Results of cosmetic lower limb lengthening by the lengthening over nail technique.

We conducted a retrospective study by reviewing our results following cosmetic lengthening using the lengthening over nail technique in terms of the importance of the patient selection process, bone and soft tissue complications, and functional and subjective clinical outcomes. The study data were obtained from medical records and radiographs. A total of 32 patients, 24 males and 8 females, with constitutional short stature underwent the lengthening over nail technique for cosmetic purposes between 2000 and 2013. Lengthening was performed in the femora of 15 patients and in the tibiae of 17 patients. All patients who were accepted for cosmetic lengthening underwent a careful selection process that included a psychiatric evaluation. The mean follow-up time was 73 months (range, 12 to 163 months). Thirty-four complications were reported. Cosmetic lengthening is not without complications. Patient selection is of paramount importance. This technique is recommended for cosmetic lengthening because it is minimally-invasive and it has documented reproducible results.

Functional results of lower extremity lengthening by motorized intramedullary nails.

OBJECTIVE: The aim of this study was to evaluate the outcome of patients undergoing limb lengthening using motorized intramedullary nails. METHODS: This study included eleven femora and 4 tibiae from 14 patients (9 male, 5 female; mean age: 26.9 years; range: 14 to 51 years) who underwent limb lengthening using motorized intramedullary femoral nails (Fitbone(®) TAA). Average preoperative limb shortening was 4.9 (range: 2.5 to 7.5) cm. Distraction was initiated on the seventh postoperative day. Serial radiographs and Paley's bone and functional outcome scoring systems were used to evaluate the results. RESULTS: Mean follow-up period was 33.5 (range: 7 to 88) months. Mean distraction index value was 1.2 (range: 0.7 to 2.1) days/mm and mean bone-healing index value was 43.7 (range: 13.8 to 144) days/cm. The average lengthening achieved was 51.7 (range: 25 to 75) mm. The distraction mechanism of the nail did not function properly in two patients, restricted transient knee motion was observed in four patients, and delayed consolidation was observed in four patients. Other complications included valgus deformities and superficial infections surrounding the antenna of the intramedullary nail, as well as femur fractures at the proximal end of the nail. Bone scores were excellent in 11 segments and were good in one segment. Functional scores were excellent for all 12 patients. CONCLUSION: While usual complications related to the external fixators, such as pin-track infections and mobilization difficulties were not encountered, the development of additional complications such as dysfunction of the distraction mechanism should be monitored with the use of motorized intramedullary nails in limb lengthening.

Development of the coronary vasculature and its implications for coronary abnormalities in general and specifically in pulmonary atresia without ventricular septal defect.

AIM: Coronary vascular anomalies are an important factor in congenital heart disease in the neonate. However, our knowledge of the pathomorphogenesis is still defective. MATERIAL AND METHODS: (1) Study of coronary anomaly variations in congenital heart disease using specimens and (2) study of the role of epicardium-derived cells (EPDC) and neural crest cells in coronary vascular formation using quail-chicken chimeras. RESULTS: The clinical and pathological data revealed the existence of ventriculo-coronary arterial communications during fetal life before pulmonary atresia was established. This supported a primary coronary developmental anomaly as the origin of some cases of pulmonary atresia as opposed to other cases in which the pulmonary orifice atresia was the primary anomaly. Our experimental work showed the high relevance of the development of the epicardium and epicardium-derived cells for the formation of the coronary vasculature, and showed the coronary vascular ingrowth into the myocardium and subsequently into the aorta and the right atrium. The absence of epicardium-derived cells leads to embryonic death, while delayed outgrowth could result in the absence of the main coronary arteries to pinpoint orifice formation. In these cases, the circulation was maintained through ventriculo-coronary arterial communications. Neural crest cells were important for the patterning of the coronary vasculature. We have extended this knowledge to a number of other heart malformations. CONCLUSIONS: Coronary vascular anomalies are highly linked to the development of extracardiac contributors like the epicardium and the neural crest. A proper interaction between these cell types and the myocardium and aortic arterial wall are important for normal vascular development.