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Biomedical subjects

J A Stock

Publications and source records attributed to J A Stock.

At least 19 recordsLinked to original sources
PubMed2002

The rectus myofascial wrap in the management of urethral sphincter incompetence.

OBJECTIVE: To review our experience with a modified rectus/pyramidalis myofascial sling, described more than a century ago for treating refractory urinary incontinence in children with neurogenic sphincteric incompetence. PATIENTS AND METHODS: Thirty-seven patients (23 females and 14 males, aged 8-21 years) presented with urinary incontinence which failed to respond to medical treatment. In 36 patients the cause of the incontinence was a neurogenic bladder; one patient had sustained a traumatic injury to the bladder neck and urethra. Patient selection was based on videocysto-urethrographic detection of an incompetent bladder neck, and a low maximum closure pressure during urethral pressure profilometry. The bladder was augmented in 33 of the 37 patients. RESULTS: Of the 37 patients, 34 (92%) are dry between catheterizations; the follow-up was 0.5-10 years. Two of the male patients continued to have persistent incontinence requiring bladder neck closure and creation of a continent stoma. One of the female patients developed stress incontinence after 4 years of being dry, with a rectus sling. CONCLUSION: The rectus myofascial sling provides long-term satisfactory dry intervals between catheterizations in patients with neurogenic sphincteric incompetence. The cinch-wrap modification appears to enhance the occlusive effect of the sling, particularly in males.

Adolescent↗
PubMed2001

Gracilis muscle sling for select incontinent "bladder exstrophy cripples".

PURPOSE: Functional reconstruction of children born with bladder exstrophy results in a successful outcome in the majority. However, failed bladder neck repair, especially after multiple surgical attempts, compromises the quality of the tissues and, thus, limits surgical options. In these cases conventional sphincteroplasty and other continence procedures, such as rectus sheath sling or artificial urinary sphincters, are ill-advised due to ischemia and fibrosis of the bladder neck. MATERIALS AND METHODS: We transferred the gracilis muscle as a vascularized pedicle flap around the bladder neck in 5 children born with bladder exstrophy, of whom 3 were "exstrophy cripples" with multiple previous failed attempts at reconstruction, and 2 were older with failed prior attempts at bladder closure. In the latter 2 cases a 1-stage repair was performed, which included bladder augmentation, ureteroneocystotomy, epispadias repair and bladder neck wrap with gracilis muscle. The other 3 children underwent gracilis muscle wrap of the compromised bladder neck. RESULTS: All 5 children were dry between clean intermittent catheterization 2 to 13 years postoperatively. Complications included urinary tract infection in all 5 cases, stomal stenosis in 2, small bowel obstruction in 1 and bladder stones in 2. However, no complication was related to the gracilis muscle transfer. CONCLUSIONS: Vascularized gracilis muscle flap can be used to wrap around the compromised bladder neck of incontinent patients born with bladder exstrophy. The muscle appears to provide a leak proof, cough competent sling that increases bladder outlet resistance and, thus, provides dry intervals between catheterization. The long-term results of up to 13 years have been satisfactory.

Bladder Exstrophy↗
PubMed2001

Medicolegal aspects of testicular torsion.

OBJECTIVES: Testicular torsion is an active area of medical malpractice litigation because of the diagnostic uncertainty, delays in diagnosis and treatment, diagnostic errors, and resultant testicular loss. We reviewed this topic to determine the nature of patient claims and their clinical and legal outcomes. METHODS: All closed case files of a large medical malpractice insurance company based in New Jersey involving testicular torsion from the years 1979 to 1997 were retrospectively reviewed. The following data were collected: patient demographics, timing of presentation, initial complaints, diagnosis given, consultations obtained, radiographic studies, treatment provided, outcomes, and indemnity payments. RESULTS: Thirty-nine cases consisting of 58 individual claims were reviewed. Indemnity payments were made in 26 cases (67%), of which 25 (96%) were settlements, and 13 cases (33%) ended in favor of the physicians. Five cases went to trial, with only one verdict in favor of the plaintiff. The median indemnity payment was $45,000. Urologists were named most frequently (48%), and a misdiagnosis of epididymitis (61%) was most commonly cited. The mean patient age was 24.3 years. Atypical initial complaints were common (46%). Late presentation (greater than 8 hours) did not affect the medicolegal outcome. The major liabilities for paid claims were an error in diagnosis (74%), a delay in or lack of referral (48%), lack of radiologic examination (19%), failure to explore (13%), error in surgical technique or judgment (13%), and falsified records (10%). CONCLUSIONS: Testicular torsion litigation most often focuses on the urologist. Claims are more common in older patients and those with atypical complaints. Settlement is the most common outcome, with a fairly standard indemnity payment rewarded. The initial treating physician must have a high index of suspicion for the diagnosis and refer promptly. In lieu of a definitive radiologic study, or when the diagnosis is in question, the urologist should strongly consider exploration and should perform contralateral exploration when torsion is found.

