Bradon Wilhelmi | University of Louisville, KY (original) (raw)

Papers by Bradon Wilhelmi

Hand, Jul 7, 2016

Background: A rare and disastrous complication of harvesting a tendon graft is the misidentificat... more Background: A rare and disastrous complication of harvesting a tendon graft is the misidentification of the median nerve for the palmaris longus. Methods: The authors report a referred case in which the median nerve was harvested as a free tendon graft. Results: Few reports of this complication are found in the literature despite the frequency of palmaris longus tendon grafting and the proximity of the palmaris tendon to the median nerve. Given the obvious medicolegal implications, the true incidence of this complication is difficult to assess. Discussion: Safe harvesting of the palmaris longus mandates a thorough understanding of the relevant anatomy, in particular the proper differentiation between nerve and tendon and recognition of when the palmaris longus tendon is absent. Techniques to facilitate proper identification of the palmaris longus are outlined.

Plastic and Reconstructive Surgery, Jun 1, 2004

Correspondence and brief communications are welcomed and need not concern only what has been publ... more Correspondence and brief communications are welcomed and need not concern only what has been published in this journal. We shall print items of interest to our readers, such as experimental, clinical, and philosophical observations; reports of work in progress; educational notes; and travel accounts relevant to plastic surgery. We reserve the right to edit communications to meet requirements of space and format. Any financial interest relevant to the content of the correspondence must be disclosed. Submission of a letter constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such letters.

Plastic and Reconstructive Surgery, Oct 1, 2002

Aesthetic Surgery Journal, May 1, 2010

Background: The aesthetically appealing eyebrow shape has been defined by its arch, located near ... more Background: The aesthetically appealing eyebrow shape has been defined by its arch, located near the junction between the medial two-thirds and lateral one-third. The position of this arch has been historically described by arbitrary anatomical landmarks that have no logical structural relationship. Moreover, selection of endoscopic brow lift incision sites that define vector of pull and fixation points have been variably described. Objectives: The authors examine the position of the deep temporal fusion line to determine whether it can act as a more accurate and functional landmark than prior anatomical landmarks for the eyebrow peak position. Methods: Eyebrows were measured in 50 subjects from the medial aspect of the eyebrow to the a) deep temporal fusion line (ridge), b) eyebrow peak (arch), c) lateral aspect of the brow, and d) lateral limbus. Pearson's correlation, descriptive statistics, and student's t test results were obtained. Results: Eyebrow measurements demonstrated that the deep temporal fusion line is the most precise indicator of brow peak position among all examined landmarks. The Pearson correlation value was strongest between brow peak and deep temporal fusion line (P = .860) and a t test confirmed this observation with no significant difference between brow peak and deep temporal fusion line. The lateral limbus and medial two-thirds lateral onethird junction more accurately predict brow peak in females, but the deep temporal fusion line is an equally reliable predictor of brow peak for males and females. Conclusions: These findings suggest that placement of endoscopic brow lift incisions and subsequent fixation points may be best defined along the deep temporal fusion line.

Annals of Plastic Surgery, Sep 1, 2002

Aggressive digital papillary adenocarcinoma (ADPA) is a rare tumor of sweat gland origin that may... more Aggressive digital papillary adenocarcinoma (ADPA) is a rare tumor of sweat gland origin that may present in a nonspecific manner on the finger. The authors report a case of ADPA that was treated initially as a chronic infection of the finger, leading to a delay in diagnosis and definitive treatment. Failure of the wound to heal led to a biopsy of the lesion, which revealed ADPA. Because of the potential for aggressive local growth and distant metastases, amputation was indicated. This case demonstrates the importance of considering ADPA in the differential diagnosis of nonhealing wounds of the finger that have not responded to other forms of treatment. Wide local excision with clear margins and close surveillance for signs of recurrence or metastasis are indicated for this rare sweat gland neoplasm.

Postgraduate Medical Journal, Dec 1, 2002

Introduction: The unreliability of the pulse examination of the foot has primarily been due to va... more Introduction: The unreliability of the pulse examination of the foot has primarily been due to variability of technique between examiners. Whereas the groove between the medial malleolus and the Achilles tendon more readily defines the location of the posterior tibial pulse, the location of the dorsalis pedis pulse remains vague. In this paper a novel method of locating the dorsalis pedis pulse by physical examination is described. Methods: Forty one consecutive patients admitted to a general surgery service of a tertiary medical centre within a two month period were examined. Using the dorsal most prominence of the navicular bone as a landmark, the distance to the dorsalis pedis pulse in bilateral lower extremities was measured by palpation and compared to Doppler ultrasound. Measurements were confirmed by two separate examiners blinded to each others' results. Results: The dorsalis pedis artery was palpable in 78% of extremities and present by Doppler ultrasound in 95%. The location of the left dorsalis pedis artery was a mean (SD) 9.8 (1.4) mm by palpation and 11.1 (2.1) mm by Doppler ultrasound from the dorsal most prominence of the navicular bone. The right dorsalis pedis artery was 10.4 (3.4) mm by palpation and 11.5 (0.7) mm from the dorsal most prominence of the navicular bone. No significant differences in location of the dorsalis pedis artery were observed bilaterally between Doppler ultrasound and palpation; No significant differences were observed comparing contralateral dorsalis pedis arteries nor any differences between the examiners' results. Conclusion: The dorsal most prominence of the navicular bone provides a bony landmark to readily locate the dorsalis pedis artery. Reliability of the examination may be increased as to the patency of the dorsalis pedis artery by using this dependable anatomic landmark.

