Thrombosis of Extra-cardiac Fontan, an Institutional Experience.

Background: Thromboembolism can complicate Fontan surgery. There are few well designed studies in the literature to determine the epidemiology of thrombosis after Fontan. Methods: We report the experience of King Faisal Specialist Hospital & Research Center- Jeddah, Kingdom of Saudi Arabia; regarding thrombosis of extra-cardiac Fontan pathways in 3 of our patients; two patients were post- Fontan operation and one patient was post- Kawashima procedure & hepatic vein incorporation. Results: The first and second patients developed thrombosis of Fontan pathways at one month & one year postoperatively respectively. In both patients, stenting of the extra-cardiac contegra reestablished the patency of Fontan circuit and saved the risks of redo-surgeries. In the third patient, conduit occlusion was diagnosed 5 months postoperatively. Several attempts of cardiac catheterizations failed to penetrate the thrombosed conduit. Surgical re-intervention was inevitable. Conclusions: The threshold for diagnostic and interventional cardiac catheterization should be lowered in post Fontan operation. Chronic oral anticoagulation may not prevent development of thrombosis despite therapeutic international normalized ratio (INR).

Using in-situ replantation of dead bone to treat infected nonunion of femur / 中国矫形外科杂志

[Objective]To study the techqiue and method of using in-situ replantation of dead bone to treat infected nonunion of femur. [Method] Debridement and removal of dead bone were carried out in 2 patients who had a chunk of dead bone and multiple sinus without involucrum formation.Sterilized sequester was replanted in-situ,tibia traction was performed and continual Kawashima's irrigation was applied with sensitive antibiotic after surgery.[Result]The time of bone healing in 1 case was ten months.The patient was followed up for 42 months,there was no recurrence of osteomyelitis.The time of bone healing in another case was about 12 months,he was followed up for 30 months,there was also no recurrence in this patient.[Conclusion]Traumatic osteomyelitis complicated with a massive sequester and nonunion could be cured by process which included debridement,in-situ replantation of sterilized death bone,continual washing as well as comprehesive treatment.It could achive the two primary purposes,inflammation cure and bone healing.Among these methods,improved Kawashima's irrigation is the most important method for inflammation cure and bone union.