Two-dimensional color Doppler imaging for precision preoperative mapping and size determination of TRAM flap perforators.

We have shown a new noninvasive modality for imaging periumbilical vascular perforators in the TRAM flap by using the two-dimensional color Doppler probe. This allows the precise preoperative planning of the TRAM flap to include the largest arterial perforators. Application of this technology may improve our results in TRAM flap breast reconstruction.

A latissimus/scapula combined myo-osseous free flap based on the subscapular artery used for elbow reconstruction.

A myo-osseous free tissue transfer based on the subscapular artery provided elbow reconstruction after a shotgun injury. This reconstruction offers a durable and stable form of soft tissue and bone, preventing some arm function. The tailoring of the latissimus dorsi muscle and the modification of not dividing the teres major in the microvascular harvest offers donor site functional preservation. Although the dissection is more tedious, preservation of the teres major permits minimal donor morbidity, maintenance of function, and the ideal reconstruction of soft tissue and bony loss.

Epidermal nevus: surgical treatment by partial-thickness skin excision.

A child with epidermal nevus, systematized, is reported in which diffuse areas of pruritic and bleeding tissue were treated by partial-thickness skin excision, a technique reported to have been successful in other forms of benign dyskeratosis, such as psoriasis. At age 5 years, a test region of the anterior thigh was treated and remained disease free with an acceptable scar. At age 8 years, this technique was applied to the back, buttock, calf, and thigh. While the areas remain disease free, they have, unfortunately, healed with hypertrophic and keloid scars.

Vascular outflow resistance and angiographic assessment of lower limb arterial reconstructive procedures.

In an attempt to predict early graft occlusion secondary to poor distal run-off, the outflow resistance was measured intra-operatively and compared with the intra-operative angiogram in 50 patients undergoing lower limb bypass procedures. With arterial inflow occluded, 60 mL of plasmalyte was infused via a catheter and the resultant pressure generated in the graft was measured through a second catheter connected to a pressure transducer and recorder. Using the infusion rate and integrated pressure value, outflow resistance was calculated. High resistance measurements were defined as grafts with outflow resistance greater than 1.1 mmHg/mL per min, low measurements were defined as values less than 0.5 mmHg/mL per min and intermediate measurements were those in the range 0.5-1.1 mmHg/mL per min. Angiograms were classified independently of resistance measurements by scoring the numbers of run-off vessels crossing the ankle and stenoses, with subsequent assignment of the patient to one of three groups with either low, intermediate, or high probability of graft failure. Early graft failure was defined as cessation of graft function within 3 months of surgery. Early graft failure occurred in both cases with high outflow resistance and in seven of 44 with low outflow resistance. Of these nine occluded bypasses, six had been placed in the high probability of occlusion category on angiographic appearance and three in the intermediate category. Assessment of angiographic appearance and prediction of patency on a prospective basis had a sensitivity rate of 67% and a specificity rate of 78%. The corresponding sensitivity and specificity rates with resistance measurements were 22% and 100%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)