Adult↗
PubMed2001

Management of prepubertal varicoceles-results of a questionnaire study among pediatric urologists and urologists with infertility training.

OBJECTIVES: Varicoceles are a common condition affecting male fertility seen by urologists. However, prepubertal varicoceles are much less common and their management is controversial. We designed a questionnaire to assess the practice patterns among urologists (pediatric urologists/urologists with infertility training) with regard to prepubertal varicocele management. METHODS: A 15-point questionnaire pertaining to management issues of prepubertal varicoceles was sent to 150 pediatric urologists and 150 urologists with infertility training. Two clinical scenarios referring to treatment algorithms of prepubertal varicoceles were included. RESULTS: Of the 300 questionnaires mailed, 174 urologists (58%) responded. Seventy-five of the respondents were urologists with an interest in infertility, and 99 were pediatric urologists. Of the 174 respondents, 86.2% treated prepubertal varicoceles and 13.8% referred patients to interventional radiologists for embolization. The ratio of varicocelectomy to expectant management was about equal between urologists with infertility training and pediatric urologists (46% versus 54%). A difference in testicular size was the most common indication for varicocelectomy (80.5%), followed by pain (51.1%) and potential fertility problems (24.7%). About one third of all urologists would perform varicocelectomy on patients of any age and seven (4%) would not operate before puberty. In 136 responses (78.2%), follow-up information was not available. Among the 35 respondents with follow-up information (21.8%), 21 reported infertility occurring after varicocelectomy and 16 after expectant management. If varicocelectomy was performed, most urologists (47.2%) used magnification loupes, 29.3% used microscopes, and 29% used no magnification. The preferred approach was inguinal (Ivanissevich) in 35.6% followed by subinguinal in 30%; 21% performed retroperitoneal varicocelectomy (Palomo) and 9.8% used a laparoscopic approach. Of the 300 complications reported, postoperative hydroceles were the most common (40.4%), followed by recurrence (20.8%) and hematomas (17.4%). CONCLUSIONS: The management of prepubertal varicoceles is controversial among different urologic subspecialties (pediatric urology/infertility). Differences include indications, timing, and techniques used for varicocelectomy. Accurate follow-up information for children with prepubertal varicoceles is rare. A prospective randomized study comparing varicocelectomy versus expectant management of prepubertal varicoceles is needed to assess the outcomes and define uniform treatment criteria.

Adolescent↗
PubMed2001

Renal ultrasound changes after internal double-J stented pyeloplasty for ureteropelvic junction obstruction.

PURPOSE: Renal ultrasound changes after pediatric pyeloplasty were reported recently in the literature, mainly on unstented pyeloplasties. We evaluated the time to improvement or resolution of hydronephrosis in pediatric patients who underwent double-J stented pyeloplasty for ureteropelvic junction (UPJ) obstruction and compared our results to unstented pyeloplasties. MATERIALS AND METHODS: Ultrasonic grading of hydronephrosis after double-J stented pyeloplasty was performed according to the Society for Fetal Urology criteria at intervals of 0 to 3. 3 to 6, 6 to 12, and greater than 12 months postoperatively. Twenty-six pyeloplasties met all criteria for inclusion. The median patient age was 4 months. RESULTS: Of the 26 pyeloplasties studied, 18 kidneys had grade 4, 7 grade 3, and I grade 2 hydronephrosis. Twenty-two percent of kidneys with grade 4 hydronephrosis had resolution of pyelocaliectasis at the 0- to 3-month ultrasound examination; all of these kidneys had the stents removed prior to being studied. No patient with improvement of hydronephrosis worsened on subsequent examinations. All but three patients improved over 1-year follow-up: 11 (42%) to grade 0, 5 (19.2%) to grade 1, 6 (23%) to grade 2, and 1 (3.8%) to grade 3. The average final grade was 1.56 for grade 4 and 0.57 for grade 3 hydronephrosis. This represented more rapid improvement than unstented pyeloplasties. Average indwelling time for double-J stent was 52 days. CONCLUSIONS: Improvement and sometimes resolution of hydronephrosis after internal double-J stented pyeloplasty for UPJ obstruction is rapid and can occur within the first 3 months postoperatively. One year postoperatively, the majority of renal units have grade 2 hydronephrosis or less. We recommend the use of indwelling double-J ureteral stents in all pediatric patients undergoing dismembered pyeloplasty for UPJ obstruction to allow for more rapid improvement and possible resolution ofpyelocaliectasis. Further comparison of stented vs. unstented pyeloplasty is needed.

