Bone graft harvested from the olecranon-an anatomic study.

BACKGROUND: Bone grafts are widely used in orthopedic surgeries. Although the conventional iliac crest graft is still the largest source of cancellous and cortical-cancellous bone grafts, it may require a new surgical field and additional anesthesia. In contrast, the use of the distal radius graft allows removal in the same field; however, it is often the recipient site; thus, only a limited amount is usually available. In the upper limb, one of the possibilities is the use of the cancellous and/or cortical-cancellous graft from the olecranon. This was a primary and experimental study that aimed to analyze the versatility of using olecranon bone grafts through anatomical assessment of cadavers. METHODS: Eight upper limbs were dissected from four fresh, unclaimed, young cadavers, with no history of the previous pathology at the removal site to demonstrate the method of graft removal and to measure the quantity obtained in two situations, namely, removal of the cancellous graft and removal of the cortical-cancellous grafts. RESULTS: The average volume of the cancellous bone graft from the olecranon was 3.9 cm3 (3.6 to 4.2 cm3). The cortical-cancellous bone graft had an average length of 4.4 cm (4.1 to 5.0), a width of 0.8 cm (0.7 to 1.0), and an average thickness of 0.4 cm (0.3 to 0.6). CONCLUSION: The technique for harvesting the olecranon graft is easy to perform, allowing a volume in average 3.9 cm3 of cancellous graft and 4.4 cm and 0.8 cm of cortical-cancellous bone, for various upper limb defects, which require this need.

Accuracy of sentinel lymph node mapping in detecting occult neck metastasis in papillary thyroid carcinoma.

OBJECTIVES: The objectives of this study were to evaluate the following: 1) the accuracy of sentinel lymph node mapping (SLNM) in detecting metastasis in papillary thyroid carcinoma (PTC), and 2) if SLNM could modify the American Joint Committee on Cancer (AJCC) staging of previous cN0 PTC patients. SUBJECTS AND METHODS: Forty SLNM were performed prospectively in 38 consecutive cN0 PTC patients, with total thyroidectomy and elective compartment neck dissection (CND). The results of SLNM were compared with CND pathological findings to verify the accuracy of sentinel SLNM. RESULTS: The mean patients' follow-up was 36 months. A total of 133 SLN were found at levels VI, II, III and IV. The SLN was identified in 95% of the patients with one false negative, 95% sensitivity, a 94% negative predictive value and 97% accuracy. The SLNM upstaging from cN0 to pN+ was 49%, and to stages III and IVa, it was 21%. CONCLUSIONS: For this series of cN0 PTC patients: 1) SLNM accuracy was 97%, and 2) SLNM upstaging from cN0 to pN+ was 49%, whereas to stages III and IVa, it was 21%.

Accuracy of sentinel lymph node mapping in detecting occult neck metastasis in papillary thyroid carcinoma

ABSTRACT Objectives: The objectives of this study were to evaluate the following: 1) the accuracy of sentinel lymph node mapping (SLNM) in detecting metastasis in papillary thyroid carcinoma (PTC), and 2) if SLNM could modify the American Joint Committee on Cancer (AJCC) staging of previous cN0 PTC patients. Subjects and methods: Forty SLNM were performed prospectively in 38 consecutive cN0 PTC patients, with total thyroidectomy and elective compartment neck dissection (CND). The results of SLNM were compared with CND pathological findings to verify the accuracy of sentinel SLNM. Results: The mean patients' follow-up was 36 months. A total of 133 SLN were found at levels VI, II, III and IV. The SLN was identified in 95% of the patients with one false negative, 95% sensitivity, a 94% negative predictive value and 97% accuracy. The SLNM upstaging from cN0 to pN+ was 49%, and to stages III and IVa, it was 21%. Conclusions: For this series of cN0 PTC patients: 1) SLNM accuracy was 97%, and 2) SLNM upstaging from cN0 to pN+ was 49%, whereas to stages III and IVa, it was 21%.