Faculty Bibliography

Laser Doppler flowmetry (LDF) is a noninvasive, continuous measure of tissue surface microcirculatory red blood cell (RBC) flux. LDF was calibrated against varying RBC volume fractions and flow rates using extracorporeal perfusion of saphenous island flaps of dogs. The RBC flux was found to be linear with LDF signal. The difference in vascular geometry of the skin appeared to play a minor role in generating the LDF signal compared to changes in the RBC flux. In vivo experiments of varying arterial perfusion pressure, flap venous pressure, and total blood flow of the cutaneous island flap had a linear relationship with LDF signal.

The temporoparietal fascia is an ideal tissue source for free transfer to distant sites where ultrathin coverage is either desirable or mandatory. The fascia's dependable vascular anatomy facilitates the technical aspects of microvascular transfer by means of its large vessels, ample pedicle, and ability to be grafted on either side. Furthermore, this highly vascular tissue is available in surprisingly large quantities, and its donor scar is hidden in the hair. The authors have found this flap useful (1) in covering exposed bone and tendon without adding unwanted bulk, (2) in providing thin flap coverage or lining in major facial reconstruction, (3) in covering vital structures such as exposed nerves and vessels, (4) in providing neovascularity both as a recipient graft bed and for control of chronic infection, and (5) in reestablishing gliding-tendon mechanisms. The authors have successfully employed this free flap in 15 cases which involved deformities of the ankle, foot, Achilles tendon, forearm, hand, nose, and contralateral ear and scalp. Seven cases are utilized to illustrate the broad application of this unique and versatile free flap.

To study the effects of the inhalation of cigarette smoke on the survival of skin flaps, 30 Syrian Golden hamsters were divided into three groups of 10. Two of these groups were acclimatized to cigarette smoke in increasing increments for 9 weeks in standard Hamburg I smoking cages. The third group of 10 (group A) served as controls and were sham-smoked throughout the experiment. After acclimatization, one group of 10 (group B) was smoked for a further 6 weeks. A standard axial-pattern flap was then raised on the dorsum of the animals. Ten animals in group C were smoked for 6 weeks preoperatively and for 2 weeks postoperatively, at which time the animals in all groups were sacrificed. All animals survived the experiment. The flaps in control group A all survived without necrosis. Two of the 10 dorsal flaps sustained terminal necrosis in group B animals. Six of the 10 flaps resulted in significant terminal necrosis in group C animals. Statistical analysis of the results indicated a significant comparison between control group A and group C of those animals smoked throughout the experiment. We conclude from this experiment that the inhalation of cigarette smoke consistent with that of a heavy smoker (2 packs per day) has an adverse effect on wound healing of skin flaps in hamsters. Apparently, cessation of smoking even at the time of surgical preparation of the flap obviates much of the noxious effect and increase flap survival significantly

The characteristics of induction with and recovery from isoflurane anaesthesia were studied in 248 children. The mean time to loss of consciousness was 1.5 min (SD 0.5). Tracheal intubation, without interruption of spontaneous ventilation, was accomplished in a mean time of 4.2 min (SD 54 seconds). Movement and excitement, of 20-30 seconds duration, occurred in 23.9% children and 22 patients coughed during induction; 15 (12.6%) during the first 124 inductions; 7 (5.6%) subsequently. The mean half-times of reduction of alveolar isoflurane concentrations in 28 children whose lungs were ventilated with isoflurane and in 13 children who breathed isoflurane spontaneously during anaesthesia were: 45 sec after exposure for one hour, 70 sec after exposure of 2-3 hours and 110 seconds following exposures of 4-8 hours. The mean recovery times of the three groups were 6.5, 9.5 and 11.5 min respectively. In two further groups of nine children the mean half times of elimination of halothane and isoflurane were 220 seconds and 54 seconds respectively; recovery from isoflurane was markedly faster. Isoflurane is well accepted by children; induction is more rapid than with halothane, and the marked flexibility in the control of its effects are due to its relative insolubility. It has wide application in paediatric anaesthesia

In a study of 200 fresh adult cadavers, calvarial thickness was measured at selected points. The variables of age, height, weight, sex, and race were subjected to multiple regression analysis to determine which were significant in the determination of skull thickness. The results indicate that weight, race, and sex are the most important variables. However, the magnitude of the effects of these variables is minimal when considered in relation to clinical requirements. The study provides the clinician with a reasonable basis to obtain preoperative estimation of the thickness of calvarial grafts in the adult at four commonly utilized points