Biomedical subjects

W B Kleinman

Publications and source records attributed to W B Kleinman.

26 records · Page 2Linked to original sources

PubMed1989

Microvascular free-tissue transfers to the hand and upper extremity.

Hundreds of authors world-wide are responsible for the development of the present state of microvascular free-tissue transplantation. The applied technique represents a true developmental landmark in the field of surgery, now applicable to the broad spectrum of surgical subspecialties. In hand surgery, the revolutionary use of free-tissue transplantation has saved innumerable limbs, and improved the quality of life for tens of thousands of patients. In spite of our comfort level using these techniques and incorporating them into our armamentarium of patient care, we stand only on the threshold of microsurgical clinical applicability. The field has expanded substantially during the last 15 years. First, as a substitute for more conventional solutions to wound coverage problems, substituting for often cumbersome attached random or axial pattern pedicle flaps; then, incorporating neurosurgical techniques to provide sensibility to viable but otherwise anesthetic flaps, and kinetic function to transplanted muscle; and subsequently, with the incorporation of muscle, bone, and total joints. An ever-increasing knowledge of the metabolic consequences of ischemia and hypoxia on different types of tissue has allowed us to be even more aggressive in assessing indications for composite tissue transplantation. In the future we should anticipate continued advances in optics and magnification in the surgical microscope, with particular emphasis on three-dimensional perspective and enhanced video capabilities. Technologic development of instruments and suture material should continue helping to raise the capability of what is presently the most limiting factor--the surgeon--to a higher level of potential for his or her patients. Even with improved links to video equipment, stereoscopic imaging, or even more sophisticated visual images, the lowest common denominator is the skill of the microsurgeon; more rigorous technical development will be necessary during the surgeon's training period. Besides a fundamental knowledge of vascular clotting mechanisms and the effects of anticoagulation, we have only an elementary understanding of chemically induced vasospasm, and a developing appreciation of the physiologic impact of microsurgical trauma on small blood vessels, even with the most sophisticated and delicate techniques. As the field enlarges, our ability to deal with irreversible vessel spasm, inexplicable arterial or venous clotting, or the enormity of other complications associated with microvascular free-tissue transplantation, will only grow. A richer understanding of tissue biology will not only improve our technical capabilities, but will promote consideration of a

Adult↗

PubMed1987

Management of chronic rotary subluxation of the scaphoid by scapho-trapezio-trapezoid arthrodesis. Rationale for the technique, postoperative changes in biomechanics, and results.

In cases of static or symptomatic dynamic scapholunate instability, reduction of the scaphoid proximal pole into the scaphoid fossa of the radius and stabilization of the relationship of the scaphoid and lunate by distal arthrodesis to the trapezium and trapezoid will significantly alter carpal mechanics; however, elimination of pain, preservation of a functional arc of motion, and restoration of the ability to pursue routine activities (including heavy labor) all suggest that the planes of radiocarpal and intercarpal motion following distal scaphoid arthrodesis are compatible with long-term physiologic function without late loss of reduction.

Arthrodesis↗

PubMed1984

Oblique retinacular ligament reconstruction for chronic mallet finger deformity.

Surgical correction of chronic mallet finger caused by terminal tendon disruption was carried out in 12 patients with passively correctable deformities. The oblique retinacular ligament (ORL) was reconstructed with the palmaris longus used as a free tendon graft. The graft was fixed to the terminal extensor tendon by soft tissue technique only. It was then routed obliquely across the palmar aspect of the proximal interphalangeal (PIP) joint and sutured to the fibroosseous rim of the flexor sheath. In all cases, the mallet finger deformity was corrected. Secondary PIP hyperextension, present in eight of the 12 patients, was also corrected by this technique. Subsequent surgical procedures were necessary in two patients: one required a limited flexor tenolysis in the digit, thereby obtaining a full range of motion; the second required lengthening of the ORL graft to obtain full PIP joint extension. All patients were pleased with the results. Reconstruction of the ORL is an advantageous procedure in certain patients with chronic mallet finger deformities. This technique is easily performed and yields consistently good results.

Adolescent↗

PubMed1982

Management of chronic rotary subluxation of the scaphoid by scapho-trapezio-trapezoid arthrodesis.

The natural history of untreated rotary subluxation of the scaphoid is traumatic radiocarpal arthritis, with loss of grip strength, pain with axial loading or dorsiflexion, and decrease in the total active arc of wrist motion. Operative reduction of the proximal scaphoid pole and stabilization of the distal pole by scapho-trapezio-trapezoid arthrodesis in 12 cases showed elimination of the perpendicular scaphoid attitude, closure of scapholunate diastasis, and neither loss of reduction nor degenerative changes on follow-up for over 2 years. Postoperative cineradiographic studies showed loss of normal reciprocal motion within proximal and distal carpal rows, a marked decrease in capitoscaphoid motion, but preservation of lunocapitate motion in addition to radiocarpal motion. Nine of 12 patients without complications returned to activities performed prior to injury, without wrist pain and with 80% of preoperative motion.

Adolescent↗

PubMed1981

Preservation of function following complete degloving injuries to the hand: use of simultaneous groin flap, random abdominal flap, and partial-thickness skin graft.

Early total wound coverage is effectively achieved in complete degloving injuries to the hand and digits by preliminary skeletal narrowing and shortening, volar partial-thickness skin grafting, and application of a long, axial-pattern attached groin flap to the dorsum of the hand and remaining phalanges. If the thumb has been skeletonized by the initial trauma, simultaneous use of a circumferential random-pattern abdominal flap ensures complete coverage and earlier mobilization. THis combination of techniques is effective in preservation of pinch power and control, hook function of the medial portion of the hand, and general grasp and release attitudes.

Abdomen↗

PubMed1979

Pectoralis major transplantation to restore elbow flexion to the paralytic limb.

In four patients, two with brachial plexus palsy and two with arthrogryposis, the entire pectoralis major muscle was transplanted to act as an elbow flexor, rotating it on its neurovascular pedicles and attaching the tendon to the acromion and the muscle origin to the tuberosity of the radius. Excellent motion and power was restored in three patients. One procedure failed due to fibrofatty degeneration of the transplanted muscle.

Arm↗

PubMed1978

Multiple volar carpometacarpal joint dislocation. Case report of traumatic volar dislocation of the medial four carpometacarpal joint in a child and review of the literature.

Traumatic dislocation of the medial four carpometacarpal joints in a child is an unusual injury. Descriptions of this injury in the literature have been reviewed and a case is presented to illustrate the pertinent anatomy, biomechanical aspects, and details of management. Specifically, the importance of collateral circulation to the hand and an effective technique of pin fixation are described.

Bone Nails↗

PubMed1978

Metastatic cancer of the spinal column.

In an effort to determine the potential of radiotherapy or surgery in alleviating the symptoms and signs of metastic cancer to the spinal neuraxis, 77 cases with documented malignant disease in this area were studied retrospectively over a 2 year period. Emphasis must be placed on early diagnosis, and recognition of intractable day and night pain as a hallmark of cancer of the spine. This symptom was found to be present for many months before the diagnosis could be made on plain X-rays. Bone-scanning, tomography, and myelography were consistently found to be useful adjuncts to early diagnosis. This study points out that operative intervention is ineffective in relieving the signs and symptoms of cord compromise, and adds significantly to the general morbidity of the patient. This was a consistent finding in cases with metastases to the thoracic spine who had developed neurological dysfunction secondary to their tumors. Radiation therapy should be considered a useful form of palliation for the pain associated with metastatic cancer.

Adult↗