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Biomedical subjects

W A Morrison

Publications and source records attributed to W A Morrison.

At least 127 records · Page 7Linked to original sources
PubMed1988

Long-term follow-up of free vascularized joint transfers to the hand in children.

Toe-to-hand vascularized joint transfers in four children were reviewed 6 to 8 years after operation (average, 6.6 years). Two children had vascularized metatarsophalangeal (MTP) joints. Both children have near normal active range of motion. The transferred epiphyses have provided a major contribution to digital growth. The other two children had second toe proximal interphalangeal (PIP) joints transferred to damaged hand joints. Active PIP joint extension has been disappointing, and the overall growth contribution of the transferred epiphysis has been small. We conclude that MTP to metacarpophalangeal vascularized joint transfer can provide painless, functional, stable motion, with near normal growth potential, and the usefulness of toe PIP to hand PIP joint transfer is limited by the inability to achieve good active extension and limited growth potential.

Child↗
PubMed1988

The fillet foot for endweight-bearing cover of below knee amputations.

Four patients with five severely traumatized lower legs but preserved feet were treated with fillet flaps from the foot to cover an elective, below knee amputation stump. The posterior tibial neurovascular bundle nourished and innervated this flap. While the posterior tibial artery and vein may be cut and re-anastomosed to prevent kinking and occlusion, the posterior tibial nerve should always be kept in continuity to maintain the quality of sensation to this flap. Four flaps survived and one necrosed secondary to venous insufficiency. Due to its innervation and the unique qualities of heel skin, the flap is very durable and has endweight-bearing capabilities. This has permitted the fitting of an endweight-bearing, total contact, fully extended, below knee prosthesis that appears to offer significant improvement in ease of use and normality of gait pattern over standard patellar tendon-bearing prostheses.

Adult↗
PubMed1988

Complex limb trauma requiring revascularization: early multidisciplinary management.

Salvage of limbs with combined vascular, skeletal and extensive soft tissue injury requires the skills of several surgical specialities. Four illustrative cases are presented, three successes and one failure, and from these some conclusions are drawn. Contrary to accepted teaching, it is believed that in the emergency management of most patients with complex limb trauma, vascular reconstruction should take priority, followed by skeletal stabilization, soft tissue repair and early flap cover.

Adult↗
PubMed1987

The free radial forearm flap with and without bone for closure of large palatal fistulae.

Three cases of palatal fistulae closed by microvascular transfer of radial forearm flaps are presented. Vascularised bone was included in one flap and all operations were free of complications. Facial scarring is minimal and the secondary deformity in the arm has not been significant. It is suggested that this procedure presents fewer difficulties than other techniques for treating the large palatal fistula and may prevent the collapse of the alveolar arch which follows the scarring associated with closure by local tissue.

Adolescent↗
PubMed1987

Anterior tibial artery flap: anatomy and case report.

A simple, large fasciocutaneous flap based on the perforating branches of the proximal anterior tibial artery and venae comitantes can be raised which is particularly suitable as an inferiorly based island pedicle flap to cover cutaneous defects of the lower third of the lower leg, an area notoriously difficult to cover with local flaps. The flap has an extremely wide arc of rotation and can reach from the knee superiorly to the sole inferiorly. It can be transferred as a fascial flap or as a free flap. The secondary donor site defect overlies muscle bellies, lies well away from bone and readily accepts split skin grafts.

Arteries↗
PubMed1987

The use of long synthetic microvascular grafts in dogs with a view to clinical application.

Five centimetres long segments of 3 mm internal diameter synthetic expanded polytetrafluorethylene (E-PTFE) vascular graft (Gore-Tex) were implanted into the femoral arteries, proximal to the origin of the saphenous artery, of 10 mongrel dogs. In five cases saphenous island flaps were raised and the femoral artery was ligated distal to the saphenous origin so that a low flow system was created through the graft. In 10 femoral vessels the Gore-Tex graft was inserted without raising a flap and the distal femoral artery not ligated so that the graft acted purely as a conduit for blood flow to the distal limb. This created a high flow rate model compared to the reduced flow in the former group. In the first group flap survival was evaluated daily by direct observation of the flaps and graft patency was assessed every 48 h by means of Doppler ultrasound. None of these flaps survived longer then 48 h. In the second group, graft patency was monitored every 48 h with Doppler ultrasound and exploration of Gore-Tex grafts at 3 weeks showed that all had thrombosed.

