Videoscopically assisted fascia lata harvest for the correction of recurrent ventral hernia.

Autologous fascia lata tissue transfer is a feasible alternative to reconstruction of the abdominal wall in selected patients. We describe a new technique using minimally invasive technology that allows harvest of the fascia lata graft without the traditional large thigh incision.

Seromuscular patch as an adjunct in reconstruction of the cervical esophagus with free jejunal transfer.

During cervical esophageal reconstruction, an auxiliary piece of seromuscular tissue can be developed based on the same vascular pedicle as the interpositional piece. This segment of vascularized tissue can be used as a reconstructive aid in compromised areas where wound problems may create disastrous complications (e.g., carotid rupture or tracheoesophageal fistula). The proximal bowel anastomosis can be reinforced, an exposed carotid can be covered, or the distal jejunal anastomosis can be circumferentially wrapped. Any skin deficiencies created by placement of the seromuscular sleeve are easily corrected by a split-thickness skin graft.

Management of early human bites of the hand: a prospective randomized study.

A prospective, randomized study was undertaken to determine if mechanical care of early human bites alone is sufficient therapy in the compliant patient or if prophylactic antibiotics (oral versus parenteral) are indicated. Beginning in June of 1985, patients presenting with human bites of the hand were entered into the study if (1) the bite was less than 24 hours old, (2) the patient was free of infection, (3) the bite did not penetrate the joint capsule, and (4) there was no injury to tendon. Forty-eight patients were ultimately segregated into one of three study groups after standardized ER mechanical wound care. Fifteen patients received an oral placebo, with 7 developing infection (46.7 percent). Sixteen patients received an oral antibiotic, and 17 patients received parenteral antibiotics. No infections were found in either of these latter groups. The results statistically substantiate that mechanical wound care alone is insufficient therapy. Oral antibiotics appear to be equal to intravenous antibiotics for prophylaxis. From a cost-benefit standpoint, vigorous cleaning, debridement, and coverage with a broad-spectrum oral antibiotic are adequate care for an uncomplicated bite in the compliant patient.

Applications and complications of tissue expansion in pediatric patients.

We have reviewed our experience with 61 tissue expansions in 49 pediatric patients. Indications for expansion included traumatic alopecia or soft tissue loss, myelomeningocele, congenital hairy nevi, burn scars, and other less common defects. The complication rate, necessitating interruption of expansion, was 25%. This occurred more frequently with scalp and burn reconstruction. Nevertheless, 86% of patients ultimately achieved good to excellent results.

Use of skin expansion in separation of conjoined twins.

Successful separation of conjoined twins attached at the thorax and upper abdomen was greatly facilitated by preliminary skin expansion. Recognized problems encountered in traditional methods of wound closure at the separation (including wound breakdown, infection, ventilatory compromise, and obstruction to venous return resulting from tight abdominal skin closure) were avoided through the use of this technique. Technical aspects of expander placement and inflation in conjoined infants are discussed. Skin expansion may represent a major advance in wound management of conjoined twins after surgical separation. This is the second report on the use of skin expansion in conjoined twins and the first involving thoracopagus (twins conjoined at the chest and abdomen).

Magnetic resonance imaging for detection of arterial and venous occlusion in canine muscle flaps and bowel segments.

Magnetic resonance imaging (MRI) was performed on 16 muscle flaps and eight jejunal segments in dogs to assess its usefulness in detecting vascular occlusion. Arterial or venous occlusion was carried out in 11 muscles and six bowel segments, with the remaining sham flaps serving as controls. Imaging was performed over 2 hours using a spin echo pulse sequence with T2 weighting. Arterial occlusions in muscles resulted in T2 values 15-30% higher than controls, while venous occlusion produced T2 values 55-75% higher than controls. Differences became significant (p less than 0.05) at 10 minutes after venous occlusion and at 35 minutes after arterial occlusion. Differences between occluded and control bowel segments, although demonstrating a similar trend, failed to reach statistical significance in this preliminary study. The authors conclude that magnetic resonance imaging may be a valuable method for early detection of venous and arterial occlusion in muscle flaps. Further study may also demonstrate this technique to be useful in the diagnosis of ischemic bowel.

Management of ganglion cysts of the hand by simple aspiration.

A prospective study has shown that aspiration treatment of ganglion cysts of the wrist and hand can safely remove 85% of these tumors if one, two or three separate treatments are administered. There is a decided cost savings when this treatment is compared with surgical excision, even when the expense of surgical excision for aspiration treatment failures is added to the equation.

Sterile flexor tenosynovitis of the hand: a report of three cases.

Three patients presented with classic signs and symptoms of acute bacterial tenosynovitis. In each instance, the inflammatory condition was found to be sterile. The patients had no other known systemic diseases associated with sterile inflammation. Two patients had digital sheath exploration. The third patient had diagnostic digital sheath aspiration. Hand elevation, rest, and prophylactic antibiotics resulted in complete resolution in all three patients. One digital sheath biopsy specimen submitted for electron microscopy showed no evidence of a viral etiology.

Treatment of severe leg wounds with muscle and musculocutaneous flaps.

The ten-year experience with difficult wounds of the lower extremity at the Atlanta Veterans Administration Medical Center is reviewed in order to evaluate the use of the muscle and musculocutaneous flap as regional and free-tissue transfers. Twenty-four patients had chronic wounds and five had acute bony and soft-tissue injury. A total of 34 procedures, including 18 regional flaps and 16 microvascular free-tissue transfers, were performed with an overall success rate of 74%. Regional transfer succeeded in 12 (67%) of 18 cases. Free-tissue transfer succeeded in 13 (81%) of 16 cases. Experience with regional muscle transfer has shown the gastrocnemius and soleus muscles to be excellent choices for reconstruction of the proximal and middle third of the lower leg. Free microvascular transfer of the latissimus dorsi, gracilis, and rectus muscles has provided reliable closure in wounds that are chronically infected with major bony and soft-tissue loss in the distal third of the lower extremity.