Circumferential torsoplasty.

The abdominal deformities remaining after massive weight loss of 30% or more body weight often are not satisfactorily corrected by standard abdominoplasty techniques. Redundant lateral flank and hip rolls may in fact be accentuated by the operation. Accordingly, a circumferential torso excision was designed by the senior author and utilized for 7 patients during the past two years. This technique dramatically reduces the lateral flank and posterior tissue rolls to improve the operative results. Contour improvement of the buttocks and lateral thighs is produced as well. We employ a four blade propeller pattern of fascial plication centered on the umbilicus which tightens the abdominal fascia in both vertical and horizontal dimensions. Details of patient selection, operative technique, post-operative management and results are presented. Complications have been minimal and satisfaction of both patients and surgeons significantly enhanced.

The gastrocnemius muscle as a free-flap donor site.

Despite the fact that the pedicled gastrocnemius flap has been used clinically for almost two decades, precise data on its neurovascular anatomy are lacking. A detailed knowledge of the neurovascular anatomy of this flap may encourage its more extensive use as a donor site by the means of microvascular free-tissue transfer. The femoral or popliteal artery in 27 fresh cadavers was injected with radiopaque contrast material to study the gross vascular supply of 54 medical and 50 lateral gastrocnemius muscles. The intramuscular vascular anatomy also was analyzed in 29 medial and 24 lateral gastrocnemius muscles using x-ray technique. Depending on the number of the sural arteries that supply the gastrocnemius muscle, flaps were classified as type 1 or type 2. Type 1 muscle bellies (lateral or medial gastrocnemius muscle belly) are supplied by one sural artery, while in type 2 muscles two arteries supply one muscle belly. Eighty-five percent of medial and 84 percent of lateral gastrocnemius muscle bellies had single vascular pedicles (type 1). The point of origin of the sural artery(s) permitted us to further classify the blood supply to the muscle bellies as subtypes A, B, and C. Intramuscular vascular anatomy is characterized as either a single vessel (dominant type) or two vessels (nondominant type). A single motor nerve, from the tibial nerve, accompanied the primary vascular pedicle into each muscle belly. When there were two vascular pedicles supplying one muscle belly, only one motor nerve accompanied the major pedicle.(ABSTRACT TRUNCATED AT 250 WORDS)

The quantitative study of the use of dextranomer in the management of infected wounds.

Open wounds using quantitative cultures and dextranomer were analyzed. Dextranomer has been shown to be an extremely effective local wound care agent, provided that the wound has an adequate blood supply and complete removal of the used dextranomer is achieved. Under these circumstances, dextranomer provides a rapid and effective means for the treatment of open, exudative wounds.

Growth in revascularized bone grafts in young puppies.

The results of microvascular transfers of growing ulnas in puppy forelegs have been studied. These transfers were carried out both heterotopically and orthotopically. The growth in the revascularized bone grafts has been compared to that in heterotopic, nonvascularized ulna transfers and to normal ulnar growth. The growth in the vascularized bone grafts was significantly greater than in the nonvascularized grafts, but significantly less than in normal ulnar growth. A metaphyseal contribution to the blood supply of the growing portion of long bones is suggested.

Replacement of dislodged biliary catheters using angiographic techniques and the fiberoptic bronchoscope.

A method for replacing biliary tract catheters with angiographic techniques is described, along with clinical experience in its use. Situations which at first seem hopeless may in fact be simply resolved as in the first instance. We found the fiberoptic scope to be useful when the cannulation tract involves a segment of bowel.

Biomedical cost of low-level flight in a hot environment.

The physiologic and performance effects of low-level reconnaissance flying in hot environments were documented and quantitated. RF-4C pilots and weapons system operators were studied in hot and cool seasons during both high and low missions to distinguish environmental temperature from flight level effects. ECG, sternal and thigh skin temperatures, and cockpit temperature at helmet level were monitored continuously. Body weights, oral temperatures, sweat Na/K ratios, and urine electrolytes, steroids, and catecholamines, as well as sleep and fatigue scores, were measured. Mission performance was assessed using photo target acquisition scores. RF-4C aircrews are exposed to moderate heat stress and acute dehydration (1.2% over 90 min) during low-level summer flights were cockpit temperature occasionally exceeded 50 degrees C. Photo target scores indicated that the potential for crew error was increased, and that the margin of safety was accordingly decreased, during such hot missions. The RF-4C cockpit air conditioning system proved inadequate.