Osteopetrosis complicated by osteomyelitis of the mandible: a case report including characterization of the osteopetrotic bone

A case of a 53-year-old Japanese man with osteopetrosis complicated by osteomyelitis of the mandible is presented. The patient experienced frequent exacerbations and remissions of osteomyelitis of the mandible, despite undergoing several surgical debridements and sequesterectomies with appropriate antimicrobial therapy, for 3 years. Finally, the patient underwent mandibular segmental resection followed by reconstruction with a titanium reconstruction plate. Fifty-one months after surgery there is no evidence of recurrent osteomyelitis of the mandible, suggesting that a more radical surgical approach is preferable for patients with severe complications resulting from osteopetrosis. Also presented here are the histopathological and biochemical features of the osteopetrotic bone. The osteopetrotic cortical bone was morbidly sclerotic with compact and irregular laminations. Degradation of osteocytes in the osteopetrotic bone was due to hypoxia and lack of nutrition resulting from osteosclerosis. There were no significant differences between osteopetrotic and normal bone according to X-ray diffraction, Fourier transform infrared spectroscopy, collagen content or mineral content. Micro-Vickers hardness measurements showed that osteopetrotic bone was significantly harder than normal bone, and the standard deviation of hardness was greater in osteopetrotic bone. Such a loss of integrity in osteopetrotic bone is considered to be a primary reason for the greater risk of a variety of complications such as pathological fracture and refractory osteomyelitis.

[Body dysmorphic disorder in 3-8% of patients in outpatient dermatology and plastic surgery clinics]

OBJECTIVE

To determine the 6-month prevalence of body dysmorphic disorder (BDD) in outpatient clinics of dermatology and plastic surgery in a university medical centre.

DESIGN

Questionnaire study.

METHOD

In the period January 2004-June 2004, the self-reported Body dysmorphic disorder questionnaire was completed by 530 and 475 new patients in the outpatient clinics of dermatology and plastic surgery, respectively. The dermatologist or plastic surgeon assessed the severity of the defect. To meet the DSM-IV criteria for BDD, the patient must have been preoccupied with treatment of all or part of their appearance, experienced obvious suffering or restriction of function with minimal or no defect present (defect score 1 or 2).

RESULTS

In the outpatient clinics ofdermatology and plastic surgery 8.5% (95% CI: 6.1-10.9) and 3.2% (95% CI: 1.7-4.7) of patients screened positive for BDD, respectively.

CONCLUSION

A high prevalence of BDD was found in the outpatient clinics ofdermatology and plastic surgery. Because dermatologists and plastic surgeons do not often recognise BDD, a simple screening tool is needed.

Potential of repairing ischemically damaged kidneys ex vivo

Therapies that would accelerate recovery from ischemic injury could positively impact the number of kidneys procured from non-heart-beating donors. An acellular warm (32 degrees C) perfusion was used to deliver growth factors to canine kidneys damaged by 2 hours of warm ischemia. Fibroblast growth factors 1 and 2 were selected for activation of the tyrosine kinases because of their known receptor-specific binding in the kidney, metabolic regulation, and mitogenic effect. During 24 hours of ex vivo perfusion at near-normothermia, oxidative metabolism was sufficiently restored to the ischemically damaged tissue to support upregulation of cellular processes dependent on new synthesis. The junctional integrity protein, ZO-1 was used to determine recovery of cytoskeletal integrity. The upregulation of proliferating cell nuclear antigen was used as a marker for recovery of synthetic functions. This modulation of both injury and repair proteins in the damaged kidneys was dependent on new synthesis. The observed modulation resulting in normalization of the cytoskeletal integrity correlated with outcomes in that when the "repaired" kidneys were reimplanted, they provided life-sustaining function. In contrast, when warm ischemically damaged control kidneys without treatment, with subsequent hypothermic perfusion or warm perfused in the absence of growth factors, were reimplanted the result was nonviability. The results of this study suggest that the administration of growth factors during 24 hours of near-normothermic, acellular perfusion, in the absence of concordant inflammation, triggers pathways for new synthesis leading to cellular recovery rather than resulting in cell death.

