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Biomedical subjects

S Asko-Seljavaara

Publications and source records attributed to S Asko-Seljavaara.

At least 91 records · Page 5Linked to original sources
PubMed1992

Reconstruction of the Achilles tendon region by free microvascular flaps. 9 cases followed for 1-9 years.

In 1981-89, 9 patients underwent reconstruction for complex injuries in the Achilles tendon region. 10 free microvascular flaps were used: 5 fasciocutaneous and 5 muscle or musculocutaneous flaps. In addition, 4 Achilles tendons and 1 tibial posterior nerve were reconstructed, 1 femoropopliteal bypass was performed, and 6 tibial fractures were treated. The patients were re-examined on an average 3.5 years after the reconstruction. The stability of soft tissues was good in all patients. Good contour was achieved in superficial defects with fasciocutaneous and in deep injuries with latissimus dorsi free flaps. The calcaneal tendon function was good in 5, fair in 2 and poor in 2 patients, depending on the severity of the underlying skeletal injury. We conclude that free microvascular transfer offers one-stage reconstruction of complex, infected wounds in the Achilles tendon region, promotes fracture healing, and allows simultaneous tendon or nerve repair.

Achilles Tendon↗
PubMed1991

DNA ploidy pattern and S-phase characteristics of metastatic melanoma.

Samples of 130 metastatic melanomas from 92 patients were analyzed by DNA flow cytometry. DNA aneuploidy was observed in 67% of the patients. DNA indices were evenly distributed from 0.6 to 2.6 Tumors originating from primary lesions in the lower extremities were more frequently DNA aneuploid than those of other sites. S-phase fraction (SPF) was evaluable from 73 tumors. DNA aneuploid tumors had a significantly higher SPF than diploid tumors, and females had a higher SPF than males. Furthermore, distant metastases had a higher SPF than metastases in regional lymph nodes and in transit metastases, probably indicating a higher growth potential in metastases spreading to distant sites.

Aneuploidy↗
PubMed1991

DNA aneuploidy and low S-phase fraction as favourable prognostic signs in metastatic melanoma.

The prognostic value of cellular DNA content in melanoma metastases was investigated by flow cytometric analysis of fresh or paraffin-embedded tumour blocks from 95 consecutive patients referred to the Helsinki University Central Hospital Melanoma Team. Thirty-three per cent of the tumours were DNA diploid and 67% DNA aneuploid. S-phase fractions were lower in DNA diploid than in DNA aneuploid tumours (10.7% and 17.6%). 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. Surprisingly, patients with DNA aneuploid tumours and with tumours with low SPF survived significantly longer than those with DNA diploid or high SPF tumours. This exceptional finding of favourable prognosis for DNA aneuploid tumours was more prominent among patients receiving intensive systemic therapy and among patients with stage IV disease, probably indicating a tendency for DNA aneuploid tumours to have higher sensitivity to systemic therapy.

Adult↗
PubMed1991

The return of sensitivity to cold, warmth and pain from excessive heat in free microvascular flaps.

Recovery of sensitivity to cold, warmth and pain caused by excessive heat in various types of free microvascular flaps was studied psychophysically in 27 patients who had undergone such operations four months to four years earlier. A thermal stimulator based on the Peltier principle and controlled by a microprocessor was used to measure the sensitivity to temperature in the transplants. The results were compared with the measured thresholds in the opposite sites in corresponding normal body areas. The present study showed that sensitivity to cold, warmth, and pain caused by excessive heat did return to some free microvascular flaps. According to the measurements the sensation started to return after 6 months in some flaps, and all types of thermal stimuli were felt by one patient as early as 10 months after operation. The return was more pronounced in younger people and in smaller flaps. If the hands, feet, or head defects were reconstructed with a thin skin flap (posterior aspect of thigh, dorsum of foot, or subscapular) the recovery of sensitivity was verified. Sensation returned to the musculocutaneous and osteomusculocutaneous transfers if they were on the hands or the head, or if they were sutured to healthy tissue with normal sensation. The main advantage of the psychophysical sensory testing method that we used is that it gave exact numerical data that made it possible to compare results among the different patient groups and even those obtained at different clinics and laboratories.

Adolescent↗
PubMed1990

Anti-melanoma antibodies bind preferentially to diploid metastases in immunoscintigraphy.

