Free vascularised tissue transfer and brachytherapy for soft-tissue sarcomas of the extremities.

We reviewed the medical files of nine patients with localised soft-tissue sarcomas of the extremities treated with surgical resection, free vascularised tissue transfer, and computerised after-loading iridium-192 high dose rate brachytherapy over a period of 8 years. All patients had external beam radiation therapy in fractions with a total dose of 48-52 Gy, followed by surgery at approximately 4-5 weeks post-irradiation. Surgical treatment included wide resection of the primary tumour in six patients, and marginal resection in three patients.

Calcium sulphate delivery system with tobramycin for the treatment of chronic calcaneal osteomyelitis.

The case of a 24-year-old woman with Pseudomonas aeruginosa and Proteus mirabilis chronic calcaneal osteomyelitis is presented. Extensive debridement of the necrotic bone and application of tobramycin-loaded polymethylmethacrylate beads was performed and ciprofloxacin was given post-operatively. Three months later, laboratory tests, including complete blood cell count, erythrocyte sedimentation rate and C-reactive protein, were normal.

Facial paralysis.

Detailed knowledge of embryology, anatomy, and function of the facial nerve is essential in treating the devastating functional, aesthetic, and psychological sequelae of facial paralysis. Two basic factors influence the method of repair and the subsequent outcome of the effort to combat facial paralysis. First is the availability of a viable proximal nerve stump which can be used as the source for motor axons, and which is related to the level of the injury.

The conjoint medial circumflex femoral perforator and gracilis muscle free flap: anatomical study and clinical use for complex facial paralysis reconstruction.

Background: [corrected] The aim of this study was to establish the anatomic basis of the conjoint medial circumflex femoral perforator and gracilis muscle flap and to expand the use of this flap in complex facial paralysis reconstruction.

Methods: An anatomic study was initially undertaken to record the existence, consistency, and diameter of musculocutaneous perforators emanating from the proximal third of the gracilis muscle to provide blood supply to the overlying fascia, subcutaneous fat, and skin. In a total of 20 clinical cases of gracilis muscle harvesting, the aforementioned anatomical data were recorded during flap dissection.

The anatomic basis of the gracilis perforator flap.

Another perforator flap, the gracilis perforator flap, has recently been added to the armamentarium of reconstructive surgeons. A detailed study of the anatomy of this flap was undertaken in this study. Forty-seven dissections were performed in cadavers and clinical cases of gracilis muscle harvesting for various reconstructive reasons.

Munchausen's syndrome presenting as severe panniculitis.

Factitious disorders may trouble any physician during his/her career. A considerable number of cases of Munchausen's syndrome (self-induced disorder) are misdiagnosed in clinical practice. A 36-year-old woman was admitted to our hospital because of fever and abdominal pain.

Alternatives in soft tissue reconstruction of the ankle and foot.

Reconstruction of soft tissue defects of the ankle and foot still presents a challenge. This is related to both the lack of large soft tissue flaps in this part of the body suitable for transfer to adjacent injured areas and to of the unique characteristics of the soft tissues of the sole of the foot. Microsurgery has solved some of these problems with the transfer of soft tissue from more distal areas.

Vascular impairment and free tissue transfer in the lower extremity.

Fourteen patients with arteriosclerotic peripheral vascular disease and extensive tissue defects of the lower extremity, underwent microsurgical reconstruction using free tissue ("free flap") transfer. It was possible to provide coverage in ten of these patients. Analysis of this small series showed that only six of these ten patients were able to resume unassisted ambulation.

Transpositional microsurgery in multiple digital amputations.

In 34 of the 62 patients treated for complete multiple digital amputations, the severed part was not replanted in its anatomical position, but in the place of the most useful stump. This procedure is defined as transpositional digital microsurgery and refers to the transposition and replantation of any digit to another stump which plays a more significant role in the function of the hand. Twenty-eight patients had transposition of a digit, while six patients underwent thumb transposition.

Vein grafts in reconstructive microsurgery of the lower extremity.

This paper describes surgical techniques and results of lower extremity microsurgical reconstruction using vein grafts. During a 5 year period, free tissue transfers were used to reconstruct 118 lower extremity defects in 109 patients. In 28 of these cases (24%), saphenous vein grafts were used when reconstruction would otherwise have been difficult or impossible.

Long-term results after chemoradiotherapy for locally confined squamous-cell head and neck cancer.

The long-term results after simultaneous chemoradiotherapy in 54 patients with previously untreated or minimally treated, locally confined (M0) squamous-cell carcinoma of the head and neck are presented. Multiple concurrent courses of radiation therapy and chemotherapy with cisplatin and a four-day 5-fluorouracil infusion were given. Twenty-eight patients underwent definitive surgery and 26 were treated without surgical resection.

Simultaneous versus sequential combined technique therapy for squamous cell head and neck cancer.