Adolescent↗
PubMed2000

The appendix as right ureteral substitute in children.

PURPOSE: The appendix has occasionally been used to replace sections of the right ureter. We reviewed the literature of the last 25 years on the use of the appendix as right ureteral replacement and report our experience with right ureteral substitution using the appendix. MATERIALS AND METHODS: We retrospectively reviewed the charts of 3 children who underwent appendiceal replacement of the right ureter. The appendix replaced the upper third of the ureter and the lower ureter in 1 and 2 cases, respectively. RESULTS: Followups of 4, 7 and 15 years, respectively, demonstrated that the appendix transports urine satisfactorily and permits renal function to be maintained with no evidence of obstruction. CONCLUSIONS: We believe that our small series supports the use of the appendix as a right ureteral substitute in select cases.

Adult↗
PubMed2000

Results of umbilicoplasty for bladder exstrophy.

PURPOSE: The umbilicus is an important aesthetic landmark and its absence or deformity may be associated with poor self-image. In patients born with bladder exstrophy the umbilicus is attached to the upper margin of the bladder and reconstructive surgery often removes the navel. The umbilicus marks the waistline and serves to complete the harmony of the curved lines above and below the waist. We present our experience with children born with exstrophic anomalies during the last 2 decades. MATERIALS AND METHODS: Our database included 61 children born with classic bladder and 8 born with cloacal exstrophy treated between 1980 and 1998. We performed primary reconstruction in 35 children, while 34 children and young adults were referred for secondary surgical repair, including bladder augmentation, continent diversion, genitoplasty and so forth. Neoumbilicoplasty was done in all of the former and in 30 of the 34 latter cases. Early in the series a V-shaped flap was raised and buried subcutaneously. The flap eventually became a tube around the cystotomy tube and the cicatrix formed the umbilical dimple. This method necessitated packing with iodoform gauze for 4 weeks with weekly dressing. The technique evolved into a tubularized U-shaped flap. A rubber tube was placed indwelling as a stent to maintain inward projection of the neoumbilicus. RESULTS: In 66 of the 69 cases the early results of umbilicoplasty were described by the surgeon as excellent or satisfactory. In 3 cases the neoumbilicus appeared flat, lost depth and was described as unsatisfactory. Long-term followup of more than 1 year was available in 48 patients, of whom 2 underwent umbilical repositioning for an off center or low umbilicus and 3 underwent repeat umbilicoplasty for a flat umbilicus that had lost depth. The best cosmetic results were achieved in patients with a relatively thick layer of subcutaneous fat, whereas cosmesis was suboptimal in thin children. Nevertheless, the patients and parents were generally pleased with the umbilical appearance even when the surgeon was not. CONCLUSIONS: Although the navel is a functionless depressed scar, it represents an important and pleasing landmark. Umbilical construction should be attempted early during functional closure or urinary diversion.

Adolescent↗
PubMed1999

Septic arthritis secondary to vesicoureteral reflux into single ectopic ureter.

A 3-week-old male infant, born full term without complication, developed septic arthritis of his left shoulder. His joint fluid, blood, and bone marrow were all positive for Escherichia coli. Urinalysis demonstrated pyuria. Urine culture obtained after one dose of ceftriaxone and several doses of nafcillin was negative. Work-up revealed a refluxing, right single ectopic ureter with severe hydroureteronephrosis and a non-functioning ipsilateral kidney. After appropriate management of the musculoskeletal infection, he underwent a right nephroureterectomy. Coliform septic arthritis is exceedingly rare in children, with only a few cases reported. We report the first case of septic arthritis with anomalous genitourinary tract development as the source of bacterial seeding. This report re-emphasizes the need to screen the urinary tract in all cases of pediatric gram-negative sepsis.

