Study on prediction of early adverse events by CapeOX therapy in patients with colorectal cancer

CapeOX is a regimen used as postoperative adjuvant chemotherapy for the treatment of advanced recurrent colorectal cancer. If early adverse events occur, treatment may not progress as planned and further dose reduction may be necessary. In this study, we investigated whether pre-treatment medical records could be used to predict adverse events in order to prevent adverse events caused by CapeOX treatment. The 178 patients were classified into two groups (97 in the adverse event positive group and 81 in the adverse event-negative group) based on withdrawal or postponement of four or fewer courses. In univariate analysis, age, height, weight, body surface area (BSA), creatinine clearance, muscle mass, and lean body mass were associated with early adverse events (P<0.05). The area under the receiver operating characteristic curve obtained by Stepwise logistic regression analysis using the Akaike information criterion method was 0.832. For nested k-fold cross validation, the accuracy rates of the support vector machine, random forest, and logistic regression algorithms were 0.71, 0.70, and 0.75, respectively. The results of the present study suggest that a logistic regression prediction model may be useful in predicting early adverse events caused by CapeOX therapy in patients with colorectal cancer. J. Med. Invest. 71 : 141-147, February, 2024.

Comparison of sensitivity characteristics between GAFCHROMIC LD-V1 and GAFCHROMIC XR-QA2 in mammographic dosimetry

In recent years, radiochromic films have begun to be used for dosimetry in mammography; however, the most sensitive GAFCHROMIC XR-QA2 (XR-QA2) film is no longer available owing to its discontinuation. In this study, we evaluated the sensitivity characteristics of GAFCHROMIC LD-V1 (LD-V1) as an alternative to XR-QA2 in the field of mammography, at a low dose and low energy. Our results show that the average ratio of the concentration change of LD-V1 divided by the concentration change of XR-QA2 at each absorbed dose was 53.7%, indicating the sensitivity of LD-V1 to be approximately half of XR-QA2. In addition, the linearity of the concentration change is sufficient even within a dose range of 0.59-14.52 mGy, which is lower than the manufacturer's recommended dose range. Therefore, the LD-V1 is capable of accurate dose assessment even with a low dose and the low level of energy used in mammography.

Evaluation of factors associated with the effectiveness of radiation protection glasses

The effects of lead equivalent and lens area of radiation-protective eyewear on lens exposure control were examined. The simulated patient underwent 10-min X-ray fluoroscopy, and the lens dose of the simulated surgeon wearing radiation protection glasses was measured using lens dosemeters attached to the corner of the eye and eyeball. In total, 10 types of radiation protection glasses were selected for measurement. Correlation analysis of the equivalent dose in the lens of the eye with lead equivalence and lens area was performed. The equivalent dose in the lens of the eye of the corner of the eye was negatively correlated with the area of the lens. The equivalent dose in the lens of the eye and the eyeball showed a strong negative correlation with lead equivalence. Lens dosemeters worn at the corner of the eye may overestimate the equivalent dose in the lens of the eye. Moreover, the reduction in exposure of the lens was significantly influenced by the lead equivalent.

Dosimetry using a radiochromic film and a mammography phantom

Mammography is one of the most effective diagnostic methods for the early detection of breast cancer; however, it poses the risk of radiation exposure. To date, mammography dosimetry has been performed according to the mean glandular dose; however, the actual exposure in the breast has not been assessed. Here, we have measured dose distributions and depth doses using both radiochromic films and mammographic phantoms, and a three-dimensional intra-mammary dose assessment was conducted. The absorbed dose distribution at the surface was markedly higher on the chest wall side but lower on the nipple side. The absorbed doses in the depth direction exponentially decreased. The glandular tissue near the surface may be irradiated with an absorbed dose of 7.0 mGy or higher. Since LD-V1 could be placed inside the phantom, the absorbed dose inside the breast could also be evaluated in three dimensions.

