Allogeneic donor split skin grafts for treatment of refractory ulcers in cutaneous chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation-a retrospective analysis on seven patients.

Refractory skin ulcers due to severe chronic graft-versus-host disease (cGVHD) remain to be associated with significant morbidity and mortality.We performed an allogeneic donor skin transplantation in seven adult patients after allogeneic hematopoietic stem cell transplantation for cGVHD-associated refractory skin ulcers. While four patients received a split skin graft (SSG), in one patient, a full thickness skin graft for two small refractory ulcers of the ankle was performed, and one patient received in vitro expanded donor keratinocyte grafts derived from hair roots of the original unrelated donor. In one additional patient, a large deep fascial defect of the lower leg was covered with an autologous greater omentum free graft before coverage with an allogeneic SSG. An additional patient was treated with an autologous scrotal skin graft for a refractory ulcer associated with deep sclerosis of cGVHD after unrelated donor transplantation.All skin grafts engrafted and resulted in permanent coverage of the grafted ulcers without any signs of immunological mediated damage. In the patient receiving in vitro expanded keratinocyte grafts, two localized ulcers were permanently covered by donor skin while this approach failed to cover extensive circular ulcers of the lower legs.Allogeneic donor skin grafts are a valuable treatment option in refractory ulcers due to cGVHD but are restricted mainly to related donors while keratinocyte grafts from unrelated donors remain experimental. In male patients lacking a related donor, autologous scrotal skin graft may be an alternative option.

WITHDRAWN: The use of integrated indocyanine green fluorescence microscope camera for intraoperative lymphography of supermicrosurgery.

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Vascular malformations of upper and lower extremity - from radiological interventional therapy to surgical soft tissue reconstruction - an interdisciplinary treatment.

This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up.Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.

New reconstruction for bone integration of non-vascularized autogenous bone graft with better bony union and revascularisation.

INTRODUCTION: Phalangeal defects are often seen after tumor resection, infections, and in complex open hand fractures. In many cases, reconstruction is difficult and amputation is performed to avoid prolonged rehabilitation that is often associated with a poor outcome. In these cases, the maintenance of length and function presents a reconstructive challenge. METHODS: We reviewed 11 patients who underwent extensive phalangeal reconstruction with non-vascularized bone graft from the iliac crest using a key-in-slot-joint technique to provide acceptable function and bony union. RESULTS: In each case, non-vascularized bone graft with a length of 1.4-6.0 cm was used to reconstruct the phalanx. Follow-up ranged from 6 weeks to 5 months, and in all cases, there was bony union after 6 weeks. We evaluated range of motion, function, and as well pain and grip strength of the fingers. CONCLUSIONS: This case series suggests that a key-in-slot technique allows non-vascularized bone graft to be used in complex large phalangeal bone defects. Due to better bone contact, a sufficient perfusion and revascularisation of the non-vascularized bone graft can be achieved for a quicker and stable bony union. This method appears to be an alternative to amputation in selected cases with a satisfactory soft-tissue envelope.

Point defects in Sc2O3 thin films by ion beam sputtering.

We show that the concentration of oxygen interstitials trapped in Sc2O3 films by ion beam sputtering from metal targets can be controlled by modifying deposition conditions. We have identified point defects in the form of oxygen interstitials that are present in Sc2O3 films, in significantly high concentrations, i.e., ∼10(18) cm(-3). These results show a correlation between the increase of oxygen interstitials and the increase in stress and optical absorption in the films. Sc2O3 films with the lowest stress and optical absorption loss at 1 µm wavelength were obtained when using a low oxygen partial pressure and low beam voltage.

[Total hip arthroplasty after proximal femoral osteotomy: 75 cases with 9-year follow-up]. / Prothèses totales de hanche après ostéotomies proximales du fémur.

