The hemodynamics of simple and sequential iliofemoral grafts in dogs three months after insertion.

Hindlimb pressures and flows were measured 3 months after insertion of simple and sequential iliofemoral grafts in the hindlimbs of dogs to determine which type of graft provides the highest blood flow under resting and vasodilated conditions. Under resting conditions, the sequential graft had 94 percent greater distal blood flow than the simple graft. The pressure gradients across the grafts were comparable. When the hindlimb was dilated by intra-arterial injection of adenosine, both distal and proximal blood flows increased in both graft types. The sequential graft, however, provided higher proximal flows than the simple graft although the pressure gradients were increased by the same magnitude across both graft types. Therefore, our data indicated that 3 months after insertion, sequential iliofemoral grafts provide improved vascular flows compared with simple grafts under resting and dilated conditions.

Complications of controlled tissue expansion in the pediatric burn patient.

All patients at the Burn Institute reconstructed with tissue expanders between June of 1984 and June of 1987 were included in this review. There were 122 expanders used in 77 patients. Complications were defined as "absolute" (23 of 122 expanders, 20 percent) if they resulted in loss of expanders or additional surgery or none of preoperative plan was satisfied or "relative" (14 of 122 expanders, 11 percent) if they included spotty alopecia or alopecia greater than 50 percent or the operative plan only partially satisfied, reflecting poor judgment. The most common absolute complication was prosthetic exposure secondary to wound dehiscence occurring in the scalp area. Complications relative to specific anatomic areas were neck and face, 2 of 20 (10 percent); lower extremity, 1 of 4 (25 percent); trunk, 0 of 6 (0 percent); and scalp, 20 of 92 (22 percent). We feel that this high complication rate in the use of tissue expanders may be unique to the pediatric burn patient. Knowledge of indications for use and potential complications is essential to add this entity to the armamentarium of the burn reconstructive surgeon.

The axillary mass in occult breast carcinoma. Case reports and overview.

The presentation of mammary carcinoma as an axillary mass is quite rare (0.5%). "Occult" breast cancer will be defined as nonpalpable breast carcinoma presenting as an axillary mass. This article presents two such patients and reviews the available literature. The patients are of similar age and have breast lesions at similar sites as "nonoccult" breast carcinoma. However, the prognosis is somewhat better than that of "nonoccult" breast cancer perhaps due to early histopathology and small primary size. This subject is reviewed in terms of case reports, clinical findings, radiographic findings, pathologic findings, management, treatment, prognosis, and a flowchart for surgical work-up.

A critical review of amputation in vascular patients.

A study was made of 53 patients who underwent amputation for peripheral vascular disease over a 5-year period at West Virginia University Medical Center. The follow-up period ranged from 1 to 6 years. Data concerning operative deaths, risk factors, use of prosthetic devices, and ultimate self-sufficient living were obtained. The functional outcome for this group of patients was encouraging with modern prosthetic fitting and social rehabilitation. Approximately 75% of the patients were returned to a useful life with a prosthetic limb or in a wheelchair. Amputation is a less desirable alternative than successful revascularization, but with the prostheses available today, amputation does not foreshadow a dismal existence.