Phylogenetic Analyses of Fat Body Endosymbionts Reveal Differences in Invasion Times of Blaberid Wood-feeding Cockroaches (Blaberidae: Panesthiinae) into the Japanese Archipelago

Cockroaches have endosymbiotic bacteria in their fat bodies. Recent molecular phylogenetic analyses on both hosts and endosymbionts have revealed that co-evolution has occurred throughout the history of cockroaches and termites. Co-cladogenesis was also shown among closely related taxa (woodroach genus Cryptocercus; Cryptocercidae), and thus endosymbiont data are likely to be useful for biogeographical analyses. To test the possibility of co-cladogenesis among inter-and intraspecific taxa, as well as the utility of endosymbiont data for inferring biogeographical scenarios, we analyzed rRNA genes of endosymbionts of Japanese and Taiwanese Panesthiinae (Salganea and Panesthia; Blaberidae), on which phylogenetic analyses previously had been performed based on the mitochondrial genes. Statistical analyses on the topologies inferred from both endosymbiont and host mitochondria genes showed that co-cladogenesis has occurred. The endosymbiont sequences examined appear to have evolved in a clock-like manner, and their rate of evolution based on the host fossil data showed a major difference in the time of invasion of the two Japanese genera, that is congruent with the recent analyses of their mitochondrial genes.

[Injury of the hand by a high pressure injection: often serious subcutaneous damage]

Two men, aged 32 and 40, had a high-pressure paint injection injury to the left index and middle finger respectively. The first patient's finger became inflamed within a week, after which the paint was removed operatively; there was complete recovery of function. In the other patient the paint was removed immediately; however the finger was amputated a week later because of gangrene. High-pressure injection injuries should not be underestimated. High-pressure injection injuries to the hand often lead to severe and irreversible loss of function. Acknowledging the severity of this type of injury is the key to adequate treatment. Mostly this means immediate operative intervention. Only injuries with clean water, air or a small amount of vaccine can be treated conservatively under close observation.

[Three patients with complications following piercing of the auricular cartilage]

In three patients, a 21-year-old man and females aged 16 and 18 years, piercing through the auricular cartilage was followed by an infection. Treatment left behind a residual deformity, for which a reconstruction was carried out with a satisfactory result. The risk of infection following piercing through the avascular cartilage of the helix and tragus of the pinna is greater than following piercing of non-cartilaginous tissue such as the ear lobe. (Peri)chondritis leads to chondral necrosis and subsequent deformities. It is important to recognise the early features of perichondritis, which include local heat, erythema and pain, before swelling appears. Treatment should focus on eradicating Pseudomonas aeruginosa and Staphylococcus aureus. Surgical intervention is required at the earliest sign of an abscess. Reconstruction for a post-piercing deformity can be considered at a later stage.

[Five patients with metastasized basal-cell carcinoma]

During the period 1986-2001, a metastasised basal-cell carcinoma of the head was diagnosed in five patients (a 35-year-old woman and four men aged 40, 44, 54 and 54 years) at the Utrecht University Medical Centre, the Netherlands. Metastases were found in the cervical lymph nodes, the skeleton, the parotid region and the lungs. The tumours were all of the morphoeic or 'wispy' type. The treatment consisted of excision and sometimes radiotherapy. Two patients died, one of whom of a cause unrelated to the tumour, two patients were free of symptoms 24 months after the last treatment and one patient was still being treated with radiotherapy. It is often assumed that basal-cell carcinomas do not metastasised, but a frequency of 0.0028-0.55% is reported in the literature. An important risk factor is the size of the tumour. Surgical excision or Mohs' micrographic surgery is the preferred method of treatment because this allows histological inspection of the excised margins. Due to the low incidence, there are no clear therapeutic guidelines for the treatment of patients with metastasised basal-cell carcinoma.

[Necrotising fasciitis and myositis as serious complications after liposuction]

Three days after liposuction of the lower abdomen, a 41-year-old woman was admitted for toxic shock-like syndrome with necrotising fasciitis and myositis, caused by Lancefield-group-A beta-haemolytic streptococci. The patient was treated by radical debridement of the skin, subcutis, fasciae and part of the pectoral muscle, plus antibiotics. Postoperatively she required artificial respiration for respiratory insufficiency. One week after the operation the wound was covered by transplantation of autologous skin. The patient survived, but was seriously disfigured. Necrotising fasciitis is a progressive soft-tissue infection, characterised by widespread necrosis of the superficial and deep fascia, often associated with severe systemic toxic reactions. Unless quickly recognised and aggressively treated, the course is often fatal. Due to the absence of cutaneous findings in the early stages, diagnosis is difficult. Important diagnostic aids are routine laboratory tests, contrast-MRI and a combination of the finger test and frozen-section biopsy. Treatment consists of early radical debridement, broad-spectrum antibiotics and supportive care. In a later stage, soft-tissue reconstruction with autografts or artificial skin grafts and skin transposition can be performed.

