Preoperative and postoperative evaluation of latissimus dorsi myocutaneous flap vascularization by color flow duplex scanning.

At the Plastic and Reconstructive Surgery Department of the University of Perugia, 104 patients have been examined by color flow duplex scanning in order to study latissimus dorsi vascular supply before and after surgical procedures. This noninvasive ultrasound technique provides a precise and accurate measurement of blood flow velocity (15 cm/s) and volume (27 ml/min) within the thoracodorsal artery, which represents the vascular pedicle of the flap, and it allows us to detect the exact location of the perforating branches with their cutaneous distribution. This preoperative evaluation, pointing out vascular pathologies that contraindicate use of the latissimus dorsi flap, can be considered a great help for the reconstructive surgeon in the choice of the most suitable operation, and it can surely lead to a significant decrease in postoperative graft failure rates.

[Aneurysm of the innominate artery: pathology simulating pulmonary neoplasm]. / L'aneurisma dell'arteria anonima: una patologia simulante una neoplasia polmonare.

A chance case of aneurysm of the brachiocephalic trunk suggested a review of the literature on this rare pathology. Stress is laid on the possible asymptomaticity of the lesion and on its frequent chance observation in chest X-rays; the diagnostic procedure, at times particularly complex, may not lead to decisive results but the possibility of aneurysm of the brachiocephalic trunk must be borne in mind in any case so as to avoid gross diagnostic and therapeutic errors.

[Cryosurgery in the treatment of condylomatosis]. / La criochirurgia nel trattamento della condilomatosi.

The authors report their personal experience of the treatment of condylomas in both male and female patients using cryosurgery. The temperature of -80 degrees C which can be obtained using hyperdry nitrogen monoxide equipment allow radical treatment to be performed without pain in an outpatient setting without general or loco-regional anesthesia. The characteristics of this treatment allow patients to be regularly monitored, thus eliminating all signs of recidivation of those lesions which were too small to be seen at the start of treatment. The patient is considered cured after an interval of approximately 30-40 days after the disappearance of all condylomas.

[Cryosurgery in the treatment of verrucae]. / La criochirurgia nel trattamento delle verruche.

The paper reports the A. experience of 1460 cases of verrucae treated with cryosurgery. A hyperdry nitrogen monoxide method was used which enables a temperature of approximately -80 degrees C to be obtained. The large number of cases treated allowed the A. to present a statistical picture which was highly significant with regard to the mean number of applications, mean freezing time and, lastly, the mean healing time for different types of verrucae. The study confirms that cryosurgery is the elective treatment for this type of pathology.

[Use of superior musculus rectus abdominis flap in the reconstruction of the thoracic wall]. / L'impiego del T.R.A.M. Superiore nella ricostruzione della parete toracica.

The paper reports the Author's experience of the use of the muscle-skin flap of the upper rectum homolateral to the abdomen in the reconstruction of defects of the anterior thoracic wall following cancer surgery or radionecrosis, and compares it to that using other flaps (lower T.R.A.M., Latissimus dorsi, etc.). The well known anatomy of the flap, which is fed by the upper epigastric artery, also requires a precise surgical technique to isolate the muscular fibres without damaging vascularisation, a fundamental requisite for the vitality of the flap itself. Equally important for the vitality of the operation is a detailed study of the skin above the flap in patients treated with radiotherapy. The common and specific (epigastric hernia) complications of this operation are also examined, together with the precautions used by the Authors to prevent their occurrence.

[Pre- and postoperative color Doppler ultrasonography of myocutaneous flaps in reconstructive surgery of the breast]. / L'eco color-Doppler nello studio pre e postoperatorio dei lembi miocutanei in chirurgia ricostruttiva della mammella.

The authors present their experience in the study of blood supply of flaps. The machine used to study both pre and postoperatively the myocutaneous flap is the echo-color Doppler, a brand new device which has recently been used in investigating the morphology and the blood supply. The use of such method has provided us with the following information: detailed ultrasound structure of the skin, subcutaneous and muscular tissues of the examined flap; localization of vessels within the flap; size of the vessel in its whole length; quality and speed of both the arterial and venous flow. Such information is very important for the surgeon to plan in detail the reconstruction by knowing the blood supply of myocutaneous flap.

Colour flow duplex scanning: an accurate, non-invasive technique for preoperative evaluation of the vascular supply of the rectus abdominis myocutaneous flap.

Forty patients were examined with colour Doppler to study the vascularization of rectus abdominis myocutaneous flaps before operations. The accuracy of this non-invasive ultrasound technique allowed us to describe the characteristics of the blood flow, including volume and velocity, diameter of vessels and their transverse section area within the epigastric arteries which supply the superior and inferior vascular pedicles of the flap. Vessels are drawn on the skin surface so that the flap can be more precisely and rapidly dissected. We are now using colour Doppler to assess variations in the diameter of vessels and in other variables of blood flow within the vascular pedicle of the transferred flap. These evaluations before and after operation are a great help to the reconstructive surgeon in the choice of operation and will lead to an appreciable reduction in postoperative morbidity.

[Use of Doppler color ultrasonography in the microsurgical treatment of idiopathic varicocele]. / L'utilizzo dell'eco-color-Doppler nel trattamento microchirurgico del varicocele idiopatico.

The aim of this paper is to evaluate the role of Doppler and echo color-Doppler in the microsurgical treatment of varicocele. Since December 1993, 87 consecutive patients underwent microsurgical treatment of varicocele. The study demonstrates that Doppler and Color-flow-Duplex scanning provide an accurate, non-invasive method to identify the position of accessory spermatic veins, evaluating at the same time the flow characteristics of the microsurgical anastomosis.