Ipsilateral flaps of the lower extremity.
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Biomedical subjects
Publications and source records attributed to R J Lung.
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Thorium dioxide, a radioactive contrast material, was commonly used for cerebral angiography prior to recognition of its radiation hazard. Extravasation of the material into the extravascular tissue in the neck results in granuloma formation, thorotrastoma, long-term morbidity, and an increased incidence of benign and malignant tumors. We report our experience with the management of 2 patients who underwent cerebral angiography with thorotrast more than 25 years ago. Aggressive surgical excision of involved tissue is warranted to ameliorate symptoms and diminish the risk of malignancy.
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Tourniquet ischemia results in tissue hypoxia which has been measured indirectly by blood gas analysis. The Medspect mass spectrometer allows direct measurement of gas tension in different tissues and may provide more useful information regarding safe tourniquet times. Calibrated Teflon catheters were inserted into the subcutaneous tissue (11 animals), tibial medullary cavities (bone) (nine animals), and tibialis anterior muscles (10 animals) in both lower extremities of anesthetized stumptail monkeys. Tourniquet ischemia was maintained for 1 hour at 400 mm Hg. Tissue and venous blood gas tensions were recorded from both limbs for 1 1/2 hours. Comparisons between gas tensions in each tissue group were made on the basis of their percentage change from control values. In the ischemic limb within 5 minutes muscle PO2 fell 42 +/- 4% (p is less than 0.001), whereas bone and subcutaneous PO2 dropped 25 +/- 4% (p is less than 0.05). Blood PO2 fell 29 +/- 3% and differed only from that of muscle (p is less than 0.01). One hour after tourniquet inflation, blood PO2 levels has fallen 90 +/- 5% (p is less than 0.001) from their control. Changes in tissue PCO2 were less dramatic and did not vary significantly from those recorded in venous blood. After deflation, blood PO2 exceeded its control by 20 +/- 6% (p is less than 0.005) in 5 minutes, but tissue tensions remained 50 +/- 6% below their control values. These studies indicate that tissue gas tensions are a more sensitive indicator of tourniquet hypoxia than are blood gases within the ischemic extremity.
The frequency of supraorbital rim fractures is increasing as incidence of motorcycle and bicycle accidents increases. These fractures are frequently depressed, comminuted, and often extend into the frontal sinus. Open reduction and fixation are the treatment of choice. Adequate debridement and cleansing with preservation of periosteum and blood supply are recommended. Unstable fragments can be fixed to the frontal bone or stabilized by suturing the torn periosteum. Severely comminuted supraorbital frontal sinus fractures may require stabilization via frontal sinus pack or balloon. We feel the latter is preferable and both Foley and Fogarty catheters have been successfully used.
Hibernomas are rare tumors of fat which are most often benign. Arteriographic fingings may be misleading with respect to the diagnosis of malignancy preoperatively. These uncommon tumors may be confused prior to surgery with lipomas, soft tissue sarcomas, and hemangiomas.
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A technique utilizing an ipsilateral thigh or buttock flap in children is described. Its advantages are the ease with which the patients ambulate and the extremely good tolerance of this position, as well as the placement of the donor scar sufficiently high to enable it to be hidden under most clothing.