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Biomedical subjects

W Lineaweaver

Publications and source records attributed to W Lineaweaver.

At least 19 recordsLinked to original sources
PubMed2005

Actinomycosis complicating fibula flap mandible reconstruction: a report of two cases.

Two patients undergoing fibula flap mandible reconstruction developed chronic intraoral wounds and salivary fistulae. After initial attempts at salvage, tissue biopsies demonstrated Actinomycosis infection. With antibiotic treatment and debridement, one reconstruction was salvaged while one was lost. Actinomycosis infection should be considered a possible agent in chronic wounds complicating mandible reconstructions with microsurgical flaps.

Actinomycosis↗
PubMed1999

Treatment and stabilization of complex wounds involving the pelvic bone, groin, and femur with the inferiorly based rectus abdominis musculocutaneous flap and the use of power color Doppler imaging in preoperative evaluation.

The authors present case reports demonstrating the trilevel utility of the inferiorly based rectus abdominis musculocutaneous flap in the closure of complex wounds involving the pelvis, groin, and femur that had failed previously or were not amenable to traditional closure techniques. The use of the rectus abdominis flap was especially advantageous for achieving infection eradication and large dead space closure. Additionally they present the emerging technique of power color Doppler imaging as a valuable tool in preoperative flap planning. This technique is particularly useful in evaluating the candidacy for rectus abdominis musculocutaneous flap placement of patients with a prior history of abdominal surgeries, trauma, infection, irradiation, or other conditions that might compromise the patency of the deep inferior epigastric vessels.

Adult↗
PubMed1998

Artery grafts in microsurgery.

Artery grafts appear to have no significant advantages over vein grafts in experimental models. Research in preservation of artery grafts continues, and holds possibilities of creating stored grafts that can be used clinically. Clinical use of artery grafts in microsurgery is limited to anecdotal use of arteries harvested from damaged body parts in emergencies and use of branched grafts from the subscapular system in elective arterial reconstruction. These clinical uses have never been analyzed, and their reliability and advantages remain undefined.

Animals↗
PubMed1997

Acute reconstruction of traumatic injuries of median and ulnar nerves by grafting with intercostal nerves from the rectus muscle: case reports.

In two cases of complicated hand and wrist injuries for which rectus flaps were used as soft-tissue coverage, intercostal nerves from the rectus muscles were harvested simultaneously to graft significant nerve defects. In one patient, a 7-cm ulnar-nerve defect was bridged with four intercostal nerves. The other patient had a 5-cm median-nerve defect repaired with three intercostal nerves. Both patients recovered either protective or normal sensation; and the patient with the median nerve injury recovered thenar muscle function. Intercostal nerves harvested with rectus muscle flaps can be the basis for acute grafting of nerve defects without using conventional nerve grafts at a traumatic site.

Abdominal Muscles↗
PubMed1997

Cross-facial vein grafting in complicated flap reconstructions of the face and mandible.

Microvascular flap reconstructions of facial and mandibular defects are achieving increasingly widespread application and, as a result, more patients are considered for such procedures after large tumors, congenital abnormalities, previous surgery (including failed and successful microsurgical procedures) and radiation have compromised potential recipient vessels on the side of the defect. In three such cases, contralateral facial vessels with vein grafts have been used to provide flap-recipient vessels. Each flap was successful. Cross-facial vein grafting is a relatively simple solution for utilizing undamaged vessels as recipient pedicles in complicated flap reconstructions of the face and mandible.

Adolescent↗
PubMed1997

Midgestational sciatic nerve transection in fetal sheep results in absent nerve regeneration and neurogenic muscle atrophy.

In order to test whether fetal nerve healing and regeneration result in complete functional recovery, we transected the sciatic nerve at trunk level in 13 midgestational sheep fetuses. In 10 fetuses immediate microsurgical nerve coaptation was performed. The neonatal lambs were evaluated clinically, electrophysiologically, and histologically. On the transected side, the 10 surviving lambs showed a sensorimotor sciatic nerve paralysis and atrophy of the muscles innervated by the sciatic nerve. Somatosensory evoked potentials were weakly present in 5 animals and absent in 5 animals. Histologically, minimal signs of axonal regeneration, massive degeneration of the entire nerve, and a marked neurogenic muscle atrophy were found. These unexpected results differ from the findings after peripheral nerve transections in late gestational sheep fetuses and also from the classic wallerian degeneration-regeneration pattern that follows adult nerve injury. We speculate that the almost absent regenerative potential at midgestation is related to axotomy-induced neurotrophic factor deprivation during a developmental phase where the neurons are critically dependent on growth factor for survival.

