Tissue Reconstruction In Patients Research Articles

Gracilis muscle flap for reconstruction of extensive soft tissue damage to the palm.

The reconstruction of a large palmar soft tissue defect is a challenge to restore both aesthetics and functionality. Reconstruction with fascio-cutaneous and fascial flaps are the most widely used in the literature, few cases are reported using muscular free flap. We report our experience with the use of the free gracilis muscle flap for palmar soft tissue reconstruction in patients with complex hand traumas. We review nine cases of complex soft tissue reconstruction to the palm of the hand using the free gracilis muscle flap performed over a period of 20 years. Eight cases involved acute trauma with damage to underlying structures, necessitating multiple surgical procedures. With an average follow-up of 36 months, the free gracilis muscle flap reconstruction enabled patients to achieve good grip, with skin quality resistant to chronic mechanical stress. All patients recovered a protective sensation to deep pressure. The hand's aesthetic appearance was restored in all cases. Flap harvesting altered neither the function nor silhouette of the donor site. The optimal palmar reconstruction technique depends on patient characteristics, associated trauma, and defect size. In our opinion, the gracilis muscle flap technique is both straightforward and effective in restoring mechanical function of the hand, particularly when a large area of the palm has been impacted.

An Open Label, Multi-center, Controlled, Retrospective Study of a Biodegradable Synthetic Graft for Soft Tissue Reconstruction in Patients Suffering from Chronic Lateral Ankle Instability

Category: Ankle; Sports Introduction/Purpose: Ankle sprains represent one of the most common injuries among both athletes and the general public (1). While most sprains resolve with conservative therapy, failure resulting in ligament laxity may necessitate surgical intervention due to pain and instability from injury to the anterior talofibular ligament (ATFL), the weakest ligament in the lateral ligamentous complex (2). Surgical repair of ATFL has relatively high success rates, however post-procedure chronic instability and pain remain a clinical challenge, with re-operation rates reported as high as 14% (3). The Artelon® FlexBand® matrix is a biocompatible, synthetic matrix designed to reinforce soft tissue repair during tendon/ligament reconstructive procedures. The goal of this study is to compare the outcomes of ATFL reconstructive surgery with and without this synthetic graft augmentation. Methods: This multi-center, IRB approved study used a combination of retrospective medical chart review and prospective procedure satisfaction phone surveys in patients that had undergone ATFL repair (isolated and non-isolated) with or without synthetic graft augmentation. These results represent an interim data analysis of an ongoing clinical study. A total of 234 patients, (82 Control and 152 FlexBand augmented) diagnosed with chronic lateral ankle instability that had failed conservative therapy, and required surgical intervention to repair the lateral ligament complex were enrolled across four different research centers. Patient demographics, physician assessment of healing progression, safety, complications necessitating a return to OR, and post-op rehabilitation schedule were analyzed. Two study sites used Visual Analog Scale (VAS) to assess pain pre-surgically and at 2, 6, and 12 week follow-up visits. Phone survey questionnaires were given to patients that reached at least 1yr post-op to assess long-term patient satisfaction and function. Results: Average patient age was 42yrs in both groups and average follow-up time was 19.2mo (FlexBand) and 28.4mo (Control). There was no statistical difference in baseline VAS pain scores between groups. Augmented patients demonstrated significantly lower VAS scores at 2-,6-, and 12-week follow-up visits (p < 0.001, p< 0.0001and p< 0.0001, respectively) compared to controls (Fig 1). In addition, a significant acceleration in return to FWB status in augmented group compared to control patients was observed (9.04 ± 0.38wks, N=101 vs. 11.82 ± 1.67wks, N=45; p = 0.027). Both groups demonstrated equivalent AE safety profiles and complications were similar across groups with 3.7% (3/82) of control and 3.9% (6/152) augmented patients requiring a return to OR, however, no AEs or complication events were related to the Flexband Device. Conclusion: Our data shows a significant reduction in VAS pain scores in patients who underwent the modified Brostrom procedure with augmentation at all follow up time points. In addition, synthetic graft augmentation may lead to earlier return to function due to the significantly lower time to achieve FWB status. Further investigation on the potential clinical benefits of ATFL augmentation with Artelon Flexband is ongoing through a prospective, randomized, controlled study. Overall, long-term (>1yr) patient satisfaction was equivalent across groups and a trend toward potential earlier recovery times were better for the augmented group than the control group.

