Faculty Bibliography

Two reliable techniques for the microvascular anastomosis of difficult-to-handle, thin-walled smaller vessels--"insert sutures first, tie later" and "loops on hanger"--are described.

The developmental expression of an embryonic chicken myosin heavy-chain (MHC) gene homologous to the genomic clone pCM4.1 was examined by S1 analysis. Transcripts homologous to pCM4.1 are first detected at day 12 in ovo, and are maximally expressed between days 15-17 in ovo. No pCM4.1 transcripts are detected at earlier stages of embryogenesis or at high levels in posthatch stages. This unique pattern of expression has led to the proposal that pCM4.1 represents a previously uncharacterized MHC gene, which is confined in its expression to late embryogenesis. Genomic hybridization data, in addition to a comparison between the DNA and amino acid sequences of pCM4.1 and other characterized chicken MHC 3' end clones, provide further evidence for this proposal. We also present observations made during the sequence analysis of pCM4.1 that may be relevant to our understanding of the 3'-end processing of homologous primary transcripts, and of the mechanism controlling developmental MHC isoform transitions.

A retrospective review of 304 consecutive microvascular free flaps to the lower extremity was done to identify the patterns of usage, results, and problems. The most common indication (91%) was for the replacement of extensive tissue loss caused by motor-vehicle injuries. Most of the defects were below the mid-tibia (73%). The associated compound fractures were predominantly gradable as Gustilo type IIIb&c. The latissimus dorsi, the rectus abdominus, and the scapular skin were the flaps used most commonly for coverage (77%). The overall flap failure rate was 8%, compared with 3% for our series of non-lower extremity cases, and 0% for the non-traumatic lower extremity cases. The magnitude of the traumatic insult was the most significant factor associated with anastomotic failure. The rate of anastomotic thrombosis doubled in the presence of vascular trauma, increased threefold in the presence of larger bony defects, and increased fivefold when vein grafts were needed. Experience was important in reducing the complications and improving the results. Fourteen patients (6%) underwent an amputation within the first 3 months, ten of them because of flap failure. Of 85 patients followed up for over one year, 91% had recovered good to excellent leg function. The ability to add healthy and well vascularized tissue to the traumatized limb is critical for the achievement of: 1) early definitive wound healing and restoration of function; 2) salvage of many impending amputations; 3) better prosthetic stump reconstructions; 4) better esthetic results.

A protocol for cephalometric analysis is presented to enable the clinician to evaluate the craniofacial skeleton for surgery. Cephalometric tracing and analysis are described and applied to a clinical case. The three-dimensional cephalometric method and analysis are discussed for application in planning the correction of craniofacial asymmetry

The type of fixation (rigid skeletal vs. wire) was assessed against embryologic origin (membranous vs. endochondral) and recipient site (depository vs. resorptive) as variables affecting inlay and onlay bone-graft survival in 20 mature dogs. Wet weight and volume measurements were made at operation and at sacrifice (16 weeks). The results were as follows: (1) Rigid skeletal fixation increased bone-graft volume survival over wire fixation (p less than 0.05). (2) Fixation (i.e., rigid skeletal) and embryologic origin (i.e., membranous) were equal determinants of bone-graft volume survival (p less than 0.001); the recipient site was not significant for onlay bone graft survival. (3) Embryologic origin was the only significant determinant of weight survival (p less than 0.001). (4) Inlay bone grafts demonstrated greater weight and volume survival than onlay bone grafts (p less than 0.05). (5) Histologic and microradiographic studies demonstrated bony union of bone grafts fixed with rigid skeletal fixation, while fibrous union predominated in bone grafts fixed with wire technique

Surgical bending or contouring of the supraorbital bar may cause inadvertent fractures during craniofacial surgery. Wires may be placed in the bony segments themselves to facilitate reshaping with the Tessier rib bender. The wires are especially helpful in stabilizing the more acute curve at the lateral orbital rim

During the 1987 Academy Meeting, a joint Optometric Education/Public Health and Occupational Optometry Symposium was held on The Delivery of Optometric Care in Nontraditional Settings. Papers were presented on prison systems, long-term care facilities, schools for the mental/physically handicapped, home eye care services, migrant work program, and juvenile detention facilities. This paper is an overview of care delivered in nontraditional settings, including important health care and demographic considerations, brief summation of the nontraditional populations presented, the impact on optometric education, and implications for optometric manpower needs

An autogenous split-thickness calvarial bone graft that was used to correct a marked depression in the frontal region of the forehead resulted in excellent cosmesis. Cancellous bone from the iliac crest, which was applied between the posterior wall of the frontal sinus and the anterior calvarial bone graft, eliminated the dead space and made infection less likely in an area prone to such infections