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Biomedical subjects

S W Parry

Publications and source records attributed to S W Parry.

At least 19 recordsLinked to original sources
PubMed2000

Diagnosis of carotid sinus hypersensitivity in older adults: carotid sinus massage in the upright position is essential.

OBJECTIVE: To assess the diagnostic value of supine and upright carotid sinus massage in elderly patients. DESIGN: Prospective controlled cohort study. SETTING: Three inner city accident and emergency departments and a dedicated syncope facility. PATIENTS: 1375 consecutive patients aged > 55 years presenting with unexplained syncope and drop attacks; 25 healthy controls. INTERVENTIONS: Bilateral supine carotid sinus massage, repeated in the 70 degrees head up tilt position if the initial supine test was not diagnostic of cardioinhibitory and mixed carotid sinus hypersensitivity. MAIN OUTCOME MEASURES: Diagnosis of cardioinhibitory or mixed carotid sinus hypersensitivity; clinical characteristics of supine v upright positive groups. RESULTS: 226 patients were excluded for contraindications to carotid sinus massage. Of 1149 patients undergoing massage, 223 (19%) had cardioinhibitory or mixed carotid sinus hypersensitivity; 70 (31%) of these had a positive response to massage with head up tilt following negative supine massage (95% confidence interval, 25.3% to 37.5%). None of the healthy controls showed carotid sinus hypersensitivity on erect or supine massage. The initially positive supine test had 74% specificity and 100% sensitivity; these were both 100% for the upright positive test. The clinical characteristics of the supine v upright positive subgroups were similar. CONCLUSIONS: The diagnosis of carotid sinus hypersensitivity amenable to treatment by pacing may be missed in one third of cases if only supine massage is performed. Massage should be done routinely in the head up tilt position if the initial supine test is negative.

Aged↗
PubMed1996

An evaluation of fascial staples (a new technique) in wide fascial plication during reconstructive abdominoplasty.

The purpose of this study is to evaluate the fascial stapler (a new technique) in the plication of the musculoaponeurotic fascia abdominoplasty in comparison to conventional (sutured) techniques. Thirty-eight patients underwent abdominoplasty with rectus sheath plication. Patients were randomized into staple and suture groups. Similar degrees of plicationing were performed in both groups (range, 12-20 cm). Fascial repairs were evaluated postoperatively at approximately 1 month and 6 months. A small, but comparable, subclinical fascial separation was demonstrated immediately in both the stapled and sutured groups. No progression of fascial separation was observed in either group at 1 month and 4 months postoperatively. No complications attributable to the fascial closure were noted in either group. Operative time was considerably less with the stapled technique. The results, although early, suggest that the use of fascial staples for plicationing of the musculoaponeurotic fascia during abdominoplasty is comparable to conventional (sutured) techniques regarding complication rate and disruption rate, but appreciably decreases operative time.

Abdominal Muscles↗
PubMed1995

Hand injuries secondary to subcutaneous illicit drug injections.

We present a retrospective analysis of 32 patients admitted over a 5-year period to a metropolitan regional trauma center with recently induced subcutaneous ("skin pop") illicit drug injectional injuries involving the hand. Cocaine derivatives were the most frequently reported illicit drug used (75%). All patients had local disease manifested by subcutaneous abscess formation, and several had regional disease (cellulitis, lymphangitis, or lymphadenopathy), but only one patient had systemic illness. Microbiological analysis revealed endogenous integumentary and oral flora sensitive to oral preparations of several antibiotic medications including cephalosporins. Primary therapy included intravenous administration of antibiotic medications in all instances and simple incision and drainage under local anesthesia in 26 patients (81%). Six patients (19%) required more radical operative therapy. All patients were hospitalized and recovered without sequelae, with preservation of hand function after follow-up evaluation, which ranged from weeks to months, except for 1 patient who required digital amputation because of necrosis. Although the issue of compliance in terms of wound and general medical care for this patient population is problematic, analysis of the data suggested that patients with illicit drug injectional injuries of the hand confined to subcutaneous regions could be effectively and safely managed in outpatient settings by simple wound care and orally administered cephalosporin medications.

Abscess↗
PubMed1994

Management of exposed inguinofemoral arterial conduits by skeletal muscular rotational flaps.