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

BackgroundThe submental island flap (SIF) is a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction. Materials and methodsA total of 32 consecutive patients with carcinoma of the oral cavity were included in this study. All patients underwent resection and immediate reconstruction with SIF pedicled the submental vessels. Donor and recipient site morbidity, functional outcome, and locoregional recurrences are reported. ResultsThe study included 22 males (69%) and 10 females. The mean age was 54 years (range of 31–79 years). The most common primary tumor site was the tongue (15 patients, 47%), followed by the buccal mucosa, alveolar margin, floor of mouth, lower lip and hard palate. In 25 patients (78%) the flap survived completely. Complete flap loss occurred in one patient (3%). Six patients (19%) developed complications related to flap vascularity. 21 patients (66%) resumed normal diet, while 11 patients (34%) tolerated only soft diet. Over a median follow up was of 15 months (range of 3–62 months), 21 patients (66%) are alive and disease free, while 8 patients died, of whom 4 of locoreginal recurrences. ConclusionsSIF is reliable for reconstruction of the intraoral soft tissue defects following cancer resection. The functional and cosmetic outcomes are satisfactory and donor site morbidity is low. Careful patient selection is necessary for favorable outcome.

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

Background: The submental island flap (SIF) has gained popularity as a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction.

Comparison between anterolateral thigh free flap and jejunal flap for tissue reconstruction in patients underwent resection of pharyngoesophageal squamous cell carcinoma after radiotherapy failure: a retrospective study

BackgroundAnterolateral thigh (ALT) free flap and jejunal flap (JF) were commonly used in tissue reconstruction for pharyngoesophageal squamous cell carcinoma (PESCC) with worsening tissue adhesion and necrosis after radiotherapy failure. However, the results of tissue reconstruction and postoperative complications of these two flaps are controversial. The purpose of this study was to compare outcomes between group ALT free flap and group JF in PESCC after radiotherapy failure.MethodsIntraoperative information and postoperative outcomes of patients with PESCC after radiotherapy failure who underwent ALT and JF reconstruction from January 2005 to December 2019 were compared and analyzed.ResultsThe defect size of ALT (Numbers, 34) and JF (Numbers, 31) was 36.19 ± 11.35 cm2 and 35.58 ± 14.32 cm2 (p = 0.884), respectively. ALT and JF showed no significant difference in operation time (p = 0.683) and blood loss (p = 0.198). For postoperative outcomes within 30 days both in recipient site and donor site including wound bleeding, wound dehiscence, wound infection, and pharyngocutaneous fistula, ALT free flap and JF showed similar results. Flap compromise (Numbers, 2 VS.3, p = 0.663), flap take backs (Numbers, 1 VS.1, p = 1.000), partial flap failures (Numbers, 4 VS.2, p = 0.674), and total flap failures (Numbers, 0 VS.0, p = 1.000) showed no difference between the two groups. In addition, no significance was found in hypoproteinemia between the two groups (Numbers, 4 VS.2, p = 0.674). ALT free flap was not statistically different from JF in the incidence of dysphagia at the postoperative 6 months (Numbers of liquid diet, 5VS.5; Numbers of partial tube feeding, 6VS.7; Numbers of total tube feeding, 3VS.1, p = 0.790) and 12 months (Numbers of liquid diet, 8VS.7; Numbers of partial tube feeding, 8VS.7; Numbers of total tube feeding, 5VS.5, p = 0.998). The cause of dysphagia not found to differ between the two groups both in postoperative 6 months (p = 0.814) and 12 months (p = 0.845).ConclusionCompared with JF, ALT free flap for PESCC patients after radiotherapy failure showed similar results in postoperative outcomes. ALT free flap may serve as a safe and feasible alternative for PESCC patients after radiotherapy failure.

