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Biomedical subjects

T R Stevenson

Publications and source records attributed to T R Stevenson.

At least 37 records · Page 2Linked to original sources
PubMed1989

Cuts and scrapes of knees and elbows.

Knee and elbow injuries are seen frequently by the primary care physician and require prompt and careful treatment in order to prevent infection, preserve joint function, and avoid scarring. A thorough history and physical examination help to rule out more significant damage to the related joint, nerves, or tendons. Immobilization of the joint may be necessary to prevent dehiscence, and the patient should be instructed to return for further examination if signs of infection develop.

Debridement↗
PubMed1989

In vitro and in vivo testing of a collagen sheet to support keratinocyte growth for use as a burn wound covering.

Neonatal Fischer 344 rat keratinocytes were cultured on a collagen sheet to create a 'quasi-skin.' The cells were grown in either control medium or a low-calcium supplemented medium to enhance proliferation. The rate of 3H-thymidine incorporation into DNA was assessed at days 3, 7, 10, and 20 to determine the effectiveness of the medium supplements. The cells grown in supplemented medium did have an elevated rate of incorporation. On days 7 and 14 post culture, the quasi-skin was used to cover full-thickness defects on the dorsum of adult male rats. The covered defects were biopsied 45 and 60 days postoperatively. Light microscopy showed the wounds to be completely re-epithelialized. Barr bodies were present at the wound site, confirming the presence of quasi-skin keratinocytes up to 60 days postoperatively.

Animals↗
PubMed1989

Force deficit of vascularized skeletal muscle grafts in rabbits.

Through autografting experiments on 9-g rectus femoris (RFM) muscles in rabbits, we substantiated a previous observation that the maximum isometric tetanic force (Po) and specific Po (N/cm2) of neurovascular-intact grafts are not different from grafts made with neurovascular repair. We then tested the hypotheses that the specific Po of vascularized grafts is significantly less than that of control RFM muscles and the deficit in the specific Po is associated with increases in connective tissue and interstitial space. The specific Po of the grafts was 65% of the value for control RFM muscles. Connective tissue protein concentration of grafts was 3.8 times greater than the control value of 16.6 +/- 3 micrograms/mg wet mass, but this only accounted for a 5% correction in specific Po. The volume of interstitial space did not differ between grafts and control muscles. We conclude that the deficit of 35% in specific Po of vascularized grafts compared with control values is partially explained by an increase in connective tissue, but a 30% unresolved deficit remains.

Animals↗
PubMed1988

Rupture of flexor tendons to the little finger due to bony irregularities in the carpal tunnel.

Rupture of a finger flexor tendon occurs most commonly in the patient with rheumatoid arthritis. We have treated two patients who suffered rupture of the flexor tendons to the little finger due to bony irregularities in the carpal tunnel unrelated to rheumatoid disease. Each irregularity was removed and the rough surface covered with a portion of the flexor retinaculum. This resurfacing affords protection against recurrent abrasion and rupture. Tendon function was restored by suturing the ruptured profundus tendon to the adjacent intact profundus tendon of the ring finger. Satisfactory function of the little finger was achieved in both patients. Neither patient has experienced recurrent rupture.

Adult↗
PubMed1988

Poland's syndrome: variable expression and associated anomalies.

Poland's syndrome is a well-known constellation of congenital anomalies that includes varying degrees of hypoplasia involving the thoracic cage in association with anomalies of the hand. Although the latter are most frequently described as syndactyly with short or absent middle phalanges, many forms of expression were seen in a series of 20 patients. Thirty-one other anomalies were seen in this group in addition to those usually considered as part of the syndrome. Of special interest are those involving the spine and genitourinary tract that require special studies for early detection.

Abnormalities, Multiple↗
PubMed1988

Reconstruction of posterior neck and skull with vertical trapezius musculocutaneous flap.

The vertical trapezius musculocutaneous flap has been successfully utilized for reconstruction in 13 patients with complex posterior skull and neck defects. This flap based on its vascular pedicle, the descending branch of the transverse cervical artery, provides well-vascularized tissue for coverage of defects related to chronic osteomyelitis, tumor extirpation, osteoradionecrosis, and dehisced cervical laminectomy wounds. Emphasis on flap design, including the location of the skin island, allows adequate wound coverage, direct donor site closure, and muscle function preservation. With its large size and wide arc of rotation, the vertical trapezius musculocutaneous flap provides reliable coverage for posterior trunk, cervical, and skull defects.

Back↗
PubMed1988

Vascular patency of fibular free graft: assessment by Doppler color-flow imager: a case report.

Viability of a vascularized free fibula transfer can be difficult to establish. It is possible, however, to assess patency of the involved microvascular anastomoses and blood flow in the vessels of the transposed fibula. A Doppler color-flow imager can be used to evaluate blood flow and vascular patency. The imager potentially can be employed in the operating room, during the immediate postoperative period, and for long term follow-up. It is non-invasive and produces a permanent record of vascular anatomy and flow characteristics.

Adolescent↗
PubMed1988

Congenital ear deformity: reconstruction using composite graft.