Anti-Bacterial Agents↗
PubMed1999

Gastrocystoplasty: long-term complications in 22 patients.

PURPOSE: Gastrocystoplasty has been performed as an alternative to enterocystoplasty to increase bladder capacity and/or compliance while avoiding the complications associated with the use of bowel segments. Gastrocystoplasty is not without metabolic and physiological complications, such as the dysuria-hematuria syndrome and hypochloremic metabolic alkalosis. Currently to our knowledge there is limited long-term followup of gastrocystoplasty, which prompted us to review our experience with gastrocystoplasty and compare our findings with those of others. MATERIALS AND METHODS: We retrospectively reviewed for complications the records of 12 boys and 10 girls 8 to 24 years old who underwent gastrocystoplasty. Followup ranged from 48 to 96 months. The diagnosis included neurogenic bladder in 12 cases, posterior urethral valves in 6, bladder exstrophy in 3 and pelvic tumor in 1. All patients underwent preoperative evaluation of serum electrolytes, blood urea nitrogen and creatinine as well as a radionuclide renal scan. Urodynamics were done preoperatively in all patients and postoperatively for complications. A gastric wedge with the pedicle based on the right gastroepiploic artery was removed, leaving the lesser curvature and vagus nerve intact. This technique was used in 21 of the 22 cases, including 1 case after initial surgery elsewhere. Ureteroneocystotomy, Mitrofanoff appendicovesicostomy and bladder neck reconstruction were performed as indicated. RESULTS: There was 1 early complication (postoperative bleeding) and the remainder were late complications, including vesicoureteral reflux in 4 cases, Mitrofanoff valve stenosis in 3, the hematuria-dysuria syndrome, renal calculi, decreased bladder capacity with incontinence and metabolic alkalosis in 2 each, and ureterovesical stricture in 1. The late complication rate in our series was 36%. CONCLUSIONS: Our long-term results differ from those of others in the number of late complications (36 versus 21.8%). In addition, 50% of our patients with complications had multiple complications. These findings may be due to a longer followup. Nevertheless, our data cast serious doubt on the long-term advantages of using stomach for bladder augmentation.

Adolescent↗
PubMed1999

Salvage continent vesicostomy after enterocystoplasty in the absence of the appendix.

PURPOSE: We describe a surgical procedure for a select group of children who had previously undergone augmentation enterocystoplasty, following which intermittent catheterization became more and more difficult or impractical. A new access to the reservoir became necessary, and alternative conduits included the appendix, ureter and tubularized ileum or stomach. Each conduit had its advantages and disadvantages but all required transperitoneal dissection. We report a simple extraperitoneal surgical technique that involves use of the Mitrofanoff and Nissen principles. MATERIALS AND METHODS: A 2x6 cm. flap of the anterior wall, which is usually intestine, of the augmented bladder is raised. The base of the flap is just below the bladder dome. The flap is then tubularized over a 14F catheter and the cystostomy is closed. The bladder is plicated around the base of the tube, similar to the Nissen gastroesophageal fundoplication. The plication extends and covers the proximal 3 cm. of the tube. Intraoperative bladder distention is performed to confirm the competence of the continence mechanism. The distal part of the tube is then anastomosed to the inverted umbilical skin or to a tubularized abdominal wall skin flap. RESULTS: The aforementioned technique was used in 5 children 3 months to 6 years old. Earlier augmentation ileocystoplasty and bladder neck reconstruction had been performed in 4 children. The appendix was unavailable for a Mitrofanoff vesicostomy in all cases. This procedure was also performed on a 13-year-old boy with severe myogenic detrusor failure, due to posterior urethral valves, and a bladder capacity of 700 ml. There was no significant surgical morbidity and all children are dry between clean intermittent catheterizations 1 to 5 years postoperatively (mean 3.3). CONCLUSIONS: Use of the Mitrofanoff and Nissen principles proved to be simple and reliable, and avoided secondary intraperitoneal exploration and use of bowel in these select cases.

Child↗
PubMed1999

The Mainz II pouch: experience in 5 patients with bladder exstrophy.