The proximally pedicled anterolateral thigh flap for reconstruction of complex soft tissue wounds of the hip and caudal trunk region

Groin and lower trunk defects are common problems, especially for elderly patients. While groin defects are often due to prior vascular interventions, trochanteric defects are mainly caused by pressure sores. Plastic reconstructive methods are manifold; however, the pedicled anterolateral thigh (ALT) flap is supposed to be reliable with sustainable results. We present our experiences using the pedicled ALT flap for soft tissue reconstruction in patients with large wounds of the medial and lateral proximal thigh. A total of 16 patients with groin and lower trunk defects due to prior vascular surgery or pressure sores received locoregional soft tissue reconstruction using aproximal pedicled ALT flap. Patient characteristics, defect size, surgery time, clinical outcome and complication rate were assessed. With the exception of two cases, sufficient soft tissue reconstruction was achieved. In all, 81,3% of patients were categorized as ASA (American Society of Anesthesiologists)3. The average duration of surgery was 149 min. Length of stay was 18,3days. A total of 31% needed revision surgery due to limited wound healing problems. Two patients died. All patients showed healed wound conditions when they were discharged. The proximal pedicled ALT-flap is areliable method for soft tissue reconstruction in groin and lower trunk defects. This reconstructive procedure enables reliable wound closure, especially in elderly patients with substantially reduced general health condition.

Options and outcomes of soft tissue reconstruction in patients undergoing surgery for locally recurrent rectal cancer

Reconstruction of extensive perineal defects following oncological surgery for locally recurrent rectal cancer poses functional as well as esthetic challenges. Good communication between the colorectal and reconstructive surgeon is essential to achieve a successful reconstruction. The reconstructive ladder includes a wide variety of options for the management of these defects; however, the best reconstructive option depends on defect characteristics, progression of disease, tissues involved, patient co-morbidities, past surgical history, prior radiation therapy, and the technical expertise of the reconstructive surgeon. In all cases, the necessity of skin coverage, as well as vascularized tissue to obliterate dead space, is required to close the defect and minimize the risk of complications.

Soft Tissue Reconstruction in Patients With Hemifacial Microsomia: A Systematic Review of the Literature.

Hemifacial microsomia is the most common congenital disorder of the face after cleft lip and palate. While treatment of the bony abnormalities has been well documented, less attention has been paid to correction of the soft tissue deformity. This study aimed to systematically review the literature addressing the techniques utilized to correct the soft tissue deformity in hemifacial microsomia. A comprehensive review of peer-reviewed literature regarding the management of soft tissue reconstruction in patients with hemifacial microsomia was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Odds ratio was used to assess differences in complication rates between reconstructions performed with free tissue transfer and fat grafting. The literature search yielded 38 articles that were fully reviewed for data extraction. Articles were grouped into one of 5 reconstructive modalities-pedicled flap, microvascular free tissue transfer, structural fat grafting, alloplastic implant, and functional reconstruction. Microvascular free tissue transfer had a complication rate of 27.1%, while structural fat grafting had a complication rate of 4.2% (odds ratio 6.7, P = 0.0003). Microvascular free tissue transfer likely provides greater volume than fat grafting at the cost of a higher complication rate. Mild to moderate soft tissue deformity can be corrected with serial fat grafting. However, severe soft tissue deformity is better corrected with microvascular free tissue transfer. When performing free tissue transfer, one should be prepared for recipient vessel anomalies. To provide adequate augmentation with isolated fat grafting, multiple sessions are likely required.

Virtual Surgical Planning and Three-Dimensional Printed Guide for Soft Tissue Correction in Facial Asymmetry.

Fat grafting has become a well-accepted surgical modality to correct soft tissue facial defects and asymmetries with overall good results. Several techniques have been reported over the last few years to assist in improving accurate evaluation of facial defects and in the preoperative planning of the reconstruction. Such techniques include among others, computer tomography, three-dimensional (3D) photogrammetry, high resolution ultrasound, and 3D laser scanning. There are advantages and disadvantages for each technique.With the rapid advance of 3D technologies that have become readily available to clinicians, new clinical applications continually emerge to guide and facilitate reconstructive procedures. The authors explored the possibility of fabricating a 3D printed surgical guide to define volume differences for soft tissue reconstruction in patients with facial asymmetry. The model was developed through the authors' virtual surgical simulation and planning system that consists of computer-assisted design (CAD) and 3D printing (3DP).Three-dimensional volumetric scans of patients' faces were analyzed with computer-aided design to quantify areas of facial asymmetry. Surgical guides with containers defining volumetric differences were fabricated using 3D printing to identify and quantify areas of soft tissue deficiency. The 3D printed patient-specific, guides were sterilized and used by the surgeon intraoperatively to accurately mark the areas of soft deficiency. Thus, facial symmetry was achieved by fat grafting the predetermined volume differences defined in the surgical guides. A postop mask was used by the surgeon at the end of the procedure and during follow-up clinic visit to verify and evaluate accurate fat grafting placement as well as to determine areas where to add volume if needed.This paper details the rational for the authors' approach, outlines the technical planning and fabrication process of these patient-specific custom surgical guides with quantified volumetric containers and their intraoperative use by the surgeon. Despite the authors' limited experience we conclude that the authors' technique offer surgeons a precise means for accurate volumetric reconstruction of facial asymmetry.

