Costochondral autograft as a salvage procedure after failed trapeziectomy in trapeziometacarpal osteoarthritis.

PURPOSE: Osteoarthritis at the base of the thumb is a common problem, especially in women. Among the many surgical procedures aimed at restoring the function of the trapeziometacarpal joint, total trapeziectomy has been shown to provide good long-term results in most patients. But in some patients continued pain may lead the surgeon to consider a revision procedure. We report the use of costochondral autograft as an interposition material in revision of trapeziectomy in trapeziometacarpal osteoarthritis and to study its usefulness. METHODS: The study design was retrospective. All of the patients had a costochondral autograft as a revision procedure after a failed trapeziectomy with ligament reconstruction. Patients were clinically assessed before and after surgery. The follow-up period was 24 months. Results were assessed as follows: good, complete relief of pain; fair, persistent mild pain and stiffness; poor, no relief of pain or any improvement with revision surgery. RESULTS: Four patients were included; there were 2 good results, 2 fair results, and no poor result. Pain relief was obtained in all patients. Thumb opposition showed a slight improvement in 1 patient and no change in the other 3 patients. Pinch strength showed no change. One case of iatrogenic injury of the sensory branch of the radial nerve was noted. CONCLUSIONS: Costochondral autograft as a revision procedure after failed trapeziectomy is a reliable procedure. These preliminary outcomes showed that the result did not compare favorably with soft-tissue interposition. Nevertheless, in case of an iterative procedure, the lack of available soft-tissue material to interpose may lead the surgeon to consider a costochondral autograft. This procedure should be considered a salvage procedure.

Treatment of vascular abnormalities with a long-pulse diode at 980 nm.

BACKGROUND: Lasers have been used to treat a variety of vascular abnormalities for over 20 years. For minor vascular targets, a small and friendly diode laser with cooling handpiece appears to be a challenger to other systems. OBJECTIVE: The purpose of this study was to compile treatment data and to examine the effectiveness of a longer pulse duration diode laser in the treatment of vascular pathologies such as facial telangiectasia, venous lakes, spider nevi, blue telangiectasia, leg veins and dermatological treatments. SUBJECTS AND METHODS: Thirty patients were treated with the diode laser with a pulse of 150 ms, energy densities of 300-500 J/cm(2) and wavelength at 980 nm. Patients were treated with a surface cooling device. Clinical evaluations were categorized into improvements of 0-25%, 25-50%, 50-75% and greater than 75%. RESULTS: 60% of the patients have up to 50% improvement. The maximum clearance was obtained with only one treatment. However even the cooling system is performed +5 degrees C, pain was relatively high for a majority of patients. CONCLUSIONS: The long-pulse diode laser at 980 nm is effective for treating a wide variety of small vascular abnormalities, for deep and thick vascular lesions and leg veins. The surface cooling device is useful for epidermal protection and pain-free treatment.