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At least 685 records · Page 38Linked to original sources
PubMed2003

Medial and lateral malleolar perforator flaps for repair of defects around the ankle.

Reconstruction for defects around the ankle continues to be challenging. Repairs have been effected with the dorsalis pedis flap, the medial plantar flap, and with reverse-flow island flaps using the anterior and posterior tibial systems and the peroneal system. However, sacrifice of the major vessels of the lower leg and wide and long scars at the donor site are disadvantages of these flaps. To overcome these disadvantages, the authors developed island lateral and medial malleolar flaps with the perforators located close to the ankle. These flaps are easy to elevate, involve a short operating time, require no sacrifice of major vessels or muscles of the lower legs, and the use of these adipofascial flaps makes donor scars more acceptable. Malleolar perforator flaps are suitable for the repair of small ankle defects.

Adult↗
PubMed2006

Vaginal reconstruction: an algorithm approach to defect classification and flap reconstruction.

Vaginal defects from oncologic resection present a complex array of reconstructive challenges. Increased use of adjuvant radiation and chemotherapy demands uncomplicated wound healing. As patients are being diagnosed at earlier stages of disease and at younger ages, maintenance of sexual function and body image are fundamental goals. This review provides an algorithm approach to defect classification and flap reconstruction. Carefully appreciation of the specific defect facilitates flap choice. There are two basic defect types partial (Type I) and circumferential defects (Type II) 1. These defect types can be further subclassified. Type IA defects are partial and involve the anterior and/or lateral wall. Type IB defects are also partial, but involve the posterior vaginal wall. Type IIA defects are circumferential, involving the upper two-thirds of the vagina. Type IIB defects represent circumferential, total vaginal resection, most commonly following pelvic exenteration. Using this method of defect classification, three pedicled flaps can be used to successfully reconstruct the majority of defects: the Singapore (or pudendal thigh) flap, the rectus flap, and the gracilis flap. With appropriate flap choice and a multidisciplinary approach to patient care, rapid wound healing, restoration of the pelvic floor, and re-establishment of sexual function may be most reliably achieved.

Algorithms↗
PubMed1981

Visualization of hypertrophied papillary muscle mimicking left ventricular mass on gated blood pool and T1-201 myocardial perfusion imaging.

A sixty-year old man with acute myocardial infarction was incidentally found to have a hypertrophied anterolateral papillary muscle (ALPPM) of the left ventricle on gated blood pool (GBP) and T1-201 myocardial perfusion images. Hypertrophy of the ALPPM was visualized as a movable defect in the lateral basal area on GBP imaging throughout the cardiac cycle and on the TI-201 study as a radionuclide accumulating structure, consistent with the defect in the GBP. A combination of these findings may suggest the presence of a hypertrophied papillary muscle of the left ventricle.

Cardiomyopathies↗
PubMed1984

Spondylolysis of the lumbar spine: demonstration of defects and laminal fragmentation.

Fifty-six cases of spondylolysis were encountered in 1500 lumbar spine reports reviewed. The frequency of detecting isthmus defects on anteroposterior (AP), lateral, 45-degree right and left oblique, 30-degree up-angled AP, and collimated lateral views was determined. The collimated lateral view showed the largest number of pars defects, 84% of cases. The 30-degree up-angled AP view was more sensitive than the AP view, showing 55% versus 32% of cases. A previously unreported sign of spondylolysis, fragmentation of lamina demonstrated on the AP or AP up-angled view, was found in 14.2% of cases of spondylolysis.

Female↗
PubMed2001

Comparative study of two series of distally based fasciocutaneous flaps for coverage of the lower one-fourth of the leg, the ankle, and the foot.

