Combined treatment of arteriovenous malformations by transarterial microembolization and surgery.

An arteriovenous malformation is defined as a congenital lesion of dysplastic vascular origin with large feeding arteries causing decreased vascular resistance. Previously, initial attempts toward treatment by complete excision of the vascular mass were complicated by hemorrhage and infection. Cardiac failure and abnormal growth may result from the shunted blood flow. With the advancement of angiography, more defined study of the arteriovenous anomaly can be identified and a reduction of risk during treatment can be promised. Three cases of extensive arteriovenous malformations are presented. Each has been successfully treated by combining radiologic microembolization followed by surgical extirpation of the vascular mass, without complication.

Electrical burns of the mouth in children.

The acceptable state of the art for commissure electric burns of the mouth in children in the past was to advocate conservative treatment, allowing spontaneous healing to be followed by reconstructive procedures. These statements were made because of the difficulty of assessing the degree of initial injury, the loss of valuable normal tissue in early excision and reconstruction, and the minor role played by infection in healing of local electric burns particularly in this anatomic area. Most authors feel that maximum tissue preservation and functional restoration could best be achieved by delay of surgery until the eschar had separated and the scar had softened. Another school of surgeons believe that scarring, distortion, and secondary infection can be circumvented by timely, early surgical intervention. More recently the fabrication and use of a "dynamic microstomia prevention splint" appears to be beneficial in eliminating the need for or decreasing the degree of surgery in children with electric burns of the commissure of the mouth.

Early cleft palate repair and speech outcome.

Speech production and age at palatal repair were investigated in 80 cleft palate children. Children whose palates were repaired prior to the onset of speech production demonstrated significantly better speech than those whose palates were repaired between 12 and 27 months of age. The supposition that earlier palatal repair results in more normal speech development was, in fact, demonstrated in these cases. Rather than using chronologic age alone as the deciding factor in determining timing of initial palatal repair, the stage of each child's phonemic development should be considered if maximum speech potential is to be achieved and if speech development is to parallel normal noncleft peers. Determining this stage of development through early speech and language evaluations, beginning at 6 months of age, thus becomes an essential component in the habilitation of children with cleft palate. Continued research is needed to ensure against giving the obtainment of early speech normalcy disproportionate emphasis over craniofacial growth considerations. To this end, continued cooperative research between surgeons and speech pathologists is imperative in order to base these important decisions on substantiated findings.

Successful treatment for exposure of a dacron aorta, with surrounding infection: case report.

The treatment of the patient with an exposed vascular implant should usually be in the hands of an expert vascular surgeon. In certain instances, such as when the exposed area is not close to a suture line and no fistulous tracts connect the exposed area to either suture line, plastic surgery can solve the problem. We present a case of an exposed aortic prosthesis which was successfully treated by removing devitalized tissue, turning a pectoralis major muscle flap over the implant, and closing the skin and subcutaneous tissue over the muscle flap.

Functional surgery for intractable conditions of the sole of the foot.

Our reasons for preferring local plantar flaps from the same foot for the repair of plantar defects are discussed. Four illustrative cases are shown.