Evaluation of the effectiveness of two support surfaces following myocutaneous flap surgery.

Recurrence of pressure ulcers is a serious problem following myocutaneous flap surgery and can lead to prolonged and expensive hospitalization. One of the most important aspects of patient care after surgery is the monitoring of reduced pressure in the area of the flap. Usually reducing pressure requires an expensive high-tech support surface. The purpose of this study was to evaluate the effectiveness of a less expensive support surface. There were 12 patients involved in a clinical trial that lasted 14 days and compared the effectiveness of the ROHO dry-floatation mattress to that of the Clinitron bed. Findings indicated that post-operative patients were effectively treated on either support surface.

Neck resurfacing with free tram flap.

Anterior neck defects are best reconstructed with flaps, to avoid contractures and extensive scarring. Local or distal flaps are hampered by significant donor site disability. The development of the TRAM flap for breast reconstruction has improved our armamentarium in reconstructive surgery. This paper purports to demonstrate the superiority of the free bilateral TRAM flap applied for anterior neck resurfacing. Two cases with such anterior neck conditions are presented.

Benign symmetric lipomatosis (Madelung's disease).

A black man with benign symmetrical lipomatosis had extensive complete surgical removal of lipomas in the neck and shoulder regions, with an excellent functional result. Despite previous reports advocating conservative surgical debulking, we believe that adequate excision under direct exposure can produce a permanent cure of these tumors.

Metastatic melanoma of the lacrimal sac.

The case history of a patient with metastatic melanoma obstructing the lacrimal sac is presented. To our knowledge, this case represents a unique metastatic pattern that has not been previously reported. The patient was first treated for a melanoma of the left arm, which was excised in continuity with the axillary lymph glands. She was free of disease for 3 years until she developed metastatic disease causing obstruction of the ipsilateral lacrimal sac. Anatomical details of the metastasis were provided by computed axial tomography. Treatment consisted of excision of the metastatic lesion with reconstruction using forehead and intranasal mucosal flaps, followed by irradiation, hyperthermia, and multiple-drug chemotherapy. Emphasis is placed here on the differential diagnosis of orbital adnexal tumors.

Duodenal diaphragm associated with superior mesenteric artery syndrome.

An unusual case of duodenal diaphragm in a 24 year old patient who presented with symptoms of the superior mesenteric artery syndrome is presented. The patient had rheumatoid arthritis and had been treated with salicylates, which were thought to have produced inflammation and occlusion of the aperture to the point of complete obstruction. Complete excision of the diaphragm through anterior duodenotomy and distal duodenojejunostomy provided an excellent result.

Splenic pseudocysts: report of two cases and review of the literature.

Two cases of pseudocyst of the spleen are discussed. The first case presented preoperatively as a pelvic mass, thought to be ovarian in origin. No history of trauma was present. The second case, also without trauma, was definitively diagnosed by computerized axial tomography. This patient was hypertensive due to compression of the renal artery by the splenic cyst. A review of the literature is given. The causes of splenic cysts, clinical manifestations, diagnosis, treatment, and complications are discussed.

Intraluminal duodenal diverticulum in the adult.

Four patients with intraluminal diverticulum of the duodenum are presented and compared with those reported previously. This lesion is a rare congenital disorder that usually becomes symptomatic in adult life. It is located in the second portion of the duodenum within the lumen, extending distally. It has the appearance of a "thumb of a glove" and it is lined by mucosa on both surfaces. It develops betweeen the fourth and eighth week of the embryo's life, but it increases in size during adult life. It usually presents with typical or atypical symptoms of peptic ulcer disease, but sometimes manifestations such as gastrointestinal bleeding, duodenal obstructions or pancreatitis may predominate and may be severe and life-threatening. The diagnosis is best made with hypotonic duodenography, which demonstrates the lesion as a barium coated pouch within the air filled duodenal lumen. The treatment of choice is duodenotomy and excision of the lesion. Proper identification of the papilla of the ampulla of Vater is important since this structure is often adjacent to the diverticulum. No recurrences have been noted in the three patients operated upon.