). By the original criteria of the assay, 35% of tumors were sensitive to DOB treatment while 15% responded to Plat-VP16. Chemosensitivity of DNA diploid and aneuploid tumors showed no significant difference; 35% of the aneuploid tumors were sensitive to DOB and 19% to Plat-VP16, whereas 41% and 13% respectively of the diploid tumors were sensitive. An association between DNA index and chemosensitivity was observed. Growth of the implant was observed in 44% of tumors with a DNA index above 1.5 receiving DOB treatment, whereas only 12% of tumors with an aneuploid DNA index < or = 1.5 grew. No significant difference was observed in the SPF of chemotherapy sensitive and insensitive tumors, though a tendency to lower SPF was observed in sensitive tumors.

Adult↗
PubMed1993

Cutaneous blood flow in the free TRAM flap.

According to clinical studies there are fewer circulatory complications with the free TRAM flap than with the pedicled TRAM flap. In this haemodynamic study, we measured perioperative cutaneous blood flow in 11 free TRAM flaps with laser Doppler flowmetry (LDF) and transcutaneous oxygen tension (ptcO2). We also studied 4 pedicled TRAM flaps with an additional microvascular anastomosis. Our results suggest that skin blood flow in the free TRAM flap is superior compared to our previously presented results of the pedicled TRAM flaps, and also superior to pedicled TRAM flaps with additional microvascular anastomoses of the inferior epigastric vessels to "supercharge" them.

Adult↗
PubMed1993

Latissimus dorsi breast reconstruction. Long term results and return of sensibility.

The long-term results of 44 patients who underwent breast reconstruction after mastectomy with latissimus dorsi musculocutaneous flaps with endoprostheses were studied. Good symmetry without a brassiere was achieved in 15 patients, slight asymmetry in 24 and poor symmetry in five (11%). Symmetry when a brassiere was worn was acceptable in all but one of the patients (43/44). A third of the patients (n = 13) had developed unacceptable (grade III or IV) capsular contraction, but 39 (89%) of the patients studied were satisfied with the long-term reconstruction. Cutaneous sensibility, measured by von Frey's test, had returned to 28 (64%) of the cutaneous skin islands, to their medial parts in particular. The flaps in patients who had received concentrated radiation or who had large prostheses remained numb. Sensation was normal in the scars of the donor areas in all but three patients. Latissimus dorsi breast reconstruction with an endoprosthesis is safe and simple. It gives a subjectively satisfactory result in nine out of 10 patients and is therefore a valuable method of reconstruction after mastectomy.

Cicatrix↗
PubMed1993

Use of the Ilizarov technique after a free microvascular muscle flap transplantation in massive trauma of the lower leg.

The use of microvascular flaps has become routine in treating compound tibial fractures with extensive soft-tissue loss. Vascularized bone grafts, or shortening of the leg and later elongation with the Ilizarov technique, have been advocated if the injury involves major bone loss. The authors treated four of these massive injuries by debridement and external fixation with the leg at its normal length. Acute free flap reconstructions (four latissimus dorsi, and one case added with a vascularized iliac crest graft) were performed. Tibial corticotomy was later made above or below the defect (varying from 2.5 to 7 cm) and the bone was corrected with slow (0.5-0.75 mm/day) segmental distraction. This was combined with elongation of the leg in two cases. The consolidation time after corticotomy ranged from nine to 12 weeks. The healing time of the fracture after the initial injury was 12, 14, 22, and 36 months, respectively. In massive injury of the lower leg, maintain the initial length of the leg, and perform early free muscle flap reconstruction and segmental bone distraction under the free flap.

Adult↗
PubMed1992

Tumour growth rate and DNA flow cytometry parameters as prognostic factors in metastatic melanoma.

The prognostic value of flow cytometric parameters and tumour growth rate of melanoma metastases under the mouse renal capsule was investigated for tumours from 117 consecutive patients referred to the Helsinki University Central Hospital Melanoma Team. DNA flow cytometry (FCM) was interpretable for the tumours of 114 patients, and growth rate analysis for 82 patients, both results being available from 79 patients. Thirty-six percent of the tumours were DNA diploid and 64% DNA aneuploid. Tumour ploidy and S-phase fraction were shown by multivariate Cox model analysis to be independent prognostic variables and major determinants of survival after first recurrence. Patients with DNA diploid or aneuploid tumours survived a median 16 and 27 months, respectively. A high growth rate of tumour sample in vivo under the mouse renal capsule tended to be a sign of poor prognosis, although not reaching statistical significance. Combining the results of FCM, tumour growth rate and TNM stage, we propose a highly efficient prognostic scoring method. Patients with a score above 0.75 had a median survival of 11 months compared to 30 months among patients scoring under 0.75 (P less than 0.0001). This score was the most significant (P less than 0.0001) prognostic factor in the Cox model when TNM stage, age, ploidy, SPF, and tumour growth rate were analysed as covariates.

Adult↗