THREE-DIMENSIONAL DOSIMETRY OF MAMMOGRAPHY USING A BLOCK CUBE BREAST PHANTOM AND RADIOCHROMIC FILM

This study developed a phantom with a shape similar to that of the breast and use GAFCHROMIC films that can be placed inside the phantom to measure the detailed breast dose distribution in mammography. GAFCHROMIC EBT3 was placed on the block cube breast phantom and irradiated with a mammography device to measure the absorbed dose distribution inside the phantom in the horizontal and depth directions. The dose distribution in the horizontal plane was the highest in the centre on the chest wall side, and it decreased in a fan shape. Along the depth of the phantom, the doses absorbed across the entire cross-section were 16.15 mGy at the surface and 7.51, 3.25 and 1.68 mGy at depths of 10, 20 and 30 mm, respectively. Compared with the mean glandular dose, the proposed method can measure breast dose distributions in greater detail and is applicable to various breast shapes.

Intensities of Incident and Transmitted Ultraviolet-A Rays through Gafchromic Films

Gafchromic films have been applied to X-ray dosimetry in diagnostic radiology. To correct nonuniformity errors in Gafchromic films, X-rays in the double-exposure technique can be replaced with ultraviolet (UV)-A rays. Intensities of the incident and transmitted UV-A rays were measured. However, it is unclear whether the chemical color change of Gafchromic films affects the UV-A transmission intensity. Gafchromic EBT3 films were suitable to be used in this study because non-UV protection layers are present on both sides of the film. The film is placed between UV-A ray light-emitting diodes and a probe of a UV meter. Gafchromic EBT3 films were irradiated by UV-A rays for up to 60 min. Data for analysis were obtained in the subsequent 60 min. Images from before and after UV-A irradiation were subtracted. When using 375 nm UV-A, the mean ± standard deviation (SD) of the pixel values in the subtracted image was remarkably high (11,194.15 ± 586.63). However, the UV-A transmissivity remained constant throughout the 60 min irradiation period. The mean ± SD UV-A transmission intensity was 184.48 ± 0.50 μm/cm². Our findings demonstrate that color density changes in Gafchromic EBT3 films do not affect their UV-A transmission. Therefore, Gafchromic films were irradiated by UV-A rays as a preexposure.

Effective energy measurement using radiochromic film: application of a mobile scanner

The effective energy calculated using the half-value layer (HVL) is an important parameter for quality assurance (QA) and quality control (QC). However constant monitoring has not been performed because measurements using an ionization chamber (IC) are time-consuming and complicated. To solve these problems, a method using radiochromic film (GAFCHROMIC EBT2 dosimetry film (GAF-EBT2) with slight energy dependency errors), a mobile scanner and step-shaped aluminum (SSAl) filter is developed. The results of the method using a mobile scanner were compared with those of the recommended method using an IC in order to evaluate its applicability. The difference ratios of the effective energies by each method using a mobile scanner with GAF-EBT2 were less than 5% compared with results of an IC. It is considered that this method offers a simple means of determining HVL for QA and QC consistently and quickly without the need for an IC dosimeter.

Simplified method for creating a density-absorbed dose calibration curve for the low dose range from Gafchromic EBT3 film

Radiochromic film dosimeters have a disadvantage in comparison with an ionization chamber in that the dosimetry process is time-consuming for creating a density-absorbed dose calibration curve. The purpose of this study was the development of a simplified method of creating a density-absorbed dose calibration curve from radiochromic film within a short time. This simplified method was performed using Gafchromic EBT3 film with a low energy dependence and step-shaped Al filter. The simplified method was compared with the standard method. The density-absorbed dose calibration curves created using the simplified and standard methods exhibited approximately similar straight lines, and the gradients of the density-absorbed dose calibration curves were −32.336 and −33.746, respectively. The simplified method can obtain calibration curves within a much shorter time compared to the standard method. It is considered that the simplified method for EBT3 film offers a more time-efficient means of determining the density-absorbed dose calibration curve within a low absorbed dose range such as the diagnostic range.

Three-dimensional CT for preoperative detection of the left gastric artery and left gastric vein in laparoscopy-assisted distal gastrectomy

INTRODUCTION

We evaluated 3-D CT imaging for preoperative classification of the left gastric artery and vein in patients with early gastric cancer and estimated its clinical benefit.

METHODS

Between April 2009 and March 2014, 279 patients underwent preoperative 3-D CT using a 64-row multi-detector CT scanner, followed by laparoscopy-assisted distal gastrectomy. The 3-D CT images of the arterial and portal phases were reconstructed and fused. The operative outcomes were compared between patients who had not undergone 3-D CT (2007-2008) and who had undergone 3-D CT (2009-2011).