Immunoscintigraphy with 99Tcm-labelled anti-melanoma monoclonal antibody F(ab')2- fragments was performed in 23 patients with histologically verified metastatic melanoma. Immunoscintigraphy was positive in 14 patients and all known metastases were detected in eight patients, five of whom had only one lesion. Lesion localization and detectability were as follows: 12/13 (92%) cutaneous and subcutaneous, 11/14 (79%) lymph node, 5/7 (71%) bone, 3/6 (50%) lung and 1/5 (20%) abdominal metastases were visualized. Despite its high specificity--no false positive immunoscintigrams--the low sensitivity of this method in detecting deep metastases hampers its usability. The false negative results were not due to lack of antigen expression as positive immunostaining results were observed also in specimens from patients with negative immunoscintigrams. Flow cytometric analysis of the metastases revealed that in 7/8 (88%) patients with diploid tumours had positive immunoscintigrams but only 7/15 (47%) patients with aneuploid tumours. These results show that the diagnostic accuracy of melanoma immunoscintigraphy can be improved by selecting patients not only by testing for the antigen but also on the basis of DNA analysis of an accessible lesion.

Abdominal Neoplasms↗
PubMed1990

Suitability of the scapular flap for reconstructions of the foot.

Eighteen patients with mainly a traumatic soft-tissue defect of the foot underwent reconstruction with a microvascular free scapular flap. Of the 17 successful transfers, 13 were to the weight-bearing parts of the foot. The stability and contour of the flaps were assessed after an average follow-up time of 3 years (range 1 to 5 years). The thicknesses of the scapular donor site and flap and the recipient site were measured by an ultrasound technique. The resistance of the flap to shear was measured with a dynamometer. The ultrasound measurements aided in refining our operative technique. In early cases, the flap thickness after transfer could be more than double what it was in the donor area. With proper tightening, the thickness could be reduced, with improvement in contour but no increase in soft-tissue stability or shear resistance of the flap. Without proper tightening, the scapular flap tended to be redundant when transferred to the foot. For good results, the patient should be lean, since the optimal thickness of the scapular donor site was less than 6 mm and the maximum thickness should not exceed 8 to 10 mm. The differences in shear resistance between the flaps were not associated with the soft-tissue stability of the reconstruction. The relative laxity of the flap on the plantar surface was found by several patients to be subjectively unpleasant. Although good contour could be achieved when covering the plantar heel, the tendency of the flap to develop abrasions and superficial breakdowns made it unsatisfactory for covering this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Mechanical sensibility in free and island flaps of the foot.

Mechanical sensibility in 20 free skin flaps and four dorsalis pedis island flaps, used for the reconstruction of foot defects, was analyzed with conventional clinical methods and by determining sensibility thresholds to vibration frequencies of 20, 80, and 240 Hz. To eliminate inter-individual variability, a score was calculated for each frequency by dividing the thresholds determined for each flap with values obtained from the corresponding area on the uninjured foot. The soft tissue stability of the reconstruction was assessed. Patients were divided into three groups according to the scores. In the group of flaps with the best sensibility, the threshold increases were low at all frequencies. In the group with intermediate sensibility, the relative threshold increases were greater, the higher the frequency. In the group with the poorest sensibility, no thresholds were obtained with 240 Hz frequency and the thresholds increases were very high at all frequencies. Sensibility was not related to the length of follow-up time, nor to the type or size of the flap. However, flap sensibility was closely associated with that of the recipient area, where sensibility was usually inferior to that of normal skin. The island flaps generally had better sensibility than the free flaps. There was a good correspondence between the levels of sensibility determined by clinical and quantitative methods. The quantitative data on the level of sensibility obtained with the psychophysical method were found to be reliable and free from observer bias, and are therefore recommended for future studies. The degree of sensibility may have contributed to, but was not essential for, good soft-tissue stability of the reconstruction.

Adult↗
PubMed1989

Recovery of sensation in free flaps.

