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Biomedical subjects

V L Lewis

Publications and source records attributed to V L Lewis.

At least 37 records · Page 2Linked to original sources
PubMed1992

Immunologic associations of keloids.

The mechanisms underlying the pathogenesis of keloids have not been fully characterized despite extensive past and present research. Results of past and present studies have shown that the immune system is actively involved in the development of these lesions. Future investigations into the biochemistry and immunologic factors of keloids are anticipated and expected to produce additional insight. The inability to identify cellular (fibroblast) abnormalities has led most investigators to focus on the humoral regulators of wound healing, that is, biochemical substances, immunologic mediators and growth factors. Future studies are needed to confirm or refute the presence of AFA. AFA, if they exist, may prove to be useful as immunologic markers of keloids and may help distinguish keloids from hypertrophic scar in the early stages of wound healing. The influence of immunologic mediators may be more impressive early in the development of scars. "Young" or "early" is defined as less than two years of age, whereas "old" or "late" keloids are more than two years of age. We suggest that future studies stratify keloids into early versus late and also measure the rates of collagen synthesis of fibroblasts derived from the normal and abnormal specimens from the same patient. Analysis of the leukocyte factors will clarify the role the immune system has in the regulation of collagen synthesis. Preliminary investigations have shown that immunotherapy may be of value in the treatment of keloids. The role of fibroblast heterogeneity needs to be investigated. It is not known which aspects of fibroblast heterogeneity are responsible for the localized and accelerated rates of collagen synthesis of keloid fibroblasts.

Animals↗
PubMed1990

Infection following cranial bone grafting--a need for caution?

A case of delayed infection following the use of split-cranial bone graft is presented. Trauma and bacterial contamination of the donor area six months before harvest were the likely causes. We advise caution and the use of alternate donor sites in cases where a history of previous contaminating trauma exists, even if the cranial bone is clinically completely healthy.

Adolescent↗
PubMed1990

Buried inferiorly based gluteus maximus musculocutaneous flap for reconstruction of large, recurrent ischiopubic pressure sores.

The ischium is the most common site for recurrence of pressure sores in the paraplegic population. Successful reconstruction of these wounds depends on the total excision of ulcer, soft tissue debris, bony prominence, and the durability of the soft tissue repair. The V-Y gluteus maximum musculocutaneous flap based on the inferior gluteal vessels can be advanced medially, deepithelialized, and buried to fill large, deep soft tissue ischial wounds. Local rotational flaps close the superficial wound. This buried flap, although not previously described, is useful for the reconstruction of large ischiopubic pressure sores initially or at the time of recurrence.

Adolescent↗
PubMed1990

The fasciocutaneous flap: a conservative approach to the exposed knee joint.

The exposed knee joint poses a challenge to the reconstructive surgeon. The currently popular approach to the repair of exposed knee joints is use of muscle flaps. However, this leaves the patient with a deficit. We have therefore begun using the fasciocutaneous flap as an initial approach to this problem. In seven patients, aged 28 to 74 years, fasciocutaneous flaps have been the reconstructive procedure of choice for repair of exposed knee joints. One patient with a very large open wound required a concomitant medial gastrocnemius muscle flap. One minor wound separation occurred in a paraplegic patient with severe spasm. No other complications occurred. Follow-up ranged from 3 to 12 months, with good success in wound closure. An approach to small and intermediate wounds is presented in which the V-Y technique is used to obviate the need for skin grafting of the donor site.

Adult↗
PubMed1989

A reliable approach to the closure of large acquired midline defects of the back.

A systematic regionalized approach for the reconstruction of acquired thoracic and lumbar midline defects of the back is described. Twenty-three patients with wounds resulting from pressure necrosis, radiation injury, and postoperative wound infection and dehiscence were successfully reconstructed. The latissimus dorsi, trapezius, gluteus maximus, and paraspinous muscles are utilized individually or in combination as advancement, rotation, island, unipedicle, turnover, or bipedicle flaps. All flaps are designed so that their vascular pedicles are out of the field of injury. After thorough debridement, large, deep wounds are closed with two layers of muscle, while smaller, more superficial wounds are reconstructed with one layer. The trapezius muscle is utilized in the high thoracic area for the deep wound layer, while the paraspinous muscle is used for this layer in the thoracic and lumbar regions. Superficial layer and small wounds in the high thoracic area are reconstructed with either latissimus dorsi or trapezius muscle. Corresponding wounds in the thoracic and lumbar areas are closed with latissimus dorsi muscle alone or in combination with gluteus maximus muscle. The rationale for systematic regionalized reconstruction of acquired midline back wounds is described.

Adult↗
PubMed1988

Free flap reconstruction of the lower back and posterior pelvis: indications, principles, and techniques.

Reconstructive microsurgery can be successfully applied to major defects of the lower back and posterior pelvis. When present, the superior and inferior gluteal vessels can be excellent free flap recipient vessels. However, if they are absent as a result of trauma or tumor ablation, a wrist carrier can be used to transfer large blocks of tissue in a staged procedure. Five patients are presented with challenging defects for which these techniques were used.

Adult↗
PubMed1988

The diagnosis of osteomyelitis in patients with pressure sores.

