Relibility of vascularized fibula in maintaining arthrodesis following extra-articular wide excisions of malignant musculoskeletal tumors

To evaluate the reliability of vascularized fibula transfer in maintaining arthrodesis following wide excision of malignant tumors located at the metaphyseal ends of long bones. Fourteen patients underwent wide extra-articular excisions followed by arthrodesis with vascularized fibula and its variants at the Department of Orthopedic Surgery and Traumatology, University of Hacettepe Medical School, Ankara, Turkey, in the period from 1996 to 2003. There were 9 males and 5 females. Their mean age was 28 years [ranging 12-52 years]. The mean follow-up time was 68 months [range 28-110 months]. The most common diagnosis was malignant giant cell tumor [6], followed by Ewing's sarcoma [3], hemangioendothelioma [2], osteosarcoma [2] and chondrosarcoma [1]. Three tumors were located at the distal end of the radius, 4 at the proximal humerus, 3 at the distal femur, one at the proximal tibia, one in distal tibia, one in distal humerus and one in proximal ulna. We used fibula as a vascularized graft in 4 patients; fibula osteoseptocutaneous flap in 4 cases; bilateral vascularized fibulae in 3; fibula with autoclaved autograft in 4 and free osteoseptocutaneous fibula in conjunction with a structural allograft and a circular external fixator in one patient. In 4 cases, implant failure developed and revision was required in 3. One case had local infection around the distal interlocking screw. In one case, clawing of first and second toes were developed at the donor side. Two patients with metastatic Ewing's sarcoma had metastatic disease. We achieved union within 9 months in 12 cases. In 2 cases with implant failure, bony consolidations were maintained at 11th and 13th months. Vascularized fibula transfer is reliable to achieve arthrodesis following extra-articular excision of malignant tumors from the metaphyseal ends

Light and electron microscopic examination of human subungual tissue Glomus and lamellated bodies

There is only limited data related to the subungual glomus body. We therefore studied the structure of this organ, aiming to obtain further evidence. Additionally, we encountered undefined receptor like structures in close association with these glomus cells, named them as lamellated bodies and examined both of the structures at light and electron microscopic levels. This study was carried out at the Faculty of Medicine, Hacettepe University, Ankara, Turkey, during the time period May 2001 to March 2002. In this study, the subungual tissues of 4 patients were examined. Within subungual tissue, 2 groups of morphologically significant structures were determined by light microscopy. The first structure was described as glomus body. It was characterized as an encapsulated structure, rich in rounded clear cells filling its central compartment. The latter structure having a lamellated appearance was described as lamellated body. In the electron microscopic examination, lamellated bodies were characterized by central filament rich large cells and surrounding cytoplasmic processes of ensheathing cells, some of which were vacuolated. Glomus bodies were surrounded by a capsule and centrally located numerous rounded cells which reflected the structural features of an active cell. The lamellated bodies are very unusual structures and they are not found in any other part of the body. The structural organization of the ensheathing cells in the lamellated bodies greatly resembles many skin associate receptors. Therefore, we planned future studies by using immunohistochemistry, to reveal nervous elements for structural contribution