Case report: radiation prevention of heterotopic ossification after bone and joint surgery in sites other than hips.

Five patients were given single dose irradiation in an attempt to prevent heterotopic ossification after bone and joint surgery in sites other than hips. All patients were at risk for the development of post-operative heterotopic ossification. Two patients were treated with 6 Gy and three patients were treated with 7 Gy the day after operation. No complications were encountered. Post-operative heterotopic ossification did not develop in patients who received 7 Gy, whereas treatment failed in the two patients who received 6 Gy. Because this is a case report study, no conclusion could be made. Further investigation is needed to assess the efficacy of post-operative single dose irradiation in heterotopic ossification prophylaxis in sites other than hips in high risk patients.

Osteolysis after silicone arthroplasty.

A young woman with a silicone lunate prosthesis for avascular necrosis developed painful lytic lesions in the distal ulna and the triquetrum. At reoperation, abundant reactive synovitis was found extending into those bone lesions. Histologic examination of the curetting samples revealed granulation tissue with histiocytes and many multinucleated giant cells containing refractile particles consistent with silicone. The authors report a giant cell lesion of the bone that radiographically and microscopically mimicked a neoplasm.

An assessment of different types of anastomosis with significant vessel disproportion using thin-walled interposition vein grafts.

The microvascular anastomosis of vessels with a diameter difference in the range of 3:1 can be a difficult surgical exercise, with the risk of bleeding or thrombosis. Five different techniques for dealing with such asymmetries were investigated in a series of autogenous rabbit vein grafts. An assessment was made of patency rates and of factors involved in the performance of the anastomoses. It is concluded that the end-to-end with oblique cut procedure is the most suitable for the clinical situation.

Vascularized fibular graft to replace resected cervical vertebral bodies. Case report.

Use of a vascularized free fibular graft is described as a method of replacing excised cervical vertebrae when severe instability is present. The vascularized bone graft heals more rapidly and with greater strength than a nonvascularized autogenous graft.

Digital distraction lengthening followed by free vascularized epiphyseal joint transfer.

This is the first report of combined digital distraction lengthening followed by free vascularized metatarsophalangeal joint transfer. This restored mobility, stability, length, and growth potential in the ring finger of the mutilated hand in a child.

Comparative study of vascularized and nonvascularized tendon grafts for reconstruction of flexor tendons in zone 2: an experimental study in primates.

Vascularized tendon grafts were compared with nonvascularized tendon grafts in a primate experimental model. In four monkeys, seven vascularized extensor hallucis longus grafts were placed in the foot's digital fibroosseous canal and these were compared with eight nonvascularized tendon grafts similarly placed in the opposite extremities. The juncture techniques and postoperative protocols were identical for both tendon groups. All tendons were explored 5 months after insertion. The vascular pedicle was patent in all vascularized tendons. Three tendon ruptures occurred in nonvascularized tendons and only one rupture occurred in a vascularized tendon. The digits with vascularized tendons demonstrated a significantly better simulated total active motion (117 degrees versus 128 degrees, p less than 0.05) than digits with nonvascularized tendons. The difference was even more significant when a localized tenolysis of the proximal juncture of the tendon graft was performed (215 degrees versus 138 degrees, p less than 0.01). This study supports the concept that vascularized tendon grafts may be advantageous in scarred tendon beds.

Folded free vascularized fibula transfer.

A technique of improved free vascularized fibula grafting for bone defects up to 15 cm in length is presented with three illustrative cases. By dividing a harvested free fibula graft at its midpoint without dividing its vascular pedicle, two vascularized bone lengths are produced that require only one set of anastomoses. This folded fibula provides twice the cross-sectional area of a single fibula transfer and allows biomechanically improved graft placement. This technique has been successfully used in long bone defects of the upper and lower limbs.

Changes in the blood biochemistry following experimental flap ischaemia.

The purpose of this study was to elucidate tissue changes occurring within an ischaemic flap by monitoring the blood biochemistry, and to evaluate these changes in relation to ultimate flap viability. A rabbit epigastric free flap was made ischaemic for 4 days at 6 degrees C, then revascularized by anastomosis of its femoral artery and vein. An identical free flap immediately revascularized in another group of rabbits served as a control. The viability of the free flap, as well as various biochemical parameters studied by drawing blood from a catheter in the ear vein, were observed daily. Immediately after the revascularization of ischaemic flaps, there was a 16-fold increase in the plasma levels of creatine kinase (CK) and a smaller but significant 1.5-fold to 2.0-fold increase in lactate dehydrogenase (LDH) and aspartate aminotransferase (AST). In flaps which ultimately failed by 7 days post-ischaemia, the plasma levels of CK, LDH and AST peaked at day 2 post-ischaemia at 68, 13 and 8 times normal respectively, whereas in flaps which survived, the levels of these enzymes recovered to normal by day 3 post-ischaemia. These enzymic changes are probably due to a combination of ischaemic changes in the flap vasculature, ischaemic changes in the flap muscle, and inflammatory changes in the surrounding abdominal tissue. The plasma levels of CK at any time post-ischaemia, and particularly in the first 24 h, were significantly higher in ischaemic flaps which failed compared with those which survived. This parameter is therefore proposed as a possible means of predicting potential flap failure after ischaemic insult, in time to make appropriate surgical intervention.

Experimental microvascular growth plate transfers. Part I--Investigation of vascularity.

A model was developed in the dog to allow both the metaphysis and epiphysis of the distal ulnar growth plate to be microsurgically revascularised from the pedicle of the anterior interosseous vessels. With both circulations revascularised, grafts retained their structural integrity and growth continued at rates only slightly less than normal (mean 85%). If either or both circulations were not revascularised, growth rates were lower and were associated with skeletal collapse in the ischaemic bone segment.

Experimental microvascular growth plate transfers. Part 2--Investigation of feasibility.

We investigated the feasibility in the dog of using transfers of the distal ulna into the radius either as growth plate replacements or as accessory growth plates in the diaphysis. Preliminary work determined the most satisfactory method of skeletal fixation. The experimental study showed that transfers used as growth plate replacements grew at almost normal rates, uniting with the recipient bone in a mean of 7.1 weeks. Transfers into the diaphysis initially nearly doubled the growth rate of the radius, although in the long-term results were unsatisfactory, because of fracture of the graft after a mean period of 8.2 weeks.

Improved suture tying technique in microsurgery.

A technique is presented that maintains control of the short suture end in microsurgical suture tying. This technique significantly shortens the time taken to tie a microsurgical knot. It reduces the number of manoeuvres required to complete the knot and by maintaining control of the short suture end, prevents adherence to soft tissue.

Total cutaneous harvesting from an amputated foot--two free flaps used for acute reconstruction.

Loss of weight-bearing skin of the foot produces a difficult reconstructive problem. A case is presented of severe bilateral lower limb trauma in which the right leg was amputated below the knee and two free flaps taken from the amputated foot were used for cover of the damaged left foot and the amputation stump.

Metacarpal distraction lengthening.

Metacarpal osteotomy and distraction lengthening is an excellent method of treating patients with multiple digit aplasia, metacarpal hypoplasia, and some types of digit amputation. The authors describe their technique and the results obtained in 24 patients operated on for 41 metacarpals.