PURPOSE OF THE STUDY: Clinical outcome and technical difficulties observed after total hip arthroplasty subsequent to osteotomy of the proximal femur were studied in 75 total hip arthroplasties. MATERIAL AND METHOD: Sixty-four patients underwent 75 total hip arthroplasty procedures at the Caen University Hospital between 1978 and 1995. These patients were reviewed at least two years after implantation. The Postel Merle d'Aubigné (PMA) score was used to assess clinical outcome and the Lequesne criteria to determine acetabular and femoral parameters on the weight-bearing AP radiograph. Off-set of the femoral epiphysis was determined by measuring the relation between the femoral shaft axis and the digital fossa. The population was composed of young active subjects who had had several operations. The main underlying diseases were: congenital dislocation of the hip (32%), dysplasia (23%), and primary degenerative hip disease (34%). Two-thirds of the hips were stiff and more than three-quarters were unstable. There were 28 osteotomies for varisation, 19 medial translations, 20 osteotomies for valgisation, and 7 subtrochanteric osteotomies. All femoral pieces except one were cemented. Implantation required 39 trochanterotomies, 39 Hardinge approaches, and 5 deosteotomies. RESULTS: The medial offset of the digital fossa compared with the diaphysis led to operative difficulties and femoral complications: Their were eight femoral fractures: 7 of these occurred with a digital fossa situated medially to the diaphysis. The Postel-Merle-d'Aubigné score at last follow-up was satisfactory in 57 cases (76%). Among the 18 non-satisfactory results, there was 7 failures requiring surgical revision, 5 potential loosenings, and 6 stiff hips in patients with congenital dislocation. For the 7 revisions (9.3%), 3 were for infection (2 late hematogenous), 1 for early dislocation, 2 for aseptic acetabular loosening, and 1 for aseptic femoral loosening. Medial translation of the digital fossa led to a larger number of varus positions (44%). For femoral cementing, 10 hips showed a non-progressive secondary lucent line; these prostheses were considered as potentially loose. Among them, varisation osteotomies has been performed in 5 cases, and in 8 the digital fossa was medial to the diaphyseal axis. There was only one aseptic femoral loosening requiring surgical revision. Implant survival, established according to the actuarial method, was 94.9% at 10 years. DISCUSSION: The almost 95% implant survival at 10 years observed in our patients is comparable with most reports in the literature and slightly better than those reported at the 1997 SOFCOT symposium on total hip arthroplasty after 50 years (84%). The most important factor determining surgical difficulty and operative complications at the femoral level was the position of the digital fossa, more than the type of initial osteotomy. CONCLUSION: Indications for osteotomy must account for subsequent total hip arthoplasty. Implantation is difficult after subtrochanteric osteotomy which can cause important technical problems. The rate of failure is very high. The risk of femoral complications and misalignment of the femoral stem, irrespective of the type of initial osteotomy, is greater when the digital fossa lies medially to the diaphyseal axis. We prefer trochanterotomy or desosteotomy for such cases. Osteotomy did not rule out arthroplasty for any of the femurs. There were however important operative difficulties and the frequency of complications suggest we should be most prudent about careful preoperative planning in the frontal plane.

[Dual x-ray absorptiometry assessment of bone density of the proximal tibia in advanced-stage degenerative disease of the knee]. / Evaluation de la densité osseuse mesurée par absorbtiométrie biphotonique à rayons X DXA (dual x-ray absorbtiometry) de l'extrémité supérieure du tibia dans la gonarthose évoluée.

PURPOSE OF THE STUDY: Axial deformity secondary to degenerative joint disease of the knee can modify stress forces. Certain studies have reported an inversely proportional relationship between degenerative disease and osteoporosis. The aim of this prospective study was to quantify the horizontal linear distribution of bone density using dual x-ray absorptiometry (DXA) of the proximal tibia as a function of the femoral neck bone density in patients with knee osteoarthritis. MATERIAL AND METHODS: Between September 1996 and March 1998, 90 cases of primary degenerative joint disease of the knee were programmed for total knee arthroplasty. Prior to the procedure, the patients were assessed clinically and radiologically according to the International Knee Society (IKS) criteria. The mechanical femorotibial angle was measured in all patients and the varus angles were recorded. Most of the patients were women (65 p. 100) with a mean age of 70 +/- 5 years. Valgus knees were excluded from this series. The mean mechanical femorotibial angle was 172 +/- 5 degrees. Fifteen patients had a normal axis (16 p. 100), 32 had a varus measuring 4 degrees to 10 degrees (35 p. 100) and 43 had a varus measuring 10 degrees or more (48 p. 100). The overall varus distance was 6.4 +/- 2 cm. All patients had two DXA explorations: femoral neck to determine the bone status according to the WHO criteria (normal, osteopenia, osteoporosis), knee to determine the linear distribution of bone density of the proximal tibia. A 7 mm high band including 7 regions of interest covering the width of the tibia were explored in the area where the tibial cut was to be made. These 7 regions of interest were: R1, R2 under the lateral compartment, R6, R7 under the medial compartment, and R3, R4, R5 on either side of the tibial spines. The level of significance was set at 5 p. 100. RESULTS: The mean Z score (0.54 +/- 1) in the 90 patients showed a symmetrical distribution. These patients were representative of their age range. Their T score was - 1.40 +/- 1 (m +/- SD) and most had osteopenia (54 p. 100) according to the WHO criteria, although 16 p. 100 had osteoporosis. Mean bone density of the knee was 0.898 +/- 0.163 g/cm(3) and was correlated with that of the femoral neck (r=0.61, p=0.001). There were significant correlations between the differences in the bone densities of the knee compartments (R6-R2, R7-R1) and the mechanical femorotibial angle [(r=0.39, p=0.0001); (r=0.52, p=0.001)]. Irrespective of the overall bone density, there was a strong medial compartment overloading, which correlated with the degree of varus deformation. CONCLUSION: DXA assessment of bone mineral density of the proximal tibia is a simple, reliable, precise and reproducible method. The distribution of bone density in the degenerative knee depends on the degree of deformation. The average level depends on the subject's general state of mineralization. Osteoporosis does not protect against degeneration of the knee joint since 16 p. 100 of our patients had osteoporosis according to the WHO criteria.

