Limb salvage in proximal humerus malignant tumors: the place of free vascularized fibular graft.

Limb-salvage surgery has become a safe and well-established alternative to amputations for malignant tumors of the proximal humerus. The authors describe six cases with favorable restoration of the upper limb following tumor resection type IB Malawer and proximal humeral reconstruction by vascularized fibula graft (VFG) as a primary or secondary procedure. A scapulofibular arthrodesis was elected in all cases. A special custom-made plate was used in four cases. One patient required a latissimus dorsi musculocutaneous flap for better coverage. Serial x-rays assessed the bone union. Neither flap necrosis nor sepsis phenomena were noted. Stress fracture was the only complication. This was encountered in two cases. Every patient was reviewed and assessed by the Enneking score. The average score was 21.8. The average follow-up was 5-years. A good quality of life was preserved due to reliable mobility of the elbow and the hand.

Vascular access in chronic dialysis: a plastic surgeon's approach.

Thirty-five years after Brescia et al. (N Engl J Med 275:1089-1092, 1966) realized the first peripheral autogenous arteriovenous fistula, the "Achilles' heel" of chronic dialysis is still the absence of a good-quality permanent vascular access. The number of patients depending on hemodialysis is increasing. Until 10 years ago, in Romania, there was a need to treat isolated critical cases. Nowadays, every dialysis center needs algorithms for a standardized approach, adaptable for each case. We reviewed 171 consecutive arteriovenous fistulas (132 patients) performed in adults in identical standard conditions: use of an inflatable tourniquet during the vascular dissection, microsurgical techniques, and use of only autogenous tissues. We analyzed our results, the technical difficulties encountered, and their management in long-term follow-up. The aim of this study was to set up the basic principles of our algorithms. Our approach, based on our education as plastic surgeons involved in hand surgery and microsurgery, might present the advantage of sparing renal patients vascular capital.

Secondary transplantation following a period of isografting: experimental study in rats.

The authors describe a study in which groin flaps from 20 Wistar rats were transplanted to another group of 20 Wistar rats and, after various time intervals, the groin flaps were re-transplanted back to the original animals. The goal of the first transfers was to preserve the flap in the second group of animals (isopreservation). During the isopreservation period, the second rat (the preserver) was treated with steroids or FK506 for immunosuppression. Thirty-three free groin flap transfers were performed between 40 rats. If possible, the same flap was transferred twice between two animals, one as an isograft, and other as an autograft following an isopreservation period in 13 pairs of animals. (A second transfer was not possible in seven pairs of animals.) The period for isopreservation varied between 2 days and 1 week. The survival of the flap was observed by visual inspection, laser Doppler flowmeter measurements, and was correlated with serial histopathologic examinations of skin and vessel biopsy specimens, including the anastomosis site. The severity of histopathologic signs that might be related to developing rejection was increased by the preservation time, and was more noticeable after the second transfer. The authors showed that successful secondary transplantation of the rat groin flap with a 1-week follow-up could be achieved, following isopreservation of at least up to 5 days.