Perioperative Glucocorticoid Treatment of Soft Tissue Reconstruction in Patients on Long-term Steroid Therapy: The Experience of 6 Cases Using Reversed Posterior Interosseous Flap for Hand Neoplasm Surgery.

IntroductionLong-term steroid therapy is associated with increased postoperative morbidity. Whether to use a stress dose of glucocorticoids (GCs) in surgical patients remains controversial. In the present study, we reported our experience in perioperative GC treatment of 6 patients on long-term steroid therapy for autoimmune diseases undergoing hand reconstruction using reversed interosseous flap.MethodsThe reversed interosseous flap reconstructions were performed after local extended resection of hand neoplasms. The patients were all diagnosed with autoimmune diseases and were undergoing long-term steroid therapy. Stress dose of GCs was not given in any case, and all the patients either remained on their baseline maintenance dose or decreased the dose until the morning of the operation day. Hypotension, water-electrolyte imbalance, hypoglycemia, and other symptoms of adrenal insufficiency were carefully assessed. Appearances of flap complications were recorded.ResultsNone of the patients developed hypotension or other symptomatic adrenal insufficiency. Flap infection, venous congestion, or complete or partial loss of flap was not observed in any patient. Effusion underneath the flap was developed in only 1 case and was solved by proper drainage.ConclusionsIt is safe, reliable, and versatile to use reversed interosseous flap to repair hand defects in patients on long-term steroid therapy. A stress dose of GCs might not be necessary in this procedure and other equally moderate soft tissue reconstructive surgeries.

The anterolateral thigh flap for soft tissue reconstruction in patients with tongue squamous cell carcinoma.

BackgroundSurgery remains the first choice of treatment for tongue cancer. Immediate reconstruction should be performed after wide resection of tumour. The aim of this study was to evaluate the anterolateral thigh flap for reconstruction of lingual defects.MethodsWe report 39 consecutive oral tongue squamous cell carcinoma patients who underwent lingual reconstruction with the anterolateral thigh flap between 2009 and 2010.ResultsThe width of the skin island was 4 to 5 cm and the length of the skin island was 6 to 8 cm in 31 patients with T2 tumour, while the width of the skin island was 5.5 to 6 cm and the length of the skin island was 9 to 12 cm in 8 patients with T3/4 tumours. The all flap survival rate was 97.5 % in our series.ConclusionsWe could obtain sufficient flap volume using the anterolateral thigh flap for tongue reconstruction. The single perforator-based anterolateral thigh flap is a good option for soft tissue reconstruction in patients with oral tongue squamous cell carcinoma.

The transverse lumbar perforator flap: An anatomic and clinical study

Lumbosacral defects are complex reconstructive problems requiring tension-free vascularised soft tissue reconstruction in patients who often have comorbidities. In an area prone to recurrent tissue breakdown, both free and islanded flaps risk complete failure. Cadaveric studies have demonstrated the consistency of lumbar perforators, yet ipsilateral lumbar perforator flaps have modest reconstructive potential owing to geometric limitations. An axial pattern lumbar perforator flap based on a contralateral lumbar perforator may surmount these problems; however, it has only been described in a small clinical and cadaveric study previously. An anatomical study was performed in the consecutive patients undergoing computed tomographic angiography (CTA) of the trunk, assessing the presence and location of lumbar artery perforators. The use of midline or contralateral lumbar artery perforators in the lumbar perforator flap was assessed in the reconstruction of lumbosacral defects. A total of 102 patients with 102 lumbosacral defects have been managed with the use of contralaterally based transverse lumbar perforator flaps over a period of 20 years. In 96 patients, the defects requiring reconstruction followed debridement of a pressure ulcer, with seven cases following debridement of pilonidal sinuses and one following abdominoperineal resection. There were 65 men and 37 women, with a mean follow-up of 1.5 years. Necrosis of the tip of the flap occurred in 3%, with no cases of complete flap loss. Recurrence occurred in two cases (both sacral pressure sores). All recurrences and/or necrosis were managed with flap advancement or skin grafts. All the donor sites were closed directly. The contralateral-based transverse lumbar perforator flap is a simple, reliable, versatile and, in some cases, reusable choice in the management of lumbosacral defects. Flap dimensions of 24×15cm can be based on one lumbar perforator.

