William W. Shaw

Immediate Reconstruction of Full-Thickness Chest Wall Defects

Twenty-one patients had full-thickness chest wall defects reconstructed at the New York University Medical Center in the last ten years. Marlex mesh provided chest wall stability in 5 patients. In 9 patients with radiation ulcers Marlex mesh was not required; a severe fibrotic reaction had obliterated the pleural space and prevented paradoxical motion. Partial sternal resections did not require Marlex stabilization, while a total sternectomy resulted in marked ventilatory insufficiency in a patient who would have benefited from the use of a stabilizing material. Random pattern flaps were used initially; more recently, axial pattern, myocutaneous, and myocutaneous free flaps were employed. Necrosis developed in 4 (36%) of the 11 patients with random pattern flaps, but was not seen with the newer flap techniques. Myocutaneous free flaps provided uncomplicated coverage of and stability to three large, potentially contaminated defects. It seems that with the currently available flap techniques and the methods of chest wall stabilization, immediate repair of all full-thickness chest wall defects is possible.

Surgical techniques in penile revascularization

A review of the current status of penile artery revascularization and its methodology is presented. Microsurgical anastomosis of the inferior epigastric artery or central arteries produces good results in younger men. Older patients or those with diabetes, hypertension or who have had coronary bypass surgery do not appear to have good results.

Reconstruction of radical parotidectomy defects

Abstract The technique of microvascular free dermis-fat flaps is an efficient method of restoring cervicofacial contour after ablative head and neck surgery. Our success in six consecutive patients, including three who had received irradiation, establishes this as a reliable technique associated with gratifying results and minimal complications.

Selective arteriography for vascular impotence

SummarySelective pudendal arteriography plays an important role in clinical research into the vascular causes of primary and secondary impotence and forms the basis for microsurgical penile artery revascularization. Arteriography has identified a heretofore undescribed cause for impotence, arteriovenous malformation. Despite potential risks, this should be performed where revascularization is a possibility. Many patients find penile implantation undesirable and are willing to be studied in this manner.

Functional Evaluation of Nonsensate Free Flaps to the Sole of the Foot

Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.

Impotence associated with pudendal arteriovenous malformation

Three young men with impotence due to a pudendal arteriovenous malformation had a common selective pudendal arteriographic finding of early passage of contrast medium from the bulbar artery region into the venous drainage of the pelvis. Perineal exploration revealed the malformation and correction resulted in significant restoration of erectile capacity. This entity may be a frequent occurrence in young men that may become apparent only when trauma or disease affects the contralateral pudendal artery or its branches.

Management of Acute Lower Extremity Nerve Injuries

While repair of acute nerve injuries in the lower extremity has not been as aggressive as in the upper extremity, there should now be more effective early intervention. Newer microsurgical techniques can be used along with increased understanding of peripheral nerve internal anatomy to obtain more satisfactory repair and reconstruction of the injured nerves. The anatomy and vulnerability of the nerves in the leg are reviewed, and the decision process is analyzed in the context of the functional deficits following such injuries. A priority of goals in lower extremity nerve repair should be established to ensure salvage of the foot.