Animals↗
PubMed1997

Microsurgical anatomy of the facial nerve.

Microsurgical dissection of cadaver facial nerves revealed quantifiable complexities not presented in standard description. Total branches, intraparotid connections between divisions, and extraparotid connections between divisions are more common than generally noted, and 33% of the dissections demonstrated an extraplanar buccal branch originating within the parotid gland, and innervating the perioral muscles. These details of facial nerve anatomy suggest surgical procedures such as tumor resection, facial nerve reconstruction, facial reanimation, and facelifting.

Facial Nerve↗
PubMed1995

Intraosseous ganglion cyst of the scaphoid.

Intraosseous ganglion cysts are rare causes of hand and wrist pain. Differential diagnosis of painful cystic radiolucent carpal lesions includes osteoid osteoma and osteoblastoma. Isolated cases of ganglion cysts occurring in the lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx have been reported. A case of intra-articular intraosseous ganglion cyst of the scaphoid is presented. A 49-year-old right-handed woman presented with a 3- to 4-month history of progressive left-wrist pain. No history of trauma was reported. Conservative treatment with anti-inflammatory medications before referral was unsuccessful. Examination revealed marked tenderness in the region of the volar scaphoid proximal pole as well as tenderness overlying the dorsal radial styloid. No palpable masses were present. Wrist motion was not limited. Grip strength was symmetric. Radiographic studies revealed a cystic lesion eroding the radial-volar surface of the scaphoid waist. Magnetic resonance imaging studies demonstrated the cystic lesion to be of the penetrating type, originating from the radiocarpal joint and eroding into the scaphoid. The patient underwent radial styloidectomy, excision of the ganglion cyst, curettage of the scaphoid lesion, and bone grafting with radial styloid bone. Intraosseous carpal ganglion cysts, although rare, present with chronic wrist pain and should be included in the differential diagnosis.

Bone Cysts↗
PubMed1992

Blood loss associated with anticoagulation in patients with replanted digits.

The incidence of blood loss and blood transfusion in patients receiving one anticoagulant in addition to aspirin (n = 40) was compared with that in patients receiving two or more anticoagulants in addition to aspirin (n = 15). Multiple-agent therapy produced a greater drop in the hematocrit than single-agent therapy (15% compared with 6%). Only 2% of the patients receiving a single agent had transfusions, as compared with 53% of the patients receiving multiple agents. We conclude that administration of multiple anticoagulants greatly increases the incidence of blood loss and blood transfusion as compared with the administration of a single agent plus aspirin. The importance of salvaging a replanted digit or digits must be weighed against the risks of a blood transfusion.

Anticoagulants↗
PubMed1992

Recipient vessels for microvascular transplants in patients with hemifacial microsomia.

Hemifacial microsomia is a developmental abnormality involving structures derived from the first and second branchial arches. Microvascular transplants are increasingly being used to improve facial contour in patients with this condition. We have reviewed 9 patients with this abnormality to determine which recipient vessels have been used. In 6 patients, the facial vessels were located and used for flap revascularization. In 3 patients, the facial vessels could not be identified intraoperatively, and the occipital artery and a branch of the external jugular vein were used as recipient vessels. In this series of hemifacial microsomia patients, therefore, the facial vessels could not be located in 3 patients. We recommend that surgeons performing microsurgical transplants in cases of hemifacial microsomia be prepared to explore the external carotid and external jugular systems for recipient vessels.

Face↗
PubMed1991

Microsurgical tissue transfer in patients more than 70 years of age.

