The plight of the traumatic amputee.

This retrospective review of the long-term problems of patients with lower extremity amputation from trauma fails to support the opinion that most traumatic amputees do well. Overall, anatomic problems involved 51% of the amputees, and social problems involved 56%. Attempting limb salvage with subsequent secondary amputation did not seem to compromise the long-term outcome for these problems. The surgeon performing the amputation should try to obtain the best possible stump and insure that the patient gets the careful follow up and multidisciplinary team support needed to manage the anticipated problems.

Fluoroscopic technique versus Phemister technique for epiphysiodesis.

Seventy patients were followed after epiphysiodesis for limb length discrepancy. The Phemister technique was used on 44 and the fluoroscopic technique on 26 patients. Both techniques achieved growth plate arrest in 100% of patients. The average hospital stay was 1.8 days for the fluoroscopic technique and 3.5 days for the Phemister technique. Of the Phemister technique patients, 40% required formal postoperative physical therapy compared to only 8% of the fluoroscopic technique patients. The complication rate was two of 44 (4.5%) for the Phemister technique and one of 26 (4%) for the fluoroscopic technique. The advantages of the fluoroscopic technique are a much smaller scar, less postoperative knee stiffness, and a shorter hospital stay. Because of the similar results, the fluoroscopic technique is recommended.

Aspirin and dipyridamole inhibit endothelial healing.

Aspirin and dipyridamole have been used to treat the thromboembolic complications of atherosclerosis. We studied the effects of these drugs on the rate of endothelial healing after a standard de-endothelializing injury of the thoracic aorta. Twenty-five rabbits received 13.5 mg/kg/day of aspirin and 15 mg/kg/day of dipyridamole one week before injury and for the period of endothelial regrowth. There were 25 control animals. Mean serum aspirin salicylate levels were 12 micrograms/dL at the time of injury and 15 micrograms/dL at death. Areas of endothelial regrowth were measured by Evans blue dye at 1, 4, 7 and 14 days after injury. The percentage of endothelial regrowth was measured by computer-assisted morphometry. Antiplatelet treatment retarded endothelial regrowth by 66% at four days, 22% at seven days, and 28% at 14 days. Antiplatelet drugs must be used cautiously, as re-endothelialization of injured arteries is retarded.