Faculty Bibliography

Full thickness chest wall resection and single stage reconstruction for osteoradionecrosis of the chest wall was performed on five patients. All patients had undergone radical mastectomy and radiation therapy from 5 to 18 years prior to chest wall resection. Defects varied from 12 X 5 cm to 15 X 15 cm, and included from two to four ribs. Reconstruction was performed using Marlex mesh to reconstruct the bony thorax and a rotated latissimus dorsi myocutaneous flap. Coverage was successfully performed in all cases, and no patient experienced postoperative pulmonary dysfunction. There were no complications related to either the bony thorax reconstruction or the latissimus flap. The use of this technique has provided a safe, convenient, and reliable method of chest wall reconstruction.

The onset of symptoms from a congenital posterolateral (Bochdalek Hernia) defect is rare in the adult. We are reporting a 25-year-old female with a previously asymptomatic Bochdalek hernia who presented with acute intestinal obstruction. The abnormal embryology, pathophysiology, and clinical manifestations of this condition in the adult are discussed.

In a four-year period, 45 patients underwent counterpulsation for cardiogenic shock following myocardial infarction. Of these patients, 27 underwent angiography. Fifteen of them were not considered to be operative candidates because angiography demonstrated only single-vessel disease or diffuse distal coronary artery disease. Twelve patients were candidates for operation and were divided into three subgroups depending on the time of surgical intervention. One patient (Group 1) deteriorated while on counterpulsation, and underwent urgent angiography and operative intervention within 24 hours of balloon insertion. He is now in New York Heart Association (NYHA) Functional Class I. Group 2 consisted of 7 patients whose condition stabilized with use of the balloon but who could not be weaned. All underwent angiography from 7 to 14 days after insertion of the balloon. One patient died suddenly prior to operation. Six patients underwent coronary bypass from 8 to 21 days after balloon insertion. Five survived and are in NYHA Class II or III. Four patients were able to be weaned after angiography (Group 3). All had triple-vessel disease. Operation was undertaken six to eight weeks after infarction to treat persistent congestive heart failure or angina, or to improve chances of long-term survival. Two patients in this group survived. Our experience demonstrates that delayed intervention is an acceptable alternative to urgent operation.

Two cases of disinsertion of the left innominate vein from the superior vena cava (S.V.C.) during primary median sternotomy have been encountered during the past 6 years. Methods of management consisting of either (1) ligation and division of the left innominate vein and patch angioplasty of the SVC injury, or (2) patch angioplasty of the disinsertion injury itself with preservation of the left innominate vein are presented. The rationale and possible complications of each method of treatment are discussed based on the anatomy and collateral circulation of the left innominate vein and other experiences with division of the left innominate vein.

The natural progression of arteriosclerotic descending thoracic aneurysms results in rupture in a high percentage of patients. Reports of surgical experience with these problems are not common although much as been written about elective resection of thoracic aneurysms. Two patients with ruptured non-traumatic descending thoracic aneurysms are presented. hemorrhage into the right hemithorax was a presenting manifestation in both patients. The mechanism for this type of rupture is discussed. Both patients were operated upon with one survivor. Preoperative evaluation, operative approach, and methods of bypass are discussed.