Between 1982 and 1989, three women and seven men older than 70 years of age underwent elective free-tissue transfer. Nonhealing wounds of 1 scalp, 2 upper extremities, and 7 lower extremities were covered with 3 serratus anterior, 3 latissimus dorsi, 2 gracilis, and 2 lateral arm flaps. Major coincidental medical problems included hypertension, congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus, metastatic lung cancer, tachyarrhythmias, syncope, elevated liver function tests, and previous arterial bypass in the affected lower extremity. One flap failed and 2 others were compromised by venous thromboses but salvaged by reoperation. There were no major anesthetic complications. This series demonstrates that elective free-tissue transfers can be safely performed in patients older than 70 years of age.

Age Factors↗
PubMed1989

Posttraumatic condylar hyperplasia.

Posttraumatic condylar hyperplasia can result in complex facial asymmetry composed of degrees of condylar and ramus overgrowth, malocclusion, and complementary maxillary deformity. Three patients with unilateral condylar hyperplasia are described to illustrate the scope of surgical and orthodontic treatment required to restore facial symmetry. Condylar hyperplasia with facial asymmetry should be recognized as a possible consequence of condylar injury, and further delineation of the onset and natural history of this deformity could lead to investigations or intervention before the establishment of all the components of the deformity.

Adolescent↗
PubMed1988

Microvascular transfers of latissimus dorsi and serratus anterior muscles in rats.

The thoracodorsal artery supplies the latissimus dorsi and serratus anterior in the rat in the same fashion as in the human. In the rat, the thoracodorsal artery and vein average 0.57 mm and 0.71 mm in diameter, respectively, at their origins and can be used as pedicles averaging 19 mm in length to the latissimus dorsi muscle and 27 mm to the serratus anterior muscle. We successfully transferred both of these muscles to groin vessels by means of end-to-end or end-to-side anastomoses. The serratus anterior muscle was technically easier to transfer because its pedicle was longer. We conclude that the serratus anterior transfer in the rat is a feasible animal model for microvascular muscle transfer and may be a useful standard model for pharmacological and biochemical studies in transplanted muscle.

Anastomosis, Surgical↗
PubMed1988

Antibiotic sensitivities of Aeromonas hydrophila cultured from medicinal leeches.

Increased use of medicinal leeches (Hirudo medicinalis) for the treatment of venous congestion in flaps and replanted parts has coincided with reports of soft tissue infections following leech application. We cultured the gullets of 20 medicinal leeches to re-examine the antibiotic sensitivities of Aeromonas hydrophila, the leech enteric organism associated with reported infections. These isolates reflected reported resistance to penicillin and first generation cephalosporins as well as sensitivity to gentamicin, tetracycline and chloramphenicol. Additionally, the cultures were sensitive to cefamandol, cefoxitin and two third generation cephalosporins (cefoperazone and cefotaxime). These findings suggest that cefamandol, cefoxitin and some third generation cephalosporins may have a role as perioperative antibiotics in replantation and flap surgery. These antibiotics might provide prophylaxis against Aeromonas hydrophila infection when leech use is required.

Aeromonas↗
PubMed1988

Distal avulsion of the palmar plate of the interphalangeal joint of the thumb.

A 63-year-old woman was unable to actively flex the interphalangeal joint of her right thumb after a hyperextension injury. Surgical exploration revealed an avulsion of the distal insertion of the palmar plate, allowing the bulk of the plate to block the joint during attempted active flexion. Resection of the palmar plate restored active flexion and caused no joint instability. We do not believe this lesion, which resulted in this disability, has been previously described.

Cumulative Trauma Disorders↗
PubMed1988

Immediate skin grafting on microvascular free tissue transfers.

Clinical reports of pedicled muscle flaps and microvascular tissue transfers include two distinctly different strategies for skin grafting. Some authors describe immediate grafting, whereas others recommend a three- to 5-day interval between flap transfer and grafting. No systematic analysis of either strategy has been reported. We reviewed 51 consecutive successful free tissue transfers that involved immediate skin grafting. Ninety-six percent of the grafts survived without complication. Bot muscle and fascial flaps supported skin grafts. Skin grafts survived infected recipient sites, pedicle revisions, partial flap necrosis, and secondary operation. We conclude that immediate skin grafting on free tissue transfers is reliable.

Adult↗