Frederick Finseth

Cigarette Smoking: Impairment of Digital Blood Flow and Wound Healing in the Hand

Smoking a single cigarette can reduce digital blood flow. Sarin (1974) showed a 42% reduction in digital blood flow in his series, and other investigators have shown similar findings (Ludbrook 1974, Rottenstein 1960). The focus of this paper is on the pharmacological effects of the various components of cigarette smoke and their potential effects on wound healing in the hand. A case is described to illustrate the effect of stopping smoking upon a non-healing fingertip ulcer.

Nicotine And Its Effect On Wound Healing

Our data demonstrate that nicotine impairs wound contraction in the rabbit ear model from the 4th to the 10th day of wound healing. However, the wounds contracted at essentially the same rate from the 12th to the 20th day in the experimental and control groups of animals. This study would suggest that cigarette smoking, with its associated nicotine ingestion, is adverse for a time to wound healing. It is clearly possible that in cases of extremity injury, or surgery, cigarette smoking may adversely affect wound healing.

An experimental neurovascular island skin flap for the study of the delay phenomenon.

We present an experimental neurovascular island skin flap. It is a consistent, reproducible model which produces a definite pattern of surviving skin flap area versus skin flap necrosis. There is a constant, anatomically definable nerve and vascular supply to the flap. This model permits independent experimental manipulation of the neural, arterial, and venous supply to the skin. It is useful, therefore, for the study of the vascular mechanisms of the skin microcirculation. We also demonstrated that increased flap survival can be produced by a delay involving denervation alone (leaving the vascular supply intact) or by devascularization alone (leaving the nerve supply intact). We conclude that both the adrenergic denervation and the ischemia contribute to the production of the delay phenomenon. We suggest that sustained vasodilation--vascular smooth muscle relaxation--is the vascular mechanism that accounts for the delay phenomenon.

Prevention of skin flap necrosis by a course of treatment with vasodilator drugs.

Large island skin flaps, comprising the entire abdominal covering in rats, were raised on one neurovascular pedicle in the groin. A standard area of necrosis was produced on the other side from the pedicle. However, when the animals were treated with certain vasodilator drugs for 15 days before and 7 days after the flaps were raised, there was little or no necrosis. The effect of the drug therapy was the same as a surgical delay.

The anterior chest approach for obtaining free osteocutaneous rib grafts.

Fresh cadaver dissections indicated that the anterior chest approach for obtaining a free osteocutaneous rib graft, based on the anterior intercostal vessels, would be feasible. Following this, a mandibular defect in radiated tissue was successfully repaired in one stage by a free osteocutaneous graft with microvascular anastomoses. A 22-cm segment of rib, with overlying muscle and skin measuring 10 X 30 cm, was transferred. Follow-up, with selective arteriography at 6 months, confirmed the belief that the periosteal blood supply alone could support the rib segment. The anterior chest approach, to obtain a free osteocutaneous rib graft, is easier, faster, and safer than the posterior approach.

Epidermolysis bullosa: current concepts and management of the advanced hand deformity.

A current classification of the types of epidermolysis bullosa is reviewed, in conjunction with some etiological concepts. The pathomechanics of the advanced hand deformity are discussed, and applied to a sequential plan of reconstructive surgery. The objective is the restoration of elementary hand function. Two illustrative cases are presented.

Clinical salvage of three failing skin flaps by treatment with a vasodilator drug.

We present 3 clinical cases, one skin flap and two myocutaneous flaps, in which we believe postoperative treatment with isoxsuprine resulted in the salvage of considerable areas that would otherwise have necrosed.

Experimental Work with Isoxuprine for Prevention of Skin Flap Necrosis and for Treatment of the Failing Flap

The administration of isoxuprine intraperitoneally resulted in the complete survival of abdominal island skin flaps in rats that otherwise underwent a standard pattern of necrosis. The drug was effective when administered for two weeks before and one week after raising the flap, or when administered afterwards alone. The mechanisms of its action were investigated and are described.

The intravenous fluorescein test: Use in timing of groin flap division

Successful division or delay of the arterial groin flap requires an accurate prediction of viability. The fluorescein dye test is an objective test to determine the earliest possible time a pedicle can be divided. It is an easy, quick, and comfortable test that can be repeated many times without injuring or altering the flap. It consists of an intravenous injection of fluorescein while the pedicle is temporarily and reversibly occluded. All areas with adequate revascularization fluoresce under ultraviolet light. In three groin flaps intended for hand resurfacing, interval fluorescence testing was the sole criterion for successful pedicle division. In an experimental neurovascular island skin flap in the rat, the validity of the fluorescein test was confirmed. In the clinical situation and in the experimental model, fluorescence is an accurate indicator of groin flap revascularization and a predictor for the timing of safe and early groin flap division.

Prevention of muscle necrosis in an experimental neurovascular island muscle flap by a vasodilator drug--isoxsuprine.

We report an experiment that demonstrates one means to prevent necrosis in an experimental island muscle flap. The results imply that necrosis of skeletal muscle in a clinical flap could be prevented by treatment with isoxsuprine.