The reliability and versatility of the pedicled latissimus dorsi muscle or osteomusculocutaneous flap make it our first choice in the management of upper arm injuries and we have treated three such patients in this way. They had severe skeletonising, crushing injuries of an upper extremity with humeral defects that were treated with latissimus dorsi musculocutaneous flaps and segments taken from the ribs. All the flaps survived completely with no injury of the pleura at the donor site. The reconstructed humerus was strong enough for the patients to participate in all activities of daily living. We think that this technique is suitable for the upper arm defects with humeral loss because of its simplicity and minimal morbidity.
Between January, 1987 and June 1988, 335 femoropopliteal bypass (FPBP) operations were performed on 308 patients who had limb ischemia caused by femoropopliteal occlusion. The greater saphenous vein graft (SVG) was used whenever possible (165) and polytetrafluoroethylene (PTFE) prosthesis was used in 165. In addition, 4 Dacron grafts and 1 umbilical vein graft were used in 5 operations but were excluded from comparison in this study. The two groups did not differ significantly regarding stage of peripheral ischemia, preoperative indication, distal popliteal anastomotic site, and number of patent runoff vessels. Overall cumulative patency rates according to occlusive criteria alone were calculated by the life table method. Graft occlusion was determined by angiography, Doppler assessment, loss of previously palpable pulses, or return of symptoms. Diabetes mellitus was associated with a significantly lower patency rate.It is concluded from this study that the saphenous vein is superior to PTFE as femoropopliteal bypass.~
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