A clinical study of touch, pain, warm and cold stimuli and two-point discrimination was performed in 27 free flaps four months to four years after the microsurgical procedure. There were 5 free skin flaps (2 with nerve suture), 15 musculocutaneous, 4 muscle-covered with split skin grafts and 3 osteomusculocutaneous flaps transplanted to various sites on the body. The results show full or nearly full recovery of touch and pain sensation in all free skin flaps. The musculocutaneous and osteomusculocutaneous free flaps developed good sensation if firmly grown onto the healthy recipient skin with normal sensation. Muscle flaps covered with split skin grafts and all flaps surrounded by scar tissue had a clinical absence of sensation. This study and our earlier findings of the regeneration of nerves in free skin grafts, in skin flaps and in experimental free flaps, lead us to suggest that the healthy denervated skin of the free flap provides a strong neurotrophic stimulus to the cut cutaneous nerves in the edges of the recipient skin. Cutaneous nerves freely regenerate in the loose subcutaneous tissue of the flap. We therefore conclude that all free flaps with skin islands have a potential for developing sufficient protective touch and pain sensation and even some superficial sensitivity.

Adolescent↗
PubMed1989

Epidermis is the origin of high creatine kinase levels in skin blister fluid.

Creatine kinase (CK) isoenzyme, CK-BB, known as the brain fraction, is not normally present in serum but predominates in several normal and malignant tissues and body fluids. We recently reported increased CK-BB levels in suction blister fluid. In the present study the cellular origin of the enzyme in skin was studied from homogenates of blister top epidermis and blister base dermis as well as from homogenates of split skin dermatome shavings and isolated keratinocytes. The CK-BB in human skin was derived almost exclusively from the epidermis. Enzyme determinations from various spontaneous bullae suggest that all types of skin blisters initially contain high CK-BB levels.

Biopsy↗
PubMed1989

[Reconstruction of the foot using free flaps].

Microvascular free-flap reconstruction of the foot was performed during a seven-year period in 25 patients to repair soft tissue loss caused mainly by traumatic injury. A scapular flap was used in fifteen cases, a dorsalis pedis in three, a radial forearm in two, a latissimus dorsi in two, and a gluteal thigh, rectus abdominis and tensor fascia lata each in one case. Two flaps were lost because of postoperative vascular complications. Soft-tissue stability was excellent or good in all of the seven patients with a successful free-flap transfer to the non-weightbearing part of the foot and in eleven of the sixteen patients with a flap on the weightbearing part of the foot. Four patients had frequent superficial ulcerations of the graft but only one flap was completely unstable. Sixteen patients had normal or near normal ability to walk. Significant gait problems in seven patients were caused by skeletal deformity of the reconstructed foot or other associated injuries of the lower limb rather than the reconstruction itself. The best fit and contour was provided by thin skin flaps such as the dorsalis pedis and radial forearm flaps while the scapular flap offered a more inconspicuous donor site and could be used to cover large defects. Sensibility of the flaps assessed by clinical methods was less than normal in all cases. Good sensibility was found in the flaps of two children, fair in six, poor or very poor in fifteen, and two flaps had no sensibility. The level of sensibility was not related to the soft-tissue stability of the flap.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Replantation service in Helsinki University Central Hospital 1980-1985.

A replantation service is a routine part of medical services. The best results are obtained when the work is centralized. In Finland five university hospitals have a replantation service. In the Helsinki University Central Hospital, 94 severed parts of the upper limb were replanted/revascularized in 1980-85. The amputation injury requiring replantation was most often a thumb avulsed by the driving axle of a tractor. The patients came from all over the country, and the short time span between the initial injury and admission to hospital--2.4 hours an average in 1985--shows that transport of these patients is not a problem in Finland. The mean duration of surgery was 6.9 hours. Most of the operations took place in the late afternoon, evening or at night. 16% of the cases needed immediate reoperation because of vascular problems. Later, over 40% of the cases underwent secondary procedures. Most of the patients returned to their former employment. In long-term follow-up, however, nine out of ten patients reported that the replanted organ was intolerant to cold. Therefore, with the exception of the thumb, single finger replantation should not be a routine procedure in a cold climate such as that encountered in Finland. A replantation service requires a minimum of four surgeons qualified in plastic surgery or hand surgery. The operating theatre will be in use through the night. Nurses, physiotherapists and occupational therapists must be specially trained. The surgeon must be prepared to perform multiple reconstructive procedures, both immediately and later on.

Adult↗
PubMed1987

Comparison of latissimus dorsi and rectus abdominis free flaps.