PURPOSE: We report our experience with 5 patients with bladder exstrophy who underwent creation of a Mainz II pouch. MATERIALS AND METHODS: We retrospectively reviewed the results of the Mainz II pouch as a primary urinary diversion in 2 and a secondary urinary diversion in 3 patients. Each patient underwent multiple surgeries, including osteotomy in 1. All patients were followed postoperatively on a yearly basis. RESULTS: All patients are continent and the upper urinary tract is stable. CONCLUSIONS: The Mainz II pouch is appropriate for children born with a small fibrotic bladder, and as a salvage procedure for those who have endured multiple reconstructive procedures and remain incontinent. Furthermore, this procedure deserves serious consideration in children residing in developing countries.

Adult↗
PubMed1998

Congenital reflux nephropathy and severe unilateral fetal reflux.

PURPOSE: When prenatal ultrasound reveals urinary tract dilatation, fetal reflux is suspected. Postnatal voiding cystourethrography confirms the diagnosis. The origin of reflux nephropathy is controversial, and the roles of urinary tract infection and pressure effects of sterile reflux on the developing kidneys are debatable. We evaluate the relationship between sterile reflux and renal scarring. MATERIALS AND METHODS: We reviewed the records of 100 infants and children seen during a 15-year period in whom fetal reflux had been diagnosed, including 81 with bilateral and 19 with unilateral vesicoureteral reflux. In 12 of the 19 patients voiding cystourethrography revealed unilateral grade IV or V reflux, and they comprise the study group. Split renal function was measured in all 12 patients by radionuclide renal scan shortly after birth and before urinary tract infection developed. RESULTS: Individual renal function was 0 to 40% in all refluxing renal units. Split renal function was less than 10% in 3 kidneys, 10 to 30% in 5 and 30 to 40% in 4. There were 2 nonfunctioning kidneys. In the remaining 10 kidneys isotope distribution on the nuclear scan indicated decreased renal length and mass. Subsequently 7 patients had breakthrough urinary tract infections while on antibiotic chemoprophylaxis. Nephrectomy, and nephroureterectomy and ureteral reimplantation with or without tapering were performed in 3 and 9 refluxing ureters, respectively. Pathological examination of the 3 nephrectomy specimens revealed severe renal dysplasia consisting of persistent primitive ducts and nests of metaplastic cartilage. CONCLUSIONS: Our study supports the notion that renal impairment associated with severe fetal reflux is present at birth, and it is likely due to congenital dysplasia.

Child↗
PubMed1998

Vaginal construction in children.

PURPOSE: We evaluated outcomes in 20 patients 1 to 21 years old who underwent vaginal construction between 1980 and 1996. MATERIALS AND METHODS: A total of 21 vaginal constructions was performed in 20 children using ileum in 13, sigmoid colon in 6, bladder mucosa from a diverticulum in 1 and scrotal skin in 1. The diagnoses included the Mayer-Rokitansky syndrome in 6 cases, micropenis in 5, cloacal exstrophy in 3, penile agenesis in 3, and testicular feminization, classic bladder exstrophy and true hermaphroditism in 1 each. RESULTS: Patients treated with intestinal vaginoplasty had excellent cosmetic results without excessive mucous production or the need for routine dilation. The bladder mucosa vagina achieved good results with periodic dilation. Loss of depth developed in the scrotal skin vagina and it was converted to an ileal vagina. Stenosis at the mucocutaneous junction in 1 patient with a sigmoid and 1 with an ileal vagina was treated with Y-V plasty. CONCLUSIONS: Vaginal construction may be performed using isolated bowel segments with excellent results and minimal morbidity. We have found ileum to be the segment of choice in younger patients, while sigmoid colon is preferred for vaginal construction in adolescents. Vaginal construction with isolated bowel segments provides a cosmetic, self-lubricating neovagina with low rates of failure and revision, and without the need for routine dilation.

Adolescent↗
PubMed1998

Ureteroneocystostomy: to drain or not to drain.

