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At least 271 records · Page 15Linked to original sources
PubMed1997

Management of colonoscopic perforations.

OBJECTIVE: To document our evolving surgical management of colonoscopic perforation and examine factors crucial to the improvement of patient care. DESIGN: We conducted a computer-based retrospective analysis of medical records (1980 through 1995). MATERIAL AND METHODS: Among 57,028 colonoscopic procedures performed, 43 patients (0.075%, or 1 perforation in 1,333 procedures) had a colonic perforation. Two additional patients were treated after colonoscopy performed elsewhere. The outcomes analyzed included surgical morbidity and mortality. RESULTS: Twenty-six women and 19 men who ranged in age from 28 to 85 years (median, 69) were treated for colonic perforation. More than 80% of perforations occurred during the latter half of the study period because of the increased volume of colonoscopic procedures (8 perforations among 12,581 examinations from 1980 through 1987 versus 35 perforations among 44,447 colonoscopies from 1988 through 1995). Emergency laparotomy was performed in 42 patients (93%). Perforations occurred throughout the colon: right side = 10; transverse = 9; and left side = 23. Three patients without evidence of peritoneal irritation fared well with nonoperative management. Most patients underwent primary repair or limited resection in conjunction with end-to-end anastomosis. In 14 patients (33%), an ostomy was created. One patient underwent laparotomy without further treatment. Intra-abdominal contamination ranged from none (31%) to local soiling (48%) to diffusely feculent (21%). Postoperative complications occurred in 12 patients and were associated with older age (P = 0.01), large perforations (P = 0.03), and prior hospitalization (P = 0.04). No postoperative deaths occurred. CONCLUSION: Despite a consistently low risk of colonic perforation, the increasing use of colonoscopy in our practice has resulted in an increased number of iatrogenic colonic perforations. In order to minimize morbidity and mortality, prompt operative intervention is the best strategy in most patients. Non-operative management is warranted in carefully selected patients without peritoneal irritation.

Adult↗
PubMed1981

Operative and nonoperative management of esophageal perforations.

During a 21-year period, 72 patients were treated for esophageal perforations; the diagnosis was made only at postmortem examination in 13 other patients. Fifty-eight of 85 patients (68%) sustained iatrogenic perforations, 11 patients (13%) had "spontaneous" perforation, nine patients (11%) had foreign body related perforation, and seven patients (8%) had perforation caused by external trauma. Eleven cervical perforations, contained between the cervical paravertebral structures, plus eight thoracic perforations, contained in the mediastinum, were treated with antibiotics, intravenous hydration, and nasogastric drainage. The mortality rate after this nonoperative approach was 16% (3/19 patients). Indications for operative treatment in 53 patients were hydropneumothorax with mediastinal emphysema, sepsis, shock and respiratory failure. The operative mortality rate in these instances was 17% (9/53 patients). Six of the nine patients who died had been operated on more than 24 hours after the onset of symptoms. For cervical perforations the best results were obtained by drainage plus repair of the perforation (mortality rate: 0%; 0/10 patients) and for thoracic perforations by suturing supported by a pedicled pleural flap (mortality rate: 11%; 1/9 patients). Simple drainage of thoracic perforation was followed by a mortality rate of 43% (3/7 patients).

Esophageal Perforation↗
PubMed2003

The effects of hyaluronic acid, epidermal growth factor, and mitomycin in an experimental model of acute traumatic tympanic membrane perforation.

