Publications by authors named "Urbaniak J"

Despite prolonged conservative therapy, including splinting, bracing, and supervised exercise programs, significant flexion contracture of the elbow after local trauma may remain both a functional and a cosmetic impairment. We studied the cases of fifteen patients who underwent a relatively limited surgical procedure consisting of anterior capsulotomy of the elbow without tenotomy of the biceps tendon or myotomy of the brachialis muscle. The mean preoperative flexion deformity of 48 degrees was reduced to a mean postoperative deformity of 19 degrees (a 61 per cent improvement).

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A stereotypical pattern of arterial intimal damage has been demonstrated in rat avulsed and crushed injuries. These intimal tears can be found up to 6 cm proximal to the site of injury in avulsion injuries and are found at a delayed time with crush injuries. In both types of injury, circumferential intimal and subintimal tears spaced approximately 1 mm apart were demonstrated.

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Transplantation of total elbow allografts has been employed as a salvage procedure in an attempt to provide patients with a useful, painless range of motion of the elbow. Patients who are candidates for this procedure include those with disabling elbow joint symptoms who refuse an arthrodesis or are not candidates for conventional total elbow replacement because of excessive bone loss or young age. Allografts must be subjected to rigid internal fixation.

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Management of ulnar artery thrombosis is a complex problem. Diagnosis is confirmed by Allen testing; other special studies are needed for adequate evaluation of circulation, and arteriography is necessary before definitive therapy can be planned. Treatment must be patient oriented and directed at the underlying abnormality.

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Reconstruction of a thumb amputated distal to the metacarpophalangeal joint can be accomplished by the "wrap-around" procedure. The operative procedure calls for an iliac crest graft to replace the bone of the amputated thumb. A flap from the great toe with innervation and circulation intact, including the toenail as well as sensory nerve, is wrapped around an iliac crest graft in a single-stage reconstruction of the thumb.

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The wrap-around procedure provides length, stability, and adequate sensibility for a functional pinch and grasp and also preserves the great toe. The procedure esthetically simulates the normal thumb and is relatively reliable when performed by a surgeon who is experienced in microsurgery. Although the technique requires thorough planning and lengthy and meticulous surgery, the successful outcome is rewarding.

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We reviewed fifty-nine consecutive cases of patients who had replantation of a single finger (excluding the thumb) after traumatic amputation, with an average follow-up of fifty-three months. Fifty-one (86 per cent) of the replanted fingers survived. Survival was found to be affected by the age of the patient, the number of vessels that were anastomosed, and the replantation experience of the surgeons.

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A method of bone lengthening for bilateral shortness of the fourth toe in a 23-year-old woman is described. The symptomatic short fourth toes were successfully treated by metatarsal and phalangeal diaphyseal lengthenings with metatarsophalangeal joint preservation.

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Vasospasm in revascularized tissue can compromise tissue perfusion even though the microsurgical anastomoses remain patent. Circulating catecholamine stimulates peripheral vasoconstriction. Chemical vasospasm was induced by the intraarterial administration of norepinephrine to denervated rat hind limbs.

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There are more repair techniques available for an injured flexor pollicis longus than for the other digital flexors. The procedure of choice is immediate primary or early delayed repair (less than three weeks after injury) by direct end-to-end suture. Good thumb function can also be obtained with the use of late delayed repair by tendon advancement with or without lengthening, free tendon grafting, and tendon transfer.

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Splenectomy continues to be the most commonly chosen method of management of traumatic injury to the spleen. However, patients of all age groups who have undergone splenectomy have significant impairment of immune functions as demonstrated by decreased production of IGM, tufsin, and properdin. This immune deficiency has been clinically manifested by an increased incidence of postsplenectomy pneumonia and sepsis which is reduced but not eliminated by the use of pneumococcal vaccine and/or prophylactic antibiotics.

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Two patients with spontaneous retrocarpal radial artery thrombosis are reported. Both patients had numbness and cold intolerance of the thumb and index finger and one patient had splinter hemorrhages. Angiography revealed identical occlusions of the radial artery over a 2.

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This study was performed to examine the microanastomotic response to needle and suture size, comparing the 10-0 (75 mu needle/22 mu suture), the 11-0 (50 mu needle/18 mu suture), and a new modified 11-0 which has a 30 mu needle and a 14 mu suture. Each artery received five full thickness sutures of either suture. The vessels were harvested at 0, 7, 14, 21, and 28 days and checked for patency, aneurysm formation, and gross strength.

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Few data are available regarding structural and functional recovery of lacerated skeletal muscle after repair. This study used the extensor digitorum longus muscle of rabbits to document recovery after laceration and repair and a healing period of 12 weeks. Completely lacerated muscles recovered approximately 50% of their ability to produce tension but were able to shorten to 80% of normal.

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In elective microsurgical procedures, it is necessary to occlude small branches when mobilizing vessels in obtaining vein grafts. The purpose of this study was to evaluate the relative merits of suture ligation, bipolar cauterization, and hemoclip ligation, and to determine the minimum safe distance of occlusion. The left inferior epigastric vein and the right profunda femoris artery were ligated under operating microscope magnification with 10-0 nylon suture, small hemoclip, or bipolar cauterization at distances of 0, 1, or 2 mm from the parent vessel in 75 rats.

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A congenital anomalous band between the flexor pollicis longus and extensor pollicis longus tendons is, according to the literature, a rare condition. This anomalous junctura was recognized in three children with congenital thumb hypoplasia. Improved thumb function was noted after surgical release of the band in all cases.

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Isolated cold stress testing is introduced as a method for quantification of thermoregulatory capacity of the upper extremities. Ninety-six patients with pain, numbness, or cold intolerance were studied. All diagnoses were confirmed by operation, arteriography, or dynamic radionuclide imaging.

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The authors present 28 patients aged 15-19 years selected from 1600 cases treated surgically for intervertebral disc prolapse. In the light of these cases and a survey of the pertinent literature the authors consider that disc prolapse is not always a consequence of injury. Certain differences of the clinical picture could be observed in younger patients.

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A variety of vascularized toe tissue transfers are available for reconstruction of the thumb. These procedures may provide length, stability, and motion for pinch and grasp, offer adequate sensibility (average two-point discrimination is 15 mm) for prehension, and esthetically simulate the normal thumb better than previous conventional thumb reconstructive procedures. These one-stage procedures have become relatively reliable when performed by reconstructive surgeons experienced in microsurgery.

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Vascular competence in the upper extremities of 44 patients was evaluated by three-phase bone scans consisting of rapid sequence dynamic radionuclide imaging (DRI), an immediate postinjection "blood pool" image, and a 3- to 4-hour delayed image. Findings were correlated with definitive anatomy determined by arteriography, operative findings, or both, in 50 extremities. DRI provided the correct diagnosis in all but four extremities (92%).

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Forty mature rabbit ears were completely amputated and stored by different methods for 24 hours and then replanted. This study suggests that there is no significant difference among conventional methods of storage as long as the part is not frozen or allowed to become normothermic for more than 2 hours. Equal viability rates in replantation surgery may be expected by storing the severed part by wrapping it in a cloth moistened in Ringer's lactate solution or normal saline and placing the packet on ice, or by total immersion of the severed part in either of these solutions contained in a plastic bag that is placed on ice.

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This is a review of seven cutaneous or myocutaneous free flaps performed at the Duke University Medical Center for coverage of foot defects. The average follow-up is 19.3 months.

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