Necrotizing enterocolitis, surgical experience.

Between January 1988 and December 1994, 29 cases of necrotizing enterocolitis (NEC) required surgical management. There were 15 males and 14 females. The gestational age range was 24-38, average 32.7 weeks and body weight range was 565-4500 grams, average 1,680 grams. Necrotizing enterocolitis developed within two weeks of age in 55% of the cases, between two and four weeks in 34% and beyond four weeks in four cases (14%). Pneumoperitoneum was the commonest indication for surgery (55%) of cases, followed by failure of response to medical treatment. The commonest surgical procedure was resection of the gangrenous bowel with creation of an enterostomy for the segmental disease in 15 cases (50%) and resection with primary anastomosis in six cases (20%). Four cases (14%) had NEC totalis for which drainage alone was done, and two cases had external drainage alone. Survival rate was 72%.

Aerodynamic assessment of the results of pharyngeal flap surgery: a preliminary investigation.

Voice-quality (i.e., nasality) judgments are commonly used to evaluate the results of pharyngeal flap surgery. However, these are subjective judgments of questionable validity and reliability. This project was designed to systematically evaluate the outcome of pharyngeal flap surgery utilizing objective, quantifiable physiologic (pressure-flow) information. Thirty-one patients who had undergone pharyngeal flap surgery were selected. Pressure-flow measurements and perceptual judgments of speech were obtained following surgery. Results indicated that using pressure-flow criteria, only 52 percent of the outcomes were considered successful. Results also indicated that 35 percent of the cases were characterized by substantial nasopharyngeal airway obstruction. In the present study, these findings, along with the related perceptual phenomenon of denasality, were considered unsuccessful. Finally, results suggest that aerodynamic measurements can be used to assess other surgical techniques designed to correct velopharyngeal insufficiency.

Anorectal continence following sphincter reconstruction utilizing the gluteus maximus muscle: a case report.

Rectal incontinence following pull-through procedure for high imperforate anus remains a difficult problem. Based on recent knowledge of the segmental neurovascular supply of the gluteus maximus muscle, the inferior half of the muscle on both sides was used for anorectal sphincter reconstruction on a 10-year-old boy who was totally incontinent following a pull-through procedure for a high imperforate anus. The technique of constructing this sphincter is simple and utilizes principles of muscle tendon transfer without jeopardizing the function of gait. Furthermore, the gluteus maximus muscle, being an accessory muscle of anal continence, is an ideal structure for this reconstruction. Colostomy can be prevented with the use of good preoperative bowel preparation and a constipating program for 1 week postoperatively. The results are directly related to the success of the operative procedure, and the maturity and degree of motivation of the child to undergo bowel-control training.

Heel coverage by a plantar myocutaneous island pedicle flap.

Defects of the heel represent a difficult reconstructive problem. Previously described methods have not always been ideal especially for the posterior heel. The weight-bearing functional requirements of the heel tissue over the calcaneus are a sensitive, well padded, durable cover. The technique of choice should provide local similar tissue plus involve a single reliable operative procedure. Skin grafts placed on the calcaneus or on a muscle transposition flap, such as the flexor digitorum brevis, abductor hallucis, or abductor digiti minimi muscle, provide a thin, insensitive, and dissimilar surface. The cross-foot, cross-leg, cross-thigh, and buttock flaps provide more bulk and thicker skin. These flaps involve a prolonged hospitalization, multiple procedures, increased morbidity, and insensitive tissue. The dorsal foot island flap and microvascular free flaps are a one-stage procedure with less morbidity. The donor tissue is still too dissimilar to provide the protection and durability to this area. Random plantar flaps have provided a functional replacement with similar tissue having adequate sensation. However, these random flaps are not always reliable, have limited motion, and are limited usually to small defects. Recently the myocutaneous flap has been proposed using the flexor digitorum brevis muscle. This neurovascularized flap is larger and more reliable. Our dissection study of plantar tissue using microlatex injected feet has expanded the plantar flap for easier heel coverage and provided a predictable flap area. By mobilizing the pedicle proximally to the posterior tibial artery, the flap has an expanded coverage arc. Thus the heel is covered with a sensitive and durable tissue to allow weight bearing, frictional trauma, and ambulation.