HYPOTHESIS: The goal of this study was to evaluate the effects of hyaluronic acid, epidermal growth factor, and mitomycin C on the healing of acute experimental traumatic perforations of the tympanic membrane. BACKGROUND: Most acute perforations of the tympanic membrane heal spontaneously. However, some form of surgical treatment (i.e., myringoplasty) is needed for nonhealing perforations. Because the closure occurs by squamous epithelial migration, drugs that stimulate this regenerative process may aid in the closure of the perforation, obviating the need for more extensive treatments. METHODS: Bilateral perforations of the tympanic membrane were created in 30 rats, divided into three groups (A, B, C). The perforations in the right ears were treated with hyaluronic acid, epidermal growth factor, or mitomycin C. Those in the left ears were left untreated for comparison. To examine the healing process in different periods, 5 animals were killed in each group at days 3, 5, 7, 9 and 14. The other 5 animals in each group were observed daily to determine the duration of perforation closures. Thirty surgical specimens (5 right sides from each group and all 15 left sides in all groups) were histopathologically examined for tympanic membrane thickness, fibroblastic reaction, neovascularization, and crust morphology. RESULTS: Hyaluronic acid and epidermal growth factor applications significantly shortened the healing in acute experimental traumatic perforations of the tympanic membrane (p = 0.0432); however, the difference between them was not significant (p = 0.3160). On the other side, tympanic membrane perforations treated with topical mitomycin C showed no evidence of closure. There were no significant differences in the histologic parameters between the treated groups and their contralateral control ears. CONCLUSION: Hyaluronic acid and epidermal growth factor accelerated the closure of acute tympanic membrane perforations in rats. This may make them clinically useful in augmenting the efficiency of conservative treatments of acute perforations of the tympanic membrane.

Adjuvants, Immunologic↗
PubMed2006

Tissue-engineered calcium alginate patches in the repair of chronic chinchilla tympanic membrane perforations.

OBJECTIVE: Chronic tympanic membrane perforations are a common problem in the United States. A high number of these cases results from placement of pressure equalization tubes. These perforations may initially be treated with paper patch techniques and although safe and well tolerated, the procedure demonstrates poor efficacy. The ideal treatment for small perforations should be rapid, minimally invasive, and efficacious. Calcium alginate-based tissue engineered tympanic membrane patches represent an attractive option, but in vivo data are required. METHODS: A controlled prospective study of tympanic membrane perforation repair using a well-known chinchilla model of chronic tympanic membrane perforation was performed. Calcium alginate-based tympanic membrane patches were created using computer-aided design techniques. A previously described chinchilla model of chronic tympanic membrane perforations was used to create stable perforations ranging from 2 to 5 mm. Ears with chronic perforations were divided into three groups: control (no patch), paper patch, and calcium alginate plugs. At 10 weeks postimplantation, all animals were killed and inspected both grossly and histologically for healing. RESULTS: In the chinchilla model, the alginate grafts demonstrated significantly improved healing rates over both the untreated control group (spontaneous repair) and the paper patch group; nine of 13 healed in the alginate group versus two of nine healed in the paper patch group (P < .05) versus one of 11 healed in the control group (P < .05). CONCLUSION: Calcium alginate tympanic membrane perforation patches offer a significant advantage in the repair of chronic perforations over traditional techniques in the chinchilla perforation model and may offer attractive opportunities in the clinical setting.

Alginates↗
PubMed2001

Middle-ear function with tympanic-membrane perforations. I. Measurements and mechanisms.

Sound transmission through ears with tympanic-membrane (TM) perforations is not well understood. Here, measurements on human-cadaver ears are reported that describe sound transmission through the middle ear with experimentally produced perforations, which range from 0.5 to 5.0 mm in diameter. Three response variables were measured with acoustic stimulation at the TM: stapes velocity, middle-ear cavity sound pressure, and acoustic impedance at the TM. The stapes-velocity measurements show that perforations cause frequency-dependent losses; at low frequencies losses are largest and increase as perforation size increases. Measurements of middle-ear cavity pressure coupled with the stapes-velocity measurements indicate that the dominant mechanism for loss with TM perforations is reduction in pressure difference across the TM; changes in TM-to-ossicular coupling generally contribute less than 5 dB to the loss. Measurements of middle-ear input impedance indicate that for low frequencies, the input impedance with a perforation approximates the impedance of the middle-ear cavity; as the perforation size increases, the similarity to the cavity's impedance extends to higher frequencies. The collection of results suggests that the effects of perforations can be represented by the path for air-volume flow from the ear canal to the middle-ear cavity. The quantitative description of perforation-induced losses may help clinicians determine, in an ear with a perforation, whether poor hearing results only from the perforation or whether other pathology should be expected.