Plastic and Reconstructive Surgery, Apr 1, 2003

Plastic and Reconstructive Surgery, Feb 1, 2004

Plastic and Reconstructive Surgery, Sep 1, 2003

Annals of Plastic Surgery, May 1, 2003

Successful replantation of the scalp with microanastomosis of a single artery and vein has been r... more Successful replantation of the scalp with microanastomosis of a single artery and vein has been reported to produce reliable results. In fact, there have been several reports of scalp replantations based on one-artery and vein repair. There has been a face and scalp replantation reported in the literature, but this was as two separate parts and was based on several arterial and venous repairs. The authors performed the first successful replantation of a face and scalp with repair of a single artery and, of course, two veins. A 21-year-old man presented after his face and scalp were completely severed. The patient's long hair was caught in a conveyor belt at work. The face and scalp underwent replantation, with repair of the right superficial temporal artery with an interposition vein graft. A multiteam approach allowed for minimization of overall ischemic time and simultaneous preparation of the vessels on the patient and amputated part as well as vein graft harvest from the arm. Also critical to the success of the procedure, the small portions of the vessels of the amputated part were sent for frozen section to differentiate artery from vein. Initially, only the right superficial temporal vein was repaired. One week after replantation, the patient returned for treatment of venous congestion of an area to the opposite side of the forehead partial transection, with repair of the left superficial temporal vein, also. This saved the entire part that underwent replantation, and the entire part survived. The face and scalp can undergo replantation based on single-artery repair.

American Surgeon, Mar 1, 2022

The origins of wound care date back to ancient civilizations. From boiling oil to honey to wine, ... more The origins of wound care date back to ancient civilizations. From boiling oil to honey to wine, healers and caregivers have adopted a fascinating array of items to cleanse, dress, and bandage wounds over the ages. While wound care practices have developed over time, the physicians and surgeons of ancient times and the Middle Ages helped build the foundation for present-day wound care. A modern scientific understanding of these treatments illustrates why practitioners abandoned some practices while others remain in use today.

Plastic and Reconstructive Surgery, Jul 1, 2003

North American Caucasian male subjects (n ϭ 59) and female subjects (n ϭ 72) were surveyed, to in... more North American Caucasian male subjects (n ϭ 59) and female subjects (n ϭ 72) were surveyed, to investigate earlobe height preferences that could serve as guidelines for aesthetic earlobe surgical procedures and reconstructions. Subjects were asked to rank their preferences for variously shaped earlobes in life-size-scaled sketched male and female profiles. Earlobe heights were varied on the basis of previously established anatomical landmarks, including the intertragal notch, the most caudal anterior attachment of the earlobe to the cheek skin (the otobasion inferius), and the most caudal extension of the earlobe-free margin (the subaurale). While the intertragal notch-to-otobasion inferius distance (range, 5 to 20 mm) and otobasion inferius-to-subaurale distance (range, 0 to 20 mm) varied, all other facial and ear anthropometric measurements were held constant. Each of the rank orders for the female and male facial profiles completed by the female and male subjects demonstrated statistical significance, as determined by one-way analysis of variance analysis of ranks (p Ͻ 0.001 for all four groups). No difference was noted between the two sexes' rank orders for either sex (p Ͼ 0.05). Therefore, analysis of the combined male and female preferences for each sex was completed with one-way analysis of variance analysis of ranks (p Ͻ 0.001 and p Ͻ 0.001) and a post hoc Dunn's test, to delineate significant preference differences between subgroups with respect to the intertragal notch-to-otobasion inferius and otobasion inferius-to-subaurale distances. Both female and male earlobe intertragal notch-to-otobasion inferius distances were preferred at either 5, 10, or 15 mm, more so than at 20 mm (p Ͻ 0.05 for all female and male comparisons). Furthermore, both female and male earlobe otobasion inferius-to-subaurale distances were preferred, in descending order, at 5 mm Ͼ 10 mm Ͼ 0mmϾ 15 mm Ͼ 20 mm (p Ͻ 0.05 for all female and male comparisons). On the basis of the findings of this survey, the first classification of earlobe ptosis (based on otobasion inferius-to-subaurale distances), as well as a criterion for earlobe pseudoptosis (intertragal notch-to-otobasion inferius distance of greater than 15 mm), is presented. These findings suggest a role for independent assessment of the lobule length with respect to its anteriorly attached cephalad component (intertragal notch-to-otobasion inferius distance) and its free-margin caudal component (otobasion inferius-to-subaurale distance). (Plast.