Outcome of vulvar reconstruction in patients with advanced and recurrent vulvar malignancies.

BackgroundThe use of flaps in vulvar cancer-related reconstruction has been increasing, but few studies have evaluated the outcome and quality of life of patients after this surgery. The purpose of this study was to evaluate the outcomes of vulvar reconstruction using musculocutaneous/skin flaps in patients with advanced and recurrent vulvar malignancies.MethodsPatients with vulvar malignancies who underwent vulvar reconstruction using different types of flaps were retrospectively reviewed. Patient outcomes were evaluated with a focus on quality of life and prognosis.ResultsThirty-six patients were enrolled, 58.33 % of them used anterolateral thigh flap (ALT), 16.67 % of them used pudendal thigh flap (PTF), 11.11 % of them used deep omferior epigastric perforator (DIEP) and gracilis myocutaneous flap were used in 2.78 % of the patients, the other 11.11 % patients used two types of flaps. Eleven patients (30.56 %) developed complications, including 5 patients (13.89 %) with partial necrosis, 5 (13.89 %) with minimal wound dehiscence and 1 (2.78 %) with flap cellulitis. All patients who developed partial necrosis (13.89 %) underwent reoperation. The mean verbal rating scale score was 1.44 before reconstruction and 0.17 after surgery (P < 0.0001). The mean performance status was 1.67 before surgery and improved to 0.31 after surgery (P < 0.0001). The median overall follow-up time after vulvar reconstruction was 9 months. Twenty-one patients (58.3 %) developed recurrence at a median interval of 5 months after vulvar reconstruction. After a median follow-up time of 14 months, 41.7 % of the patients were living and disease-free. The 5-year survival of the 36 patients was 53.8 %.ConclusionSoft tissue reconstruction in patients undergoing resection of advanced/recurrent vulvar malignances is associated with a low rate of postoperative complications, decreased pain, and improved functional status. Although the recurrence rate in this patient population is high, a reasonable proportion of patients who undergo resection for advanced/recurrent vulvar cancer and reconstructive surgery appear to benefit.

The Versatility of Propeller Flaps for Lower Limb Reconstruction in Patients With Peripheral Arterial Obstructive Disease

In this study, we evaluate the feasibility of propeller flaps, for soft tissue reconstruction in patients with peripheral arterial obstructive disease (PAOD). Five patients (average age, 72 years old), presenting with necrosis of several foot units, were diagnosed with stage IV PAOD and diabetes mellitus. All underwent revascularization, followed by soft tissue reconstruction using propeller flaps. A total of 6 flaps were performed, with dimensions ranging from 4 x 7 cm to 8 x 31 cm. Perforator origin was the peroneal (5 flaps) or the tibial posterior artery (1 flap). Average operative time was 190 minutes. Overall patency was 83.3%; 1 case was complicated with total flap loss followed by below-knee amputation; 1 case developed partial necrosis necessitating skin grafting. All flaps developed mild postoperative edema, which resolved spontaneously. Propeller flaps prove to be useful tools for soft tissue reconstruction in patients with PAOD because of low operative morbidity, easy technique with fast learning curve, and low complications rate.

Breast-conserving surgery and autogenous tissue reconstruction in patients with breast cancer: efficacy of MRI of the breast in the detection of recurrent disease.