RESULTS

According to Adachi's classification, the numbers of type I, II, III, IV, V, and VI arterial patterns were 253, 15, 1, 3, 3, and 1, respectively. Three cases could not be classified. According to the Douglass classification, the left gastric vein flowed into the portal vein, splenic vein, junction of the portal vein and splenic vein, and left branch of the portal vein in 119, 111, 36, and 5 patients, respectively. The left gastric vein could not be visualized in six patients, and two patients could not be classified. In addition, the relation was absent for an Adachi type I vein and one of the "other" types of veins. The total operative time was significantly shorter with 3-D CT than without it (P = 0.01), and the degree of lymph-node dissection was significantly higher (P = 0.01). Inflammatory parameters and operative morbidity tended to decrease with 3-D CT.

CONCLUSION

Three-dimensional CT is a useful modality to visualize the vessel anatomy around the stomach, and it improves clinical effectiveness and reduces the invasiveness of surgery.

Correction of nonuniformity error of Gafchromic EBT2 and EBT3

This study investigates an X‐ray dose measurement method for computed tomography using Gafchromic films. Nonuniformity of the active layer is a major problem in Gafchromic films. In radiotherapy, nonuniformity error is reduced by applying the double‐exposure technique, but this is impractical in diagnostic radiology because of the heel effect. Therefore, we propose replacing the X‐rays in the double‐exposure technique with ultraviolet (UV)‐A irradiation of Gafchromic EBT2 and EBT3. To improve the reproducibility of the scan position, Gafchromic EBT2 and EBT3 films were attached to a 3‐mm‐thick acrylic plate. The samples were then irradiated with a 10 W UV‐A fluorescent lamp placed at a distance of 72 cm for 30, 60, and 90 minutes. The profile curves were evaluated along the long and short axes of the film center, and the standard deviations of the pixel values were calculated over large areas of the films. Paired t‐test was performed. UV‐A irradiation exerted a significant effect on Gafchromic EBT2 (paired t‐test; p=0.0275) but not on EBT3 (paired t‐test; p=0.2785). Similarly, the homogeneity was improved in Gafchromic EBT2 but not in EBT3. Therefore, the double‐exposure technique under UV‐A irradiation is suitable only for EBT2 films.

PACS number(s): 87.53 Bn

Comparing three UV wavelengths for pre-exposing Gafchromic EBT2 and EBT3 films

Gafchromic films are used for X‐ray dose measurements during diagnostic examinations and have begun to be used for three‐dimensional X‐ray dose measurements using the high‐resolution characteristics of Gafchromic films for computed tomography. However, the problem of unevenness in Gafchromic film active layers needs to be resolved. Double exposures using X‐rays are performed during therapeutic radiology, although this is difficult for a diagnostic examination because of a heel effect. Thus, it has been suggested that ultraviolet (UV) radiation be used as a substitute for X‐rays. However, the appropriate UV wavelength has not been determined. Thus, we conducted this study to decide an appropriate UV wavelength. UV peak wavelengths of 245 nm (UV‐A), 310 nm (UV‐B), and 365 nm (UV‐C) were used to irradiate EBT2 and EBT3 films. Each UV wavelength was irradiated for 5, 15, 30, and 60 min, and irradiation was then repeated every 60 min up to 360 min. Gafchromic films were scanned after every irradiation using a flatbed scanner. Images were split into RGB images, and red images were analyzed using ImageJ, version 1.44, image analysis software. A region of interest (ROI) one‐half inch in diameter was placed in the center of subtracted Gafchromic film images, and UV irradiation times were plotted against mean pixel values. There were reactions in the front and back of Gafchromic EBT3 and the back of Gafchromic EBT2 with UV‐A and UV‐B. However, UV‐C resulted in some reactions in both sides of Gafchromic EBT2 and EBT3. The UV‐A and UV‐B wavelengths should be used.