This review of 41 latissimus dorsi and 7 rectus abdominis free flaps describes the advantages and disadvantages of these two donor tissues. Flap survival was over 95%. Rectus abdominis carries the greatest area of skin of all the free flaps and makes salvaging of extremities with massive soft tissue loss possible, and it also provides the most elegant small free muscle flap. The latissimus dorsi is suitable for nearly any defect of the body except the foot and the hand because of bulkiness of the tissue and poor development of sensation, and the face because of poor colour match.

Abdominal Muscles↗
PubMed1987

Incidence of burns requiring hospitalization in Finland in 1980.

In 1980 there were 1296 emergency hospitalizations for burn injuries in Finland, averaging 27 per 10(5) inhabitants. The incidence varied from 20 to 58 per 10(5) by central hospital district, 70% of the patients were men. The incidence was higher among men than women at all ages. High risk population groups were children aged 0-4 and men aged 80 years and over. The incidence was higher in rural than urban areas. That was true especially among the elderly, whereas the opposite was true among small children. Most (59%) of the burns were caused by hot substances. Open fire caused 16%. The treatment of burns accounted for a total of 23,327 hospital days. The average duration of the emergency hospital stay was 14.3 days. Causes of regional variation and high incidence among old men require further research. The establishment of burn units in high risk areas should be considered.

Adolescent↗
PubMed1986

Localization of melanoma with radiolabelled monoclonal antibody fragments and iodoamphetamine.

In two melanoma patients, metastases accumulated both 99mTc-labelled monoclonal anti-tumor F(ab')2 fragments and N-isopropyl-p-(123I)-iodoamphetamine. Small metastatic deposits were localized only by labelled antibody, for which a higher target-to-nontarget ratio was observed than for radioiodoamphetamine, indicating that immunoscintigraphy may be the more sensitive method. In these two patients positive immunohistochemical staining for the antibody used was observed, whereas in a third patient, with no concentration of labelled antibody, the staining result was negative showing the specificity of the immunoscintigraphy findings. It is possible that the accumulation of radio-iodoamphetamine is due to binding to melanin but this is not certain as tissue samples from one of the two patients with positive scintigrams did not contain stainable melanin.

Adult↗
PubMed1986

Burn research--animal experiments.

A major burn causes in the body severe local and general alterations which last weeks or months. During the last two decades, a rapid progress of new treatment modalities, has dramatically improved burn care. With modern treatment, patients with burns covering 60-80 per cent of the body surface area can survive. Advances in treatment are based on burn research carried out in burn centers and units. Six major topics have recently been clinically and experimentally investigated: burn wound, fluid replacement, immune mechanisms, metabolism, inhalation injury and excisional therapy. A vertebrate model is essential for burn research. Before clinical use, the pathophysiology of the burn wound and the causes of immune suppression as well as new therapeutic modalities have to be first investigated at experimental level.

Animal Testing Alternatives↗
PubMed1985

Management of infected fractures of the tibia with associated soft tissue loss: experience with external fixation, bone grafting and soft tissue reconstruction using pedicle muscle flaps or microvascular composite tissue grafts.

The aim of this study was to assess the results of treatment given by a team of orthopaedic and plastic surgeons in a series of infected unhealed fractures of the tibia associated with loss of adjacent soft tissues. Twenty-five lower leg fractures, treated during a 10 year period, entered the study and were grouped according to the principles of treatment followed. In the earlier Group A (nine patients), the osteosynthesis implants were retained or changed to more stable internal fixation devices, the soft tissue defects were closed by conventional muscle or musculocutaneous flaps and bone grafting procedures were performed late in the treatment scheme. In the later Group B (16 patients) the implants were removed and the fracture stabilised by external fixation; the defects were covered with pedicle muscle flaps or with microvascular composite tissue grafts and cancellous bone grafting was performed at the same operation. Twenty-three fractures healed. One fracture developed non-union and in one patient infection necessitated below-knee amputation. The time of union after surgical reconstruction was significantly shorter in Group B (24 +/- 3 weeks) than in Group A (47 +/- 11 weeks). The results suggested that: in severe infected fractures of the tibia surgical implants used previously for fracture treatment should be removed and replaced with an external frame using firm axial compression, microvascular composite grafts seem to improve greatly the rate of healing, early bone grafting should be included in the reconstruction and late infections can be largely avoided even after extensive one-stage reconstructive procedures.

Adolescent↗