Animals↗
PubMed1986

Functional evaluation of the hand and foot after one-stage toe-to-hand transfer.

Twenty toe-to-hand transfers in 17 patients with an average follow-up of 54 months have been reviewed to quantify hand function and donor morbidity. Eleven toe-to-thumb and nine toe-to-finger procedures were performed. Surgical and follow-up data were available for all patients. Twelve patients (14 procedures) were reviewed in detail, with particular attention given to foot and hand function. Total active motion after toe-to-thumb transfer was 48 degrees and 106 degrees after toe-to-finger transfer. Two-point discrimination was less than or equal to 15 mm in 13 digits (65%). Grip and pinch power were related to the number of digits present on the reconstructed hand and to the presence or absence of functioning thenar muscles. Eleven of 12 patients can walk and run normally (mean of 5 years after surgery). Six (50%) cannot wear thongs or heavy boots, but all can wear normal shoes. The transferred great toe decreased in volume by an average of 10% over the years since the operation. Transferred toes became useful digits in the hand, and foot morbidity was minor and not progressive.

Adolescent↗
PubMed1986

The nature and extent of histopathologic injury in human avulsed arteries and veins and in experimentally avulsed monkey arteries.

To determine the end point of histopathologic damage in avulsed arteries, the forearm arteries of five monkeys being sacrificed were avulsed longitudinally and samples of proximal and distal arteries prepared for light microscopy and transmission and scanning electron microscopy. A severe and consistent circumferential skip lesion was found on the luminal surface involving the intima and media. In 30 percent of vessels, histopathologic damage extended more than 3.0 cm from the rupture point. Similar circumferential tears occurred on the luminal surface of resected human avulsed arteries collected at the time of replantation surgery. No consistent lesions were noted in resected veins from human avulsed amputations. It is possible that in the human artery (as in the monkey) circumferential lesions frequently extend many centimeters from the rupture point and therefore beyond resection distances. Lesions present in the vessel after resection and microsurgical repair might be the site of thrombosis and subsequent occlusion.

Animals↗
PubMed1985

Effect of stasis on the patency of microvenous grafts in avulsed rabbit femoral vessels.

Seventy femoral arterial avulsions with interpositional microvenous graft repairs were performed in rabbits and were divided into three groups. In Group A clamps were reapplied for 15 minutes with an overall patency rate of 97% after 3 weeks. The overall patency rate in Group B with 30 minutes reclamping was 93% three weeks later. Group C without clamping served as Controls and a 100% patency rate was achieved. The position of the microclamps, static blood in the region of the anastomoses and in the microvenous grafts as well as the time of reclamping up to 30 minutes did not influence the patency rate in damaged vessels after sufficient resection of injured vessel walls. The results of this experiment suggest that if necessary clamps can be reapplied safely in the clinical situation for up to 30 minutes after microvenous grafts have been completed to enable the microsurgeon to perform further dissection in a bloodless field.

Animals↗
PubMed1985

A study of the extent and pathology of experimental avulsion injury in rabbit arteries and veins.

A comparison was made between operating microscope observations and histopathological examination of the ruptured ends of experimentally avulsed rabbit femoral arteries and veins. Under the operating microscope no damage was evident in arteries or veins more than 0.8 cm (on average) from the rupture site, the common lesions being tears, holes, bruising, sleeving and dilatations. In light microscope and electron microscope studies arterial and venous lesions were often noted up to 4 cm from the rupture site both proximally and distally. Severe circumferential skip lesions involving the tunica intima and media in the arteries were noted, and commonly deep clefts also extended through all three tunicae at arterial bifurcations. In avulsed veins complete tears through all tunicae or partial loss of intima and media were observed. The extensive nature of these lesions is the most likely reason for the lower success rate of avulsed digits in replantation surgery.

