Gravitational retrograde venous perfusion--a technique for limb extremity salvage when microvascular arterial repair is not possible.

Occasionally in plastic surgery immediate microvascular arterial repair is not possible. This occurs when distal vessels in the extremities are extensively damaged or thrombosed. If there is some intact venous anatomy it may be possible to maintain adequate perfusion for viability using a gravitational retrograde venous perfusion technique, until collateral arterial supply develops. We have used this technique successfully in three cases--blast injury to the hand, extensive digital thromboembolism and a devascularised sole of foot. This technique involves elevating and lowering the limb at 30 min intervals for 5-7 days. Elevation results in venous drainage and pallor of the limb and dependency results in venous congestion confirming retrograde venous flow. In the authors' experience ischaemic necrosis was inevitable in these cases without the use of this new technique. We have attempted to explain this phenomenon by way of retrograde venous perfusion in association with high venous pressure and high oxygen tension.

Description of site-specific morphology of keloid phenotypes in an Afrocaribbean population.

By examining the keloid scars of 211 Afrocaribbean patients presenting to the Plastic Surgery unit in Kingston, Jamaica, we have described site-specific morphologies of scarring; keloid disease is not a homogenous biological entity. All cases conformed to clinical criteria for diagnosis of keloid scarring: 369 keloid scars were present in 137 females (2-83 years; mean 29.6 years; SD+/-14.9 years) and 74 males (5-90 years, mean 29.5 years; SD+/-15.0 years). Morphologies were specific to each anatomical site: trunk scars (n=45,12.1%) were geometrically shaped with clear margins or irregular in outline, surface and margin; back single scars were well-demarcated botryoid but multiple scars were butterfly-shaped, spheroidal and irregular; chest scars (n=72,20.1%) were butterfly or nonbutterfly shaped found most commonly in the midsternal line; upper limb scars (n=57,15.3%) mostly in the deltoid region (propeller shaped) or elsewhere nodular, linear to irregular; ear (n=85,23%) commonest site being the lobe, having reniform to bulbous shape; face and neck (n=60,16.2%) scars were firm nodular to hard; posterior auricular scars were either horizontal and oblong-shaped or vertical and reniform in outline; scalp scars (n=11,2.8%) were commonest in the occipital area varying from small papules to large plaques; lower limb scars (n=39,10.5%) varied from propeller, butterfly, petalloid to dum-bell-shaped. Three plantar and eight pubic keloids were rare findings. Recognition of different morphological phenotypes is necessary in understanding genotypic predisposition and aiding diagnosis, treatment and prognosis of keloid scars.