Peripheral vascular reconstructions are common operations for the treatment of occlusive atherosclerosis, and the vast majority are uncomplicated. However, despite all precautionary measures, a small percentage of patients will manifest wound infection and graft exposure that may evolve to loss of limb and/or life. Treatment has traditionally consisted of systemic administration of antibiotic medication(s), graft extirpation, and extra-anatomic arterial bypass; yet despite use of these more radical modalities, morbidity and mortality have remained high. An additional meritorious adjunct for the treatment of exposed prosthetic or autogenous saphenous vein arterial bypass grafts is the use of local/regional autogenous skeletal muscular rotational flaps. Reported herein are the results of this technique applied to the inguinofemoral regions of eight patients. Rectus abdominis (1 patient), rectus femoris (4), and sartorius (4) skeletal muscular rotational flaps were employed. Seven of eight (88%) patients convalesced well at mean duration of follow-up measuring 24 months, although one patient subsequently required major amputation due to progression of occlusive atherosclerosis. One of eight (12%) patients succumbed secondary to irreversible sepsis, despite radical amputation. The data suggest that use of local/regional skeletal muscular rotational flaps is a useful adjunct for the treatment of patients with exposed arterial conduits.

Adult↗
PubMed1993

Ventral/incisional abdominal herniorrhaphy by fascial partition/release.

Ventral/incisional abdominal hernias following celiotomies continue to be a vexing problem for both patients and general and plastic and reconstructive surgeons, since no universally applicable preventive or reconstructive techniques have evolved. With reference to reconstruction, for example, primary repair is associated with a high incidence of recurrence; utilization of synthetic mesh is susceptible to extrusion, infection, and intestinal fistulization; and employment of truncal or extremity, free or rotational, myofascial flaps is associated with the morbidity of the procedure per se. By contrast, the use of fascial partition/release of the components of the abdominal wall employing bilateral parasagittal relaxing incisions in the obliquus externus abdominis and/or transversus abdominis fascia facilitates coaptation of the linea alba and obviates the aforementioned morbidity. This technique was utilized electively in seven adult patients with large defects of the anterior abdominal wall. In addition, for two patients, synthetic nonabsorbable mesh was applied superficial to the midline fascial closure. During a mean follow-up interval of 18 months (range 6 to 36 months), each patient healed per primum without evidence of eventration or herniation. The theoretic and pragmatic advantages of this technique are discussed. The use of fascial partition/release for reconstruction of abdominal wall defects should be part of the armamentarium of all herniotomists.

Abdominal Muscles↗
PubMed1992

Use of the biceps femoris following failed inferior gluteal flap transfer. Case report.

Considering the high recurrence rate of pressure ulceration in paraplegic patients, flap procedures to reconstruct a defect should not be at the expense of another possible future flap. The posterior thigh fasciocutaneous flap is useful for the coverage of ischial and trochanteric pressure sores; the biceps femoris musculocutaneous flap is a useful choice for deep ischial defects. However, the cutaneous portions of these two flaps is nearly identical. The previous transfer of the biceps flap excludes the further use of the posterior thigh flap. In contrast, use of the posterior thigh flap still permits the employment of a biceps V-Y advancement flap. Even if the donor site of the previous posterior thigh flap must be skin-grafted, the graft will remain viable on its muscular bed and function as the cutaneous portion of the flap; thus stable coverage is provided, despite previous use of 'first line' flaps. We demonstrate how careful planning of the stages of flap procedures can allow the most economic use of donor areas in this difficult patient group.

Adult↗
PubMed1991

Indications for surgical débridement in 125 human bites to the hand.

Indications for operative intervention following human bites to the hand were determined based on physical examination and time elapsed since injury. One hundred twenty-four patients admitted to Charity Hospital of New Orleans, La, were stratified according to time elapsed from injury to treatment (early, less than 24 hours; delayed, 1 to 7 days; and late, greater than 7 days). Patients in the early group were mainly treated with conservative wound care, consisting of local wound exploration and irrigation in the emergency department, while those in the late group underwent surgical débridement. Patients in the delayed group either received conservative wound care or underwent débridement in the operating room. The early and late groups recovered excellent hand function while results within the delayed group were variable with improved results depending on rapid surgical débridement or drainage.

