ABSTRACT
Multiple fixation techniques have been developed for distal interphalangeal (DIP) joint arthrodesis. Delayed and nonunion rates varying from 0% to 20% have been reported. The senior author has refined a technique for DIP joint arthrodesis by using an intramedullary Kirschner wire and an interosseous wire for fusion of the DIP joint and interphalangeal (IP) joint of the thumb. In 24 joint arthrodeses in 19 patients, the nonunion rate was 4%, and the minor complication rate was 12%. The advantages of this technique include the absence of protruding hardware that would necessitate removal; consistency in achieving osteosynthesis, with a low nonunion rate; and technical simplicity.
ABSTRACT
A high level of suspicion is required when treating patients with a history of esophageal bleeding and portal hypertension. The preoperative workup must be extensive; if the reconstructive surgeon is considering the use of a rectus abdominis muscle transfer, noninvasive studies and an exhaustive physical examination are required. Factors affecting the microcirculation might also influence the patency rates of the venous anastomosis and require further study. When treating these patients, the surgeon must be aware that portal hypertension can exist without clinical evidence.
Subject(s)
Hypertension, Portal/complications , Postoperative Complications , Rectus Abdominis/transplantation , Surgical Flaps/adverse effects , Abdominal Muscles/blood supply , Adult , Anastomosis, Surgical , Esophageal and Gastric Varices/complications , Fascia/blood supply , Gastritis/complications , Humans , Male , Microcirculation , Rectus Abdominis/blood supply , Surgical Flaps/pathology , Thrombosis/etiology , Tibial Arteries/surgery , Tibial Fractures/surgery , Umbilical Veins/transplantation , Vascular Patency , VeinsSubject(s)
Abdominal Muscles/surgery , Endoscopy/methods , Lipectomy/methods , Adult , Female , HumansABSTRACT
Reperfusion injury is a phenomenon complicating microvascular reconstruction. Extensive investigations of free-radical scavengers exist in the literature. The potential beneficial effects of verapamil, deferoxamine, and dimethylsulfoxide were studied in the rabbit forelimb subjected to 3 hr of tourniquet ischemia, followed by a period of reperfusion. Five minutes prior to tourniquet release, rabbits were given single intravenous infusions of normal saline, verapamil (0.2 mg/kg), deferoxamine (50 mg/kg), or dimethylsulfoxide (100 mg/kg). Following reperfusion, neither light microscopy nor laser Doppler flowmetry revealed significant differences between the sham and treated limbs. Muscle function was evaluated by measuring maximal twitch tensions in the flexor digitorum superficialis. Deterioration of muscle contractile function at 0.5, 3, and 24 hr after reperfusion was significantly improved by treatment with verapamil or deferoxamine. Conversely, dimethylsulfoxide worsened muscle function post ischemia. Dimethylsulfoxide does not appear to be beneficial, while verapamil and deferoxamine may be of benefit in mitigating reperfusion injury in microvascular transplantation.
