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.

Congenital pseudarthrosis of the tibia: treatment with free vascularized fibular graft.

Five children with congenital pseudarthrosis of the tibia were treated by resection of the lesion and reconstruction of the extremity with a free vascularized fibular graft (FVFG). Two of five cases had had multiple surgical procedures before FVFG. These two cases were complicated with the non-union of the proximal grafthost junction. Of these, one case achieved bone union after further resection of the non-union and adding allogenic bone graft and another case denied further operation and was lost to follow-up 6 months postoperatively. Three cases, two of which underwent FVFG as a primary treatment and another one after failure from the Sofield procedure respectively, were initially treated successfully and solid union of the grafthost junctions was within four months postoperatively. Problems including: anterior bowing, refracture, valgus deformity of the ankle and leg length discrepancy occurred in all four followed cases.

The effects of medial patellar plica on clinical diagnosis of medial meniscal lesion.

A prospective study involving 190 patients presenting with symptoms suggesting internal derangements of the knee was performed to demonstrate the likelihood of symptoms and signs produced by medial patellar plica to mimic those of medial meniscal lesions. Arthroscopic examination was done in each patient by an independent examiner after the establishment of clinical diagnoses. Only patients with isolated medial patellar plica (Group A, n = 54) and isolated medial meniscal lesion (Group B, n = 19) were further assessed. Although isolated medial patellar plica can produce symptoms and signs similar to medial meniscal lesion, statistical analysis clearly demonstrated that giving way, locking, medial joint line tenderness and positive McMurray test were more commonly detected in Group B (p < 0.05). The sensitivity of detecting either one or more than one symptom or sign included in this study was higher in group B (89.5%), but a positive symptom or sign was more predictive in Group A (39.2%). Considering the variation of prevalence of medial patellar plica in other regions, the results from this study indicate that giving way, locking, clicking, medial joint line tenderness and positive McMurray test would be more predictive of medial patellar plica and thus clinical diagnosis of medial meniscal lesion might be affected if the prevalence of isolated medial patellar plica exceeded 16.6 per cent.

Osseous adenocarcinoma of unknown primary site: study of survival and prognostic factors.

A prospective study of 149 patients suffering from adenocarcinoma of unknown primary site (ACUPS) of bone was carried out. The tumors are classified as 63 extraspinal, 67 spinal and 19 mixed involvement. Upon meticulous physical examination, Virchow's node was detected in 15 cases, rectal shelf in 11 cases and hepatomegaly in 44 cases. Blood chemistry showed elevation of alkaline phosphatase (> 3 sigma units) in 98 cases and chest roentgenogram showed pulmonary lesions in 23 cases. Treatment was surgery and radiotherapy in 64 and two cases respectively. In all of these patients histological findings of the biopsy or resection specimen had confirmed the diagnosis of adenocarcinoma. Among 124 evaluable patients, overall survival was analysed using Kaplan-Meier life table analysis. Survival rates at one, two and four months after diagnosis were 80.7, 60.5 and 25 per cent with a mean and median survival times of 90 and 77 days respectively. Statistical analysis was also performed to ascertain the prognostic importance of the following variables: age, gender, Virchow's node, rectal shelf, hepatomegaly, serum alkaline phosphatase, pulmonary lesion, and multiplicity and site of the osseous lesions. The presence of pulmonary lesion or hepatomegaly significantly produced unfavorable impact on the duration of survival (p = 0.0004 and 0.0150, respectively) while other remaining factors had not.

Vastus lateralis myocutaneous flap: the treatment for trochanteric pressure sores in paraplegic patient.

The vastus lateralis myocutaneous flap for trochanteric pressure sore is simple and reliable. A good padding is obtained, the donor site is closed primarily. It should always be considered with every paraplegia patient.

Group A beta-hemolytic streptococcal meningitis in adults.

Two cases of Group A beta-hemolytic streptococcal meningitis are reported. One patient presented with fever, coma, seizure and was associated with skull defect whilst the other had meningitis after surgical removal of an epidural cyst. The first died but the latter completely recovered. This organism should be considered in patients with skin wounds and bacterial meningitis due to Gram-positive cocci.