Skin defects over the lower one-fourth of the leg and over the foot are difficult to cover. Two types of pedicled fasciocutaneous flaps used to cover such defects were studied: the lateral supramalleolar flap and the distally based sural neurocutaneous flap. The series consisted of 27 and 36 cases, respectively. The lateral supramalleolar flap was used 27 times: for skin defects over the ankle (4), foot (16), and leg (7). The distally based sural neurocutaneous flap was used 42 times: over the foot (24), ankle (13), and leg (5). Fourteen of these patients were 65 years of age or older, and local vascularity was diminished in 16 cases. The flaps were evaluated clinically twice: in the immediate postoperative period for survival or for partial or total flap necrosis, and again to determine the presence of pain at the donor or recipient sites and the cosmetic appearance. Thirty-nine patients (62 percent) were reviewed subsequently, with a mean follow-up of 5 years for the supramalleolar flap and 2 years for the sural neurocutaneous flap. The results were evaluated for the presence or absence of pain, the appearance of the flap, the disability due to the insensate nature of the flap, and the presence or absence of secondary ulceration. Painful neuromata were noted in three cases with the sural neurocutaneous flap, whereas complete necrosis of the supramalleolar artery flap occurred in three patients. The distally based sural neurocutaneous island flap is very reliable, even in debilitated patients. Though the lateral supramalleolar artery flap offers the possibility of covering the same areas as the sural neurocutaneous flap, it is much less reliable in the presence of diminished local vascularity (18.5 percent failure rate as compared with 4.8 percent for the sural neurocutaneous flap). Because the procedure can cover extensive defects and is easy to perform, the distally based sural neurocutaneous flap was the method of choice for covering skin defects over the foot, heel, ankle, and the lower one-fourth of the leg. The lateral supramalleolar artery flap is indicated only when the sural neurocutaneous flap is contraindicated.

Adolescent↗
PubMed1982

Osteogenetic properties of reimplanted decalcified and undecalcified autologous bone in the rabbit radius.

In facial reconstructive surgery extensive studies have been performed to find substitutes to autologous vital bone as grafting material. Decalcified homologous compact bone has been found to possess a capacity of inducing new bone formation in rabbits whereas the application in man has not been successful thus far. In order to investigate the osteogenetic properties in autologous devitalized bone, the difference in bone forming capacity between decalcified and undecalcified devitalized autologous bone was studied. In rabbits, from the radius of each foreleg a piece of bone was resected, rinsed from periosteum and marrow whereupon one was decalcified in 0.6 N HCl. Both pieces were reimplanted in the radial defects 3 days later. The healing process was examined by radiography, light- and fluorescence microscopy. Decalcification seems to accelerate the osteogenetic process when bone is reimplanted to a defect in the rabbit radius.

Animals↗
PubMed1997

[Electromyography studies for objective assessment of loss of function of the lateral pterygoid muscles after dislocation fractures of the mandibular processes].

The aim of treatment for luxation fractures of the mandibular articular processes is not only complete anatomical restitution but also restoration of the mobility. In a retrospective study on 242 patients after operative and conservative treatment, it was possible to demonstrate that there are no correlations between fragment position and functional result. Functional restitution was observed after conservative treatment in 65% of cases and after operative treatment in 57%. In order to establish the causes for dysfunction of the lateral pterygoid muscle an electromyographical technique was developed to dissipate the action potentials of the muscle. Another retrospective study, performed in 23 patients with dysfunction of the mandible revealed loss of activity of the lateral pterygoid muscle after fracture treatment, independent of the treatment method, in 11.5% of cases (two patients). Without any connection to the treatment method, the remaining results permit to conclude that there are preoperative neurological defects. Therefore the pre- and posttherapeutic functions of muscles and nerves were investigated in a prospective study on 18 patients. Before the treatment 16.6% of the patients (n = 3) showed defects of the lateral pterygoid nerve with a resulting loss of muscle function. According to the findings, residual dysfunction of the lateral pterygoid muscle is determined by the extend of the traumatic nerve injury, independent of the treatment method. In the case of axonal defects of the pterygoid nerve, there can be no expectation of a restitutio ad integrum after the operative fragment position.

Adolescent↗
PubMed1994

[Experimental study of peripheral nerve expansion with a tissue expander].

