Autogenous tissue reconstruction in the management of aortoiliofemoral graft infection

Management of infected prosthetic arterial grafts remains a challenging clinical problem. Revascularization following removal of the infected arterial prosthesis is frequently necessary and usually achieved using remote extraanatomic bypasses. We present three cases where complete removal of the infected prosthesis was followed by autogenous reconstruction using reversed saphenous vein, endarterectomized segments of superficial femoral artery, or endarterectomy of the native occluded vessels. Eradication of the infection was seen in all three patients. The reconstructions have remained patent in the three patients with follow-up from four months to three years. Percutaneous balloon dilation was successful in the management of a distal limb stenosis in one patients. Autogenous vascular reconstruction following removal of infected prosthetic vascular grafts remains a viable alternative in the treatment of difficult, selected cases of infected arterial prosthesis. It is probably an underutilized alternative, when one considers that the surgical techniques employed are familiar to vascular surgeons. Cure of the infection and prepreservation of critical vascular beds can both be achieved with autogenous tissue, either in situ or from remote areas. Available percutaneous techniques may play an important role in maintaining durability of these reconstructions.Presented at the Annual Meeting of the Peripheral Vascular Surgery Society, New York, New York, June 17, 1989.     

Roy-Camille腰椎、腰骶椎融合术治疗腰椎滑脱症(附14例报告)

使用Roy-Camille 腰椎、腰骶椎融合术治疗腰椎滑脱14例。采用特制的钢板,一般固定3～4个脊椎。若合并神经根刺激症状可同时作椎板切除、椎间盘摘除、侧隐窝松解术,同时进行丰富的侧后方植骨。经随访平均19个月,均获得骨性融合,无脊髓或神经根损伤等手术并发症。作者认为此手术是治疗腰椎滑脱的比较理想的方法。     

TOTAL LARYNGECTOMY WITH PRIMARY VOICE RESTORATION

Forty-three patients were prospectively studied following tracheo-oesophageal puncture at the time of laryngectomy (primary voice restoration). Blom-Singer voice prostheses were used. The surgery was regarded as successful if a patient continued to use the voice prosthesis as the major means of communication with clear intelligibility 4 months after the operation. Using this criterion, the success in this series was 70%. No attempt was made to assess the quality of speech. Complications and causes of failure are discussed.     

经腹胃癌全胃切除P形空肠代胃108例报告

目的 探讨胃癌全胃切除术后合理的消化道重建方式，提高病人生存质量。方法 108例胃癌病人经腹全胃切除后，食管．空肠行P形吻合，空肠．空肠行Roux-Y吻合，术后加强营养支持治疗。结果 本组无手术死亡病例，无食管空肠吻合口瘘等严重并发症发生，与经胸腹术相比，具有创伤小，恢复快，并发症少等特点。结论 经腹胃癌全胃切除P形空肠代胃术是一种安全、实用、疗效满意的手术方法．术后加强营养支持治疗．有益于病人顺利康复。     

间置空肠贲门再造术在抗返流性食管炎上的应用

作者对１５例贲门癌患者行根治术同时，采用食管残胃间插入带蒂空肠并附加贲门再造术，通过ＳＰＥＣＴ胃食管返流指数测定、食管下端ｐＨ检测及返流症状评定方法，并与单纯食管胃套叠吻合术进行随机对比分析，证明该术式具有单向住屏障作用，能有效地预防返流性食管炎的发生。     

Preexpanded distant "super-thin" intercostal perforator flaps for facial reconstruction without the need for microsurgery.