PACS number(s): 87.53 Bn

Ultraviolet exposure of Gafchromic XR-RV3 and XR-SP2 films

Gafchromic film has been used for X-ray dose measurement in diagnostic examinations. Their use has been initiated for three-dimensional X-ray dose measurement by using the high-resolution characteristics of Gafchromic films in computed tomography. However, it is necessary to solve the problem of nonuniform thickness in the active layers of Gafchromic films. A double exposure technique using X-rays is performed in therapeutic radiology; it is difficult to use in a diagnostic examination because of the heel effect. Therefore, it is suggested that ultraviolet (UV) rays be substituted for X-rays. However, the appropriate UV wavelength is unknown. In this study, we aimed to determine which UV wavelengths are effective to expose Gafchromic XR-RV3 and XR-SP2. UV lamps with peak wavelengths of 245 nm, 310 nm, and 365 nm were used. The three UV wavelengths were used to irradiate Gafchromic XR-RV3 and XR-SP2 films for 60 min, and irradiation was repeated every 60 min for 600 min thereafter. Films were scanned after each irradiation period on a flatbed scanner. The images were split into their red-green-blue components, and red images were stored using ImageJ version 1.44o image analysis software. Regions of interest (ROI), 0.5 inches in diameter, were placed at the centers of the subtracted Gafchromic film images, and graphs of UV irradiation duration and mean pixel values were plotted. There were reactions to UV-A on both Gafchromic XR-RV3 and XR-SP2; those to UV-B were moderate. However, UV-C demonstrated few reactions with Gafchromic XR-RV3 and XR-SP2. From these results, irradiation with UV-A may be able to correct nonuniformity errors. Uniform UV-A irradiation of Gafchromic films with large areas is possible, and UV rays can be used as a substitute for X-rays in the double exposure technique.

Evaluation of GAFCHROMIC EBT2 dosimetry for the low dose range using a flat-bed scanner with the reflection mode

Recently developed radiochromic films can easily be used to measure absorbed doses because they do not need development processing and indicate a density change that depends on the absorbed dose. However, in GAFCHROMIC EBT2 dosimetry (GAF-EBT2) as a radiochromic film, the precision of the measurement was compromised, because of non-uniformity problems caused by image acquisition using a flat-bed scanner with a transmission mode. The purpose of this study was to improve the precision of the measurement using a flat-bed scanner with a reflection mode at the low absorbed dose dynamic range of GAF-EBT2. The calibration curves of the absorbed dose versus the film density for GAF-EBT2 were provided. X-rays were exposed in the range between ~0 and 120 mGy in increments of about 12 mGy. The results of the method using a flat-bed scanner with the transmission mode were compared with those of the method using the same scanner with the reflection mode. The results should that the determination coefficients (r (2) ) for the straight-line approximation of the calibration curve using the reflection mode were higher than 0.99, and the gradient using the reflection mode was about twice that of the one using the transmission mode. The non-uniformity error that is produced by a flat-bed scanner with the transmission mode setting could be almost eliminated by converting from the transmission mode to the reflection mode. In light of these findings, the method using a flat-bed scanner with the reflection mode (only using uniform white paper) improved the precision of the measurement for the low absorbed dose range.

Organization and structure of NADH-dependent glutamate synthase gene from rice plants

Genomic clones for NADH-dependent glutamate synthase (NADH-GOGAT; EC 1.4.1.14) were obtained from a genomic library of rice (Oryza sativa L. cv. Sasanishki). A genomic clone (lambdaOS42, 14 kb) covered an entire structural gene and a 3.7 kb 5'-upstream region from the first methionine. Another clone (lambdaOS23, 14 kb) contained a 2.8 kb 3'-downstream region from the stop codon. A 7047 bp long clone (lambdaOSR51) consisting of full length cDNA for NADH-GOGAT was isolated from a cDNA library prepared using mRNA from roots of rice seedlings treated with 1 mM NH4Cl for 12 h. The presumed transcribed region (11.7 kb) consisted of 23 exons separated by 22 introns. Rice NADH-GOGAT is synthesized as a 2166 amino acid protein with a molecular mass of 236.7 kDa that includes a 99 amino acid presequence. DNA gel blot analysis suggested that NADH-GOGAT occurred as a single gene in rice. Primer extension experiments map the transcription start of NADH-GOGAT to identical positions. The 3. 7 kb 5'-upstream region was able to transiently express a reporter gene in cultured rice cells. Putative motifs related to the regulation of NADH-GOGAT gene expression were looked for within the 5'-upstream region by database.