Acoustic Stimulation↗
PubMed1975

Stercoraceous and idiopathic perforations of the colon.

Fourteen patients have been encountered with stercoraceous or idiopathic perforations of the colon. Seven patients had a stercoraceous perforation; four had an idiopathic perforation; and three patients remained without exact classification. All the patients were admitted to hospital because of sudden abdominal pain. All except one patient, who was in an agonal condition, were operated on with a diagnosis of peritonitis. The preoperative clinical, radiologic and laboratory examinations were not specific, and in only one instance, the provisional diagnosis was correct. The main differnece between idiopathic and stercoraceous perforations was the macroscopic and histologic appearance of the perforation. In a perforated stercoraceous ulcer, the perforation was a round or an ovoid hole with necrotic and inflammatory edges, while in the idiopathic form, the perforation was a tear with a normal appearance of the colonic wall. The treatment consisted of a closure of the perforation and a proximally situated stoma, or exteriorization. Four patients of the seven with stercoraceous perforations survived. In idiopathic perforations, the prognosis was poor. All patients died during the first 24 hours after the operation. This possibly is an indication of some basic difference in the pathophysiology of these two diseases.

Adult↗
PubMedDate not supplied

Necrotizing enterocolitis complicated with perforation in extremely low birth-weight premature infants.

This study determined the incidence, clinical characteristics, treatment and outcome in extremely low birth-weight (ELBW) premature infants with perforated necrotizing enterocolitis (NEC). We retrospectively reviewed the medical records of ELBW (birth weight <1000 g ) premature infants with perforated NEC diagnosed and managed at National Taiwan University Hospital (NTUH) from January 1993 through December 2000. A total of 8 ELBW premature infants with perforated NEC were collected. The incidence of perforated NEC in ELBW premature infants was 5.1% (8 out of 158). The average age at onset of perforated NEC was 26 days. The most common clinical features were abdominal distention, decreased bowel sound and poor activity level. Dilated and fixed bowel loops, bowel wall thickening and ascites with stool-like substance drainage out from penrose drain tube were the predominant signs at the time of diagnosis of perforated NEC. Thrombocytopenia, elevated C-reactive protein and anemia were the major laboratory findings. All infants received a primary penrose drain in the acute stage of disease. The overall survival rate was 37.5% (3 out of 8). Death occurred due to nosocomial infection with sepsis in 3 patients and due to perforated NEC in 2 patients. Two of the three surviving patients started enteral feeding 19 and 41 days after the diagnosis of perforated NEC and tolerated oral feedings well; the third patient still required total parenteral nutrition two years after diagnosis. Although the clinical characteristics and radiographic findings of perforated NEC in ELBW premature infants were variable, brown color ascites with stool-like substance may be considered a significant sign of perforated NEC despite the absence of free air on radiography at the early stage of disease. Close observation of clinical symptoms and signs, more aggressive surgical intervention and prevention of the following nosocomial infection may have the opportunity to reduce the mortality due to perforated NEC.

Drainage↗
PubMedDate not supplied

Surgical treatment of esophageal perforation.