Dynamic rectus abdominis muscle flap for intestinal stomal continence: a systematic approach

Several attempts to create a continent stomal sphincter using dynamic myoplasty with limited success have been reported. Denervation atrophy and early muscle fatigue have plagued all reported attempts to make a continent stoma a reality. To address this problem in a series of experiments, we designed a stomal sphincter using the most caudal segment of the rectus abdominis muscle. Then, we performed a study to determine whether a sphincter created with a rectus abdominis muscle island flap could maintain stomal continence in the short term. We found that when stimulated using two different electrical stimulation protocols, in all cases the rectus abdominis muscle sphincter generated peak pressures well above those needed to maintain stomal continence (60 mm Hg). All sphincters were able to maintain stomal continence at all intraluminal bowel pressures tested. We found one of these protocols to be far superior and reached 4 hours of stomal continence after 8 to 10 weeks of electrical stimulation.

Gracilis muscle neosphincter for treating urinary incontinence

The purpose of this study was to test the anatomical and functional feasibility of using a gracilis muscle free flap to create a urinary sphincter. Anatomical studies were performed in 12 human cadavers and short-term (n = 7) and long-term (n = 8) functional studies were performed in dogs. In the short-term functional studies, the left gracilis muscle was transferred into the pelvis and wrapped around the urethra and the right gracilis muscle was wrapped around a stent. A cuff electrode was placed on the muscle's nerve pedicle and used to stimulate the neosphincter while peak pressure, fatigue rate, and perfusion measurements were performed. In the long-term functional studies, intramuscular electrodes were inserted into the neosphincter to stimulate the flap. The flaps were wrapped around the urethra and dogs were followed for 16 weeks, during which time urodynamic measurements were performed. Our anatomical studies demonstrated that the gracilis muscle free flap could be transferred into the pelvis to create a urinary neosphincter. Our short-term functional study demonstrated that gracilis muscle free-flap function and perfusion were not compromised by transfer. In our long-term functional study, all neosphincters provided bladder outlet resistance pressures consistent with continence. Our anatomical, short-term, and long-term functional studies indicate that a gracilis muscle free-flap neosphincter is an effective procedure for treating urinary incontinence.

Changes in aortic rotational flow during cardiopulmonary bypass studied by transesophageal echocardiography and magnetic resonance velocity imaging: a potential mechanism for atheroembolism during cardiopulmonary bypass

The human aorta is a curved conduit with a complex three-dimensional geometry. The curvature influences axial velocity distribution and introduces transverse velocity components. Rotational flow in the aorta can be demonstrated during normal pulsatile flow using transesophageal echocardiography. Cardiopulmonary bypass may affect the pattern of rotational flow in the aorta and thus influence the generation of atheroemboli. We investigated rotational flow in the descending aorta using color flow mapping and pulse-wave Doppler on transesophageal echocardiography before and during cardiopulmonary bypass. We correlated our findings with magnetic resonance velocity imaging in a model of a human aortic arch connected to a cardiopulmonary bypass circuit. Before cardiopulmonary bypass, rotational flow in the descending aorta was seen in 37 of 40 patients (93%). In the majority of these patients, rotational flow was in the clockwise direction during systole, looking in the direction of flow (30 of 37 patients, 81%, P < 0.01 vs counterclockwise rotation). During cardiopulmonary bypass, there were almost equal numbers of patients with clockwise (18 patients) and counterclockwise rotation (19 patients). Forty-seven percent of patients with clockwise rotation before cardiopulmonary bypass developed reversal in the direction of rotation to counterclockwise during cardiopulmonary bypass. Twenty-nine percent of patients with counterclockwise rotation developed reversal of the direction of rotation during cardiopulmonary bypass. The transverse velocity component increased during cardiopulmonary bypass regardless of the direction of rotation. We also demonstrated clockwise rotation in the descending aorta of a human aortic arch model connected to a cardiopulmonary bypass circuit using magnetic resonance velocity mapping. Before cardiopulmonary bypass, rotation was predominantly clockwise, while during cardiopulmonary bypass, there was no preferred direction of rotation. The geometry of the aorta, which is fairly constant in all patients, imposes handedness to aortic flow before cardiopulmonary bypass. However, during cardiopulmonary bypass, other extrinsic factors such as aortic cannula orientation may influence the direction of rotation. The change in direction of rotational flow and increase in its transverse velocity component during cardiopulmonary bypass may have implications for atheroembolism and arterial branch perfusion during extended periods of non-pulsatile flow.

