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Biomedical subjects

S J Mathes

Publications and source records attributed to S J Mathes.

At least 73 records · Page 4Linked to original sources
PubMed1984

Reconstruction of the breast: where do we fall short? An evolution of ideas.

We have analyzed our 5 year experience with 153 breast reconstructions. There were 83 latissimus dorsi reconstructions, 16 simple silicone implant insertions, 21 transverse rectus abdominus myocutaneous flaps, and 33 reconstructions using a variety of other methods. The rate of postoperative complications was 24 percent. The most common shortcoming was the inability to obtain symmetry with the other breast. Persistent problems included inability to fill the subclavicular hollow or the superior con-cavity due to partial atrophy of the pectoralis major muscle, and particularly, the lack of projection and ptosis in the reconstructed breast.

Breast↗
PubMed1984

The use of a rectus abdominis myocutaneous flap to reconstruct a groin defect.

An inferiorly based rectus abdominis myocutaneous skin flap was used carrying a large transversely aligned superior abdominal skin paddle to close successfully an infected and seriously compromised wound in the contralateral groin. The versatility of the rectus abdominis myocutaneous muscle unit, with its dual blood supply, is indicated yet again.

Abdominal Muscles↗
PubMed1984

A comparative study of skin blood flow in musculocutaneous and random pattern flaps.

The present study in dogs was performed to evaluate the development of blood flow in cranial-based, rectus abdominis musculocutaneous (MCF) and random pattern (RPF) flaps and in adjacent intact skin before and after operation. Prior to raising of the flaps the intact skin area had the same blood flow in all the test injections. Following flap elevation blood flow in the MCF increased and on the second postoperative day (POD) it was 2.6 times the preoperative value. From POD 2 through POD 15 only minor changes were found for blood flow in MCF. Blood flow in the RPF immediately after surgery was only 31% of the preoperative value and 24% of the MCF value. After POD 2-3 blood flow in RPF, however, increased and reached the preoperative level and continued to increase through POD 15. Intact adjacent skin showed changes similar to those of MCF through POD 6, however, by POD 15 blood flow had decreased and was lower than that in MCF and RPF. Blood flow rates at remote sites in the groin and shoulder were identical and showed only a slight increase during the first two postoperative days. It is concluded that MCF have an early and continuous increase in blood flow after raising, while RPF have an early decrease. RPF, however, develop a subsequent increase in flow lasting through POD 15. Intact adjacent skin also showed increased blood flow which could not be attributed to a generalized increase in skin blood flow.

Animals↗
PubMed1984

Musculocutaneous flap or muscle flap and skin graft?

Six factors must be considered in choosing between muscle only and musculocutaneous flaps for reconstruction of defects: size, bulk, donor deformity, durability, pliability, and sensibility. The choice depends on the location and characteristics of the specific defect. Advantages and disadvantages of each flap in different circumstances are discussed, with emphasis on restoring form and function to the defect while preserving them at the donor site.

Female↗
PubMed1984

Recurrent macromastia after subcutaneous mastectomy.

Management of sudden unrelenting breast growth in a young woman included use of antiestrogen hormone therapy and subcutaneous mastectomy. Later, massive breast growth again occurred during pregnancy, requiring a repeat postpartum subcutaneous mastectomy. The dramatic response to a specific antiestrogen agent and the subsequent massive regrowth of breast tissue after subcutaneous mastectomy suggests that breast tissue is extremely sensitive to circulating hormones in certain patients with macromastia. The unusual nature of this patient's recurrent macromastia warrants this review of reports of similarly affected patients and discussion of general concepts in the medical and surgical management of the disorder.

Adult↗
PubMed1984

The dynamic properties of tissue oxygen in healing flaps.

Oxygen delivery to random pattern and musculocutaneous flaps was investigated in a canine model. Oxygen tension was measured in the proximal and distal portions of each flap and in adjacent normal skin by means of a recently developed technique. The effect of delay techniques on tissue oxygen tension was also examined with modifications of the same flap model. All measurements were made over a range of inspired oxygen concentrations (21% to 100%) both before operation and at intervals up to 15 days after operation. Tissue oxygen tensions were significantly higher in the musculocutaneous flaps than in random pattern flaps up to 6 days after operation. They were higher in the proximal portions than in the distal portions in each flap type. This difference was greater in the random pattern flap. Delay techniques prevented the early dramatic decrease in postoperative oxygen tension seen in random pattern flaps. Differences in the pattern of oxygen delivery to random pattern and musculocutaneous flaps may in part explain the greater reliability of musculocutaneous flaps when transposed in the presence of infection.

Animals↗
PubMed1983

The rectus abdominis free flap for lower extremity reconstruction.

The authors present their successful experience with an attractive alternative to the latissimus dorsi and gracilis muscle flaps for lower extremity reconstruction--the free rectus abdominis muscle flap. The muscle flap has a dual blood supply, but the longer pedicle length and larger vessel diameter of the inferior epigastric vascular pedicle favor its use for free-tissue transfer. Surgical anatomy, technique, indications, and potential complications are outlined.

Abdominal Muscles↗
PubMed1983

Coverage of the infected wound.