Adolescent↗
PubMed1991

The great auricular nerve revisited: pertinent anatomy for SMAS-platysma rhytidectomy.

Aesthetic platysma surgery during rhytidectomy has gained popularity for contour restoration of the jaw line, cervicomental angle, as well as anterior neck defects. The superficial musculoaponeurotic system-platysma flap is elevated and suspended in a cephaloposterior direction by suturing to the investing fascia overlying the sternocleidomastoid muscle and the mastoid bone. This procedure is usually performed without total visualization of the great auricular nerve, possibly placing this nerve at risk during suspension. Anatomical dissections of the great auricular nerve were performed bilaterally on 10 cadavers to delineate its course in the superior neck and identify anatomy pertinent to the elevation of flaps and placement of sutures during superficial musculoaponeurotic system-platysma suspension.

Cadaver↗
PubMed1989

Blood supply of the upper extremity muscles as related to functional tendon transfers.

For a given function to be restored, we feel that a "low risk" muscle should be employed in preference to a "high risk" muscle. If a "high risk" muscle must be used, a knowledge of its segmental blood supply should lead one to proceed with careful dissection (even under magnification), wider exposure, and preservation of every possible distal pedicle. We would strongly discourage blind "stripping" of the muscle belly in "high risk" muscles. This technique could be employed almost with impunity in the "low risk" muscles. We realize that this is a static, purely anatomic study with a new, theoretical viewpoint of tendon transfer techniques. Other factors must be considered (expendability, muscle strength, synergism, and amplitude). However, we feel that results may be improved through application of these detailed anatomic data. We have attempted to better delineate the blood supply to the muscles of the upper extremity. This knowledge may help improve our results in functional tendon transfer procedures.

Arm↗
PubMed1989

Reconstruction of the burned hand.

Several basic principles of burned hand care must be kept in mind at all times. Intervention should be early and aggressive, small splints should be placed within 24 hours, and early tangential excision of the burn should be done within 72 hours. Hemostasis should be absolutely meticulous prior to grafting. Depending upon the availability of donor site skin, full-thickness skin grafts, split-thickness grafts, or meshed split-thickness grafts (expanded or not expanded) are preferred. I have found the functional and cosmetic results to decrease with use in exactly the order stated. The skin graft should be placed with stent or bolster dressings and observed for "take" early. Light active range of motion is usually begun on the tenth postoperative day. Escharotomy or fasciotomy should be performed for any signs of ischemia. In order to control edema, one should be meticulous in the positioning of burned hands, emphasizing elevation, and early range of motion exercises. Pressure garments may be employed when the wound is stable and should continue for 6 to 12 months to control hypertrophic scar formation. Linear scars should not cross any hand joints; Z-plasties are employed over the web spaces. Whenever possible, flaps should be employed to preserve all web spaces and skin grafts used to cover the remainder of the hand. I am aggressive in releasing and reconstructing late deformities such as extension contractures of the wrist, the metacarpal hand, absence of the thumb, finger contractures, and burn syndactyly. These are listed in order of treatment priority. Only in this manner can the patient be returned to "normal life." Patient self-esteem will thus be increased markedly, as will quality of life. It is strongly urged that the surgeon be "captain of the team." The key person in this treatment regimen is the hand therapist, who uses appropriate splints, range of motion exercises, and desensitization programs. I encourage the use of multiple personnel on the "burn team." This may include psychotherapists and, in children, teachers with extraordinary qualities.

Burns↗
PubMed1988

Vascular anatomy of the upper extremity muscles.

This study delineates the vascular anatomy of the upper extremity with particular attention toward the size, location, and number of vascular pedicles supplying each muscle. Ten cadaver upper extremities were dissected. A total of 440 muscles and 2209 pedicles were identified. The major "named" arterial source, number of pedicles, and pattern of perfusion for each muscle were delineated. Detailed description of the vascular anatomy of muscles commonly used for tendon transfer and local flaps is presented. The potential use of the coracobrachialis flap for contouring the infraclavicular area is elucidated. The anatomic bases of the anconeus and flexor carpi ulnaris flaps are confirmed. The radial and ulnar arteries may be used as microvascular donor or recipient vessels without compromising forearm muscle perfusion.

Adult↗