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1.
J Hand Surg Asian Pac Vol ; 27(3): 594-597, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35808875

ABSTRACT

We reconstructed a segmental bone defect in a finger associated with a dorsal skin defect using a bone graft covered with a free medial femoral condyle periosteal flap and a skin graft in two patients. The vascularised periosteal flap (VPF) improved the survival of the bone graft and allowed the take of the skin graft. The use of a VPF can be considered in patients with crush injury of the digits with segmental loss of bone and dorsal skin Level of Evidence: Level V (Therapeutic).


Subject(s)
Free Tissue Flaps , Bone Transplantation , Bone and Bones , Femur/surgery , Femur/transplantation , Humans , Skin Transplantation
2.
J Hand Microsurg ; 10(2): 105-108, 2018 Aug.
Article in English | MEDLINE | ID: mdl-30154625

ABSTRACT

Reconstruction is challenging in a patient with loss of a segment of Achilles tendon and infection in the overlying soft tissue. Here the authors describe one-stage tendon reconstruction, using an anterolateral thigh free flap incorporating a vascularized muscle flap and a strip of iliotibial tract in a patient with re-rupture of an Achilles tendon and soft tissue infection. Postoperative immobilization of the affected ankle using an external fixator enabled us to observe the flap directly and reduce pressure on the flap. The patient had a successful outcome, with no difficulty in walking, running, or climbing stairs and no limitation of range of motion at the ankle joint postoperatively. This is a promising technique for reconstruction of the Achilles tendon and treatment of infection as a one-step procedure.

3.
Hand Surg ; 20(2): 304-6, 2015.
Article in English | MEDLINE | ID: mdl-26051774

ABSTRACT

Since irreducible dislocation of the distal interphalangeal joint (DIP joint) is dorsal dislocation, irreducible palmar dislocation of the DIP Joint is very rare. This case was associated with a closed degloving injury of the distal phalanx of the little finger and required operative treatment.


Subject(s)
Finger Injuries/surgery , Finger Joint/surgery , Finger Phalanges/injuries , Joint Dislocations/etiology , Orthopedic Procedures/methods , Child , Finger Injuries/complications , Finger Phalanges/surgery , Humans , Joint Dislocations/surgery , Male
4.
Case Rep Orthop ; 2014: 962575, 2014.
Article in English | MEDLINE | ID: mdl-25215255

ABSTRACT

Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole.

5.
J Med Invest ; 60(3-4): 213-20, 2013.
Article in English | MEDLINE | ID: mdl-24190038

ABSTRACT

BACKGROUND: A congested flap is a good indication for leech therapy. However, determining the appropriate number of leeches as well as the appropriate application time in clinical cases is difficult. We analyzed hemodynamics in rabbit island flaps under leech therapy to find a suitable clinical procedure for determining the appropriate number of leeches to be used and the duration of therapy. METHODS: Island flaps were raised in 35 rabbit ears, and congestion was induced by venous clamping. Treatment involved use of 1 or 3 leeches and was begun 60 minutes after venous occlusion. Flaps were examined for area of surviving tissue, alterations in transcutaneous oxygen and carbon dioxide tension (TcPO2 and TcPCO2), and flow volume. Arteriole and venule diameters and flow velocities were examined microscopically. RESULTS: Flap survival area in the 3-leech therapy group was significantly larger than the 1-leech therapy group and the control group. With 3-leech therapy, TcPCO2 decreased significantly, as did arteriole and venule diameters. After clamp release, TcPCO2 and venule diameter continued to decrease in this group, and flow velocity increased significantly. CONCLUSIONS: Leech therapy may salvage compromised flaps by replacing congested blood with new arterial blood and thus maintaining flap viability. TcPO2 and TcPCO2 monitoring may help evaluate the therapeutic effect and determine the appropriate number of leeches to apply and the duration of therapy.


Subject(s)
Free Tissue Flaps/blood supply , Leeching , Animals , Arterioles/pathology , Carbon Dioxide/blood , Free Tissue Flaps/pathology , Hemodynamics , Microcirculation , Oxygen/blood , Rabbits , Venules/pathology
6.
Plast Reconstr Surg Glob Open ; 1(2): 1-8, 2013 May.
Article in English | MEDLINE | ID: mdl-25289213