Canadian Journal of Plastic Surgery, Feb 1, 2005

Recurrent carpal tunnel syndrome is uncommon yet troublesome. Significant adhesions and scarring ... more Recurrent carpal tunnel syndrome is uncommon yet troublesome. Significant adhesions and scarring around the median nerve can render it relatively ischemic. A number of vascular flaps have been described to provide vascular coverage in attempts to decrease further cicatricial adhesions and to improve local blood supply around the median nerve. A rare case of an anomalous muscle in the distal forearm used as tissue to provide good vascularized coverage of the median nerve that was severely scarred in its bed is reported. The anomalous muscle was distal to the flexor digitorum superficialis tendon and inserted in the palmar fascia on the ulnar aspect of the hand. Referring branches from the ulnar artery provided vascular supply to the anomalous muscle. The muscle on these vascular pedicles was transposed over the median nerve, providing good, stable, unscarred coverage. The patient had an excellent result with resolution of the carpal tunnel symptoms. The redundant anomalous muscle provided a unique vascularized source for coverage of the median nerve in recurrent carpal tunnel syndrome.

Plastic and Reconstructive Surgery, Sep 1, 2002

... Bradon J. Wilhelmi, MD. Steven J. Blackwell, MD. ... Journal of Hand Surgery-American Volume ... more ... Bradon J. Wilhelmi, MD. Steven J. Blackwell, MD. ... Journal of Hand Surgery-American Volume A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: The Dalhousie project clinical phase Lalonde, D; Bell, M; Sparkes, G ...

Annals of Plastic Surgery, Dec 1, 1999

Pneumosinus dilatans is a rare condition of unknown etiology in which there is enlargement of the... more Pneumosinus dilatans is a rare condition of unknown etiology in which there is enlargement of the paranasal sinuses by air, with extension beyond the normal boundaries of bone. The authors present a case of pneumosinus dilatans of the frontal sinus and review the literature.

Plastic and Reconstructive Surgery, Feb 1, 2001

PubMed, 2023

Background: In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surger... more Background: In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surgeries performed by plastic surgeons. Various approaches for the skin incision of these procedures have been described. The vertical pattern has become an increasingly popular option due to its lower scar burden. However, it is prone to dog-ear formation along the caudal aspect of the incision. Herein, we describe 5 technical steps to eliminate the dog-ear in patients undergoing vertical mammoplasties. Methods: A retrospective chart review was performed on all patients who underwent vertical breast reduction and mastopexy between the years 2008 and 2020 performed by the senior author. The 5 steps employed in eliminating the dog-ear are delineated and depicted pictorially. Results: A total of 58 patients and 89 breasts were operated upon. A majority of 66.6% were Caucasian, 33.3% were African American, and 1 patient was of Hispanic descent. The mean age was 53.2 years (19-73 years), and average BMI was 31.5 kg/m2 (21.3-42.7 kg/m2). The average resection weights for reduction and mastopexy patients were 479 grams (100-1500 grams) and 58.1 grams (18-100 grams), respectively. Mean follow-up was 10.5 months (1-35 months). Only one patient developed a dog-ear (1.7%) in bilateral breasts (2.2%); however, the patient did not request a revision. Our revision rate over 13 years remained at 0%. Conclusions: Utilizing these 5 technical steps reduces the risk of dog-ear deformity and thereby diminishes the overall need for revisional surgery in patients undergoing short scar vertical mammoplasties.

Plastic and Reconstructive Surgery, Nov 21, 2022

Background: The umbilicus is often not a midline structure. Centralization of the umbilicus durin... more Background: The umbilicus is often not a midline structure. Centralization of the umbilicus during an abdominoplasty is routinely performed at the level of the skin; however, this is associated with a high rate of postoperative reversion. The authors propose using an eccentric fascial plication centered on the true midline to maintain postoperative centralization of the umbilicus in addition to correction at the skin level. Methods: A retrospective study was conducted of all patients between 2015 and 2019 who underwent abdominoplasty with either skin only (concentric plication) or fascial (eccentric plication) umbilical centralization. The Fisher exact test and t test were used to compare the two groups and assess differences in rates of umbilical reversion. Results: A total of 71 patients were included in the study; the majority of patients were women [n = 69 (97%)] and White [n = 50 (70%)]. There were 28 (39%) patients who underwent concentric plication, and 43 (61%) had eccentric plication. Mean body mass index in the concentric and eccentric groups was 32 kg/m2 and 28.5 kg/m2, respectively. Average follow-up was 51.6 months for concentric plication and 27.8 months for eccentric plication. Of those who received concentric plication, 10 patients (36%) had their umbilicus revert to the preoperative position; none in the eccentric plication group reverted (P < 0.0001). Conclusions: Midline placement of the umbilicus during an abdominoplasty is important in providing symmetry to optimize aesthetics. Eccentric fascial plication maintains the centralization of the umbilicus when compared with concentric fascial plication with skin-only centralization. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.