Reconstruction of extensive soft tissue defects of the lower extremity, especially when complicated by open fracture and bone loss, is usually a difficult problem for the plastic surgeon. Many methods have been devised to treat these conditions Musculocutaneous flaps add a valuable surgical alternative that bring vascularized cover to the defects, and the free microvascular transfer of these flaps gives the surgeon an added dimension of versatility. The latissimus dorsi is an extremly reliable musculocutaneous flap with a long, large-caliber vascular pedicle, so that dissection of the muscle can be performed with relative ease. The size of the latissimus dorsi muscle lends itself to coverage of large defects. While these characteristics appear to make the free latissimus dorsi musculocutaneous transfer ideal in many circumstances, it has some disadvantages. At the recipient site, the flap is ofter too bulky, and donor-site closure requires skin grafts if the flap is wider than 10cm. These skin grafts on the posterior thorax seriously detract from the final appearance of the donor site. The authors have experienced 12 cases of reconstruction of extensive lower extremity soft tissue defect in which the latissimus dorsi muscle alone was transferred and covered with a split-thickness skin graft. This method improves the recipient-site contour by decreasing the bulk of the flap and it also improves the donor-site appearance. We described technical considerations in each case and the advantages of free latissimus dorsi muscle flap and skin graft for the reconstruction of extensive soft tissue defect in the lower extremity.
Fractures, Open ; Humans ; Lower Extremity ; Myocutaneous Flap ; Skin ; Superficial Back Muscles* ; Thorax ; Tissue Donors ; Transplants

A retrospective, multivariate statistical analysis of 394 patients who underwent cleft palate repair was performed to document the incidence of postoperative oronasal fistula formation, and to assess possible contributing factors. Fistulas of the secondary palate were included, but nasal-alveolar fistulas and intentionally unrepaired anterior palatal fistulas were excluded. Postoperative oronasal fistulas occurred in 25 of the 394 patients(6.35%). The mean age at repair was 16.4 months, and mean follow-up period was 2.5 years. Several variables that are included sex, age, extent of clefting(as estimated by the Veau classification), type of repair, and experience level of the operating surgeon were analyzed by means of the log-rank test to determine their significance in postoperative fistula formation. Sex (p=0.077), age(p=0.538), and experience level of the operating surgeon(p=0.094) did not significantly affect the rate of fistula formation. However, extent of clefting(p=0.005) and type of repair(p=0.001) are the strongest predictor of the occurrence of a cleft palate fistula.
Cleft Palate ; Fistula* ; Follow-Up Studies ; Humans ; Incidence ; Intention ; Palate ; Retrospective Studies

The perichondrium has neochondrogenic potential. Many authors have published their study for the cartilage regeneration from perichondrium and the clinical uses of perichondrial graft. How is the difference of thickness of the regenerated cartilage after crushing the free perichondrial graft, compare with uncrushed graft? In this study, the perichondrium was obtained from rabbit, ears, and sectioned 10x10 mm slices. The uncrushed and crushed perichondriums were grafted into subcutaneous layer of back. After the 2,4 and 8 weeks, authors obtained regenerated cartilage from both crushed and uncrushed free perichondrial graft from rabbit back, examined the survival rate and thickness by histologic study.The results are as follows: 1. The survival rate was no difference between the uncrushed perichondrium & crushed perichondrium (p>0.05). 2. The cartilage from the uncrushed perichondrium was thicker than the crushed perichondrium, at only 8 weeks(p<0.01). 3. The thickness of regenerated cartilage was similar to the cartilage of the donor site of free perichondrial graft at 4 weeks(p>0.05).
Cartilage* ; Ear* ; Humans ; Regeneration* ; Survival Rate ; Tissue Donors ; Transplants

