Biomedical subjects
Publications and source records attributed to W W Dzwierzynski.
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.
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.
Early diagnosis of RSD is essential. A keen clinical awareness of this problem is required by all hand surgeons. RSD is a clinical diagnosis that may be supplemented by digital temperature, three-phase bone scan, and digital radiographs of the hand. A thorough examination is necessary to identify untreated or inadequately treated sources of RSD. Once diagnosed, prompt treatment of RSD is beneficial. Patients are referred to our anesthesia department for diagnostic and therapeutic stellate ganglion blocks. A trial of 2 to 3 blocks is attempted initially. After successful block is performed, as measured by a Horner's sign and extremity temperature, the patient is brought to the hand clinic where active range-of-motion exercises are started. A stress loading program is an important and essential part of our treatment protocol. Sympathetic blocks are performed on a biweekly basis until the pain is relieved. Consideration is given to long-acting stellate ganglion blocks with a continuous catheter infusion for patients who show a limited, but short-lived response to stellate ganglion blocks. For RSD that does not respond to the stellate ganglion block, we generally perform a bretylium intravenous regional block. Patients with RSD are referred to our hand psychologist for counseling, psychotherapy, relaxation therapy, and possibly biofeedback. We use a multitherapy approach with all available modalities to achieve the best success in breaking the cycle of pain and returning the patient to normal, productive function.