Fifty-four consecutive patients with chronic wounds were identified by the following criteria: (1) established infection for 6 months, (2) exposure of bone, mediastinum, or other vital structure, (3) mechanical and/or vascular limitations to delayed closure techniques, (4) no response to wound debridement in prolonged antibiotic therapy. These wounds were divided into four groups: osteomyelitis (21), pressure sore (17), soft tissue wound (10), and osteoradionecrosis (6). Wound treatment in all patients included debridement, muscle flap closure, and culture specific antibiotic therapy. These consecutively treated patients over a 4-year period presented with an average duration of chronic infection of 2.9 years. Ninety-three per cent of these patients after treatment have demonstrated stable coverage without recurrent infection with a minimum of 1 year and a maximum of 4.6 years follow-up. The results demonstrate safe, effective coverage (93% of patients) of chronic infected wounds associated with long bone and pelvic osteomyelitis as well as chronic perineal sinuses following proctocolectomy and osteoradionecrosis. Debridement with short-term (average 12 days) antibiotic therapy has been effective when muscle flap coverage is provided.

Adult↗
PubMed1983

The platysma musculocutaneous flap: experience with 24 cases.

The platysma musculocutaneous flap has been used in 24 patients for reconstruction in the head and neck area. In 22 patients, the superior vascular pedicle, the submental branch of the facial artery, was used, and in two other patients, the inferior pedicle, the superficial branch of the transverse cervical artery, was used. Twelve patients had reconstruction of the intraoral lining with a skin paddle on the platysma. The buccal mucosa and mandibular alveolar ridge are particularly well suited to this flap. Six patients had restoration of external skin, four had provision of both skin and lining with the same flap, and two had coverage of vulnerable structures with muscle alone. Forty-two percent of patients experienced a minor complication. Only four patients, however, required further surgery, and all 24 patients ultimately had satisfactory results. Of seven patients experiencing loss of a portion of the skin paddle, six had intraoral reconstruction. Meticulous dissection and attention to anatomic detail is necessary in raising the flap. Because of its thinness and pliability, we feel that the platysma musculocutaneous flap is an important addition to the techniques of head and neck reconstruction.

Adult↗
PubMed1983

Experience with the transverse lower rectus abdominis operation for breast reconstruction.

Our initial experience with the lower rectus abdominis procedure for breast reconstruction in 19 patients is presented. Anatomic considerations, surgical technique, and results are reviewed. Errors in flap design and execution resulted in a disproportionately high complication rate, which improved following certain technical refinements. The lower rectus flap has proved to be an alternative to conventional techniques of breast reconstruction. As more experience is gained with this flap, its particular role in the reconstructive armamentarium will be more clearly defined.

Adult↗
PubMed1982

Platysma musculocutaneous flap: clinical and anatomic considerations in head and neck reconstruction.

The platysma musculocutaneous flap was used in 14 patients for reconstruction of the oral lining and external skin coverage in the head and neck area. Complications occurred in five patients. Only one patient, however, required further surgery and this was for correction of a poor cosmetic result. The skin and subjacent muscle are supplied by a major vascular pedicle from the facial artery and vein and a minor pedicle from the transverse cervical artery and vein. Either pedicle can be used as the pivot for the flap's arc of rotation. The donor defect can be closed primarily and did not present any problems. The flap can be raised with both its motor and sensory supply intact. The thinness and pliability, color match, and proximity make this flap a useful adjunct in head and neck surgery.

Aged↗
PubMed1982

Bilateral gluteus maximus myocutaneous advancement flaps: sacral coverage for ambulatory patients.

The standard gluteus maximus myocutaneous flap, though an excellent procedure for coverage of sacral soft-tissue defects, has several disadvantages. It is usually quite bulky, and risks hip instability in the ambulatory patient. Bilateral gluteus maximus myocutaneous advancement flaps obviate these problems. The superior half of each gluteus maximus muscle, with overlying skin island, is released from its origin and insertion. The superior gluteal artery is identified and preserved. Each myocutaneous unit may be advanced to the midline. The line of cleavage between units preserves normal contour. Donor-site deformity is closed in the V-Y advancement fashion. Hip instability is thus avoided. This technique is useful in the management of sacral defects in the ambulatory patient.

Buttocks↗
PubMed1982

Comparison of the effect of bacterial inoculation in musculocutaneous and random-pattern flaps.

The response of musculocutaneous and random-pattern flaps to bacterial inoculation was studied in dogs by intradermal injection of bacteria and deposition of bacteria into stable wound spaces created by wound cylinders. No difference could be demonstrated in the susceptibility to bacterial challenge in the different portions of the musculocutaneous flap and in normal skin. A larger area of necrosis was observed in the random-pattern flaps, and the distal part was significantly more susceptible to necrosis. While the musculocutaneous flaps recovered rapidly from the bacterial inoculation, necrosis was observed in the random-pattern flaps. The bacterial count increased in the wound spaces surrounded by the random-pattern flaps, leading to full-thickness flap necrosis. The bacterial count decreased in the wound spaces surrounded by musculocutaneous flaps; there was evidence of healing around the wound cylinders. The musculocutaneous flap demonstrates a greater resistance to bacterial inoculation than the random-pattern flap on both its cutaneous and muscular surfaces.

Animals↗
PubMed1982

Surgical treatment of the totally avulsed scalp.

Scalp avulsion is associated with significant physical and psychological morbidity. In the past, extended hospitalizations and multiple procedures to achieve coverage were the rule and the chronic morbidity of partial thickness coverage was high. Microvascular surgery now allows an initial chance for successful replantation or a subsequent one-stage reconstruction with well-vascularized tissue with a 90 per cent chance of success. The use of the free latissimus dorsi muscle has been a significant advance in this regard. When progress in immunologic research allows allotransplantation with little morbidity, scalp transplantation may become a useful reconstructive tool.

Female↗