Clubfoot: a cord retainer.

Using a cord to retain the surgically corrected clubfoot replaces the need for repeated plaster casts and prolonged orthotics. Cords of braided polyester or nylon suture material 0.5 mm in diameter (a pair or more) were stretched between the fifth metatarsal and the lower metaphysis of the fibula. The required strength of the cord was judged from the initial range of motion (ROM) of the ankle and subtalar joints, and a factor derived from the body weight. The mean follow-up in five patients was 26.8 months (range 18-33 months). The peroneal muscles recovered an average of 9 months (range 7-11 months). Our one failure was caused by inaccurate estimation of cord strength.

The effect of prolonged blood stasis on a microarterial repair.

There is much controversy in the literature about the effect of blood stasis on the patency rate following microvascular repair. Sixty Sprague Dawley rats underwent transection and repair of their femoral arteries. The rats were divided into three groups, which had their repaired arteries clamped for 1 1/2, 2, and 2 1/2 hours. Patency was evaluated by the "stripping test," and the presence of a "flicker" both immediately and on the second day of the experiment. At the time of evaluation on the second day, all arteries in Group I were patent, in Group II two were thrombosed and in Group III, five out of 20 thrombosed. The only significant statistical difference was found between Groups I and III in both immediate (p less than 0.0025) and second day (p less than 0.05) evaluations. Results indicate that the "safe limit" for blood stasis in a repaired artery of 0.8 mm diameter is 1 1/2 hours.