Suppression of G1 arrest and enhancement of G2 arrest by inhibitors of poly(ADP-ribose) polymerase: possible involvement of poly(ADP-ribosyl)ation in cell cycle arrest following gamma-irradiation

Low-dose gamma-irradiation of mouse embryonic fibroblast C3D2F1 3T3-a cells caused G1 arrest along with G2 arrest and inhibition of replicative DNA synthesis. When the cells were cultured in the presence of inhibitors of poly(ADP-ribose) polymerase [EC 2.4.2.30], such as 3-aminobenzamide, benzamide and luminol, G1 arrest of C3D2F1 3T3-a cells was suppressed and enhancement of G2 arrest was observed. In contrast, 3-aminobenzoic acid, a non-inhibitory analog of 3-aminobenzamide, did not suppress G1 arrest following gamma-irradiation. These results suggest that the poly(ADP-ribosyl)ation reaction is critical for the pathway of G1 arrest and is also involved in the pathway of G2 arrest.

[Clinico-statistical observation of patients referred from our hospital at the Department of Oral Surgery]

The patients referred from our hospital at the Department of Oral Surgery, University of Tokyo, during the two years from January 1990 to December 1991 were analyzed statistically. The results were as follows: 1. Our subjects were 1,152 patients (24.2% of first-time patients), 540 males and 612 females. 2. Concerning age distribution, the majority was in their forties, fifties and sixties. 3. More patients were from internal medicine, ENT clinic, plastic surgery and cardiothoracic surgery. 4. On the number of patients categorized by disease at other departments, the largest number was cardiovascular disease. 5. On the number of patients categorized by disease at our department, the majority were dental diseases (dental caries, marginal periodontitis and missing teeth).

[Clinico-statistical observation of emergency patients at the Department of Oral Surgery]

Emergency patients at the Department of Oral Surgery, University of Tokyo, during the three years from January 1990 to December 1992 were analyzed statistically. The results were as follows: 1. The total number of emergency patients was 209 and tended to increase with the advance in years. 2. There were a few more males than females and most of the patients ages were in the twenties. 3. The disease causes were dental caries or periodontal disease in 95 (45.5%), trauma in 58 (27.8%), and inflammation in 32 patients (15.3%). 4. It is clear that a system of oral emergency treatment is necessary.

Non-covalent interaction between poly(ADP-ribose) and cellular proteins: an application of a poly(ADP-ribose)-western blotting method to detect poly(ADP-ribose) binding on protein-blotted filter

We describe a sensitive method for the detection of interactions between poly(ADP-ribose) and proteins. Proteins were blotted onto nitrocellulose filters and incubated with 32P-labeled poly(ADP-ribose). Purified core histones and poly(ADP-ribose) polymerase were found to bind poly(ADP-ribose) polymer. Blots of HeLa cell protein extracts revealed a 48 kDa protein and several others of smaller than 35 kDa likewise bound the polymers even at high salt concentrations. Those proteins, along with a 69 kDa protein, also showed resistance to competitor DNA. Polymer binding of aforesaid HeLa extract proteins was restricted to polymers above 20 residues in length. Thus poly(ADP-ribose)-protein affinities were polymer-length dependent.

[Questionnaire about dental health in new university students]

A questionnaire about dental health was given to 6846 new students in the University of Tokyo. The results were as follows: 1. 5.3% of students had experienced periodontal diseases. The percentage of students with gingival bleeding was 20.7%. 2. Most of the students brushed their teeth 3 minutes at a time, 2 times a day. 3. 11.5% of the students had experienced orthodontic treatments. The percentage of female students was significantly higher than the percentage of male students. 4. 0.9% of the students had experienced TMJ disorders. TMJ symptoms were noted in 9.7%. 5. More than 90% of the students usually chewed on both sides of the mouth.

Effects of serine protease inhibitor FOY-305 and heparin on the growth of squamous cell carcinoma

Effects of serine proteinase inhibitor FOY-305 and heparin on autochthonous skin carcinoma were examined using ddY female mice with single tumor induced by methylcholanthrene. FOY-305 given intraperitoneally for 9 consecutive weeks inhibited the growth of the pre-existing dermal tumors. Heparin alone was equally therapeutically effective. However, heparin induced severe mucocutaneous bleeding of the gastrointestinal mucosa. In contrast, the combined administration of FOY-305 and heparin suppressed tumor growth without any visible side effects. There was a significant increase in well differentiated cancer cells in mice treated with FOY-305 and heparin in combination, suggesting that co-administration of FOY-305 and heparin may be useful for the treatment of squamous cell carcinoma.

