Satisfaction with sex and erection hardness: results of the Asia-Pacific sexual health and overall wellness survey.

The Asia-Pacific Sexual Health and Overall Wellness (AP SHOW) survey assessed sexual satisfaction and health and the association with erection hardness in 13 Asia-Pacific countries/regions. Adults aged 25-74 years who had sexual intercourse > 1 time in the past 12 months answered Internet surveys or participated in street-intercept interviews. Data were weighted by demographics and country/region size. Of 3957 (men, n=2016 and women, n=1941) respondents, 41% of men and 34% of women were completely or very satisfied with sex. Satisfaction with sex was linked to satisfaction with life priorities and overall health. Few respondents (men, 38% and women, 26%) were very or completely satisfied with erection hardness. Optimal erection hardness was reported by 45% of men (48% of women regarding their partners' erections). Erection hardness was associated with increased frequency of sex and importance of and satisfaction with erection-related elements of men's sexual performance. Approximately half of respondents (men, 57% and women, 47%) were at least moderately interested in improving the sexual experience. Most Asia-Pacific respondents were less than very satisfied with sex. Satisfaction with sex was associated with satisfaction with life priorities. Erection hardness was associated with sexual satisfaction and activity, satisfaction with life priorities and overall health.

Microvascular free flap reconstruction: the Kwong Wah Hospital experience.

The early experience of free flap reconstruction in a regional plastic surgery unit was reviewed. Forty-seven free flap surgical procedures were performed for 46 patients during a 2-year period from 1 January 1995 to 31 December 1996 in a regional plastic surgery centre that specialises in head and neck, and breast reconstruction. Twenty-six free transverse rectus abdominus myocutaneous flaps were performed for 25 breast cancer patients. Head and neck reconstructions were mostly performed after surgical ablation of oral and pharyngeal cancers. A variety of free flaps were used, including fibular osteocutaneous flaps, radial forearm fasciocutaneous flaps, jejunal grafts, and rectus abdominus musculocutaneous flaps. Lateral arm fasciocutaneous and scapular fasciocutaneous flaps were used for three patients who had foot ulceration. The success rate of free flap transfer was 94%. Flap loss was found in three patients who had pedicle complications that were due to traction, kinking, and thrombosis. There was no mortality in the series. The most common morbidity was wound infection. Two thirds of the free flap transfers were uneventful. Seven (15%) patients had major complications that required re-operation. Institutional support was essential for the development of microvascular surgery.

A multidisciplinary approach to salvage the 'unsalvageable' foot.

Extensive tissue loss in a weight-bearing area of the foot almost invariably heralds limb loss. We report on a 74-year-old man with diabetes mellitus who had an ischaemic foot that was affected by prolonged pressure, which resulted in a necrotic heel. After two sessions of debridement, the calcaneum became exposed. Amputation was initially suggested but was refused by the patient. The foot was subsequently salvaged by staged operations. The first operation was a femoro-anterior tibial bypass using an autogenous saphenous vein to revascularise the foot. This was followed by debridement and attachment of a free subscapular flap to cover the defect 2 weeks later by a plastic surgeon. After 85 days of rehabilitation by physiotherapy and education of foot care by a podiatrist, the patient was discharged home and was able to walk with a walking-stick. This multidisciplinary approach

The management of intermittent claudication.

Intermittent claudication is a common symptom. It is a marker of generalised antherosclerotic disease and may herald other cardiovascular catastrophes. The aim of management is to reduce the total cardiovascular morbidity and mortality. The functional status and quality of life of severely affected patients can be improved by endovascular and surgical interventions.