The gracilis myofasciocutaneous flap: vascular anatomy and clinical application.

Unreliable skin perfusion has been reported frequently in the gracilis myocutaneous flap, resulting in moderately high partial flap necrosis. We modified the traditional myocutaneous operative technique by including all available regional fascia and created a myofasciocutaneous flap with increased skin viability. In addition, we defined the arterial anatomy of the flap that contributes to enhanced flap survival. In a cadaver study, blue latex was injected into the external iliac arteries of 11 cadaveric legs and the gracilis myofasciocutaneous flap dissected. Selective ink injection of the pedicle and perforating vessels also was performed in 8 legs. Two additional legs were injected with a barium-latex mixture, cut into 2-cm-thick transverse sections, and radiographed. Dissections demonstrated arterial connections between the pedicle vessel (medial femoral circumflex artery) and fasciocutaneous perforating vessels from the superficial femoral artery. Perforating vessels contribute to an axially oriented fascial network that supplies the overlying skin. Selective ink injections demonstrated the individual primary cutaneous vascular territories for each perforator. Radiographs of 2-cm-thick transverse sections confirmed the presence of arterial connections between the pedicle and the superficial femoral artery perforators. Twelve patients, previously pelvically irradiated, then underwent harvest of 18 large, longitudinally oriented (8-cm-wide, up to 30-cm-long) gracilis myofasciocutaneous flaps. All fascia beneath the skin paddle was taken in continuity with the deep fascia surrounding the gracilis muscle to minimize disturbance of any connecting vasculature held within the fascia. Patients were followed for an average of 12.1 months (range 3 to 31 months). Minor complications related to the flaps occurred in 6 of 12 patients (50 percent), i.e., seromas, mild wound infections, and a partial dehiscence; however, vascularity was excellent with no partial or complete flap necrosis. All wounds healed completely.

Cardiopulmonary bypass used in the resuscitation of eventual organ donors: a case report.

Little has been published regarding cardiopulmonary bypass in the resuscitation of eventual organ donors. One such pediatric donor at our institution provided organs, which have thus far been successful. Pediatric organs have demonstrated usefulness, even when transplanted into adult recipients. Further research will provide data on the utility of organs obtained after cardiopulmonary bypass resuscitation.

Formation of PC12 tumors after transplantation into rat brains: dependence of time course on host age.

Rat pheochromocytoma PC12 cells form tumors when placed into the brains of Sprague-Dawley rats under specific conditions. We now show that tumorigenic potential is regulated by the microenvironment of the developing cerebrum. PC12 cell aggregates were identified in the periventricular or intraventricular spaces within 24 h after injection of cell suspensions into rat brains. In fetal or young neonatal (1-4-day-old) recipient rat brains, these cell aggregates formed large masses within 21 days. The tumor incidence declined in recipient neonates between the ages of 5 and 8 days. In both cases, tumors spread throughout the ventricular system and subarachnoid and Virchow-Robin spaces as they grew. In contrast, tumors were not generated by injections into adult rat brains or by placement of PC12 cell pellets into preformed cavities. Despite the loss of tumorigenicity, surviving cells were present at the injection site. The presence of surviving cells and the ability of another rat cell line (the C6 rat glioma line) to form tumors in adult rat brains suggest that an immune response is not solely responsible for the lack of PC12 tumorigenicity in adult rat brains. We propose that developmentally increasing local concentrations of specific factors (e.g., nerve growth factor of fibroblast growth factor) may also contribute to the suppression of tumor formation in this system.