Vasectomy is one of the most common forms of male contraception throughout the world. However, more vasectomy reversals are sought each year because of the increasing number of second marriages and other causes. Before recommending vasectomy, urologists may wish to resolve in their own mind the conflict between reports that maintain the testis is harmed by vasectomy and those that slate is not. We studied a group of patients undergoing vasectomy reversal to determine whether histopathologic change on light and electron microscopy would be detected. Only one testis specimen from post-vasectomy patients showed an abnormality correlated with spermatogenesis and five cases showed mild focal interstitial fibrosis without abnormality of spermatogenesis on light and electron microscopy. We found that vasectomy has some influence to the spermatogenesis and pathologic change.
Contraception ; Fibrosis ; Humans* ; Marriage ; Microscopy, Electron ; Spermatogenesis ; Testis* ; Vasectomy* ; Vasovasostomy

A clinical observation was made on 64 cases of the bladder rupture who were admitted to our hospital during the period from June, 1979 to February, 1991. The results are as following ; 1. Of 355 cases of the genitourinary tract injury, the bladder rupture were 64 cases (18.0%), which were composed of 40 cases (62.5%) of bladder rupture without pelvic bone fracture and 24 cases (37.5%) of bladder rupture with pelvic bone fracture. The bladder rupture without pelvic bone fracture were composed of 35 cases (87.5%) with intraperitoneal bladder rupture and 5 cases (12.5%) with extraperitoneal bladder rupture, the bladder rupture with pelvic bone fracture were composed of 13 cases (12.5%) with intra and extraperitoneal bladder rupture. 2. In 24 patients with pelvic bone fracture, the most common site of bladder ruptures were found on the lateral wall in 12 cases (50%), and followed by the dome in 9 cases (37.5%), multiple areas in 3 cases (12.5%). In 40 patients without pelvic bone fracture, the most common site of bladder ruptures were found on the dome in 33 cases (82.5%), and followed by the multiple areas in 4 cases (10%), lateral wall in 3 cases (7.5%). 3. The average size of the bladder rupture was 6.5cm in cases without pelvic bone fracture, 6. 8cm in cases with pelvic bone fracture, especially comminuted pelvic ring fracture had most severed bladder rupture (average; 8.3cm). 4. Of 24 pelvic bone fractures, pubic rami fractures were most common (41.6%), and followed by comminuted pelvic ring fracture (25%), anterior and posterior pelvic ring fractures (12.5%), acetabulum and isolated fractures (8.3%), symphyseal separation fractures (4.1%) in order of frequency. 5. 5 cases (20%) of pelvic bone fractures were associated with posterior urethral injury, especially 60% in The pubic rami fracture. There was no significant relation between the type of pelvic fracture and the type of bladder rupture, but the fractures involving pubic arch were more often associated with posterior urethral injury.
Acetabulum ; Humans ; Pelvic Bones* ; Rupture* ; Urinary Bladder*

Wilms' tumor is malignant renal tumor, originated from undifferentiated mesonephric blastema. Adult Wilms' tumor, unlike that of childhood, is a rare disease and a total of l67 cases have been reported in the world medical literature until 1980. Diagnosis of adut Wilms` tumor is very difficult preoperatively and the pathologic hallmark is the presence of abortive or embryonal glomerulotubular structure with an immature spindle cell stroma. The therapeutic guidelines and surgical principles that govern childhood Wilms' tumor should be applied to adult Wilms' tumor. We reported a case of Wilms' tumor developed in 34 year-old male patient complaining of right flank pain with gross hematuria for 2 months.
Adult* ; Diagnosis ; Flank Pain ; Hematuria ; Humans ; Male ; Rare Diseases ; Wilms Tumor*

We report a case of hepatoma with duodenal metastasis in a 53 year-old male patient. Hepatoma was confirmed by fine needle aspiration cytology technique, and duodenal metastasis by gastrofiberscopic biopsy. Duodenal metastasis of hepatoma is rare. We briefly review the role of fine needle aspiration cytology technique in diagnosis of hepatoma.
Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular ; Child* ; Diagnosis ; Endodermal Sinus Tumor ; Humans ; Male ; Mediastinum ; Middle Aged ; Neoplasm Metastasis ; Proteinuria* ; Specific Gravity*

No abstract available.
Fascia* ; Foot* ; Leg*

No abstract available.
Skin* ; Tibia*

No abstract available.