ABSTRACT

BACKGROUND: Measurement of transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) has been used for free flap monitoring. Because these values are obtained with sensor probes heated to 44°C, there is potential for low-temperature burns on skin flaps. We measured TcPO2 and TcPCO2 at 37°C in both animals and humans to determine the feasibility and safety of the procedure as a postoperative flap monitoring method. METHODS: Twelve epigastric island flaps were elevated in rabbits, and TcPO2 and TcPCO2 were measured at 37°C before and after ligation of the pedicles. In addition, TcPO2 and TcPCO2 at 37°C were measured in healthy men. Subsequently, the method was applied to postoperative monitoring of free flaps in 49 clinical cases. RESULTS: TcPO2 and TcPCO2 values were significantly affected by the experimental flap elevation. A rapid increase in TcPCO2 was observed with both arterial and venous occlusion. In the healthy men, TcPO2 and TcPCO2 were measurable at all skin surface sites. In the clinical cases of free flap transfer, TcPO2 values remained very low for at least 72 hours. TcPCO2 values ranged from 40 to 70 mm Hg for 72 hours in more than 80% of cases. In 2 cases, TcPCO2 values increased to more than 90 mm Hg, and exploration surgery was performed. These compromised flaps were saved by reanastomosis of the veins. CONCLUSIONS: Continuous monitoring of TcPCO2 at 37°C can provide objective information and alert doctors and nurses to the need for checking the free flap.

7.
J Hand Surg Am ; 37(3): 434-9, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22385774

ABSTRACT

PURPOSE: To introduce a new surgical strategy for chronic fracture-dislocations of the proximal interphalangeal (PIP) joint with 2-staged external fixation. We also assessed the results of this method in all of our patients with at least 2 years of follow-up. METHODS: We used the procedure in 6 cases. For the first step, we applied mini external fixators for 1 week before surgery to apply traction to the PIP joint with sufficient force to stretch the dislocated joint components. The second procedure was surgical release of the PIP joint and an attempt at percutaneous reduction and fixation. This was not possible in 4 cases, and we performed an open reduction and corrective osteotomy. Postoperative early rehabilitation was achieved under controlled movement using an external fixator that allowed PIP joint flexion and extension. RESULTS: At long-term follow-up (mean, 3.5 y), the range of movement of PIP joints had increased by 76°, and that of distal interphalangeal joints by 35°. Osteochondral remodeling likely occurred not only while the joint was protected with the dynamic external fixator during a 12-week period (range, 8-14 wk), but also after removal. CONCLUSIONS: Preoperative traction softens the PIP joint, facilitating both surgery and rehabilitation. Postoperative early exercise with controlled movement, while maintaining concentric reduction with the external fixator, may accelerate osteochondral repair of the injured PIP joint.


Subject(s)
Finger Injuries/surgery , Finger Joint/surgery , Fracture Fixation , Fractures, Bone/surgery , Joint Dislocations/surgery , Adult , Chronic Disease , External Fixators , Female , Follow-Up Studies , Humans , Male , Middle Aged , Treatment Outcome
9.
Adv Physiol Educ ; 33(2): 91-7, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19509393

ABSTRACT

Current engineering applications in the medical arena are extremely progressive. However, it is rather difficult for medical doctors and engineers to discuss issues because they do not always understand one another's jargon or ways of thinking. Ideally, medical engineers should become acquainted with medicine, and engineers should be able to understand how medical doctors think. Tohoku University in Japan has managed a number of unique reeducation programs for working engineers. Recurrent Education for the Development of Engineering Enhanced Medicine has been offered as a basic learning course since 2004, and Education through Synergetic Training for Engineering Enhanced Medicine has been offered as an advanced learning course since 2006. These programs, which were developed especially for engineers, consist of interactive, modular, and disease-based lectures (case studies) and substantial laboratory work. As a result of taking these courses, all students obtained better objective outcomes, on tests, and subjective outcomes, through student satisfaction. In this article, we report on our unique biomedical education programs for engineers and their effects on working engineers.


Subject(s)
Biomedical Engineering/education , Biomedical Engineering/trends , Curriculum/trends , Adult , Biomedical Engineering/methods , Competency-Based Education/methods , Competency-Based Education/trends , Educational Measurement/methods , Female , Humans , Male , Program Development/methods , Students , Teaching/methods , Teaching/trends , Young Adult
10.
J Reconstr Microsurg ; 23(5): 269-74, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17876730