Forty-eight patients with locally confined (M0) squamous cell head and neck cancer were prospectively randomized to receive either simultaneous (SIM) or sequential (SEQ) combined technique therapy with a 5-fluorouracil infusion, a cisplatin bolus injection, and radiation therapy. Patients with residual resectable disease underwent surgery after induction therapy, whereas those achieving a complete response to induction did not require surgery. Patients on the two treatment arms were equivalent in all measured variables, including disease extent.

Treatment of oral squamous cell carcinoma with simultaneous chemotherapy and radiation: results and surgical implications.

Thirty-seven patients with oral squamous cell carcinoma, many with advanced disease, were treated initially with a protocol using simultaneous intravenous 5-fluorouracil (5-FU) cis-platinum, and radiation. Twenty-two patients (62%) experienced complete remission after one cycle of therapy. Fifteen patients (38%) demonstrated an incomplete response; surgical resection was possible in 14 of these 15 patients.

Oral squamous cell carcinoma in children.

Squamous cell carcinoma of the oral cavity occurs very rarely in children and is particularly rare during the first decade of life. This article describes a case of squamous cell carcinoma of the maxillary alveolar ridge in a 7-year-old child. Subtotal maxillectomy was carried out with an apparent cure (33-month follow-up).

Short saphenous vein grafts as an aid to microsurgical reconstruction of the lower extremity.

The authors present a method of free flap reconstruction using the short saphenous vein, when local vessels are not available in the lower extremity. Initially, a temporary arteriovenous fistula is created. This is subsequently divided to provide both arterial access and venous drainage for the flap.

Simultaneous radiotherapy and chemotherapy with 5-fluorouracil and cisplatin for locally confined squamous cell head and neck cancer.

Fifty-four patients with previously untreated or minimally treated locally confined (MO) squamous cell carcinoma of the head and neck were treated with chemoradiotherapy employing multiple courses of simultaneous radiation, cisplatin, and a 4-day 5-fluorouracil infusion. Twenty-eight patients subsequently underwent definitive surgery, and 26 were treated without surgical resection. Of the 54 patients, 51 were ultimately rendered disease free by this combined modality protocol.

Beyond replantation: microsurgical salvage of complex hand injuries.

The authors believe that certain complex hand injuries so severe as to be considered for amputation or simple proximal revision, may under some circumstances be salvaged with the use of appropriate microsurgical techniques. They present three examples of severely injured hands to illustrate the reconstructive potential of microsurgery. Salvage techniques are considered in some detail including debridement, evaluation and planning, fixation, restoration of circulation, reconstruction of tendons, joints and nerves, and provision of coverage.

Chemoradiotherapy as initial management in patients with squamous cell carcinoma of the head and neck.

Thirty-nine previously untreated or minimally treated patients with squamous cell carcinoma of the head and neck were entered onto a chemoradiotherapy protocol employing multiple courses of simultaneous radiation therapy, cisplatin, and a 4-day 5-FU infusion. Thirty-eight patients were evaluable for response and toxicity. Twenty-three patients underwent surgical resection midway through this therapy and 11 (48%) were pathologically free of disease.

Avulsion injuries of the thumb.

Similar findings in a series of seven avulsions of the thumb suggest that this injury is a well-defined entity. In all cases avulsion was the result of catching the digit in a rotating machine. In most cases a glove was worn.

A palmar cross-finger flap for coverage of thumb defects.

We have devised a method of covering tissue defects of the distal thumb using a flap elevated between the two flexion creases on the palmar skin over the proximal phalanx of the long finger. The advantages of this method over the usual dorsally based, distal, cross-finger flap include improved appearance of the donor finger, comfortable positioning, and avoidance of joint contractures. Although sensitivity of the palmar scar, contractures, or other disadvantages of this approach were sought during follow-up, none were found.

Combination chemotherapy prior to definitive local therapy in squamous cell carcinoma of the head and neck.

30 patients with locally advanced squamous cell carcinoma of the head and neck were given chemotherapy with methotrexate, bleomycin and cis-Platinum prior to planned definitive surgery and/or radiation therapy. Chemotherapy was well tolerated and 90% of patients responded. Of 14 initially unresectable patients, 6 became operable after chemotherapy.

A simple method of controlling rotation in replanted digits.

A method of fixation for replanted digits is described. It consists of axial fixation with a wire passed longitudinally through the replanted digit, supplemented with a transverse wire passed across all the digits. In this way, splinting is provided and rotation is controlled.

Intraoperative heparin in replantation surgery--an experimental study.

An experimental study to define the usefulness of heparin in microvascular surgery was undertaken. Fifty-four rabbits underwent replantation of an amputated ear. The animals were randomly divided into two groups--"heparin" and "no heparin," with 27 animals in each group.

Crossed fingers and other tests of ulnar nerve motor function.

All tests for ulnar nerve motor function require demonstration and explanation if they are to be carried out reliably. The tests used most commonly may be difficult to elicit, particularly in children or in the presence of an acute injury. The authors have found that the ability to cross the middle over the index finger is a reliable test of ulnar nerve function.