A simple technique for testing the viability of cross-finger pedicle flaps.

A simple test to determine the viability of cross-finger pedicle flaps is described. This test can be performed in the office or operating theatre to help determine the optimal timing for division of the flap pedicle.

Interference screw fixation strength of a quadrupled hamstring tendon graft is directly related to bone mineral density and insertion torque.

The purpose of this study was to determine whether bone mineral density of the host bone, measured using conventional dual photon absorptiometry techniques, and insertion torque can predict part of the ultimate failure strength of interference screw fixation of quadrupled hamstring tendon grafts. The semitendinosus and gracilis tendons were harvested from 10 human cadaveric knees, mean age 66.5 years (range, 53 to 81). The bone tunnel was sized within 0.5 mm of the graft. The graft was fixed with a biodegradable screw (7 x 25 mm for the femur, and 9 x 25 mm for the tibia) directly against the tendon and at the joint surfaces. Tibial fixation and femoral fixation were tested to failure using a materials testing system. Bone mineral density was measured in the metaphyseal region of the tibia and femur. The results of multiple regression analyses showed that both insertion torque and bone mineral density were related to the maximum load the graft withstood. These two variables explained 77.1% of the maximum load observed. We concluded that bone mineral density measurements of the host bone site are an important determinant of postoperative graft strength and thus have an important, but previously unrecognized, clinical role in establishing individual postsurgery rehabilitation protocols. Insertion torque in this study was a useful predictor of graft fixation strength.

Treatment and outcome of right colon cancers adherent to adjacent organs or the abdominal wall.

Fifty-four (4%) of 1284 patients treated for adenocarcinoma of the colon and rectum during a 10-year period ending in 1989 underwent potentially curative resection of right colon lesions found during surgery to be adherent to adjacent organs, abdominal wall, or retroperitoneum. Final pathologic staging was as follows: modified Dukes' class B1 (n = 2), B2 (n = 24), C1 (n = 1), and C2 (n = 27). Thirteen (24%) patients had postoperative complications, including two (3.7%) with sepsis. One patient died after surgery (mortality, 1.9%). Survival rates at 1, 3, and 5 years were 74%, 52%, and 37%, respectively. Only one (11%) of nine patients with pancreatic or duodenal adherence treated with limited resection was free of disease during follow-up. Adjuvant radiation therapy and chemotherapy did not improve survival. Histologic depth of tumor penetration could not be predicted by intraoperative assessment, and therefore radical resection is recommended whenever possible.

Death and disability from agricultural injuries in Wisconsin: a 12-year experience with 739 patients.

During a 12-year period, 739 patients were admitted to a referral trauma center as the result of injuries incurred while farming. There were 608 (82%) male patients and 131 female patients. Ages ranged from 1 to 89 years including 160 patients (22%) less than 16 years old and 78 patients (11%) more than 65 years old. The injury mechanism was a farm animal in 225 (30%), farm machinery in 168 (23%), a tractor in 120 (16%), a fall in 77 (10%), a power take-off in 47 (7%), a cornpicker in 42 (6%), and miscellaneous in 60 (8%). There were 16 (2%) deaths attributable to the agricultural accident. Tractors were involved in eight of these deaths, falls in four, power take-offs in three, and farm machinery in one. Furthermore, 159 (22%) patients were left with significant permanent disability including orthopedic problems in 131 patients, neurologic deficits in 22, and pulmonary disability in 6. Agricultural trauma is frequent and diverse with unique injury mechanisms. Life-threatening injuries are often seen and permanent disability is common. Effective injury prevention must focus on farmer education, additional mandatory safety features on agricultural equipment, and appropriate design of rural trauma systems.