Expanded polytetrafluoroethylene as a microvascular graft: a study of four fibril lengths.

The utility for a prosthetic microvascular graft is well demonstrated, but previous studies have been inconclusive. Expanded polytetrafluoroethylene (Gore-Tex) has been most widely tested as a prosthetic graft. Polytetrafluoroethylene is composed of transverse nodules connected by long fibrils. This study evaluates the effect of fibril length on observed patency in a 1-mm inner-diameter system. Fibril lengths tested were 30, 60, 90, and 120 micron. One-hundred and sixty-three grafts were implanted in the abdominal aorta of Sprague-Dawley rats by a single surgeon using a standardized technique. No anticoagulants were used. Grafts were harvested at predetermined times and evaluated macroscopically, by scanning electron microscope, and by standard histology. The highest patency observed was 97.7 percent in the 90-micron fibril-length grafts. Fibril morphology also affected patency. Increased patency was associated with an amorphous fibril pattern. The graft functioned as a matrix for the formation of a pseudoartery, complete with monocell-thick intima and smooth-muscle media. A foreign-body reaction was observed in the 60-micron fibril-length graft only. Expanded polytetrafluoroethylene does show promise as a microvascular graft. Both fibril length and morphology affect observed patency.

Penile reconstruction with gracilis pedicle grafts.

Penile loss results from various external and self-inflicted catastrophic events. Many types of reconstructive efforts have been used successfully. Recently, bilateral pedicle grafts of the gracilis muscle have been successful and have provided serviceable results in our hands. Technique, complications and indications are discussed and illustrative cases are reported.

Total prosthetic replacement of the temporomandibular joint.

Twenty-seven patients have been operated on for total replacement of the temporomandibular joint because of ankylosis due to trauma, arthritis, neoplasm, infection, or pain. One prosthesis had to be taken out because of gross infection due to Staphylococcus albus, 2 more were removed for pain and dislocation of the prosthesis, and 1 was removed because of erosion through the skin. The remaining 23 had no complications.

Congenital arteriovenous malformation of the head and neck.

A discussion of congenital arteriovenous malformation of the head and neck based on five patients followed from three to twenty years is presented. Definition of the lesion and its progression as followed by angiography is described. The poor response to surgery is ascribed to the ischemic nature of the area of involvement. The concept of supplying normal tissue with normal vascularity to the involved area is advocated.

Valvular obstruction of the nasal airway.

Valvular nasal obstruction may occur in the postoperative rhinoplasty patient. One may anticipate a dropping of the tip, from residual redundant or inelastic skin, in some older patients with long noses. Measures to correct (or avoid) this may be undertaken at the time of the primary rhinoplasty. However, an overcorrection may be necessary if there is much redundant skin. Discretion may indicate the need for a secondary procedure. Lateral wall valving is unusual-but it may occur in the long, high, thin nose (where a suggestion of this action may be observed preoperatively). Maintenance of continuous cartilage along the alar rim, at the time of alar cartilage resection, appears to be important in prevention of postoperative valvular obstruction in these few patients.