Phylogeny and biogeography of wood-feeding cockroaches, genus Salganea Stål (Blaberidae: Panesthiinae), in Southeast Asia based on mitochondrial DNA sequences

Molecular phylogenetic relationships among 25 species of the wood-feeding cockroach belonging to the genus Salganea Stål (Panesthiinae; Blaberidae) in Southeast Asia were analyzed based on the DNA sequence of the complete mitochondrial cytochrome oxidase II (COII) gene. Most basal relationships among species of Salganea are poorly resolved by both neighbor-joining and nonweighted parsimony analyses, suggesting the possibility of a hard polytomy due to a rapid and potentially simultaneous radiation early in the history of the genus. For more apical relationships, however, some interesting phylogenetic relationships were recognized. The monophyly of the two species groups, morio and foveolata, the former of which is distributed mainly in the Sunda lands (containing the Malay Peninsula, Sumatra, Java, and Borneo), whereas the latter is Sulawesi endemic, was strongly supported. Based on the inferred phylogenetic patterns and recent palaeogeographic scenario for Southeast Asia, it is suggested that a radiation of Salganea species occurred in Southeast Asia presumably in the early Tertiary, and several barriers against dispersal and gene flow, such as the formation of straits or high mountains, have arisen from the middle Tertiary.

[Proximal row carpectomy: a 'salvage' procedure for radio-carpal arthritis of the wrist]

In 4 patients, a woman aged 46 years, and 3 men aged 58, 28 and 60 years, respectively, a proximal row carpectomy was done for pain and loss of function due to scapho-lunate dissociation, scaphoid nonunion, Kienböck's disease and scapho-lunate advanced collapse wrist deformity (bilateral). Pain relief was achieved post-operatively in all patients, allowing patients to return to their previous work and activities. Proximal row carpectomy involves the removal of the os scaphoideum, the os lunatum and the os triquetrum. This improves wrist extension and ulnar deviation. Intensive postoperative treatment is essential to achieve good mobility and strength.

Mechanical properties of glass-only porcelains prepared by the use of two feldspathic frits with different thermal properties

Low- and non-leucite-containing commercial porcelains with low firing temperatures have become popular. However, improving the strength of glass porcelains is difficult. The purpose of this study was to determine if dispersed glass particles could be used as a reinforcing agent for an all-glass porcelain. We produced 3 feldspathic glasses (high-fusing, medium-fusing, low-fusing) by melting powders consisting of potassium-feldspar and 0, 5, or 20 mass% Na2O, respectively. For high-fusing, medium-fusing, and low-fusing feldspathic glasses, the deformation temperatures were 945 degrees C, 647 degrees C, and 518 degrees C, and the thermal expansion coefficient values were 8.6 x 10(-6)/degrees C, 10.3 x 10(-6)/degrees C, and 13.4 x 10(-6)/degrees C between 25 degrees C and the glass-transition temperature, respectively. The high-fusing-glass (or medium-fusing-glass) powders were mixed with low-fusing-glass powders before being fired into test specimens. The mean flexural strength and fracture toughness (K1C) of 3 single-glass porcelains ranged from 57 to 63 MPa and from 0.68 to 0.73 MPa m(1/2), respectively, presenting no significant differences in one-way ANOVA. However, the flexural strength of 50% high-fusing-glass + 50% low-fusing-glass porcelain was 114 MPa (p < 0.05) and K1C was 1.2 MPa m(1/2) (p < 0.05). Microcracks were observed with a back-scattered scanning electron microscope and were associated with the high- (or medium-) fusing glass particles, suggesting residual stress in the low-fusing-glass matrix due to a coefficient of thermal expansion mismatch between the dispersed glass particles and the matrix glass. The dispersing glass particles appeared to act as a reinforcing agent for strengthening a glassy porcelain.

Reinforcement effect of short glass fibers with CaO- P(2)O(5) -SiO(2) -Al(2)O(3) glass on strength of glass-ionomer cement

OBJECTIVES

A high strength glass-ionomer (not resin-modified) cement was developed using short fibers of CaO--P(2)O(5)--SiO(2)--Al(2)O(3) (CPSA) glass. The purpose of this study was to clarify the effect of the CPSA short fibers contained in the flexural strength of the glass-ionomer cement.

