Migration of silicone gel to axillary lymph nodes after prosthetic mammoplasty.

Foreign-body reaction to material optically resembling silicone gel was evident in an axillary lymph node of a patient eight years after subcutaneous mastectomy for fibrocystic disease and breast reconstruction with a silicone gel-filled prosthesis. The lymph nodes. was removed as a component of a radical mastectomy for adenocarcinoma and Paget's disease of the nipple that had developed in the residual breast tissue and preserved nipple. Silicone gel may "bleed" through a structurally intact prosthetic envelope and subsequently migrate to regional lymph nodes

Paget's disease of the breast after subcutaneous mastectomy and reconstruction with a silicone prosthesis.

Eight years after subcutaneous mastectomy for extensive fibrocystic disease, a patient developed Paget's disease of the breast associated with an underlying infiltrating duct cell adenocarcinoma. We emphasize the need for meticulous examination of the subcutaneous mastectomy specimen and long-term follow-up examination of the breasts in patients treated with subcutaneous mastectomy.

The scrotal myocutaneous flap.

The scrotum is a thermoregulatory, well-vascularized structure formed by skin and nonstriated muscle with unique elastic properties. This makes it an ideal source of tissue coverage for problem wounds in its vicinity. Two patients in which scrotal musculocutaneous flaps were used are reported: one, a paraplegic, with a recurrent ischioperineal decubitus ulcer, and another with an ulcer of the penis with exposed Dacron graft previously placed to treat Peyronie's disease. After reviewing the anatomy of the scrotum and the existent literature, we studied scrotal vascularity in a fresh specimen by transillumination. Based on our experience, we conclude that this flap is easy to perform, reliable, and very useful for wounds around the perineal region.

The Dacron EXS graft: patency in femoropopliteal and femorotibial surgery.

Choice of the most suitable synthetic graft for use in peripheral vascular surgery in the lower extremity is controversial. The knitted Dacron Velour Externally Supported (EXS) graft is a recently developed vascular prosthesis which promises to be effective and durable for use in femoropopliteal and femorotibial bypass surgery. Between 11/80 and 7/83, 56 grafts were implanted in 49 patients. Eight patients were lost to follow-up, leaving 46 grafts for which patency data was determined. The distribution of sites of distal anastomosis was as follows: 25% were to the popliteal artery above the knee, 50% were to the popliteal artery below the knee, and 25% were to the tibial or peroneal arteries. Graft occlusion was determined by loss of Doppler pulses, return of ischemic symptoms, or failure to visualize flow in angiograms. Overall cumulative patency rates, calculated by the life table method, were as follows: 81% at 6 months; 76% at 1 year; 68% at 2 and 2 and 1/2 years. There was no statistical difference in patency between above-knee and below-knee popliteal artery bypasses. Moreover, patency rates were similar for diabetics vs. non-diabetics, for patients operated on for claudication vs. limb salvage; and for patients who had sympathectomy vs. no sympathectomy. Patency rates for bypass to the tibial and peroneal vessels in this series were better than recently reported in the literature for other synthetic prostheses; i.e. 75% at 4 months and 1 year; 56% at 2 and 2 and 1/2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Reconstruction of the left innominate vein in a patient with invasive thymoma undergoing coronary artery bypass surgery.

This is a report of a case in which a patient undergoing coronary artery bypass surgery was found to have a thymoma invading the left innominate vein without obstructing it. The tumor was removed, the left innominate vein reconstructed with ringed PTFE graft and the coronary revascularization performed successfully. The surgical treatment adopted the considerations involving this particular patient and the literature of similar cases is reviewed and briefly discussed.

Pressure ulcer of the breast after subcutaneous mastectomy and reconstruction with prosthesis.

A 28-year-old woman underwent bilateral subcutaneous mastectomy and immediate reconstruction with silicone gel-filled prostheses. Three months after surgery, she developed an acute pressure sore on one side, owing to prolonged pressure of the insensitive breast against a hard surface. This complication is presented, the literature on the subject is reviewed, and brief considerations and recommendations are made.