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We studied 324 patients admitted to Harlem Hospital Center from July 1981 to June 1986 with stab wounds of the thoracoabdominal region (area limited by a coronal circle through the fifth interspaces anteriorly and seventh interspaces posteriorly from above to a subcostal circle 5 cm caudad to the costal margins and 12th ribs from below). We divided this region into 12 zones (six symmetrical zones on each side) using the above upper and lower limits and the costal margins, the midlines, and the anterior and posterior axillary lines. This study was conducted to determine the incidence of transdiaphragmatic penetration for the thoracoabdominal region stab wounds in each of the 12 zones identified for the first time and applied in this study, and the reliability and safety of surgical management based mainly on physical examination. The highest incidence of transdiaphragmatic penetration occurred in stab wounds of the left anterior lower thoracic zone (21.7%). The lowest incidence was 0% and the overall incidence was 11%. Physical examination was accurate in making the diagnosis in 95.4% of all cases and no mortality was associated with a delay in diagnosis that may have resulted from the serial physical examinations. We conclude that this method of selective operative management based on physical examinations is accurate and safe.

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INTRODUCTION: Readmission secondary to dehydration after ileostomy creation has significant morbidity.This study is designed to identify potential risk factors for high output and readmission. METHODS:A retrospective review was done on patients admitted to our colorectal service following ileostomy creation for diversion from 2010-2020. Patient demographics and clinical characteristics were compared between those readmitted within 30 days for dehydration and those not. Chi Square test and student t test were utilized to identify independent predictors of readmission.

Non-operative management of appendicitis (NOMA) has recently gained popularity, but a concern is that NOMA might miss appendiceal neoplasms. We conducted a retrospective review of 1694 appendectomies done for acute appendicitis at our institution between January 2001 and December 2019 to study the incidence and distribution of appendiceal tumors. We identified 24 appendiceal neoplasms (1.43%), including 9 Low Grade Appendiceal Mucinous Neoplasms (LAMNs), 6 neuroendocrine tumors (NETs), 6 mucoceles, and one each of adenocarcinoma, endometrioma, and neurofibroma. Tumor occurrence had two age peaks, with LAMNs prominent in the 5th and 6th decades of life and NETs in the 2nd and 3rd decades. All patients under age 40 had benign disease. Presence of appendicoliths was independent of the presence of neoplasms. All cases were managed per National Comprehensive Cancer Network (NCCN) guidelines, with twenty cases cured by appendectomy alone. Given these, we conclude that NOMA is safe for patients under 40.

Background: The sartorius muscle transposition flap is the traditional method of femoral vessel tissue coverage after superficial inguinal lymphadenectomy for regionally-metastatic cancers to the inguinal lymph nodes. Well-vascularized muscle is the best material to cover vessels. However, if the groin has undergone radiation therapy, the sartorius muscle is contained within the irradiated field, and may be problematic for wound healing, in addition to being thin and tendinous at its insertion and intimately related to several nerves. The gracilis muscle, which is a thick well-vascularized muscle, has been used for soft tissue defects and vascular graft infections, but its utility as an alternative to the sartorius muscle flap in the setting of radiation has never been reported. Here, we report the successful use of the retroflexed gracilis muscle flap for femoral vessel coverage after superficial inguinal lymphadenectomy, in a patient who previously underwent chemoradiation for locally-metastatic anal squamous cell carcinoma to the groin. Case Presentation: An 86-year old female presented with Stage IIIB anal squamous cell carcinoma metastatic to one left inguinal lymph node (T2N2M0). She underwent modified Nigro protocol chemoradiation treatment, which included radiation to bilateral inguinal node basins and subsequent boost radiation to the left side. A left superficial inguinal lymphadenectomy was performed with a retroflexed gracilis muscle flap to cover the femoral vessels. This was chosen over a sartorius flap because the gracilis muscle was not located within the field of radiation and was more robust to fill the defect. The patient developed a groin wound infection, and the gracilis muscle flap remained viable and successfully protected the major vessels. Conclusions: We report the gracilis muscle flap as a viable alternative to the sartorius transposition muscle flap for femoral vessel coverage after oncologic superficial inguinal lymphadenectomy in the irradiated groin.

The sartorius muscle transposition flap is the traditional method of femoral vessel coverage after superficial inguinal lymphadenectomy for regionally-metastatic cancers to the inguinal lymph nodes. However, if the groin has undergone radiotherapy, the sartorius muscle is contained within the irradiated field, and may be problematic for wound healing, in addition to being thin at its insertion and intimately related to several nerves. The gracilis muscle has been used for soft tissue defects and vascular graft infections, but its utility as an alternative to the sartorius muscle flap in the setting of radiation has never been reported. Here, we report the successful use of the retroflexed gracilis muscle flap for femoral vessel coverage after superficial inguinal lymphadenectomy, in a patient who previously underwent chemoradiation for locally-metastatic anal squamous cell carcinoma to the groin. An 86-year old female presented with Stage IIIB anal squamous cell carcinoma metastatic to one left inguinal lymph node. She underwent modified Nigro protocol chemoradiation treatment, which included radiation to the inguinal node basins. A left superficial inguinal lymphadenectomy was performed with a retroflexed gracilis muscle flap to cover the femoral vessels. This was chosen over a sartorius flap because the gracilis muscle was not located within the field of radiation. Despite a subsequent groin wound infection, the gracilis muscle flap remained viable and successfully protected the major vessels. We report the gracilis muscle flap as a viable alternative to the sartorius transposition muscle flap for femoral vessel coverage after oncologic superficial inguinal lymphadenectomy in the irradiated groin.