Omental transfer for salvage of the moribund lower extremity.

Use of omental flaps is well documented in soft tissue reconstruction of the head and neck, chest wall, and abdomen. Three cases of omental transfer for soft tissue reconstruction of the lower extremities are presented. In two patients, free vascularized omental flaps were used to cover deep soft tissue defects over the lower leg and in one patient, a pedicle flap was used to cover a deep groin defect extending into the hip joint. In all patients, use of an omental graft allowed revascularization and subsequent wound healing with good cosmetic results.

Large diameter expanded polytetrafluoroethylene grafts for infrarenal aortic aneurysm surgery.

The performance of an expanded polytetrafluoroethylene (ePTFE) graft used for aortic aneurysm replacement was evaluated. ePTFE grafts were implanted in 241 patients undergoing infrarenal abdominal aortic aneurysm (AAA) repair. Sixty patients were operated as emergencies for aneurysm rupture and 181 electively. One hundred and fourteen bifurcated and 127 tube grafts were inserted. The transperitoneal approach was used in 64 cases and the remainder were placed using a retroperitoneal approach. There was a one-month mortality of 2.8% in elective and 20% in emergency cases. Median follow-up was 26 months. Specific graft complications included one infected graft resulting in a graft-enteric fistula. No graft rupture, degeneration, dilatation, pseudoaneurysm or late graft limb thromboses were observed in up to 7 years of follow-up. The aortic ePTFE prosthesis demonstrated satisfactory performance over the period studied.

Five-year survival following chemotherapy of non-small cell lung cancer.

Five-year survival of patients with inoperable non-small cell lung carcinoma is rare. We report a patient with inoperable large cell lung carcinoma who is apparently cured after receiving a course of combination chemotherapy. As the primary treatment of inoperable non-small cell carcinoma, we recommend combination chemotherapy over radiation therapy because: Chemotherapy gives a response rate of 30-40%; Quality of survival following chemotherapy appears better than following radiation therapy; Chemotherapy following radiation therapy appears to be ineffective.

Iliac reconstruction with arterial allograft during pancreas-kidney transplantation.

An intraoperative dissection of the external iliac artery during pancreas transplantation was successfully repaired using the donor iliac artery allograft as a conduit between the internal iliac and distal external iliac artery. An angiogram performed 6 months after surgery showed a patent bypass without stricture or pseudoaneurysm. At 1 yr follow-up after transplant the grafts are functioning well, and the affected extremity is normal. In immunosuppressed recipients of solid organ transplants, fresh arterial allografts may be successfully used for iliac artery reconstruction. Further study will be needed to determine the role of arterial allografts for lower extremity bypass surgery in immunosuppressed patients.

Osteomyelitis of the foot in diabetic patients: evaluation with plain film, 99mTc-MDP bone scintigraphy, and MR imaging.

Diagnosis of osteomyelitis of the foot in diabetic patients may be difficult because of the coexistence of chronic cellulitis, vascular insufficiency, and peripheral neuropathy. This study compared the diagnostic accuracies of plain films, bone scans, and MR imaging studies in diabetic patients with suspicion of osteomyelitis of the foot. Twenty-nine plain radiographs, 20 bone scans, and 30 MR studies were obtained in 24 patients. Twenty-nine bones from 14 patients were pathologically proved either positive (25 bones) or negative (four bones) for osteomyelitis. Another 15 bones (10 patients) studied with MR had no pathologic proof, but the bones healed with only local wound care and/or a short course of oral antibiotics. These patients had trauma, cellulitis, or unhealed ulcers. The sensitivity and specificity of plain films were both 75%. Bone scans had a very low specificity (100% false-positive rate). A negative bone scan should strongly exclude the probability of osteomyelitis. Unlike the findings in previous reports, MR had much higher sensitivity and specificity than bone scans in detecting osteomyelitis in diabetic patients. When the 10 patients without pathologic proof (those who presumably had neuroarthropathy, vascular insufficiency, and/or cellulitis) were included, the sensitivity and specificity of all three techniques decreased. Our experience with this small group of patients suggests that MR is a useful imaging technique for diagnosing osteomyelitis of the foot in diabetic patients.