We present a congenital deformity of the right ear, characterized by absence of the central portion of the helix and antihelix. The deformity was reconstructed by advancing retroauricular skin and closing the resultant defect with a composite graft from the posterior aspect of the left ear. This technique was performed in a single stage and required no incisions on the anterior surface of either ear. Postoperative appearance of the right ear was satisfactory, and donor deformity was minimal.

Cartilage↗
PubMed1988

Reconstruction of ear helix: use of self-tubing pedicle flap.

The tube pedicle flap is useful in reconstruction of an absent ear helix. However, immediate tubing of the flap may result in vascular compromise. By elevating a bipedicle flap in the postauricular region and shielding it with a silicone sheet, it is possible to allow the flap to assume a tubular shape while preventing adherence to the underlying suture line. Once mature, the flap maintains both a cylindrical shape and a sufficiently thin external diameter to provide adequate restoration of the ear helix.

Adolescent↗
PubMed1988

Total and regional blood flows in vascularized skeletal muscle grafts in rabbits.

The transplantation of whole skeletal muscles is a common clinical procedure. Although atypical blood flows have been reported in small free muscle grafts, the blood flow of large neurovascular-intact (NVI) and neurovascular-anastomosed (NVA) grafts have not been measured. Because the maximum specific force (N/cm2) of NVI and NVA grafts is 65% that of control muscles, we hypothesized that total and regional blood flows (ml.min-1.100g-1) of NVI and NVA grafts at rest and during twitch contractions are significantly lower than lower flows of control muscles. In rabbits, blood flows of control rectus femoris (RFM) muscles and NVI and NVA grafts of RFM muscles were measured by the radioactive-microsphere technique. In control muscles, blood flow increased linearly from 6.8 +/- 1 ml.min-1.100 g-1 at rest to 64.4 +/- 7 ml.min-1. 100 g-1 at a stimulation frequency of 3 Hz with no further increase at 4 Hz. Total blood flows in grafts were not different from the control RFM muscle values, except for a higher resting flow in NVA grafts and a lower flow at 3 Hz in NVI grafts. Minor variations in regional flows were observed. We conclude that the operative procedures of grafting and repair of blood vessels affect the vascular bed of muscles minimally, and the deficits observed in grafts do not arise from inadequate perfusion.

Animals↗
PubMed1988

Reduction mammaplasty in adolescents with myelodysplasia.

Macromastia may occur in patients with myelodysplasia and paraplegia. Breast enlargement complicates weight shifts, crutch walking, sitting balance, and personal hygiene. Three patients with macromastia and myelodysplasia who underwent reduction mammaplasty are presented. Their postoperative recoveries were uncomplicated and each was symptomatically improved.

Adolescent↗
PubMed1987

Doppler blood flow measurement in atherosclerotic posterior tibial artery.

An important element in successful free tissue transfer is an intact recipient artery. This vessel must be anatomically accessible, structurally suitable for anastomosis, and able to transmit an adequate blood volume. In the case presented, there was radiographic evidence of recipient artery disease, with a presumed decrease in flow. However, Doppler blood flow studies predicted near normal flow. This information was useful in making intraoperative decisions regarding the suitable vessel for anastomosis.

Adult↗
PubMed1987

Squamous cell carcinoma of the perineum: management with Mohs' surgical excision and gluteal thigh flap.

Two patients with squamous cell carcinoma of the perineum are presented. The carcinomas were treated by wide local excision using Mohs' fresh-tissue technique for control of the surgical margins. The wounds were closed using a gluteal thigh flap. In 1 patient the flap was extended across the midline for coverage of a contralateral perineal site. Healing was complete in each case. The combination of Mohs' fresh-tissue methods and the posterior thigh flap provided accurate identification and removal of the perineal tumor with stable wound coverage.

Buttocks↗
PubMed1987

Bolster dressing to support a full-thickness skin graft.

The patient with a through-and-through defect of the nose suffers from a loss of skin, subcutaneous tissue, cartilage, and nasal lining. Repair of this defect is generally directed toward restoring the components of skin and lining. The forehead flap is a useful substitute for nasal skin. A full-thickness skin graft may be used to substitute for absent nasal mucosa and serve as a lining for the forehead flap, covering its deep surface and retarding wound contracture. In the case presented, firm contact was maintained between the forehead flap and its full-thickness graft lining using a bolster dressing of simple design. We believe this dressing discourages seroma and hematoma formation while maintaining contact between the graft and the vascularized flap bed.

Bandages↗
PubMed1987

Cutaneous leiomyosarcoma.

A cutaneous leiomyosarcoma arose in the upper lip skin of a 22-year-old patient. This unusual tumor was diagnosed clinically as a basal cell carcinoma although histological studies confirmed a leiomyosarcoma. The tumor was excised using Mohs technique and the wound reconstructed with a nasolabial flap and full-thickness skin graft. No recurrence or distant metastasis has appeared in a two-year follow-up.

Adult↗
PubMed1987

Skin graft from a scalp flap.

We present a case of scalp avulsion treated with a transposition scalp flap utilizing a split-thickness skin graft from the flap. Using the flap as a donor site confined the operation to a single anatomic region and saved the patient an additional donor-site scar. The flap healed uneventfully with normal regrowth of hair, the donor site was well concealed, and there was complete take of the split-thickness skin graft.

Child, Preschool↗