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The bovine graft axillary artery to axillary vein fistula provides a simple method of circulatory access. This method is reserved for patients in whom Cimino arteriovenous fistulas or looped grafts have failed. The grafts are easy to cannulate, flow is excellent, and the patients adapt to it very promptly.

Although well protected and infrequently injured, penetration of the esophagus has a reported mortality of 10 to 30 per cent. The results of the management of seventy-seven patients with noniatrogenic penetrating injuries of the esophagus were reviewed. The region of esophageal injury was cervical in forty-five patients, intrathoracic in twenty-one patients, and intraabdominal in eleven patients. Gunshot wounds accounted for 75 per cent of the injuries. The overall mortality was 23 per cent. The highest morbidity and mortality was among patients with intrathoracic injuries, due to both difficulty in exposure and complexity of associated injuries. Because of the high incidence of late complications in intrathoracic injuries, cervical diversion and tube gastrostomy or complete esophageal exclusion must be considered early. Fundoplastic procedures were used in four patients with distal esophageal injuries. Although the overall mortality from truncal penetrating wounds has improved in recent years, the mortality from esophageal injuries remains high, reflecting a need for advancement in initial operative management.

We have modified the most commonly utilized wound drainage system to further reduce the incidence of postoperative accumulation of fluid under the skin flaps. This modification allows more efficient removal of debris, loose tissue fragments, and clots from the wound catheters and insures a constant negative pressure in the system. These maneuvers lengthen the usefulness and improve the efficiency of the catheters and have reduced the incidence of fluid accumulation.