Arthroscopic medial meniscectomy on stable knees.

We reviewed 74 partial medial meniscectomies in 57 patients with stable knees, to assess the long-term functional and radiological outcome. The International Knee Documentation Committee score and the residual laxity were assessed in both knees. At the time of surgery the mean age of the patients was 36 +/- 11 years and the mean follow-up was 12 +/- 1 years. All had a limited medial meniscectomy. The anterior cruciate ligament was intact in all cases. The meniscal tear was vertical in 95% and complex in 5%. The posterior part of the meniscus was removed in 99%. A peripheral rim was preserved in all cases. After 12 years 95% of the patients were satisfied or very satisfied with their knee(s). Objectively, 57% had grade A function and 43% were grade B. The outcome correlated only with the presence of anterior knee pain at final follow-up. In the 49 cases of arthroscopic meniscectomy for which there was a contralateral normal knee there was narrowing of the 'joint-space' in 16% of the operated knees. There was no correlation between this and other parameters such as age or different meniscal pathologies.

[Outcome of 95 stable meniscal tears left in place after reconstruction of the anterior cruciate ligament]. / Devenir de 95 lésions méniscales stables laissées en place lors de la reconstruction du ligament croisé antérieur.

PURPOSE OF THE STUDY: The purpose of this retrospective analysis was to study clinical and radiological outcome of 95 stable meniscal tears left in place after arthroscopic reconstruction of the anterior cruciate ligament with a free patellar autograft (with or without a lateral component). MATERIAL AND METHODS: We reviewed 86 patients who had undergone arthroscopic treatment for chronic anterior laxity (56% solely anterior laxity) with at least one meniscal lesion left in place after ligamentoplasty. IKDC criteria and ARPEGE scores were recorded. A total of 95 stable meniscal lesions had been left in place: 35 lateral lesions (80% longitudinal tears and 77% posterior lesions) and 60 medial lesions (55% peripheral disinsertions and 90% posterior lesions). The lesions measured a mean 10 mm (range 5-20 mm) for the lateral and medial menisci. Mean follow-up was 4 years (range 3-9 years). These patients were young (mean age 26 years), and predominantly men (75%). The right knee was involved in 53% of the cases. RESULTS: At last follow-up, 26% of the patients were grade A, 65% B, 7% C and 2% D according to the IKDC criteria. No revision procedure was required for lateral menisci despite the large size of the lesions left in place in certain cases. Among the 60 medial lesions left in place, 10 (17%) had become symptomatic (8 bucket-handle, 1 longitudinal tear, 1 posterior fragment) and required surgery a mean 3 years (range 1-6 years) after ligamentoplasty. There was no statistical difference between functional score, residual laxity, or type of stabilization in patients who had revision surgery for symptomatic meniscal lesions and the others. Inversely, these lesions were statistically larger (p=0.038) than the others (mean 13 mm versus 9.8 mm). CONCLUSION: Outcome of stable meniscal lesions left in place after treatment for anterior laxity depends on the meniscus involved. For the lateral meniscus, irrespective of the size of the lesion, therapeutic abstention has no clinical impact at 4 years. Inversely, for the medial meniscus, 37.5% of the lesions measuring more than 10 mm that were left in place required revision while only 9% of those measuring less than 10 mm necessitated subsequent surgery. Beyond 10 mm, therapeutic abstention led to a revision procedure in 17% of the cases, suggesting the usefulness of a discussion on other indications. Stable lesions of the medial meniscus should not be left in place if they measure more than 10 mm.

[Lateral meniscal cyst. Retrospective study of 105 cysts treated with arthroscopy with 5 year follow-up]. / Les kystes du ménisque latéral. Etude rétrospective de 105 kystes traités par arthroscopie avec 5 ans de recul.