METHOD

The 40 mass% short fibers of CPSA glass were added to the powder of commercial glass-ionomer cement. Beam specimens of set cement (25 x 2 x 2 mm) were prepared for measuring the flexural strength (FS). The specimens of set commercial glass-ionomer cement (GI) were used for comparison with glass ionomer cement with CPSA (FRGI). Half of all specimens were thermocycled in water for 60s of dwell time at 4 and 60 degrees C for 2500, 5000, and 10,000 cycles. The other specimens were stored in water at 37 degrees C as a control. The measurements were statistically analyzed using ANOVA.

RESULTS

The initial FS of FRGI was 18.1 and that of GI was 7.7 MPa. After thermocycling, the mean FS ranged from 19.3 to 26.3 MPa and 9.8 to 11.1 MPa for FRGI and GI, respectively. After storage in water, the mean FS of FRGI and GI ranged from 20.4 to 25.9 MPa and 9.4 to 10.1 MPa, respectively.

CONCLUSION

These findings suggested that glass-ionomer cement reinforced with CPSA short fibers maintains a higher strength than the conventional cement after aging.

Complications of abdominoplasty in 86 patients

A total of 101 consecutive abdominoplasty patients were reviewed retrospectively. Of these, 14 male (mean age at time of operation, 34.3 years; range, 23 to 53 years) and 72 female (mean age at time of operation, 38.9 years; range, 19 to 64 years) patients had adequate documentation for inclusion in this study. Complications were recorded as either wound complications (wound infection, partial wound dehiscence, seroma, hematoma, and skin edge necrosis) or complications after surgery (deep vein thrombosis, pulmonary emboli, ileus, sensibility disorder of the skin of the thighs, and death). The complications were subsequently correlated for sex, race, the patient's age at surgery, body mass index before surgery, and the seniority of the surgeon. Nine male patients (64.3 percent) and 11 female patients (15.3 percent) had wound complications. Almost 10 percent of our patients sustained an injury to the lateral cutaneous nerve of the thigh. Male patients should be informed about their possible higher risk of complications, and special attention must be given by the surgeon to the prevention of such complications.Moreover, specific attention must be given to the preservation of the lateral cutaneous nerves of the thigh in both male and female patients undergoing abdominoplasties.

The long-term durability of plication of the anterior rectus sheath assessed by ultrasonography

The purpose of this study was to assess the long-term durability of a standard vertical plication of the anterior rectus sheath. For this purpose, 70 women who had undergone this procedure as part of an abdominoplasty were sent a questionnaire, their records were studied, and they were invited back to the clinic for an examination using ultrasound. A total of 63 patients returned the questionnaire, and 40 were willing to attend a follow-up consultation and ultrasound investigation. The presence of rectus diastasis was assessed by ultrasound (a real time scanner with a 7.5-MHz linear probe). The study showed that after a follow-up of 32 to 109 months (mean, 64 months), standard plication of the abdominal wall with absorbable material led to residual or recurrent diastasis in 40 percent of the patients. It also confirmed that vertical plication only is not enough to improve the waistline and may eventually lead to epigastric bulging.

Microsurgery without a microscope: laboratory evaluation of a three-dimensional on-screen microsurgery system

In microvascular surgery, procedures may be both technically and physically demanding. Precise movements sustained over long hours in addition to typically compromised surgeon and assistant positioning lead quickly to physical and mental fatigue. Many of the positioning problems encountered are related to the fact that the eyes of the surgeon must be continually fixed to the microscope eyepieces. This study explores a possible solution: a microscope system that eliminates the need to view the operative field through the microscope eyepieces. A Three-dimensional On-screen Microsurgical System (TOMS) was used and contrasted with conventional operative microvascular surgery in the laboratory setting. The surgeon's comfort, his ability to instruct microsurgical technique, pertinent technological performance, and the procedure itself were evaluated using a standardized questionnaire. Based on data collected in this study, we conclude that divorcing the surgeon's eyes from the microscope eyepieces using the TOMS may make prolonged microvascular procedures less physically demanding and may increase the comfort level of both the surgeon and his assistant, although refinements to the technology are required.