BACKGROUND/AIMS: In spite of the progress made during the last few decades, esophageal perforation continues to carry a serious prognosis. The aim of this study is to present our experience with surgical treatment of esophageal perforation. METHODOLOGY: Eight patients with esophageal perforation were submitted to surgical treatment with varying time intervals between the perforation and the operation. The surgical technique was individualized according to the location of the perforation and the severity of the local inflammatory and necrotic findings. Follow-up data was obtained by follow-up examination or telephone contact with the family doctors. The medical records were reviewed. The cause, the location and the clinical manifestations of perforation, the underlying esophageal disease, the imaging techniques and other examinations which were used to establish diagnosis, the time interval between the perforation and the operation, the surgical techniques, the outcome, the complications, the duration of postoperative hospitalization, and the late results were analyzed. RESULTS: The perforation was due to iatrogenic injury in 6 of 8 patients. Underlying esophageal disease was present in 4 patients. The mean time interval between the perforation and the operation was 4.3 days. Primary repair was attempted in 5 patients, exclusion-diversion of the esophagus in 2 and thorough drainage in 1 patient. There was no mortality. Primary closure was achieved in 80% of the patients in whom primary repair was attempted. Seven out of 8 patients were alive 46-150 (mean, 99.12) months after the operation. CONCLUSIONS: Surgery is the treatment of choice for patients with esophageal perforation including those seen more than 24 hours after the onset of symptoms. The chosen surgical technique depends on the location of perforation and the severity of local inflammatory and necrotic findings.

Adolescent↗
PubMed1985

Childhood appendicitis: factors associated with perforation.

A retrospective study was performed to identify factors associated with perforation in 150 children with acute appendicitis. The children's parents were interviewed about the nature and timing of care, family history of appendicitis, and history of abdominal pain episodes, and the children's medical records were reviewed. Delay in treatment--the interval between first recognized symptoms of abdominal pain and surgery--was most predictive of perforation. A treatment delay of more than 36 hours was associated with a 65% or greater incidence of perforation. Mean delay for the group with perforation of the appendix was 66.7 hours compared with 35.8 hours for the group having appendicitis without perforation (P less than .01). Mean professional delay was significantly longer in the group with perforated appendicitis than in the group having appendicitis without perforation (P less than .01), but mean parental delay was not. Children aged 1 to 4 years and those aged 5 to 8 years had a 74% and 66% incidence of perforation, respectively, compared with a 30% to 42% incidence in older children (P less than .01). Age had a significant effect upon perforation even when adjusted for delay in treatment. Other factors associated with perforation were family history of appendicitis, social class, advice given by the first health professional contacted, and the presence of fecaliths. When all factors were considered simultaneously by using logistic regression techniques, delay in treatment, age, and absence of a family history of appendicitis were all significant predictors of perforation.

Acute Disease↗
PubMed1980

The continuing challenge of perforating appendicitis.

A series of 335 consecutive patients treated for acute appendicitis is presented. The incidence of perforation in the series was 32.2 per cent. The mortality was 0.3 per cent for the total series and 0.9 per cent for those patients with perforating appendicitis. When perforation occurs, a twofold increase in the hospital stay and a threefold increase in hospital costs result. A complication rate of 47.2 per cent in instances of perforation was significantly greater than that noted in instances of nonperforation. A 40 per cent incidence of perforation was noted during the first decade of life, after which the frequency of perforation declines. Beginning with the fifth decade, a progressive increase in the incidence of perforation was noted. Prior to hospital admission, a significant delay was noted among patients with perforation. In addition, those with perforating appendicitis were far more likely to have been seen previously by a physician who failed to advise hospital admission. Finally, a significant inhospital delay, from admission to operation, was noted in patients with perforating appendicitis. While geographic access to health care did influence the incidence of perforation, insurance status and possession of a telephone did not.

Adolescent↗
PubMed1994

Viscus perforation in peritoneal dialysis patients: diagnosis and outcome.