Animals↗
PubMed1985

A simple rapid method of fixation of unstable zygomatic fractures.

A simple, effective and rapid method of fixation of unstable zygomatic fractures is described, in which a K-wire is inserted percutaneously through the prominence of the fractured malar and stabilized by further passage through both maxillae. The results of 11 cases are discussed. The method is compared with other commonly used methods of fixation, and with other techniques for internal fixation with K-wire previously described.

Fracture Fixation, Internal↗
PubMed1984

The late functional results of upper limb revascularization and replantation.

The functional results in 25 of 30 patients after successful upper limb revascularization or replantation were evaluated by subjective-patient surveying and objective measurements. Young patients with complete, sharply amputated extremities at the wrist level or those with incomplete injuries and uninjured peripheral nerves had the best functional results. Multiple-level, diffuse crush, or avulsion injuries, even if the injuries were incomplete, and patients with high-level nerve injury had less return of function.

Adolescent↗
PubMed1984

Free vascularized small joint transfer to the hand.

Free vascularized digital joint transfers should provide joint stability, painless functional range of motion (ROM), tolerance of normal stresses without degeneration, and growth potential in children. In our department since 1977, seven transfers have been carried out in seven patients, including four children aged 4 to 11 years and three adults aged 19 to 46 years. Donor sites were the metatarsophalangeal joint of the second toe (four cases), the proximal interphalangeal (PIP) joint of the second toe (two cases), and the PIP joint of a useless amputated small finger (one case). Recipient sites were digital PIP and metacarpophalangeal (MP) joints (three cases each) and the MP joint of a thumb (one case). Six of the seven procedures were successful. There was retention of normal joint space and stable, painless functional ROM, while epiphyseal centers in the children remained open and showed normal growth. Follow-up ranged from 2 to 4.7 years, averaging 3.5 years. Some adherence of an associated extensor tendon has been observed. The feet have been asymptomatic. When digital joint replacement is required because of local causes of destruction, free toe joint transfer should certainly be considered in children and in young adults.

Adult↗
PubMed1984

Ring finger transfer in reconstruction of transmetacarpal amputations.

Four cases are described in which the opposite ring finger was used for finger reconstruction in transmetacarpal hand amputations. Thumb reconstruction was required in three of these four cases. This was achieved by hallux transfer, tube pedicle combined with an innervated first foot web neurovascular free flap, and second toe transfer respectively. In the fourth case, where a thumb was not required, double finger reconstruction was performed by the use of a second toe combined with a ring finger. This case highlights the limitations of the second toe for finger reconstruction, particularly in achieving palmar-digital grip. The advantages of the ring finger are length and mobility, especially sophisticated intrinsic muscle movement, sensory capacity, strength, wider span, and esthetic excellence.

Adolescent↗
PubMed1983

Effect of nicotine on blood flow and patency of experimental microvascular anastomosis.

Nicotine is known to have deleterious effects on the cardiovascular system, causing vasoconstriction and increased blood pressure. A drop in blood-flow velocity in humans, endothelial damage in rats, and inhibition of platelet aggregation in rabbits' blood have all been shown experimentally. In this article two studies are described that investigate the effects of nicotine on microvascular anastomotic patency. In experiment 1, electromagnetic blood-flow recordings were made in the saphenous artery of the saphenous flap after intraarterial installation of nicotine. Decreased blood flow was consistently recorded up to a maximum of 72% of normal flow. In experiment 2, rabbit femoral arteries were anastomosed and the patency rates at three weeks checked after various combinations of pre- and postoperative intraperitoneal nicotine had been injected. There was no significant increase in thrombosis between the groups treated with nicotine and the control. Although no thrombosis occurred in these experiments, decreased blood flow was noted in the saphenous flap in the dog. This slowing of flow should predispose to thrombosis, especially if other factors associated with the vascular repair were suboptimal. It is concluded in view of this study and the observed clinical effects in 2 patients with microvascular transfer that smoking in the perioperative period should be avoided.

Animals↗