If a peripheral nerve could be elongated by a tissue expander (TE) without apparent damage, the length gained could be used to overcome a nerve gap without recourse to nerve graft. An experimental study was made to investigate whether this method for repairing a nerve gap is feasible. The tissue expander was designed by the authors and the median nerve of rabbits were stretched with TE at the rate of about 1 mm/day. The results showed that when the elongation rate was 18.4%, the motor nerve conduction velocity (MCV) was 67.8% and the myelinated nerve fibres (MNF) was 82.9% of the control nerves. In a further study nerve grafting and nerve expansion for repairing segmental nerve loss were compared with 10 mm defects. 4 months later the MCV, MNF, isometric contraction force (ICF) and muscle wet weight (MWW) were not significantly different between the 2 techniques. But with the 15 mm defects, elongated nerve were inferior to the nerve grafting method.

Animals↗
PubMed2005

Association of cartilage defects with loss of knee cartilage in healthy, middle-age adults: a prospective study.

OBJECTIVE: The significance of asymptomatic knee cartilage defects in healthy individuals is not known. The aim of this study was to examine the association between cartilage defects in the knee and cartilage volume both cross-sectionally and longitudinally in healthy, middle-age adults. METHODS: Eighty-six healthy men and women (mean +/- SD age 53.8 +/- 8.8 years) underwent T1-weighted fat-suppressed magnetic resonance imaging of their dominant knees at baseline and at the 2-year followup visit. Knee cartilage volume was measured. Cartilage defects were scored according to a grading system (0-4) and as present (a defect score of > or = 2) or absent in the medial and lateral tibiofemoral compartments. RESULTS: Cartilage defects in the medial and lateral tibiofemoral compartments were very common (in 61% and 43% of subjects, respectively). Those with cartilage defects had a 25% reduction in medial tibial cartilage volume, a 15% reduction in lateral tibial cartilage volume, and a 19% reduction in total femoral cartilage volume relative to those with no cartilage defects in cross-sectional analyses (all P < 0.05). In the medial tibiofemoral compartment, the annual loss of tibial cartilage in those with cartilage defects was 2.5% (95% confidence interval [95% CI] 2.2%, 3.1%) compared with an annual loss of tibial cartilage of 1.3% (95% CI 0.5%, 2.0%) in those with no defects (P = 0.028), independent of other known risk factors for osteoarthritis (OA). CONCLUSION: These data suggest that the presence of asymptomatic, non-full-thickness medial tibiofemoral cartilage defects identifies healthy individuals most likely to lose knee cartilage in the absence of radiographic knee OA. Thus, interventions aimed at reducing or reversing cartilage defects may reduce the risk of subsequent knee OA.

Australia↗
PubMed2006

Repair of large defects in the forehead using a median forehead rotation flap and advancement lateral U-shaped flap.

BACKGROUND: The forehead is a large and highly expressive and dynamic cosmetic unit. Most forehead defects that cannot be closed primarily are reconstructed with laterally based advancement flaps. OBJECTIVE: A combination of median forehead rotation flap and advancement lateral U-shaped flap for repair of medium- to-large-size defects in paramedian and lateral forehead is described. METHODS: Technically, the design of median forehead rotation flap based on supratrochlear vessels used here is similar to the median forehead transposition flap used to reconstruct large defects of the nasal dorsum. The length and the movement of the flap are much smaller in this case. Approximately 2/3 of the closure of the defect is achieved by displacing the median forehead flap while the remaining 1/3 corresponds to the advancement of the lateral U-shaped flap. RESULTS: The flaps are simple to perform, have minimal complications, and have good cosmetic results. A representative case is presented with photographs. CONCLUSION: For selected medium- to large-size horizontal defects in the paramedian and the lateral forehead, the combination of a median forehead rotation flap and an advancement lateral U-shaped flap offers a simple, visually pleasing repair that preserves the forehead architecture.