OBJECTIVE: To determine the incidence and outcome of spontaneous viscus perforation in peritoneal dialysis (PD) patients and which factors could facilitate early diagnosis. DESIGN: A retrospective chart review was done on all patients with viscus perforation and on a control group with peritonitis secondary to gram-negative organisms. SETTING: A tertiary care University Hospital Peritoneal Dialysis program. PATIENTS: All patients with surgically proven spontaneous viscus perforation from 1978 to June 1992 (n = 15). A group of control patients (n = 15) with gram-negative bacterial peritonitis was also reviewed for comparison. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hospital days, patient survival after perforation, and return to peritoneal dialysis were the main outcomes measured. Peripheral white blood cell (WBC) count, PD fluid WBC count with differential, PD fluid cultures, radiologic information, and surgical intervention were also evaluated. Data were analyzed using the Mann-Whitney test to determine significant differences between the two groups. RESULTS: Viscus perforation occurred in 15 of the 431 patients on PD from 1978 to June 1992 (3.5%). In comparison to the control group, patients with viscus perforation had a significantly higher peripheral WBC count (p = .016), a higher mean PD fluid WBC count (p = .006), and a higher mean percentage of polymorphonuclear cells in the PD effluent (p = .038). Multiple organisms on PD fluid cultures were noted in 12 of 15 patients with perforation and in only 3 control patients. Pneumoperitoneum was seen on abdominal or chest radiograph or computerized tomographic (CT) scan in 10 of 15 patients with perforation and in only 1 of 15 patients in the control group. All patients with viscus perforation required surgery and 6 expired. Only 1 death occurred in the control group. Only 1 of the 9 patients surviving perforation was able to resume PD, in contrast to 13 of 14 surviving control patients. CONCLUSION: We conclude that viscus perforation is associated with high morbidity, mortality, and technique failure. Diagnosis may be made by repeatedly searching for intraperitoneal free air on radiograph or CT scan in patients with persistently elevated peripheral and PD fluid WBC count, and for multiple organisms on PD fluid culture.

Adult↗
PubMed1996

Treatment of chronic tympanic-membrane perforations with a platelet-derived releasate.

PURPOSE: Tympanic membrane perforations are very common and often require surgical treatment. Recent studies have suggested that growth factors may be an effective nonsurgical alternative for treating chronic perforations. The purpose of this study was to assess the efficacy of a platelet releasate in the treatment of chronic nonhealing perforations in the chinchilla model. METHODS: Bilateral perforations were created in 47 chinchillas by excising 80% of the tympanic membrane with a thermal myringotomy knife. Bilateral perforations > 50% of its surface area persisted for 10 weeks in 34 animals, and unilateral perforations > 50% of its surface area, in nine animals. Only animals with bilateral chronic perforations were included in this study. After deepithelializing the perforation and packing the middle ear and external ear canals with Gelfoam, we treated the perforations with either platelet releasate or buffered saline. Each animal served as its own control. RESULTS: The tympanic membranes were evaluated over a 12-week period by microscopy, photography, tympanometry, and histology. No statistical difference between treated and control ears in the incidence of perforation closure was evident. Histologically, the treated tympanic membranes consistently had a thicker fibrous layer than the controls. CONCLUSIONS: These data suggest that platelet releasate is not effective in enhancing closure of chronic tympanic membrane perforations in the chinchilla model.

Animals↗
PubMed2004

Reconstruction of the hand and upper limb with free flaps based on musculocutaneous perforators.

Since the advent of perforator flaps, a wide variety of applications have been documented. This study focuses on free flaps based on musculocutaneous perforators, because they have not been well-described in the literature of upper-limb reconstruction. They can be trimmed to be thin and pliable, and may provide large flaps with multiple components on the same pedicle to facilitate three-dimensional inset of flaps. Microvascular free flaps based on musculocutaneous perforators were performed in 36 cases for reconstruction of the thumb and thenar web, palm, dorsum of the hand, wrist, and forearm. They included the anterolateral thigh perforator flap (27 cases), thoracodorsal perforator flap (5 cases), and deep inferior epigastric perforator flap (4 cases). In 2 other cases not included in this series, the thoracodorsal perforator flap could not be elevated due to anatomical variations. There was no failure in this series, but complications included: 1) hematoma in 2 cases, and 2) infection in 2 cases with flap rim necrosis which was treated by a local rotation flap and skin graft. The thin flaps facilitated secondary reconstructive procedures, and only minor effort was required for the debulking procedure of the flaps. On average, these patients required 2.3 occasions of secondary procedures for further reconstruction following coverage with a perforator flap. The perforator flaps provide medium-thickness flaps for coverage of large defects in the upper limb with improved aesthetics and function. With careful dissection of the musculocutaneous perforators and primary thinning of the flaps, the use of a perforator flap is quite safe. Preservation of the muscles leads to better preservation of donor-site functions. Less requirement of secondary debulking procedures is a great advantage. However, caution should be taken in the presence of wound infection.