UNLABELLED: A retrospective study was performed on 122 patients with 124 lateral meniscal cysts, selected from a series of 8100 knee arthroscopies (1.5 per cent). Eight of the patients were lost for follow up, 11 patients had chronic anterior cruciate ligament deficiency or previous medial meniscectomy. Therefore 105 of 124 patients were included in this study. Average follow-up was 5 years (range of 1 to 12.5 years). MATERIAL AND METHODS: Mean age was 33 years (range of 12 to 69 years). All patients had pain over the joint line with a palpable mass. All were noted to have a meniscal tear at the time of surgery and 60 (57 per cent) had a horizontal cleavage component. They were all arthroscopically treated. RESULTS: Meniscal tears were treated by arthroscopic partial meniscectomy in 104 cases and meniscal repair in one case. Cysts were treated by intra-articular debridement in 91 cases and open cystremoval in 14 cases. Eleven cysts recurred and a second arthroscopy was required. The clinical results, including cysts recurrence, were excellent or good in 87 per cent of cases. Osteoarthritis following treatment of these meniscal cysts occurred in 9 per cent of cases. CONCLUSION: When there is a cyst and no other intra-articular damage, the prognosis was excellent at 5 year follow-up. For lateral meniscal cysts; arthroscopic partial meniscectomy with intra-articular debridement yields predictable results.

[Incidence of arthrosis in the results of the treatment of coxarthrosis in the young adult with Chiari's osteotomy. Retrospective study of 52 hips with 10.5 years of follow-up]. / Incidence de l'arthrose dans les résultats du traitement de la coxarthrose de l'adulte jeune par ostéotomie de Chiari. Etude rétrospective de 52 hanches avec 10.5 ans de recul moyen.

PURPOSE OF THE STUDY: Fifty two of 53 Chiari pelvic osteotomies performed between 1974 and 1991 were reviewed clinically and radiographically with an average follow-up of 10.5 years. MATERIAL AND METHODS: In more than 46 per cent of cases, the osteotomy was performed on a dysplastic painful hip with severe osteoarthritis. Major complications were rare. The Chiari's osteotomy fixation screw was removed in 16 cases. Technically, the average displacement was 22 mm. A ascending osteotomy, related to the level of the osteotomy (p = 0.001), provided good displacement. RESULTS: The functional results were very good or good in 65 per cent of the patients and lasted more than 10 years. Seventy five per cent of the hips were pain free. Radiographically, the center edge angle and the femoral head covering were corrected by the procedure. Degenerative changes of the hip joint were improved or stabilized in 63.5 per cent of the cases. Fifteen hips had undergone secondary total hip replacement, seven during the first five years and 8 after 13 years. DISCUSSION: Factors associated with a positive outcome included: age under 30 at the time of surgery (80 per cent of survivorship up to 15 years of follow up), low stage (I or II) of osteoarthritis, and a technically perfect Chiari osteotomy. The outcome of initial stage III or IV initial osteoarthritis were not as long lasting. Chiari osteotomy functional results were good for the initial 10 years, after this time they deteriorated quickly. CONCLUSION: Chiari pelvic osteotomy is an alternative procedure to early total hip replacement for severe painful dysplastic hips with low stage of osteoarthritis in young patients.

Distribution and structure of cloned P elements from the Drosophila melanogaster P strain pi 2.

P transposable elements of Drosophila melanogaster cloned from the strong P strain pi 2 have been analysed. The structures and chromosomal locations of 26 of the 30-50 elements estimated to be present in pi 2 have been determined. At one location two elements are inserted 100 base pairs (bp) apart, and in a second location two elements are only separated by the 8 bp duplicated upon P-element insertion. In addition to 2.9 kilobase-pair (kbp) elements, elements with 14 different internal deletions from 1.3 to 2.3 kbp in size have been isolated. There are 7 copies of the 2.9 kbp element, 2 copies each of 5 internally deleted elements and a single copy of 9 internally deleted elements. One of the elements found twice is the KP element, which may play a role in the regulation of hybrid dysgenesis in strains which contain many copies of this element. Apart from internal deletions the elements are extremely homogeneous in DNA sequence, with only 2 single base polymorphisms detected twice each in over 16 kbp of P-element sequence. Although transpositions are infrequent in an inbred P cytotype strain such as pi 2, the distribution of these cloned elements indicates that when the genomic library was made, the strain was polymorphic with respect to element location. The distribution and structures of the element are discussed with respect to models for regulation of P-element transposition.