Surgical diathermy is not suitable for vascular tissue welding.

The possibility of using radiofrequency energy (RFE) to produce a sutureless anastomosis is attractive both to the military surgeon and on the grounds of cost and simplicity. To investigate this, fresh rabbit aorta was divided lengthways into 4 mm strips and apposed, intima-to-itima. A Valleylab Force 30 Electrosurgery machine supplied RFE at 500 kHz. The energy was applied using standard bipolar forceps and 121 attempts were made to weld the tissue. Seventy seven welds resulted of which 36 were able to withstand a distraction force of greater than 0.1N: the strongest weld was disrupted at 0.35N. Intact tissue withstood a distraction force of greater than 2N, whilst sutured joints disrupted at 0.97 N. It is concluded therefore that radiofrequency energy at 500 kHz does not satisfactorily weld vascular tissue.

Syme's amputation: a neglected procedure.

Over a 9-year period nine patients underwent Syme's amputation, one patient undergoing a staged bilateral procedure. Six of the ten amputations were carried out for the complications of peripheral vascular disease, including one with Buerger's disease who had bilateral amputations. Three patients had amputations for infected diabetic gangrene and one amputation was performed as a result of trauma. Five patients had previously undergone surgery to improve their peripheral circulation. Two patients required a subsequent below knee amputation. The indications for and technique of Syme's amputation are discussed.

Morning emergency operating list: effects of implementation.

The effect of the introduction of a regular morning emergency list for general surgery was assessed immediately on its inception and after 1 year. The main effect was a reduction of the surgical caseload after midnight. The number of surgical procedures carried out between midnight and 0800 dropped from 32% of all emergency procedures in 1989 to 11% in 1991. The number of nights during which emergency surgery took place after midnight dropped from 56% to 30% over the same period. After the adoption of a regular morning emergency list there was no surgery carried out after midnight on 70% of 'duty' nights.

Post-operative wound infections in Belize.

The incidence of post-operative wound infections in Belize in 1986 and 1987 was studied. Both military practice in the military hospital and civilian practice in the rural hospitals of the local towns were included. Despite previous misgivings and sub-optimal conditions in the rural hospitals an acceptably low incidence was found in both areas of work.

Tattoo removal by surgery in a bloodless field.

Tattoo removal from the forearm often requires excision and split skin grafting. The authors propose the use of a bloodless field to facilitate accurate dermal peeling, to ensure complete removal of the pigment, and to reduce operative time.

Orchidopexy in a military hospital.

A retrospective analysis of 53 consecutive cases of orchidopexy performed at the British Military Hospital Munster between 1984 and 1988 showed that the average of referral for orchidopexy was 4 years 7 months and that the average age at surgery for mal/un-descended testes was 5 years exactly. Sixty-four percent of all orchidopexies were carried out before the age of 5 years; 8 percent were carried out by the age of 2 years.