The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases.

The most common recipient site for free-flap breast reconstruction is the subscapular system. Because of a number of problems we encountered using this recipient site, we became interested in revisiting the internal mammary vessels. This paper reports the use of the internal mammary artery and vein as a recipient site in 110 consecutive cases of breast reconstruction in 87 patients. We also report the technical details of recipient-vessel dissection and vessel size in our series. Complications encountered in the series are discussed, and the advantages of using the internal mammary vessels are enumerated. Our experience of a 99 percent successful flap transfer rate supports the reliability of these recipient vessels in breast reconstructions.

The latissimus dorsi/scapular bone flap (the "latissimus/bone flap").

During the past 4 years, our trauma and reconstructive service has treated a number of patients with lower extremity trauma involving the loss of both soft tissue and significant segments of tibia. While there are many methods for reconstruction of such defects, we became interested in providing a one-stage reconstruction of both the soft tissues and the missing bone segments. Since our standard flap for lower extremity reconstruction is a latissimus dorsi flap, we became interested in transferring a portion of the lateral border of the scapula along with the latissimus muscle. We dissected 34 cadaver scapulas in order to verify the reliability of the blood supply to the lateral border of the scapula based on the thoracodorsal artery. We then performed 12 "latissimus/bone flaps" from 1988 to 1992. Prior to flap transfer, control of the wound was obtained with surgical debridement and aggressive wound management. The flap usually was performed 5 to 7 days after initial contact with the patient. The muscle was skin grafted. All patients reported are ambulating, with x-ray evidence of bony incorporation of the transferred bone segment into the tibia. We feel that inclusion of the lateral scapula bone with the latissimus dorsi is a useful adjunct in the management of lower extremity trauma.

The subscapular artery: an alternative conduit for coronary bypass.

The search for an alternative conduit for coronary bypass has prompted our use of the subscapular artery for coronary bypass via a left thoracotomy in three patients. Historically, this artery in conjunction with muscle flaps has been used successfully as a free graft. Its size and length have proved feasible for coronary bypass to the circumflex coronary artery system. All three patients have had excellent clinical results lasting from 6 to 21 months.

The forehead lift. A review.

Our forehead lift technique is a modification of several techniques that have evolved since Lexer first elucidated a surgical approach to diminish the signs of aging in the upper part of the face. It essentially consists of the development of a forehead advancement-rotation flap through a coronal incision to deal with ptosis, and muscle incision and excision to deal with forehead and glabellar creases. The surgical goals are achieved readily in the vast majority of cases. Morbidity is minimal, but real, and can be decreased by astute observance of the details of the surgical techniques outlined. A review of 51 cases assessed success in achieving the surgical goals and the morbidity associated with the procedure.

Nasal masses in infants and children.

Nasal or perinasal masses in children may be classified as congenital or developmental masses, inflammatory lesions, or benign or malignant neoplasms. Because of a possible connection with the central nervous system, nasal masses may be difficult to manage. A premature biopsy, or even a noninvasive palpation, may precipitate intracranial infection, meningitis, or severe bleeding. The indolent nature and benign appearance of these lesions shold not lead to deferral of complete evaluation and appropriate treatment.