A prospective blind trial was undertaken to assess the usefulness of commonly used tests to diagnose osteomyelitis underlying pressure sores. Sixty-one pressure sores were studied, with a histopathologic diagnosis from the ostectomy specimen being available in 52. White cell count, erythrocyte sedimentation rate, plain pelvic x-ray, technetium-99m bone scan, computerized tomography, and Jamshidi needle bone biopsy were studied. The most useful individual test was a needle bone biopsy, with a sensitivity of 73 percent and a specificity of 96 percent. Technetium-99m bone scans and computerized tomography are not indicated in the diagnosis of osteomyelitis associated with pressure sores. Plain pelvic x-ray, white cell count, and erythrocyte sedimentation rate, with a diagnosis of osteomyelitis if any test is positive, is the most sensitive (89 percent), specific (88 percent), noninvasive workup. Jamshidi needle biopsy may be useful where these tests are negative and a clinical suspicion of osteomyelitis remains. Extent of surgical debridement and antibiotic therapy can then be rationally decided on the basis of this information.

Biopsy, Needle↗
PubMed1987

The sural artery and vein as recipient vessels in free flap reconstruction about the knee.

The sural artery and vein were used successfully as recipient vessels in nine patients who required free flap reconstruction about the knee. The anatomy of the sural vessels and the potential advantages of their use as free flap recipients are reviewed and discussed. Indications include popliteal vessels that are absent or severely damaged, as determined by preoperative angiography. No anastomotic complications were encountered in this series, indicating that the sural artery and vein can be used successfully as recipient vessels.

Adolescent↗
PubMed1987

Some ancillary procedures for correction of depressed adherent tracheostomy scars and associated tracheocutaneous fistulae.

A procedure for the surgical correction of depressed tracheostomy scars and tracheocutaneous fistulae is described which involves reapproximation of the strap muscles and the selective application of a subcutaneous Z-plasty. The results are predictable, satisfactory, and the procedure is quite simply accomplished. Utilization of the Z-plasty improves contour in patients with atrophic tissue and assists the distribution of tension forces in subcutaneous and muscular layers.

Cicatrix↗
PubMed1987

Accelerating recovery after trauma with free flaps.

Free flap versatility and dependability make the final result of microvascular reconstruction highly predictable. Free tissue transplantation should be considered as a primary treatment after trauma. The early use of free tissue transfer will result in fewer operations and a shortened duration of hospitalization in the initial post-trauma period.

Humans↗
PubMed1987

Chronic expanding hematoma.

Two cases of chronic expanding hematoma are presented. Although the location and presentation vary, chronic expanding hematoma has a distinct histopathologic pattern. A diagnosis of neoplasm is suggested by its slow growth pattern. The criteria for their formation are incompletely understood, and in one case, a hematoma occurred despite apparent adequate drainage. Computed tomography is helpful in distinguishing chronic expanding hematoma from other soft-tissue masses.

Adult↗
PubMed1987

The dorsal thoracic fascia: anatomic significance with clinical applications in reconstructive microsurgery.

The anatomic distribution and potential arterial flow patterns of the circumflex scapular artery were investigated by Microfil injection. These studies demonstrated that the circumflex scapular artery lies within the dorsal thoracic fascia, which plays a significant role in the circulation of the overlying skin and subcutaneous tissue. We conclude that scapular/parascapular flaps are fasciocutaneous flaps, the dorsal thoracic fascia can be transferred as a free flap without its overlying skin and subcutaneous tissue, and intercommunication exists between the myocutaneous perforators of the latissimus dorsi myocutaneous flap and the vascular plexus of the dorsal thoracic fascia. We present microvascular cases in which the vascular properties of the dorsal thoracic fascia facilitated wound closure with free fascia flaps or expanded cutaneous or myocutaneous flaps.

Adult↗
PubMed1985

Facial injuries associated with cervical fractures: recognition, patterns, and management.

Publications in both the orthopedic and maxillofacial literature have noted the association of cervical spine and facial injuries. However, because the incidence of spinal injury is low, we found no study which documented the relationship between maxillofacial and cervical spine injuries. The present study reviewed 982 cervical spine injuries in two major trauma centers, finding a 19.3% incidence of facial injury. Fourteen per cent of patients had soft-tissue injuries and 8.6%, facial fractures. Important relationships were noted between fractures of the mandible and upper cervical spine, and soft-tissue injuries of the upper face and fractures of the lower cervical spine. Methods of care adapted to the combined injuries are described. The study concludes that examination of the face for soft-tissue and bony injuries may give important clues on the direction and intensity of the force injuring the cervical spine.

Adolescent↗
PubMed1985

Care of pentamadine ulcers in AIDS patients.

Two cases of soft-tissue infection resulting from antibiotic therapy given AIDS patients are presented. Operative treatment resulted in a closed wound in one patient. In the other patient, who suffered from recurrent acute illnesses, nonoperative treatment resulted in slow wound contraction and epithelialization without secondary wound complications. Wound sepsis did not occur, despite the absence of normal immune function. Operation and additional hospitalization, with their attendant risks, were avoided.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Neurofibromas of the head and neck.

Twenty patients with neurofibromas of the head and neck have been observed for periods ranging from ten to 25 years. Seventeen patients had classical von Recklinghausen's disease. Of these, ten showed recurrence or appearance of new lesions after surgical resection, whether it was done during childhood or adulthood. While there is no known means of curing or even arresting neurofibromatosis, it is desirable to remove, as completely as possible, tumors which are deforming or symptomatic. Subsequent operations are often necessary to keep pace with the growth of the tumors. However, surgical resection, incomplete and imperfect as it may be, is extremely useful in improving the appearance, comfort and quality of life of these unfortunate patients.

Adolescent↗