A new, rolled-sponge technique for transoral exposure of C1 and C2

Instead of the general use of a catheter attached to the uvula or of catheters passed through the nasal cavity to the mouth for elevation of soft palate, the authors describe a new technique utilizing two rolled sponges producing maximum elevation of soft palate and good perioral cosmetic results for transoral exposure of C1 and C2.

[Clinical and pharmacokinetics studies of ceftriaxone upon 2g once daily administration in respiratory tract infections]

Clinical studies on ceftriaxone (CTRX) were conducted with 2 g once daily administration to respiratory tract infections. In addition, CTRX concentrations in serum, sputum and urine were determined. The results obtained are summarized as follows: 1. Clinical responses to CTRX in a total of 29 cases with respiratory tract infections were excellent in 7 cases, good in 13, fair in 8 and poor in 1 with a response rate of 69.0%. 2. CTRX concentrations in serum, sputum and urine (total and free body) were determined in 3 cases after intravenous drip infusion of 2g CTRX. Peak levels in sputum were 2.6 to 7.8 micrograms/ml, and CTRX maintained high sputum levels for 12 to 24 hours after administration.

[An operated case of Mycobacterium fortuitum infection with hemoptysis]

An operated case of M. fortuitum infection on the bronchiectatic lung was presented. A 68-year-old female had had hemoptysis due to bronchiectasis since she was 44 years of age. She had a history of pulmonary tuberculosis at the age of 58 and treated by anti-tuberculosis drugs for a year. She was referred to the National Sanatorium Hiroshima Hospital in March 1986 for surgical treatment, when M. fortuitum infection was found. Lobectomy of the right middle lobe, right S6 Segmentectomy and partial resection of right S2 were performed on December 1st 1986. After the operation, hemoptysis disappeared but M. fortuitum was still found in sputum. Chest X-ray examination revealed some new abnormal shadows. When radical surgical treatment for secondary M. fortuitum pulmonary infection is considered careful attention should be given to its indications including the extent of resection and the predicted post-operative pulmonary function.

Comparison of the radiosensitivity of interleukin-2 production between species, between tissues, and between young and old individuals

The radiosensitivity of interleukin-2 (IL-2) production was assessed of (a) peripheral blood mononuclear cells (PBMC) of young humans, dogs, and mice (C57BL/6); (b) PBMC and splenic cells of young mice; and (c) PBMC of young and old humans and the splenic cells of young and old mice. The results indicate that (a) large differences in radiosensitivity exist between the PBMC of humans, dogs, and mice (e.g., the radiation doses which resulted in 37% remaining IL-2 activity (D37) of human, dog, and mouse PBMC were 3771, greater than 10,000, and 1398 rads, respectively); (b) only a small difference exists between the PBMC and splenic cells of mice; and (c) no difference exists between the PBMC of young and old humans and between splenic cells of young and old mice. Topological abnormalities, as judged by scanning electron microscopic analysis, could not be detected in dog PBMC after their exposure to 1800 rads, but could be detected in mouse PBMC after their exposure to 400 rads.

Differential effects of age on mitotically active and inactive bone marrow stem cells and splenic T cells in mice

Young and old BALB/c mice and thymectomized young mice were subjected to continuous exposure of 6-thioguanine (6-TG), and the numbers of their bone marrow spleen colony-forming units (CFU-S) and in vitro culture colony-forming units (CFU-C) and the number and mitogen-induced proliferative activity of their splenic T cells were determined at various time intervals. The results indicated that (a) old mice have seven times more 6-TG-resistant (6-TGr) CFU-S than young mice, (b) the mitogen-induced proliferative activity of 6-TGr T cells is comparable to that of 6-TG-sensitive (6-TGs) T cells of both young and old mice, and (c) 6-TGr CFU-S and T cells are resistant to 6-TG because they are mitotically inactive and not because they are drug-resistant mutants.

A new method to create a philtrum in secondary cleft lip repairs

We report an additional surgical method to form a philtrum in cleft lip cases. The key point of this new method is to release the skin tension of the upper lip, thus protecting against the disappearance of the newly-made philtrum. We have obtained better results with this method, in comparison with the other methods previously reported.

The length: breadth ratio of skin flaps on the trunk: two new long narrow flaps

Our experience of skin flaps on the trunk is reviewed. A single-pedicle flap based on the sterno-clavicular region and a bipedicled longitudinal back flap have length: breadth ratios much in excess of random pattern flaps.