Adolescent↗
PubMed1999

[Acquired reactive perforating dermatosis. Successful treatment with allopurinol in 2 cases].

Perforating disorders represent a heterogenous group of dermatoses characterized by transepithelial elimination of dermal structures. Primary perforating disorders should be distinguished from secondary perforating disorders in which perforation with transepithelial elimination is a rare component of a variety of dermatoses. The primary perforating disorders are hyperkeratosis follicularis et parafollicularis in cutem penetrans (Kyrle's disease), elastosis perforans serpiginosa and perforating folliculitis. Acquired reactive perforating dermatosis (also known as acquired reactive perforating collagenosis) together with the hereditary variant of the reactive perforating collagenosis represent further examples of the primary perforating disorders. We report on 84 year old and 96 year old female patients with an acquired perforating dermatosis. Both of the patients additionally showed diabetes and hyperuricemia. Oral administration of allopurinol (100 mg daily) led to a healing of the disseminated skin lesions in 1-2 weeks. After a follow-up period of 6 months, both patients were in complete remission. On one hand, these results prove again the existence and the severity of this disease, and on the other hand suggest an immunomodulating or differentiation-promoting action in addition to the uricostatic effect of allopurinol.

Aged↗
PubMed2005

Development of a perforated biodegradable interference screw.

PURPOSE: The objective was to develop a perforated biodegradable interference screw to allow for enhanced osseous implant integration without impairing screw stability during insertion. TYPE OF STUDY: Mechanical testing, followed by animal study. METHODS: At first, manual perforation of 8 x 23-mm biodegradable poly-(L-co-D,L-lactide) interference screws was performed, using 3 different perforation patterns (clockwise spiral, counter-clockwise spiral, and parallel perforation), followed by torsional tests. Next, parallel perforated screws (n = 6) and unperforated control screws (n = 6) were applied to the proximal tibia of 12 sheep. The sheep were put down after 24 weeks and the screw site was examined histologically. Subsequently, molding of a parallel perforated screw followed by torsional tests was undertaken. RESULTS: The parallel perforated screw presented a torsional strength insignificantly different from the unperforated control screw and well beyond the reported maximum manual insertion torques of biodegradable interference screws in young human bone. When compared with the regular unperforated interference screw, the molded perforated screw exhibited a torsional strength of 91%, indicating a secure surgical application. In contrast to the unperforated screw, histologic evaluations revealed clear bone ingrowth into the perforations including the core of the perforated interference screw. CONCLUSIONS: Perforated, "cage-like" interference screws may be promising for the acceleration of osseous implant integration into the bone with a very low risk of screw breakage during insertion. CLINICAL RELEVANCE: To ameliorate osseous implant integration and possibly enhance ossification of former implant site in anterior cruciate ligament surgery.

Absorbable Implants↗
PubMed2004

An analysis of inadvertent perforations of mucosa and skin concurrent with mandibular reconstruction.

