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Biomedical subjects

T R Stevenson

Publications and source records attributed to T R Stevenson.

At least 55 records · Page 3Linked to original sources
PubMed1987

End-stage reflex sympathetic dystrophy.

Reflex sympathetic dystrophy is an automatic dysfunction that occasionally complicates healing after trauma or surgery. The syndrome is characterized by pain, swelling, stiffness, and discoloration often out of proportion to the original injury. Early diagnosis and appropriate treatment are the most important factors in the successful outcome of this disabling condition. A case of longstanding, previously untreated reflex sympathetic dystrophy secondary to a minor injury is presented.

Adult↗
PubMed1987

The gluteus maximus musculocutaneous island flap: refinements in design and application.

The gluteus maximus island musculocutaneous flap has been described using a variety of designs. We employ an island whose long axis is directed toward the pressure sore, minimizing tension in wound closure. Skin overlying the greater trochanter is avoided. Previously undermined skin can be included in the flap. Fifty patients with ischial or sacral pressure sores have been managed by this technique. Superficial dehiscence occurred in 13 percent of patients, and deep dehiscence occurred in 10 percent. The dehiscence closed spontaneously in all but one patient. Forty-nine of the 50 patients experienced complete wound healing at the pressure sore site. The patients have been observed for an average of 20 months (range 3 to 38 months), with one recurrent pressure sore seen at 28 months postoperatively. The gluteus maximus musculocutaneous island flap has proven to be both reliable in healing and durable over the observed interval.

Buttocks↗
PubMed1987

Heel reconstruction with the deep circumflex iliac artery osteocutaneous flap.

A patient with extensive loss of bone and soft tissue from the right heel is presented. The defect was reconstructed using an osteocutaneous flap based on the deep circumflex iliac vessels. Indications for this procedure include extensive loss of bone and soft tissue precluding the use of local flaps. A 30-month period has elapsed since her reconstruction. A single ulcer developed 13 months postoperatively that healed after flap revision. We feel that tailoring the flap to minimize redundancy at the initial operation, subsequent tissue excision if necessary, and reinnervation augment durability of the flap.

Child↗
PubMed1987

Osteoradionecrosis of the olecranon: treatment by radial forearm flap.

Osteoradionecrosis of the olecranon is an unusual pathologic entity, treated best by debridement and wound closure using vascularized tissue. Local skin is often unavailable for flap design and transposition. The radial forearm flap can be isolated on a proximal vascular pedicle and transposed to cover the wound. In the case presented, healing was brisk and complete, allowing early elbow mobilization. Although the donor site is not easily concealed, no functional impairment results from flap elevation and all full-thickness wounds are confined to the involved extremity.

Adult↗
PubMed1986

Knee joint salvage utilising a plantar musculocutaneous island pedicle flap.

A young adult male presented with an open tibia-fibula fracture, extensive circumferential soft tissue loss and exposed bone. Although the fracture sites were stabilised by an external fixator, chronic infection complicated this 2-week-old wound. Treatment by amputation was elected. Local skin alone was inadequate for coverage of a preferred below-knee amputation. As an alternative to above-knee amputation, the patient underwent coverage of a below-knee amputation using a musculocutaneous island pedicle flap of sensate plantar skin and muscle.

Adult↗
PubMed1986

Neurofibroma of the ear.

Neurofibromas cause unsightly and crippling deformities. These locally destructive tumors arise along the distribution of peripheral and cranial nerves. The 2 patients presented here had neurofibromas of the external ear. In one patient, the lesion was limited to the auricle. In the other, the tumor extended into the facial nerve and parotid gland. Preoperative computed tomographic scanning, a postauricular approach to the tumor, and careful dissection produced an aesthetic debulking of the auricular neurofibromas with preservation of facial nerve function and improvement in hearing.

Child↗
PubMed1986

Management of foot injuries with free-muscle flaps.

Transfer of a free-muscle graft with application of a split-thickness skin graft is one of many techniques available for reconstruction of the massive foot injury. The durability of such a reconstruction has been questioned. We have treated nine patients suffering from foot injuries with extensive soft-tissue loss. Each patient underwent reconstruction using a free-muscle transfer covered by a split-thickness skin graft. A mean follow-up of 33 months (range 17 to 48 months) is reported for these nine patients. Each patient is ambulatory. One patient developed an ulcer on the plantar surface, which was treated successfully by flap revision and skin grafting. We feel this technique provides a durable reconstruction for significant soft-tissue loss of the foot.

Adult↗
PubMed1986

Radiographic evidence of breast implant rupture.

A patient with a past history of breast augmentation, fibrous capsule formation, and repeated closed capsulotomies is described. Deformity of the breast occurred in conjunction with radiographic evidence of implant rupture. This rupture was confirmed at the time of open capsulotomy and implant exchange. After augmentation and closed capsulotomy, a diverticulum of the fibrous breast capsule can mimic implant rupture on mammography despite an intact prosthesis. Mammographic features, including multiple loculations and streaming of implant contents, increase the suspicion of rupture.

