osteocutaneous free fibular graft for extensive defects in long bones

Free composite osteocutaneous flaps were used to reconstruct five extensive bone and skin defects. Four cases had tibial and skin losses, while the fifth patient suffered from ulnar and skin defect over it. Fibular bone graft with its overlying skin and the peroneal artery with its venae comitants were anastomosed by the aid of microvascular technique and the bone was fixed in place after preparation of the recipient site. The skin color of the flap was checked every few hours. Thrombectomy was performed in one case, while Thiersch skin graft was done to cover the raw area of sloughed skin in another case. The third reported complication was a draining sinus which closed conservatively after one month. The fourth complication happened in the first case after three months was fracture of the fibular graft and bony union occurred after another two months fixation by above-knee cast. It is concluded that osteocutaneous fibular graft can solve many problems of extensive bone and skin losses

Percutaneous drainage of hepatic abscesses

Eighteen patients with hepatic abscesses have been drained percutaneously by ultrasonographic guided technique. Five patients had amebic abscesses, while 13 patients suffered from pyogenic abscesses. The patients were not requiring surgical procedure for a concomitant or a primary cause and were entered the trial after failure of medical treatment. The average time required for catheter drainage ranged from 5 to 16 days. Three cases [16.7%] required replacement of the catheter. Two patients [11.2%] required surgical intervention, for surgical drainage in one case and to deal with subhepatic peritonitis resulted from spillage of infection during percutaneous drainage in the second case. Mild hemorrhage was reported inside one abscess cavity [5.6%], which was stopped conservatively. The success cure rate was 77.7% which reached up to 88.8% after replacement of a wider catheter. It is concluded that Percutaneous drainage is an effective method for draining hepatic abscesses not requiring a concomitant surgical procedure and not responding to medical treatment. However, surgical intervention may be required at any time with that technique

Management of 12 cases of extrahepatic biliary carcinomas

Twelve patients with extrahepatic bile duct carcinomas were managed in this work. Their ages ranged from 46-68 years; 7 were males and 5 were females. They were investigated by biochemical study of their liver functions, abdominal ultrasound, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography [1 case]. Five patients had proximal perihilar tumors, two were operable and one was managed by left hepatectomy and the second was treated by skeletonization resection with right and left hepaticojejunostomies, while the other three had unresectable tumors; one of them was palliated by left intrahepatic cholangioenteric anastomosis and the obstructive jaundice of the other two patients were relieved by making an internal fistula between a dilated hepatic duct and the gall bladder with cholecystojejunostomy. Three cases with operable mid-duct tumors were treated by skeletonization resection of the common bile duct, then right and left hepaticojejunostomies. The patient with unresectable mid-duct cacinoma was palliated by hepaticojejunostomy. Two cases with operable distal duct tumors were managed by pancreaticoduodenectomies; one with pyloric preservation and the second without pyloric preserving technique. The last patient was diagnosed preoperatively as inoperable distal duct tumor and was palliated by percutaneous transhepatic bilary decompression

Low molecular weight heparin versus low-dose heparin in thromboprophylaxis after major abdominal surgery

One hundred twenty patients undergoing elective major abdominal surgery were divided into 3 equal groups: Group A [LMWH], group B [low-dose heparin] and group C [placebo, control group]. The results showed that both LMWH and low-dose heparin are equally effective in lowering the incidence of postoperative deep vein thrombosis [one case in each group, while four cases developed deep vein thrombosis in the control group]. The bleeding complications were nearly the same in the first two groups and exceeded those reported in the control group. LMWH as it has the same efficacy and side effects of low-dose heparin is a practically alternative way of thromboprophylaxis in patients undergoing elective major abdominal surgery because of the once-daily regimen with better patient acceptance