The British journal of surgery
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In a series of 18 patients delayed embolectomy of the limb was performed 8-63 days after embolism had occurred. Three patients died (2 of them after amputation), and 7 limbs were amputated after surgery. In 10 instances blood flow was fully restored by the operation. ⋯ This is thought to be due to increased mural adherence of the embolus, with secondary thrombus formation after a delay of 8 days or more. A plea is therefore made for a more aggressive surgical attitude to delayed arterial embolization. Provided that preoperative arteriography has localized the obstructive level and that the patient's general condition allows major vascular surgery, direct removal of the embolus and secondary thrombi by open exposure of the obstructed artery is recommended.
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Four patients with severe ischaemia of a leg due to atherosclerotic occlusion of the tibial and peroneal arteries had reversed long saphenous vein grafts to the patent lower part of the anterior tibial artery. Two of these grafts continue to function 19 and 24 months after operation respectively. ⋯ The early failure rate of distal grafting is higher than in the case of femoropopliteal bypass, but a number of otherwise doomed limbs can be salvaged. Contrary to widely held views, grafting to the anterior tibial artery appears to give results comparable to those obtained when the lower anastomosis is made to the posterior tibial artery.
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Particles of talc have been identified on the route surface of surgeons' rubber gloves and in sections of tissue classified as 'starch' or 'foreign body' granulomas. This analytical study indicates that under certain circumstances these granulomas could have been caused by talc contamination.
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Five different types of surgical mask of varying design and composition of natural and synthetic fibres were tested for their efficiency in vivo by means of a special test chamber. Contaminated particles escaping through or around the mask during speech by the wearer could be collected and sized. ⋯ The best masks contained more fabric, were softer and were pleated, while the worst were stiffer, smaller and not pleated. Reusable cotton fabric masks were as effective as synthetic fabric masks when made to a good design.