Adult↗
PubMed1985

Heating pad burns in anesthetic skin.

Patients requiring reconstruction by muscle or musculocutaneous flaps often have an associated area of skin anesthesia. This skin is susceptible to trauma because of its insensibility. This study reports 3 cases in which patients sustained deep partial-thickness burns of anesthetic skin following flap reconstruction. All burns healed by reepithelialization. Following flap reconstruction, patients should be warned regarding the use of heating pads. Burns of this type represent a preventable complication of flap reconstruction.

Aged↗
PubMed1985

Syringoma: removal by electrodesiccation and curettage.

Syringomas are benign adnexal tumors often located on the lower eyelid skin. Patients usually request removal for aesthetic reasons. Electrodesiccation and curettage of these lesions provides local control while preserving uninvolved eyelid skin.

Adenoma↗
PubMed1984

The superficial inferior epigastric artery flap for coverage of hand and forearm defects.

Large wounds of the hand and upper extremity require secure closure for protection of the underlying structures. The skin of the lower abdomen can be raised in a lenticular fashion, supported by the superficial inferior epigastric artery and veins and applied as a flap to wounds of the distal upper extremity. The flap demonstrates versatility in positioning, and the donor site can be closed in a linear fashion. Viability of this superficial inferior epigastric artery flap is demonstrated by the case reports.

Abdomen↗
PubMed1984

Radiation to the breast. Complications amenable to surgical treatment.

UNLABELLED: Major complications of radiation directed to the breast, axilla, and mediastinum were treated in 54 patients from 1974 to 1983. A classification of these complications facilitates both an understanding of the pattern of injury and the development of a treatment plan. CLASSIFICATION: I. Breast necrosis; II. Radionecrosis and Chest Wall Ulceration; III. Accelerated Coronary Atherosclerosis with Median Sternotomy Wound Failure After Coronary Revascularization; IV. Brachial Plexus Pain and Paresis; V. Lymphedema and Axillary Cicatrix; VI. Radiation-induced Neoplasia. The treatment has evolved during the 10-year study period to excision of the necrotic wound, including any tumor, and closure with a transposed muscle or musculocutaneous flap of latissimus dorsi (II, III, V) or rectus abdominis (I, II, VI). This strategy reflects a change from primary use of the omentum during the first years of the study. The vascularity, oxygen and antibiotic delivery of these muscle and musculocutaneous flaps promote wound healing, usually with one operation. The transfer of these muscles has not caused significant functional deficits.

Adult↗
PubMed1984

More experience with the "reverse" latissimus dorsi musculocutaneous flap: precise location of blood supply.

Our work demonstrates that the "reverse" latissimus dorsi musculocutaneous flap has a predictable and consistent blood supply. A major portion of the muscle can be nourished by the dorsal perforating branches of the ninth, tenth, and eleventh intercostal vessels. The skin island based on the "reverse" latissimus dorsi muscle can be as large as 8 X 20 cm. This is confirmed by anatomic dissections and clinical cases. Knowledge of the blood supply facilitates elevation of the flap and extends its utility.

Adult↗
PubMed1984

Shoulder reconstruction following disarticulation for ruptured mycotic aneurysm.

A method of wound management following shoulder disarticulation is described. In this report, the primary lesion is a mycotic aneurysm of the axillary artery. The pectoralis major muscular flap provides satisfactory coverage and maintains shoulder contour. It can be performed in a single procedure. Preoperative arteriography is important to determine the extent of arterial damage as well as the vascular anatomy of the proposed flap.

Adult↗
PubMed1984

Traumatic upper arm defect treated with latissimus dorsi muscle transposition.

Transfer of the latissimus dorsi muscle was useful in restoring contour and function to a child's acutely injured upper extremity. The procedure provided protection for exposed vital structures. A split-thickness skin graft covered the exposed muscle. Transposition of the latissimus dorsi insertion was not necessary to obtain adequate elbow flexion.

Arm Injuries↗
PubMed1976

Cleansing the traumatic wound by high pressure syringe irrigation.

The purpose of this study was to examine the influence of the fluid dynamics of syringe irrigation on the efficacy of wound cleansing and the infection rate of experimental wounds. The pressure experienced by a surface following wound irrigation was directly proportional to the pressure within the syringe and the size of the needle. High pressure syringe irrigation effectively removed bacteria from the surface of the wound. This reduction in the wound bacterial count resulted in a decrease in the infection rate of tissues. Low pressure irrigation with an asepto syringe did not significantly cleanse the wound of its bacterial contaminants and had no demonstrable clinical merit. On the basis of these studies, high pressure syringe irrigation is being employed routinely in our emergency department for the care of traumatic wounds.

Animals↗
PubMed1975

Primary peritonitis in adults.

Infection within the peritoneal cavity without an identifiable source of contamination is rare. The diagnosis is one of exclusion, and can be made with certainty only after a thorough laparotomy. The response to antibiotic therapy is usually prompt and gratifying.

Adult↗