Biomedical subjects

W W Dzwierzynski

Publications and source records attributed to W W Dzwierzynski.

At least 19 recordsLinked to original sources

PubMed2001

Median "pseudoneurapraxia" at the wrist: reassessment of palmar stimulation of the recurrent median nerve.

OBJECTIVE: To determine the occurrence and effect of incidental deep ulnar nerve (DUN) costimulation during palmar stimulation of the recurrent median nerve (RMN). DESIGN: Observational. SETTING: Electromyography laboratory. PARTICIPANTS: Seventeen asymptomatic adult volunteers (34 hands) and 4 fresh cadaver hands. MAIN OUTCOME MEASURES: Median nerve stimulation at the wrist and careful incremental surface and subcutaneous (needle) palmar stimulation were performed while recording thenar and first dorsal interosseous manus compound muscle action potentials. Thenar palm-to-wrist amplitude difference (P -- W Delta) and palm-to-wrist amplitude ratio (P/W) were compared with published values. Correlation of DUN costimulation with falsely elevated P -- W Delta and P/W values was assessed. Multiplanar magnetic resonance imaging (MRI) and subsequent dissection of 4 fresh cadaver hands was done to measure the distance between the RMN and DUN at the palmar stimulation site. RESULTS: Two groups emerged: Group I (63%), with DUN stimulation, and II (37%), with no DUN stimulation. When DUN costimulation occurred (Group I), there was a statistically significant increase in P -- W Delta (p =.002 percutaneous, p =.02 subcutaneous) and P/W (p =.004 percutaneous, p =.007 subcutaneous) when compared with previously published data. Combining all trials on all hands, 53% and 25% had P -- W Delta values and P/W values that exceeded previously published normative data, respectively. The mean distance between the DUN and RMN at the palmar stimulation site was determined by dissection (1.2cm) and MRI (1.5cm). CONCLUSIONS: Close proximity of the DUN to the RMN causes frequent and often unavoidable DUN activation during palmar stimulation of the RMN. This inadvertent stimulation may cause a false diagnosis of median neurapraxia at the wrist.

Adult↗

PubMed2000

Psychological adjustment in children after traumatic disfiguring injuries: a 12-month follow-up.

The psychological adjustment of 57 children (age range, 3 to 12 years) who sustained mutilating traumatic injuries to the face or upper or lower extremities was assessed over a 12-month interval. The injuries had occurred as a result of boating, lawn mower, or home accidents or dog bites. Within 5 days of the traumatic event, 98 percent of the children were symptomatic for posttraumatic stress disorder, depression, or anxiety. One month after the injury, 82 percent were symptomatic. Symptom frequency had declined by the time of the 3-month and 6-month evaluations, but 44 percent of the children continued to report symptoms at 12-month follow-up visits, and 21 percent met the diagnostic criteria for posttraumatic stress disorder. Typical symptoms included flashbacks, fear of re-injury, mood disorders, body-image changes secondary to disfigurement, sleep disturbances, and anxiety. These findings support the importance of psychological evaluation and treatment of children who suffer mutilating injuries that require the attention of plastic surgeons.

Accidents, Home↗

PubMed1999

Subcutaneous tissue emphysema of the hand secondary to noninfectious etiology: a report of two cases.

Subcutaneous emphysema of the hand can be benign and noninfectious in origin. Emphysema from gas-forming organisms is associated with systemic symptoms, whereas benign subcutaneous emphysema is not. High-pressure pneumatic tool injuries are a well-known cause of subcutaneous emphysema. Minor wounds in the web space skin may result in a transport of air across the defect, acting like a ball valve mechanism to trap and then force the air into the subcutaneous tissue, as illustrated by 1 of our patients. In the second patient, use of a high-vibration tool without apparent breach of skin was associated with extensive subcutaneous emphysema. The benign nature of the emphysema was revealed by a lack of local pain and inflammation in the presence of extensive crepitus and a lack of systemic symptoms. A noninfectious cause should always be considered. This may prevent unnecessary surgical intervention, which occurred in 1 of the 2 cases presented here.

Adult↗

PubMed1999

Psychometric assessment of patients with chronic upper extremity pain attributed to workplace exposure.

Upper extremity pain attributed to workplace exposure is a growing concern in medicine today. This study was undertaken to investigate the psychological findings in patients with chronic upper extremity pain attributed to workplace exposure. Sixty-three consecutive patients were evaluated. All patients underwent a history and physical examination by a hand surgeon and a psychological evaluation by a licensed psychologist, including a Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Physical and psychological findings were then compared. Forty-one patients (65%) showed abnormalities on MMPI-2 examination (t score > 70 = 97% confidence). This result is far above what generally would be expected in medical patients. When physical findings were grouped with psychological findings, 5 distinct groups were identified: 1 patient had normal physical and psychological results, 6 patients had normal physical findings but abnormal psychological assessments, 21 patients had abnormal physical findings but normal psychological assessments, 28 patients had both abnormal physical and psychological findings, and 7 patients had abnormal physical results but invalid MMPI-2 evaluations due to purposeful attempts to deny psychological symptoms. Identification of these groups may have diagnostic, prognostic, and treatment value. In addition, identification of these groups may help clarify several aspects of the debate over the role of psychosocial factors in the development and maintenance of chronic upper extremity pain that patients attribute to workplace exposure.

