Retroperitoneal transfer of a transverse rectus abdominis musculocutaneous flap for closure of a sacral radiation ulcer.

Closure of sacral wounds remains a challenge, especially when dealing with previously irradiated tissue. A report of a chronic sacral radiation ulcer successfully closed with the retroperitoneal transfer of a transverse rectus abdominis musculocutaneous flap is presented. Anatomical and technical details are highlighted.

Diagnosis of an anomalous superficialis muscle in the palm by magnetic resonance imaging.

Anomalous muscles of the upper extremity are encountered occasionally and in most cases, identification has been made at operation. Plain radiographs do not visualize soft tissues well. Magnetic resonance imaging provides good definition of soft tissue structures. We report a case of an anomalous flexor digitorum superficialis muscle in the palm, that was seen initially as a mass associated with a previous injury and pain. Magnetic resonance studies showed the mass to be a muscle belly in the palm. Preoperative identification of anomalous muscles is possible with magnetic resonance imaging.

Factors affecting length of hospital stay for femoropopliteal bypass. Implications of the DRGs.

We compared the length of hospitalization of 329 patients undergoing femoropopliteal bypass during 1982 with that allowed under Medicare's diagnosis-related groups (DRGs) for major reconstructive vascular surgery (DRGs 110 and 111). The mean length of stay was found to be related to the patients' age, increasing at a rate of about 1 percent per year. The site of distal anastomosis, a factor not considered in establishing the criteria for these DRGs, was also important. The lengths of stay for above-the-knee popliteal, below-the-knee popliteal, and tibioperoneal anastomoses were significantly different (F = 3.31; P less than 0.05), with lengths of stay increasing for more distal anastomoses. More distal anastomoses were also associated with increased rates of postoperative morbidity, reoperation, and mortality. Significant differences were noted among the patients treated by different surgeons, with respect to their age, the percentage with previous ipsilateral surgery, the frequency of tibial bypass, and the rates of morbidity, reoperation, and mortality. The most highly qualified surgeons dealt with the sickest patients. We conclude that the DRG system does not take account of important variables influencing the length of hospitalization for femoropopliteal bypass, that it favors younger patients undergoing proximal bypass, and that it is biased against distal bypass for limb salvage.