An ideal stent for reliable and efficient skin graft application.

A simple, efficient, yet expedient method producing an ideal stent has proved to be highly reliable in over 150 clinical cases. When performed technically correctly, 100% graft take may be anticipated under most grafting circumstances. The method uses Reston (3-M Company, St. Paul, MN), a synthetic urethane foam pad, as the stent material. Reston has intrinsic compressibility; therefore, a consistent external pressure can uniformly be exerted within the effective physiological range needed to achieve graft take. The stent is stapled in position and does not depend upon the mechanical forces generated by tissue elasticity. Several advantages inherent to the method include rapid and efficient surgical application, ease of postoperative care, use in clean or contaminated wounds, and effective and reliable graft survival. The pitfalls of other techniques are avoided. An in vitro study demonstrated the magnitude of the physiological pressures (mm Hg) applied by the elasticity of Reston when stapled in a simulated wound.

The split latissimus dorsi myocutaneous flap.

Consistent proximal branching of the latissimus dorsi neurovascular anatomy permits surgical splitting of the myocutaneous unit into two flaps. Either or both branches of the split flap can be independently transferred. Experimental and clinical applications of this flap, which illustrate several of its uses and advantages, are presented. Applications include simultaneous provision of cover and lining flaps for head and neck reconstruction, motor transfers with split muscle branches, preservation of motor function in the flap donor site with one split muscle branch, and microvascular free tissue transfer of the branched flap or of individual branches.

Effect of organ preservation in cadaver kidney transplantation.

Hypothermic pulsatile perfusion did not adversely affect long-term renal allotransplant function and did not result in an increased rate of rejection. Thus, we can conclude that perfusion had little effect on the immunogenicity of renal allografts. The incidence of acute tubular necrosis was directly related to the length of warm ischaemia and perfusion time. However, long-term renal function was not influenced by acute tubular necrosis. Perfusion is a safe and reliable way of preserving cadaver donor kidneys until transplantation.

Organ preservation in success of cadaver transplants.

The long-term function of 110 cadaver kidney transplants preserved by hypothermic perfusion was compared with that of 79 fresh cadaver kidneys. The one-month failure rate was 4 percent in the perfused kidneys in contrast to a 32 percent one-month failure rate reported by one cooperative group. These data were again confirmed in a prospective, paired study comparing perfused and fresh cadaver kidneys from the same donor. Thus, perfusion of kidneys was not harmful for cadaver transplantation. In fact, of 83 first cadaver transplants, less than 30 percent of perfused kidneys failed in the first year. There appears to be no evidence supporting the idea that bloodless hypothermic perfusion permanently damages human kidneys or increases the chances of rejection.