Surgical treatment of adolescent idiopathic scoliosis using Harrington distraction rod combined with segmental sublaminar wiring.

One hundred and twenty cases of adolescent idiopathic scoliosis were treated surgically using Harrington distraction rod combined with sublaminar wires as an adjunction to spinal fusion. There were 94 female and 26 male patients. Ages ranged from 13-19 years old. There were 90 thoracic curves, 24 thoracolumbar curves and 6 double major curves. Curve severity ranged from 35-90 degrees. The most common one was between 51-75 degrees. Average follow-up period was 5 years ranging from 4-9 years. Average surgical time was two and half hours (range from 2-3 1/2 hrs.) Blood loss was about 600 ml (range from 400-1600 ml) since the operation was performed under hypotensive anaesthesia. Result of the surgical correction ranged from 53-76 per cent depending on the curve severity and the age of the patients, usually with less curve severity in younger patients with thoracic curve a higher percentage of correction would be obtained. We obtained good thoracic kyphosis and lumbar lordosis in all cases. There were no serious complications in our series. It is due to the contoured square and rod combined with sublaminar wiring that could correct and control both sagital plane and rotational deformities. This type of surgical approach is appropriate in patients with low economic status and required a period of external support.

Reconstruction of bone and skin defect using the osteocutaneous free fibular graft.

The attempt to use an osteocutaneous free fibular graft (OCFFG) to reconstruct composite bone and skin defects of the extremities following trauma was carried out in eighteen cases. Ten of seventeen cases were successful with the method without surgical complications and bony union occurred after 3 to 6 months (average 5.2 months). Three cases had skin flap necrosis (2 partial and 1 total) and required further skin grafting or skin coverage. Four cases failed due to thrombosis of the vascular anastomosis. The procedure was abandoned in one case because of failure to identify a reliable septocutaneous vessel to the skin flap.