ABSTRACT

The authors conducted a two-part study to determine whether transcutaneous oxygen pressure (TcPO (2)) and transcutaneous carbon dioxide pressure (TcPCO (2)) can be used to monitor flap viability after transplantation. The first part was an animal study in which TcPO (2) and TcPCO (2) were measured in 10 epigastric island flaps subjected to arterial or venous ischemia. The second part was a clinical study in which both were measured in 27 free skin flaps. In the experimental study, TcPO (2) decreased to nearly 0 mmHg after 10 minutes of arterial and venous ischemia. TcPCO (2) increased to 100 mmHg after 60 minutes of either type of ischemia. In the clinical study, congestion was suspected in six flaps on the basis of clinical signs alone. Three congested flaps with TcPCO (2) more than 90 mmHg were selected for intervention. The remaining three congested flaps, with TcPCO (2) 80 mmHg or less, survived completely without further treatment. The TcPO (2) of all treated flaps and of the six flaps not requiring further treatment was 0 mmHg. Results of experimental study indicate that TcPO (2) is more sensitive than TcPCO (2) to flap ischemia. However, results of clinical study suggest that it is very hard to distinguish congested flaps from healthy flaps by TcPO (2) alone. The authors believe that a congested flap with a TcPCO (2) more than 90 mmHg requires further treatment.


Subject(s)
Blood Gas Monitoring, Transcutaneous , Ischemia/blood , Surgical Flaps/physiology , Adult , Aged , Aged, 80 and over , Animals , Female , Humans , Male , Middle Aged , Rabbits
11.
J Craniofac Surg ; 15(3): 464-8, 2004 May.
Article in English | MEDLINE | ID: mdl-15111811

ABSTRACT

A 23-year-old woman with hemifacial microsomia type IIB was treated by simultaneous mandibular and maxillary distraction. During the course of the distraction, cephalometric analysis showed that the maxilla was not moving downward and that the upper edge of the mandibular condyle was moving upward into the space between the condyle and the glenoid fossa. This phenomenon could lead to early consolidation of the osteotomized maxilla, resulting in malposition and occlusal difficulties. This is thought to be a problem unique to bimaxillary distraction of hemifacial microsomia type IIB with severe hypoplasia of the mandibular ramus and space between the condyle and the glenoid fossa. Surgeons should be alerted to this risk and prepared to address it when performing this procedure.


Subject(s)
Facial Asymmetry/surgery , Malocclusion/etiology , Mandible/surgery , Maxilla/surgery , Osteogenesis, Distraction , Adult , Bone Transplantation , Cephalometry , Facial Asymmetry/classification , Female , Follow-Up Studies , Humans , Mandibular Condyle/pathology , Osteogenesis, Distraction/adverse effects , Osteogenesis, Distraction/methods , Osteotomy/methods , Osteotomy, Le Fort/methods , Temporal Bone/pathology
12.
Plast Reconstr Surg ; 111(7): 2307-14, 2003 Jun.
Article in English | MEDLINE | ID: mdl-12794473

ABSTRACT

In failed flap transfers and in burn injuries, superoxides and thrombi generated in the microcirculation are considered responsible for tissue injury. A dynamic and morphologic analysis of thrombus formation was conducted in a model of microvessel injury, and an analysis was made of the different antithrombotic effects of heparin, urokinase, and prostaglandin E(1). The dye-light method was used (i.e., injury of the endothelium by reactive oxygen species) to induce thrombus formation in both the arterioles and venules of the rabbit ear chamber under an intravital microscope-television system. The dynamic course of thrombus formation was observed, and the period from irradiation to complete obstruction of blood flow (i.e., time to stasis) was measured and compared in relation to various treatment conditions. Arteriolar thrombi were formed by platelet aggregation. Venular thrombi were composed of platelets and erythrocytes that gathered and adhered around leukocytes stuck to the vessel wall. Heparin treatment prolonged the time to stasis in both the arterioles and the venules. Urokinase extended the time to stasis in the venules but not in the arterioles. Prostaglandin E(1)-treatment significantly prolonged the time to stasis in the arterioles, but only high-dose prostaglandin E(1) prolonged the time to stasis in the venules. The results of this study show that endothelial damage caused by superoxides promotes the formation of thrombi that differ in composition between the arteriole and the venule and that the effectiveness of each drug varies accordingly. The authors believe that these agents can be used with increased efficacy if the two types of thrombi and the specific antithrombotic effects of each agent are considered.


Subject(s)
Alprostadil/pharmacology , Endothelium, Vascular/drug effects , Fibrinolytic Agents/pharmacology , Heparin/pharmacology , Microcirculation/drug effects , Surgical Flaps/blood supply , Thrombosis/blood , Urokinase-Type Plasminogen Activator/pharmacology , Animals , Dose-Response Relationship, Drug , Ear, External/blood supply , Microscopy, Video , Rabbits , Reactive Oxygen Species/toxicity , Treatment Outcome
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