Craniocerebral Trauma↗
PubMed1996

Delayed articular cartilage slough: two cases resulting from holmium:YAG laser damage to normal articular cartilage and a review of the literature.

We present two cases referred from other physicians with chondral damage and cartilage slough secondary to use of the holmium:YAG laser during knee arthroscopy. The first patient had a partial lateral meniscectomy, which was done with a 20-W Ho:YAG laser. The patient never fully recovered and underwent a second arthroscopy that revealed full-thickness cartilage defects of the lateral femoral condyle. The second patient had debridement of Outerbridge grade III changes of the lateral tibial plateau and patella, as well as a partial lateral meniscectomy using a Ho:YAG laser. The patient developed recurrent symptoms, and when a second arthroscopy was performed, new degenerative changes to the lateral femoral condyle were noted with large areas of cartilage loss. A careful look needs to be taken at the limited use of lasers until further randomized prospective studies are carried out comparing patient outcomes, cost, and long-term complications.

Adult↗
PubMed1994

Reverse peroneal flaps: two surgical approaches.

The peroneal vascular pedicle supplies the posterolateral aspect of the lower limb and can be used in a reverse-flow manner to reliably cover wounds of the lower third of the leg and ankle. Two surgical approaches may be used, medial and lateral, to treat a variety of soft-tissue deficits. For the medial approach, the patient is positioned supine and the flexor hallucis longus muscle along with the peroneal vascular pedicle is raised. This easily covers medial malleolar or distal anterior tibial defects. For the lateral approach, the patient is positioned prone and a fasciocutaneous flap is dissected and can be used to cover soft-tissue defects down to the proximal foot and ankle. A total of 13 patients underwent reverse peroneal flaps with a follow-up of 6 months to 3 years. All patients healed their wounds, but there were minor wound complications in 4 patients. When used in a reverse-flow manner, the peroneal vascular system can allow for a wide variety of flap designs to treat selected patients.

Adult↗
PubMed1998

Pelvic prolapse: diagnosing and treating cystoceles, rectoceles, and enteroceles.

The current generation of women is maintaining a healthier and more active lifestyle into an older age. Treatable conditions such as stress urinary incontinence and pelvic prolapse detract from this active lifestyle. In many cases, an improved quality of life can be maintained by treating pelvic prolapse conditions with relatively minor surgical procedures. Optimal treatment requires a knowledge of pelvic floor anatomy, an understanding of the various pelvic floor defects, and experience in selecting the appropriate procedure. The unequivocal diagnosis of pelvic prolapse conditions can only be made on physical examination. Each section of the vagina -- anterior, posterior, lateral, and apex -- must be inspected and evaluated separately to define the true nature and degree of prolapse. The examination should be performed with a moderate amount of urine in the bladder, and the patient must strain forcefully during the procedure. In some cases, this requires that the patient stand or sit upright during part of the examination to allow all areas of prolapse to become manifest. When the proper procedures are performed, excellent long-term results can be anticipated. The successful treatment of cystoceles requires an evaluation for both lateral and central defects, as inadequate treatment of either defect will lead to recurrences. The treatment of rectoceles is more controversial: Most clinicians would repair symptomatic rectoceles, but many choose not to treat asymptomatic rectoceles because there is little documented benefit to justify the risk of postoperative dyspareunia. Small asymptomatic enteroceles may be treated with a pessary; however, large symptomatic enteroceles usually require surgery.

Female↗
PubMed2000

[The de-epithelialized turnover flap for defect coverage iin the area over the Achilles tendon and over the lateral malleolar region].

The deepithelialized "turn-over-flap" is a reversed dermis flap. The pedicle of the flap remains intact. The mobile upper part of the flap is turned over the defect and the pedicle itself. A mesh graft covers both, the flap and the donor side. Two case reports will present the principles of the flap design and the clinical outcome of a patient with a defect over the lateral malleolar region and a patient with a defect over the Achilles tendon.