BACKGROUND: Concept of the 'super-thin perforator flap' was introduced in 1994 by authors. Since then, various types of 'super-thin perforator flaps' were applied successfully especially for contour sensitive reconstruction such as face and neck. METHODS: Eleven patients requiring large flaps who presented with extensive disfiguring facial scar (male: seven cases, female: four cases). On the consideration of flaps' colour, texture and thickness requirements, the authors selected 'super-thin' anterior intercostal perforator flaps (AICP, range from 4 x 14 cm to 25 cm x 9 cm) for reconstruction purpose. First, tissue expanders (volume range from 800 cc to 1200 cc) were carefully inserted under the AICP. After the flaps were expanded for 2 months, distant scars were removed and the covering super-thinned flaps were transferred into recipient site. Two weeks later, pedicles in the anterior chest were cut down and flaps were transferred to replace all the left scars. RESULTS: Flap were survived without any complications. The colour, texture and thickness of the transferred flap were satisfactory, shrink of flaps were not observed after long term follow-up. The authors present a method of facial reconstruction that has the advantages of creating a large amount of thin tissue of both good colour and texture, without the need of microsurgery and few disadvantages of donor-site morbidity. The disadvantages are three-staged procedures, complications of tissue expansion and uncomfortable compulsory posture for patients. In our opinion, this is an alternative method of choice for reconstructing all large defects in the lower two-thirds of the face.     

Reconstruction of pectus excavatum with silicone implants.

The pectus excavatum deformity is characterised by a deep depression usually involving the lower one-half to two-thirds of the sternum. The indications for surgery are often aesthetic. Extensive procedures, requiring fracturing and remodelling of the chest wall skeleton are associated with high morbidity and high rate of complications. In this article we describe our renewed experience with reconstruction of mild and moderate pectus excavatum deformities with custom made prefabricated silicone implants. The fabrication of the implant and the surgical technique are described in detail. An excellent aesthetic correction of the deformity was achieved in all of the patients in our series, with high patient satisfaction rate. We conclude that with careful patient selection, artistic implant fabrication and meticulous surgical technique, this approach achieves excellent aesthetic correction with minimal morbidity and a low complication rate and therefore should maintain its place in the armamentarium of surgical techniques for reconstruction of pectus deformities.     

How four and twelve weeks of implantation affect the strength and stiffness of a tendon graft securely fixed in a bone tunnel: a study of Evolgate fixation in an extra-articular model ovine model

Healing of a tendon graft to a bone tunnel is slower than the healing of a bone plug. Therefore, the device chosen for hamstring fixation may need to maintain its strength and stiffness longer than the device chosen for bone-tendon-bone fixation. We evaluated, in an extraarticular ovine model, how 4 and 12 weeks of implantation affect the strength of a tendon graft fixed to bone with the Evolgate. The long digital extensor tendon was transplanted and fixed with the Evolgate into a 30-mm long, 8 mm diameter bone tunnel drilled in the tibial metaphysis of both posterior limbs of 15 skeletally mature Suffolk sheep. Immediately after implantation, and 4 and 12 weeks later, biomechanical cyclic load tests in 50 N increments were performed until failure to evaluate the ultimate failure load (UFL). Histological analysis was also performed at 4 and 12 weeks. Biomechanical tests revealed a UFL of 339±120 N at time 0, and increases to 635±19 N (4 weeks) and to 867±80 N (12 weeks). The differences between all 3 groups were significant (p<0.001, paired t test). The histological evaluation showed a layer of cellular, fibrous tissue between the tendon and the bone, along the length of the bone tunnel; this layer progressively matured and reorganized during the healing process. The collagen fibers that attached the tendon to the bone resembled Sharpey’s fibers. The strength of the interface significantly and progressively increased between weeks 4 and 12 after transplantation, and was associated with a degree of bone ingrowth noted histologically. The use of the Evolgate seems not to interfere with the bone ingrowth after implantation, allowing an improvement in strength of the bonetendon- device complex.     

短伸肌腱修复供足第1跖骨深横韧带(附55例报告)

目的在第2足趾移植再造拇指术中,应用     

计算机体层成像多平面重建在评价椎间融合中的作用

目的 探讨计算机体层成像多平面重建(CTMPR)在评价椎间融合中的作用,寻找定量评价椎间融合的新方法.方法 13例行腰椎间融合的患者术后1周、3个月、6个月行CTMPR,行椎间融合器(Cage)内植骨CT值定量测量.结果 术后1周Cage内植骨CT值为(619.52±26.97)Hu,术后3个月为(628.69±42.60)Hu,术后6个月为(657.77±37.43)Hu.术后1周与术后3个月相比无显著性差异,与术后6个月相比有显著性差异.结论 CT值的测量在椎间融合的判断中具有高准确性.