Microcirculatory changes following different temperature washouts in a free flap model

In spite of the extensive experimental work on vascular washout in free flap surgery, an optimal temperature for the washout solution has not been established. This study was designed to determine the effect of the washout solution temperature on the degree to which the microcirculation is cleared of blood. The cremaster muscle flap in the rat was used, in which the microcirculation can be directly viewed and the presence of blood and perfusion parameters within various vessels can be measured during and after washout. Washout was started with a single, high-pressure infusion and continued at 130 mmHg for 15 minutes. The temperature of the washout solution was either 2-3, 20-22, or 35 degrees C. In all three groups, washout cleared the microcirculation almost completely within the first minute. However, we observed that a cold or room temperature washout cleared the microcirculation more completely than a warm washout did. The temperature of the washout solution did not effect post washout capillary perfusion and/or arterial diameters.

Effect of vascular freezing on the histopathology of dissected small vessels in the rat: vascular freezing does induce intimal hyperplasia in arteries and veins

Intimal hyperplasia is the primary response of a vessel wall after injury. It may be the single most significant factor affecting long-term patency. The purpose of this study was to find out whether freeze injury, inflicted on rat microvessels, would be followed by intimal hyperplasia. Toward this aim, we exposed the superficial femoral vessels in the rat. On one side they were frozen using liquid nitrogen spray. The other side was dissected as the control. Vessel segments, harvested immediately and after 1, 2, 3, and 5 months, were studied light microscopically for the occurrence and content of intimal hyperplasia. In the arteries a considerable intimal hyperplasia was found within a 4-week interval, persisting for at least 5 months, as a result of the freeze injury. In the veins, the intimal hyperplasia was much less marked but was nevertheless demonstrable. These findings are not in agreement with earlier studies, in which freezing of injured rat microarteries with liquid nitrogen spray was followed by complete regeneration of the vessel wall, without intimal hyperplasia taking place. The factors contributing to these differences are discussed. It is concluded that freezing of a vessel wall is followed by intimal hyperplasia, which is part of the normal healing process.

Arthrodesis after osteosynthesis and infection of the ankle joint

Nineteen patients with a severely infected ankle joint after previous osteosynthesis were treated with arthrodesis in our institution. Their notes and X-rays were reviewed. Goals of treatment were eradication of infection by aggressive débridement of infected tissues, obtaining adequate soft-tissue coverage, preservation/restoration of bonelength, and finally consolidation of the arthrodesis. Thirteen men and six women were treated, with a median age of 46 (17-69) years. Arthrodesis took place after a median of 6 months (0.5-40) post-accident, and after one to six earlier operative procedures. Primarily there had been four bimalleolar, five trimalleolar and ten pilon tibial fractures. Fifteen fractures were open with severe soft tissue damage. Seven free muscle transfers were performed, and ten cancellous bone graftings. Finally 29 attempts at arthrodesis were performed. Ultimately we had to perform two amputations. After a mean follow up of 3.5 years, one patient has an aseptic but asymptomatic pseudarthrosis, for which no further surgery is scheduled. Sixteen extremities are free from infection while full weightbearing is possible. The limb-threatening problem of deep infection after osteosynthesis of an ankle fracture can be resolved by consistent but prolonged treatment. After successful arthrodesis a weightbearing extremity without infection remains in the majority of cases.

Dynamic rectus abdominis muscle sphincter for stoma continence: an acute functional study in a dog model

Fecal stomal incontinence is a problem that continues to defy surgical treatment. Previous attempts to create continent stomas using dynamic myoplasty have had limited success due to denervation atrophy of the muscle flap used in the creation of the sphincter and because of muscle fatigue resulting from continuous electrical stimulation. To address the problem of denervation atrophy, a stomal sphincter was designed using the most caudal segment of the rectus abdominis muscle, preserving its intercostal innervation as well as its vascular supply. The purpose of the present study was to determine whether this rectus abdominis muscle island flap sphincter design could maintain stomal continence acutely. In this experiment, six dogs were used to create eight rectus abdominis island flap stoma sphincters around a segment of distal ileum. Initially, the intraluminal stomal pressures generated by the sphincter using different stimulation frequencies were determined. The ability of this stomal sphincter to generate continence at different intraluminal bowel pressures was then assessed. In all cases, the rectus abdominis muscle sphincter generated peak pressures well above those needed to maintain stomal continence (60 mmHg). In addition, each sphincter was able to maintain stomal continence at all intraluminal bowel pressures tested.