Adult↗
PubMed2006

Innervated lateral middle phalangeal finger flap for a large pulp defect by bilateral neurorrhaphy.

BACKGROUND: The dorsal middle phalangeal finger flap is a reliable flap. However, it requires skin grafting on the whole surface of the dorsum of the middle phalanx of the donor finger for an exposed extensor tendon and leaves a conspicuous contour deformity at the donor site. In an effort to overcome this problem, the authors have been using a heterodigital innervated lateral middle phalangeal finger flap for resurfacing sizable defects of the pulp. METHODS: Flaps were designed on the lateral ulnar side of the middle finger for five thumb defects and the ring finger for two little finger defects. To provide sensation to the flap, one nerve fascicle from the direct small branches of the proper digital nerve after interfascicular dissection (palmar aspect of the flap) and the dorsal branch of the proper digital nerve (dorsal aspect) were identified and sectioned proximally, leaving a 1-cm nerve tail attached to the flap. RESULTS: These flaps provided sensate coverage with static two-point discrimination values of approximately 6 mm. Donor finger morbidity was minimal, and pulp sensation in donor fingers was normal in all cases. No donor finger cold intolerance was reported in this series. CONCLUSIONS: This described flap supplies glabrous skin of nearly normal sensibility. One nerve fascicle from the direct small branches of the proper digital nerve and the dorsal branch of the proper digital nerve were used for maximal sensation. Donor fingers are cosmetically better than those of dorsal middle phalangeal finger flaps because the grafted skin is hidden by an adjacent finger.

Adult↗
PubMed1992

Pathogenesis of ethanol-induced limb reduction defects in mice.

Acute administration of dosages of 2.5, 2.8, or 2.9 g/kg of ethanol to pregnant C57BL/6J mice on gestational day 9 1/4 resulted in major malformations of the forelimb including postaxial ectrodactyly, preaxial syndactyly, and reduction defects involving intermediate digits. The incidence and severity of these defects was positively correlated with dosage. Sidedness of the defects was also dose-dependent. In affected embryos, excessive amounts of cell death were notable within 5-9 hr of treatment initiation in selected cell populations. Cell death was primarily distributed in two regions of the developing limb bud--a ventrodistal ectodermal cell population (apical ectodermal ridge) and a proximal mesenchymal cell population. The patterns of cell death observed appear to be pathogenically related to the limb defects noted at later stages. In particular, it would appear that the deficiencies in the apical ectodermal ridge resulting from ethanol-induced cell death can account for virtually all the subsequent limb defects.

Abnormalities, Drug-Induced↗
PubMed2003

Neural and mammary gland defects in ErbB4 knockout mice genetically rescued from embryonic lethality.

Mice lacking the epidermal growth factor receptor family member ErbB4 exhibit defects in cranial neural crest cell migration but die by embryonic day 11 because of defective heart development. To examine later phenotypes, we rescued the heart defects in ErbB4 mutant mice by expressing ErbB4 under a cardiac-specific myosin promoter. Rescued ErbB4 mutant mice reach adulthood and are fertile. However, during pregnancy, mammary lobuloalveoli fail to differentiate correctly and lactation is defective. Rescued mice also display aberrant cranial nerve architecture and increased numbers of large interneurons within the cerebellum.

Animals↗
PubMed1995

A pathway for lateral root formation in Arabidopsis thaliana.

In plants, the hormone indole-3-acetic acid (IAA) can initiate the developmental program for lateral root formation. We have isolated mutants that have permitted the dissection of this program into initiation and maturation of lateral roots. The alf1-1 mutation causes hyperproliferation of lateral roots, alf4-1 prevents initiation of lateral roots, and alf3-1 is defective in the maturation of lateral roots. The alf3-1 mutant can be rescued by IAA, whereas the alf4-1 mutant is not rescued. Our data suggest a model in which IAA is required for at least two steps in lateral root development: (1) to initiate cell division in the pericycle, and (2) to promote cell division and maintain cell viability in the developing lateral root.

Arabidopsis↗