PURPOSE: Indications for the use of external abdominal drains after ureteral reimplantation are not well defined. We determine the nature of the drainage fluid as well as the current use of drains by pediatric urologists. MATERIALS AND METHODS: We prospectively evaluated 15 consecutive patients 7 months to 19 years old who underwent unilateral or bilateral intravesical ureteroneocystostomy for primary vesicoureteral reflux. All patients were treated with a urethral Foley catheter and closed suction Jackson-Pratt abdominal drain. Fluid from the Jackson-Pratt drain and Foley catheter was analyzed for urea and creatinine on postoperative day 1, and compared to serum values. The Foley catheter was removed after the urine became clear, and the Jackson-Pratt drain was removed after drainage was 5 ml. or less for 12 hours. In addition, a questionnaire was distributed to 268 pediatric urologists to determine current practice regarding the use of routine postoperative drains. RESULTS: Urea and creatinine from the Jackson-Pratt drains in all 15 patients were consistent with serum values. The Foley catheter and Jackson-Pratt drain were removed an average of 3 and 4 days postoperatively, respectively. There were 186 responses from the 268 questionnaires distributed (69.4%). Of the pediatric urologists surveyed 70.4% performed intravesical ureteral reimplantation exclusively, 5.9% extravesical reimplantation exclusively and 23.7% both techniques. Of the group surveyed 73.1% placed external abdominal Jackson-Pratt or Penrose drains, although 26.5% of those who routinely used external drains believed that they were probably unnecessary. Of the physicians who placed drains 53.7% believed that the drainage fluid had some component of urine. CONCLUSIONS: In our small prospective study group we demonstrated that external abdominal drainage fluid is consistent with serum despite the popular belief that it may have some component of urine. The gynecological literature has shown repeatedly that there is no increase in morbidity after radical hysterectomy and pelvic lymph node dissection when no external abdominal drains are used. Although to our knowledge there are no previous reports of drain use after ureteral reimplantation, 26.9% of pediatric urologists currently do not place external abdominal drains with no apparent increase in morbidity. Larger prospective cohorts with long-term followup are needed to address adequately the issue of whether drains are needed after uncomplicated ureteral reimplantation.

Adolescent↗
PubMed1998

Refined microscopic urinalysis for red blood cell morphology in the evaluation of asymptomatic microscopic hematuria in a pediatric population.

PURPOSE: The use of refined microscopic urinalysis for the presence of dysmorphic red blood cells (RBCs) has been evaluated in children and adults with a known source of hematuria. We examined the clinical usefulness of this study in a pediatric population with an unknown source of hematuria. MATERIALS AND METHODS: Children 12 years old or younger referred for evaluation of asymptomatic microscopic hematuria exhibiting 4 or more RBCs per high power field were enrolled in this study. Patients provided a first morning urine sample subjected to refined urinalysis for RBC morphology. Standard evaluation of patients was performed until a final diagnosis of the hematuria source was identified. RESULTS: A total of 44 patients completed the study. Refined urinalysis revealed pure dysmorphic RBCs in 22 patients, pure isomorphic RBCs in 8 and mixed isomorphic/dysmorphic RBCs in 14. The presence of dysmorphic RBCs correctly predicted a glomerulotubular source of hematuria in 29 of 36 patients (sensitivity 83%, specificity 81%), while the presence of isomorphic RBCs predicted a uroepithelial source of hematuria in 2 of 8 patients (sensitivity 25%, specificity 22%). Hematuria and 2+ proteinuria (100 mg./dl.) were more sensitive (100%) and specific (83%) than the presence of dysmorphic RBCs in predicting glomerulotubular hematuria. CONCLUSIONS: We believe that this is a costly test offering little additional information to the evaluation of microscopic hematuria in children. A thoughtful history and physical examination with microscopic urinalysis and dipstick for proteinuria provide an equal amount of diagnostic information. We do not recommend its routine use in the evaluation of microscopic hematuria in children.

Child↗
PubMed1997

Pantaloon spica cast: an effective method for postoperative immobilization after free graft hypospadias repair.

PURPOSE: We used a postoperative dressing of silicone foam in conjunction with a pantaloon spica cast to optimize the chances for successful graft take in hypospadias repairs with grafts. We compared the results to those of inpatient bed restriction. MATERIALS AND METHODS: A total of 15 patients underwent graft urethroplasty, and application of a penile silicone foam dressing and fiberglass pantaloon spica cast. Patients were discharged home the following morning. RESULTS: Two fistulas developed. Results are no different from those of our previously reported cases which required 6 or 7 days of hospitalization. CONCLUSIONS: We believe that the pantaloon spica cast provides necessary immobilization for facilitating imbibition and inosculation, which are required for graft survival. Also, the spica cast allows early discharge home, obviating the need for prolonged hospitalization and bed rest.

Bandages↗