Arm↗

PubMed1999

Malignant clear-cell hidradenoma of the toe.

Malignant sweat gland tumors are rare tumors of the extremity. Their insidious growth patterns and often confusing pathological characteristics can cause confusion with more common benign tumors. However, these tumors cannot be neglected because they do have a propensity to metastasize. Presented is a 56-year-old woman with a malignant clear-cell hidradenoma of the foot actually presenting as a benign lesion.

Acrospiroma↗

PubMed1999

The innervated gracilis musculocutaneous flap for total tongue reconstruction.

A functional neotongue following total glossectomy requires both soft-tissue bulk and reconstruction of muscle function. We used innervated transverse gracilis musculocutaneous flaps to reconstruct total glossectomy defects in eight patients. The obturator nerve to the gracilis muscle was approximated to the hypoglossal nerve to reinnervate the gracilis muscle by using microsurgical technique. The cutaneous paddle of the gracilis flap easily supplies sufficient bulk to replace the total glossectomy defect. Follow-up of patients ranged from 3 to 47 months. All patients were able to resume oral feeding. Electromyographic studies performed on one patient showed reinnervation of the flap with active elevation of the posterior pharynx. Ultimately, seven patients died because of recurrence of their disease. The innervated gracilis musculocutaneous flap may benefit patients who have a total glossectomy by allowing them to achieve a more functional recovery.

Deglutition↗

PubMed1998

Improvement in resource utilization after development of a clinical pathway for patients with pressure ulcers.

Clinical pathways are interdisciplinary patient care plans intended to reduce variance and improve quality of care while lowering health care cost. This study was undertaken to determine whether the development of a clinical pathway for care of patients with pressure ulcers can indeed decrease health care costs while preserving quality of care. A clinical pathway for surgical reconstruction of pressure ulcers was developed by standardizing the current practices of our plastic surgeon group. The pathway provided direction in optimal scheduling of physician interventions along with nursing, physical and occupational therapies, and spinal cord rehabilitation interventions. It covered all potential elements of patient care, including laboratory, radiology, dietary services, intravenous fluids, and use of specialty beds. It defined patient outcomes and outlined discharge planning. Pathways were distributed throughout all services caring for patients with pressure ulcers. Patient charts and billing data were reviewed for the 16-month periods before and after initiation of the pathway. No other significant changes in treatment occurred during this time frame. Ninety-seven patient charts were examined (54 before pathway and 43 after pathway implementation). Parameters evaluated included length of stay and total charges (including bed use, medications, laboratory tests, and radiology). Patient readmission rate was also examined. A significant reduction in patient length of stay and total charges was achieved after implementation of the clinical pathway. Reduction was seen not only for patients treated with flaps by plastic surgery but also for patients with pressure ulcers who were not specifically targeted such as those from other services. The readmission rate decreased slightly, although not significantly, after the pathway inception. Total cost saving was almost $11,000 per patient (23 percent). In conclusion, implementation of a clinical pathway, because it standardizes care and reduces variations and duplication of care, can reduce health care cost without impairing quality of care in the treatment of decubitus ulcer patients.

Costs and Cost Analysis↗

PubMed1998

Sequential transfer of free flap to two defects.

This case report describes the use of a single lateral arm flap sequentially transferred to two defects in a bilateral hand injury. We believe this is a novel approach in reconstructing defects in bilateral hands when a staged reconstruction is planned.

Adult↗

PubMed1997

Anatomy of the intermetacarpal ligaments of the carpometacarpal joints of the fingers.

In this study, the structure of the retaining ligaments between the proximal metacarpal bones of the fingers was defined. Anatomic dissections were performed on 10 fresh cadavers. Four separate ligaments were found: a dorsal metacarpal ligament, a palmar metacarpal ligament, and 2 interosseous ligaments oriented in a V-shaped configuration. The V-shaped interosseous ligaments were found to be the strongest; along with the palmar and dorsal intermetacarpal ligaments, they form a very strong connection between the bases of the adjacent metacarpals.

Carpal Bones↗

PubMed1997

Use of Mitek suture anchors in head and neck reconstruction.

Attachment of soft tissue to bone is a common problem encountered in head and neck reconstruction. Soft-tissue attachment is encountered in the formation of slings to recreate oral competence. We report the use of the Mitek suture anchor in 7 head and neck reconstruction patients (5 underwent an attachment of a tensor fascia lata sling for oral competence and 2 underwent an attachment of a gracilis musculocutaneous free flap to recreate facial symmetry). Use of the Mitek anchor facilitates soft-tissue-to-bone attachment. Minimal dissection is required and secure bony fixation is obtained.