PURPOSE: This article reports on the incidence and outcome of inadvertent perforations of mucosa and skin during the reconstruction of segmental defects of the mandible using cancellous cellular bone. PATIENTS AND METHODS: This study reviews 11 patients experiencing an inadvertent perforation of skin and/or mucosa among 211 consecutive patients (5.2%) undergoing reconstruction of the mandible with this graft model. RESULTS: Eleven patients experienced 16 perforations of either mucosa (n = 14) or skin (n = 2). Six diagnoses necessitated these 11 reconstructions where a perforation was encountered, including ameloblastoma (n = 3), chronic osteomyelitis (n = 2), stage III osteoradionecrosis (n = 2), fibrosarcoma (n = 1), synovial cell sarcoma (n = 1), stage IV squamous cell carcinoma (n = 1), and odontogenic myxoma (n = 1). Fourteen of the 16 perforations occurred intraoperatively, and 2 occurred postoperatively (dehiscence). Eleven of the 16 perforations occurred at either the distal or proximal segment, while 5 of the perforations occurred in the mid portion of the segmental defect tissues. Postreconstruction follow-up ranged from 11 to 70 months (mean, 28.5 months). Infection occurred in 1 of the 11 patients (9.1%) with resultant partial graft loss. Protocols are proposed that serve to preserve a contamination-free tissue bed and minimize or eliminate infection of the graft when a perforation is encountered. CONCLUSION: An inadvertent perforation of mucosa or skin does not result in automatic graft infection and failure when proper intraoperative management is carried out. When the graft perforates through the mucosa postoperatively, proper wound management similarly can preserve the graft. This information reinforces the fact that it is not necessary to abort reconstructive surgery once a perforation is identified intraoperatively, nor to debride an entire graft that becomes exposed postoperatively.

Bone Transplantation↗
PubMed2006

Superior forniceal conjunctival advancement pedicles (SFCAP) in the management of acute and impending corneal perforations.

OBJECTIVE/AIM: Corneal perforations can result from a wide variety of disorders and can lead to devastating visual sequelae. Various surgical procedures have been described to manage nontraumatic corneal perforation. Conjunctival flaps offer an important technique in dealing with such corneal emergencies. We report a modified conjunctival flap procedure referred to as superior forniceal conjunctival advancement pedicle (SFCAP) in the successful management of corneal perforation and impending corneal perforation. PATIENTS AND METHODS: Out of 20 patients who underwent SFCAP for non-traumatic corneal perforation and impending perforation, 16 had corneal perforations. Perforations were secondary to acne rosacea (2), advanced bacterial keratitis (6), corneal anaesthesia(2), multiple retinal procedures (2), previous corneal grafts with a compromised ocular surface (3), and advanced Mooren's ulcer (1). RESULTS: The globe was preserved in all patients. In 14 of the 16 eyes with perforated corneas the pedicle stabilised. One patient, who was a chronic alcoholic, rubbed the eye during sleep detaching the pedicle a week after surgery. However, the ulcer healed and the integrity of the globe was restored. None of these patients developed secondary glaucoma or ptosis. CONCLUSION: SFCAP is an appropriate procedure to manage corneal perforations and impending corneal perforations where donor material is not available and transplantation of such tissue is not suitable.

Acute Disease↗
PubMed2002

Perforator flaps in lower extremity reconstruction.

Perforator flaps are defined as skin flap without fascia or muscle and they are nourished by one or more perforating vessels perforating the fascia, muscle, or intermuscular septum. As early as 1985 in Japan, we proposed this concept over that of the fasciocutaneous flap, which was believed to be nourished by fascial plexus. The pedicle perforators are classified as septocutaneous, muscular (intermuscular), periosteal, and intertendinous perforators. As useful perforator flaps in the lower extremity, posterior tibial perforator island flaps, saphenous island flaps, peroneal island flaps, malleolar island perforator flaps, deep inferior epigastric perforator free flap (DIEP flap), anterolateral thigh free flap (ALT flap), and latissimus dorsi muscle free perforator flap (thoracodorsal artery perforator flap, T-DAP or TAP flap) were described. These flaps have the advantage of minimal donor-site morbidity, relatively rapid dissection and flap elevation, and reliable skin territory.

Adult↗