The objective of the present study was the evaluation of MRI of the breast in the follow-up of patients who had undergone autogenous tissue breast reconstruction using either a latissimus-dorsi muscle flap or a transverse rectus abdominis myocutaneous (TRAM) flap as correlated with patients' clinical, conventional mammographic and sonographic findings. Included in the study were 41 patients. The MRI consisted of T2-weighted turbo spin-echo (TSE) sequences and dynamic measurements pre- and postcontrast using T1-weighted gradient-echo (GE) sequence. The following factors were evaluated: recognition of the flap; evidence of edema; skin thickening; and focally increased contrast medium uptake. Contrast medium dynamics were documented in instances of increased focal uptake. Flaps could be distinguished from surrounding residual breast tissue in all cases. Edema and skin thickening in the residual mammary tissue and flap implant were observed in 72.7% of patients undergoing radiation, but in only 15.8% of those not undergoing radiotherapy. The MRI excluded disease recurrence in 4 patients with suspicious mammographic and/or sonographic findings. One instance of multifocal disease recurrence identified at MRI evaded detection with all other imaging techniques used. The MRI returned false-positive findings in three cases. Because of their configuration and contrast medium uptake dynamics and their location immediately adjacent to the contact zone between the flap implant and residual mammary tissue, these findings were impossible to differentiate from a recurrent carcinoma. The MRI of the breast is generally suitable for follow-up examination of autogenous tissue reconstructions. Problems may be encountered in the evaluation of the contact zone between local adipose tissue and the flap leading to false-positive results.

Free tissue transfer in patients over 75 with head and neck malignancy

Radical excision and reconstruction, often with free tissue transfer, has been shown to offer the best hope of cure for advanced head and neck malignancy. Despite the fact that these patients are often elderly, with significant preoperative morbidity there have been few, if any, reports of the success of excision and free tissue reconstruction in patients over 75 years old. We therefore performed a consecutive review of 12 patients over 75 undergoing such surgery in this unit over the past three years in an effort to clarify indications, success rate and complications. The age of the patients ranged from 75 to 88 years (mean 81). All of the flaps survived. Two (16%) required early reexploration. Six of the twelve (50%) patient remain tumour free an average of 18.3 months after surgery (range 1–33 months). One died of causes unrelated to his tumour 14 months after surgery. Of the remaining five, two died in the early post-operative period, two of recurrent tumour or a second primary and one remains alive 8 months post-surgery despite local reccurrence. We dicuss the indications, complications and outcomes of surgery in these cases and discuss patient selection and measures which may help reduce peri-operative morbidity and mortality in these elderly patients undergoing radical surgery.

Reconstruction of the cardiac valves with autologous tissue.

A rather long and extensive experience with tissue reconstruction in patients with mitral valve disease, and a much less extensive one with oartic lesions, has convinced us of the superiority of the presented techniques of reconstruction, and of the preferability of fascia lata over all other tissues so far tried for this purpose. Despite an early increment of shrinkage of the order of about 30% of each linear measurement, late studies of fascia lata removed from reconstructed valves after several years (over five) indicate no loss of cellularity and no measurable loss of tissue strength or flexibility. Late calcification was not observed in any of our baboons, although it appears to be a consistent development in dogs. It has been seen in only one patient (after four years) to date. It is now believed that we can offer prolonged clinical benefit approaching actural "cure" to many of the younger patients who otherwise would have no recourse but to prosthetic palliation. It is true that recently Willen, Dubiel and Johansson (50, 51), Gersbach and Wegmann (52), and Senning and Rothlin (53) have demonstrated that repetitive deposits of fibrin upon the surfaces of fascia lata implanted within the cardiovascular chambers lead to progressive encapsulation with organizing connective tissue (scar). At some time period following surgery, closer to 10 years than to 5, degeneration of the fascia takes place, presumably due to "strangulation" by the organized exudate which interrupts the "normal" mechanism of its nutrition which is based upon diffusion from the flowing blood. The recent contributions of Sullivan, Harken and Gorlin (54), Weily and Genton (55), and Harker and Slicter (56) to our understanding of the role of the platelets in initiating such fibrinous deposition now provide us with a way to prevent such late degeneration of valves made of fascia lata. The regular administration of platelet dispersing agents (aspirin, Persantin, or inderol) in ordinary therapeutic dosage would seem to be completely protective. Undoubtedly, anticoagulant therapy would be equally effective. However, the permanent maintenance of a proper level of "anti-coagulation" such as is usually deemed necessary following implantation of a prosthetic heart valve is a heavy psychological and biological burden for a patient to bear. Many such individuals live precariously between the risks of thromboembolism and the risks of hemorrhage. Thromboembolism really only represents a farther point along the spectrum of the readiness of fibrin accumulation following initial platelet aggregation and deposition. Since frank thromboembolism appears "never" to follow intracardiac implantation of fascia lata, it would seem that platelet dispersive therapy sould suffice in such cases.