RESUMO
No current method of flap monitoring is ideal for use in all types of free tissue transfers. No method provides objective, easily communicated data that is identical in all types of transfers. In particular, reliable monitoring of buried transfers has proved difficult with available methods. The rat anterior thigh flap based on the external iliac vascular pedicle was introduced by us as a model of deep free tissue transfer. Four sets of 10 flaps were raised in the following groups: Group A (control), Group B (arterial occlusion), Group C (venous occlusion), and Group D (arterial and venous occlusion). Postoperative muscle flap pH was measured with a micro-pH electrode (1.2 mm) and correlated with arterial blood gas. Results showed excellent correlation of flap and serum pH over time (mean flap pH, 7.28; mean serum pH, 7.30). Arterial occlusion produced a rapid drop in flap pH of 0.66 pH units at 1 hour. Venous occlusion pH drop was 0.27 pH units at 1 hour, 0.53 pH units at 3 hours. Arterial and venous occlusion produced a pH drop of 0.55 pH units at 1 hour. The most rapid rate of pH drop occurred immediately after vessel occlusion. We have used continuous pH monitoring in 21 free tissue transfers for up to 84 hours after surgery. PH values remained constant in each transfer (range, 7.20-7.50; grand mean, 7.35). There was one flap failure among the monitored group of flaps, which was predicted by pH drop before loss of Doppler pulse.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Monitorização Fisiológica , Retalhos Cirúrgicos , Adulto , Animais , Gasometria , Membro Posterior , Humanos , Concentração de Íons de Hidrogênio , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Ligadura , Masculino , Monitorização Fisiológica/métodos , Músculos/irrigação sanguínea , Músculos/metabolismo , Músculos/patologia , Ratos , Ratos Sprague-Dawley , Fluxo Sanguíneo RegionalRESUMO
Hemangiomas of the genitalia are extremely rare. A hemangioma is self-limited and usually resolves spontaneously, therefore conservative treatment is generally recommended. However, genital hemangiomas may require surgical treatment if they become symptomatic. Herein we report a case of hemangioma of the penis and scrotum requiring surgical excision. The natural history and alternative treatments of hemangiomas are described.
Assuntos
Neoplasias dos Genitais Masculinos/cirurgia , Hemangioma/cirurgia , Neoplasias Penianas/cirurgia , Escroto , Neoplasias dos Genitais Masculinos/complicações , Humanos , Lactente , Masculino , Neoplasias Penianas/complicaçõesRESUMO
Three cases of hand injury caused by meat grinders are presented. All 3 injuries involved the dominant hand and resulted in varying degrees of deformity. Two of the 3 patients arrived in the emergency room with the injured hand still firmly wedged in the meat grinder. Although these injuries continue to prove very mutilating, maximum restoration of the injured hand can be accomplished by careful extrication, followed by preservation and reconstruction of all viable tissues. Perioperative antibiotics and wound irrigation with antibiotic solution are recommended. Microsurgical technique can be of value in treating selected patients.
Assuntos
Amputação Traumática/cirurgia , Traumatismos da Mão/cirurgia , Adolescente , Adulto , Amputação Traumática/etiologia , Feminino , Traumatismos dos Dedos/etiologia , Traumatismos dos Dedos/cirurgia , Traumatismos da Mão/etiologia , Humanos , Masculino , MétodosRESUMO
An experimental dorsal rat skin flap which produces a consistent pattern of necrosis is described. As judged by the area of necrosis in this flap, short post-operative courses and several vasodilator agents failed to increase flap survival. However it is not possible to conclude from this that those agents did not influence small vessel blood flow. Necrotic flaps in rats may not be the most appropriate models in which to test the effect of vasodilator agents.