Adult↗

PubMed1997

Case report: sequential vascular connection of free flaps in the upper extremity.

Devastating hand injuries often require multiple microvascular reconstructions. We report a patient in whom two flaps were used for late reconstruction of a devastating hand injury involving devascularization of the right hand, severely comminuted fractures of the hand and forearm, and multiple tendon avulsions. We believe the sequential vascular connection of free flaps offers the best method of reconstruction in this severe case, allowing composite tissue transfer, monitoring of the osseous flap, and optimal positioning of the two free tissue transfers.

Adult↗

PubMed1996

Biomechanics of the intact and surgically repaired proximal interphalangeal joint collateral ligaments.

Collateral ligament injuries to the proximal interphalangeal joint are common. When the collateral ligament is completely ruptured, surgical repair may be required. The strength of the lateral collateral ligaments of the proximal interphalangeal joint was examined using axial distraction on an electrohydraulic testing apparatus. Eighty-five fresh human adult cadaver fingers were assessed; 38 intact ligaments were first examined. The strength of the native ligament was 162.5 N. Forty-seven ligament repair preparations were tested: suture repair (27.8 N), pull-out wire repair (35.9 N), and repair using a Mitek suture anchor (38.4 N). The breaking strength of the intact ligaments was significantly greater than that of any repair. All repaired ligaments failed at the site of the repair. The ligaments repaired by the pull-out wire and Mitek anchor technique were significantly stronger than those repaired with the suture technique.

Adult↗

PubMed1996

Magnetic resonance imaging scanning in the diagnosis of zone II flexor tendon rupture.

This study was undertaken to determine the usefulness of magnetic resonance imaging (MRI) in the diagnosis of flexor tendon rupture in patients who had prior surgery. Magnetic resonance imaging scans were performed on 11 digits (16 tendons) with the clinical diagnosis of flexor tendon rupture. Clinical suspicion correlated with MRI and surgical findings. Clinical examination yielded a 60% accuracy in diagnosis. MRI differentiated rupture from adhesions with a 100% accuracy rate. The MRI scan is a valuable tool in diagnosing tendon ruptures and may help reduce the incidence of unnecessary tendon explorations.

Adolescent↗

PubMed1996

Complications and salvage of an ectopically replanted thumb.

The ectopic replantation of a thumb is described after a mutilating hand injury. The case was followed by a series of complications and surgical procedures to treat these complications. Through perseverance and multiple microsurgical procedures the patient attained a functional hand. The patient's psychological and physical course is described.

Accidents, Occupational↗

PubMed1996

Reflex sympathetic dystrophy/conversion disorder.

Both reflex sympathetic dystrophy (RSD) and conversion disorder are difficult to diagnose and treat. The following article depicts a situation in which diagnosis presents a particular challenge and suggests ways of applying both medicine and psychology in the treatment of this complex problem.

Accidents, Occupational↗

PubMed1996

Cutaneous keratocyst in naevoid basal cell carcinoma syndrome.

We report a patient with naevoid basal cell carcinoma syndrome (NBCCS) who developed cutaneous cysts on her digits. Histological examination of one of the cysts showed a festooned lining epithelium maturing without a granular cell layer, similar to that of the jaw keratocyst characteristic of this syndrome. This type of cutaneous keratocyst has been reported only once previously. in two patients with NBCCS.

Adolescent↗

PubMed1995

Combination latissimus dorsi and groin free flap with double microvascular transfer.

A combined free tissue transfer using the skin and muscle supplied by the thoracodorsal artery and the superficial circumflex iliac artery (groin flap) was transferred to reconstruct a large lower extremity soft-tissue defect. The combination of these two flaps allowed coverage of a large tissue defect, more reliable coverage than either of these flaps alone, and direct donor site closure.

Adult↗

PubMed1995

Anatomic considerations in transconjunctival blepharoplasty.

To better identify the anatomy of the lower eyelid in relation to the transconjunctival approach to blepharoplasty, 20 fresh cadaver lower eyelids were dissected. Cross-sectional cuts of fresh cadaver specimens also were made and examined by whole-organ photomicrographs of the entire lower eyelid and its associated soft-tissue structures. These were correlated with magnetic resonance imaging studies in the living patient. Measurements were made of the relationship of the lid margin, tarsal plate, infraocular fat (including the three traditional fat compartments), inferior oblique muscle, and eyelid (on stretch). Our findings suggest that a transconjunctival incision closer to the fornix, directed toward the infraorbital rim, allows the surgeon a direct and safe approach to the fat compartments. No distinct anatomic compartmentalization of the periorbital fat as traditionally described was found. There was a consistent extension of the lateral pad, lateral to the lateral canthus of the eye. There are also accumulations of fat outside the orbital septum in the cheek and beneath the orbicularis muscle that contribute to the fullness of the lower eyelid and which cannot be addressed by the transconjunctival approach.

Adipose Tissue↗