Surgical correction of subclavian steal syndrome

Eleven patients with subclavian steal syndrome underwent surgical correction without mortality. Ten patients were relieved from their symptoms. Two vessels reoccluded, two months and three years postoperatively, with reappearance of symptoms. One patient was hemiplegic after the operation. Associated lesions of other precerebral vessels were found in 7 patients, and surgical correction of two or three stenosed or occluded arteries was performed in 5 of them. Satisfactory and complete preoperative angiographic study of all precerebral vessels is therefore important. In 4 patients studied, the vertebral artery flow changed from a mean retrograde flow of 91 ml/min to a mean forward flow of 64 ml/min.     

Surgical correction of the nasopalpebral lipoma-coloboma syndrome

The nasopalpebral lipoma-coloboma syndrome was first described in 1982. It is an autosomal dominant syndrome with complete penetrance, characterized by congenital symmetrical upper lid and nasopalpebral lipomas, bilateral symmetrical upper and lower lid palpebral colobomas, telecanthus, and maxillary hypoplasia. We describe a 2-year-old boy who with this syndrome and discuss the surgical treatment. This is the fifth report in the literature, and the first one in the field of plastic surgery. It is also the first to present pitfalls in the surgical management of this syndrome.     

马凡氏综合征患者脊柱侧凸的矫治

目的:探讨马凡氏综合征(Marfansyndrome,MFS)患者脊柱侧凸的手术疗效。方法:对1997年9月至2002年1月使用脊柱三维矫形内固定系统后路手术治疗的8例MFS患者脊柱侧凸的矫正度、脊柱平衡及并发症等进行分析。结果:8例患者随访12~48个月,平均24个月。6例KingⅡ型患者胸弯及腰弯的矫正率分别为47%、57%,随访矫正率丢失分别为21%和16%;1例KingⅠ型患者胸弯及腰弯矫正率分别为25%及42%,随访矫正率丢失分别为21%和15%;1例KingⅢ型患者胸弯及腰弯的矫正率分别为58%、29%,随访矫正率丢失分别为9%和18%。所有患者躯干平衡得到改善,无神经并发症发生。2例出现交界性腰椎后凸,1例切口延迟愈合。结论:使用脊柱三维矫形内固定系统后路手术治疗马凡氏综合征患者脊柱侧凸可以获得满意疗效。     

Surgical treatment of post-traumatic malalignment of the ankle

Post-traumatic malalignment is evident in cases of malunion of ankle fractures. This condition predisposes to the development of chronic pain, functional impairment, and finally post-traumatic arthritis. The aim of this paper is to present a joint-saving surgical treatment of post-traumatic ankle malalignment. It is based on the review of a series of patients who developed fracture malunion and were treated with articular reconstruction.Twenty-two ankle fractures, which malunited and resulted into valgus deformity and fibular shortening are presented. Pre-reconstruction and mid-term follow-up evaluation included the AOFAS score and standard weight-bearing radiographs. Surgical treatment consisted in articular reconstruction with malleolar osteotomies. Post-operatively, the non-weight-bearing period extended to 6 weeks post-surgery, while full weight-bearing was allowed at 12 weeks on average.All osteotomies healed, while no intra-operative or early post-operative complications were reported. The average pre-operative AOFAS score was 45, while post-operatively climbed to 87. At the last follow-up, on average at 5-years post-surgery, 10 patients reported “excellent” function, 7 “good”, 3 “fair” and 2 “poor” function. The correction of the malalignment was maintained in 20 cases. The two patients with poor function and loss of reduction underwent ankle fusion.Articular reconstruction with malleolar osteotomies is indicated for the treatment of ankle post-traumatic malalignment, offering reduction of pain, improvement of the ankle function, delaying the development of post-traumatic arthritis, and minimising the need of radical surgery such as ankle fusion or prosthetic replacement. Moreover, once a correct alignment of the joint is achieved, secondary surgery, if necessary, can be performed more easily, and with better results.     

Surgical correction of the craniofacial dysmorphology of Apert syndrome

The authors present the objectives, timing, techniques, and results of surgery for the dysmorphology of the cranium, orbits, nose, midface, and mandible of patients with Apert syndrome based on personal experience with 14 patients and comprehensive review of the literature. The status of hypotheses generated in the early phase of craniofacial surgery is discussed. Published schedules for longitudinal treatment are examined and a preferred plan proposed.     

Surgical correction of the craniofacial anomalies in Apert syndrome

The craniofacial anomalies in Apert syndrome are some of the most obvious manifestations of a systemic disorder directed by an abnormal genome (pleiotropy). Although our knowledge of etiopathogenesis is woefully inadequate, imaginative surgical techniques have evolved to correct the major functional and aesthetic problems in this syndrome. During infancy, the frontal (or nasofrontal) skeleton is modeled and advanced in order to protect the proptotic globes and to expand the anterior cranial fossa. This procedure also sets the stage for midfacial advancement, accomplished in either early or late childhood. The timing depends on indications, both physiologic and psychologic. Subcranial midfacial advancement, with a variety of technical alternatives, is a safe procedure with an acceptable aesthetic outcome. For some children with prominent hypertelorbitism, a facial bipartition or another variation on orbital translocation may be indicated. By adolescence, the extent of normal mandibular growth beyond the lagging midface becomes obvious. After completion of skeletal growth, these patients benefit from adjustments of the maxilla and the mandible and by procedures to refine the forehead, eyelids, nose, and chin. Until the mechanism of acrocephalosyndactyly I is understood, further technical improvements are needed before these patients have a truly "normal" face. More attention should be focused on correction of the entire cranial vault.     

Surgical reconstruction of late pelvic post-traumatic nonunion and malalignment

We have retrospectively reviewed the clinical and radiological results in 204 consecutive adult patients who had surgical correction of 70 late post-traumatic pelvic nonunions and 134 malalignments. The deformed pelvises were subdivided into united (true), unstable, ununited, and partially stable malalignments with heterotopic bone. The principal complaints were of pain, pelvic instability, sitting imbalance, and apparent limb-length discrepancy. After surgery, 195 patients (96%) achieved a primary union and 144 (71%) had slight, intermittent or no pelvic pain, while pelvic instability was entirely eliminated. Overall, 131 patients (64.2%) were extremely satisfied, 58 (28.4%) were satisfied and 15 (7.4%) were unsatisfied. After reconstruction of the malaligned pelvises, 67 results (50%) were anatomical, 47 (35%) were satisfactory and 20 (15%) were unsatisfactory. For a pelvic nonunion with local osteopenia and malalignment, stabilisation of all three pelvic columns is recommended. True pelvic (united) malunions were the most satisfactorily realigned and had the fewest complications. Ununited and unstable malalignments, especially those with heterotopic bone, had the poorest corrections and the most neurological complications. A therapeutic alternative, by the local resection of a symptomatic bony prominence, and fixation in situ of a posterior pelvic nonunion, gives highly effective symptomatic relief with fewer complications. Despite this, many patients had persistent low back pain.     

Surgical correction of trismus in a child with Hecht syndrome

Hecht syndrome is a rare condition that is also known as trismus pseudocamptodactyly syndrome. Short muscle and tendon units limiting the range of motion of upper and lower extremities and mouth characterize this disorder of muscle development. There is no consensus on the optimal treatment of temporomandibular joint (TMJ) ankylosis in this patient population. Endoscopic release in one patient resulted in early postoperative recurrence. The authors present a 28-month old boy who had a limited mouth opening of 6 mm. CT scan showed no bony ankylosis. The range of mouth opening did not to improve with physical therapy. The patient underwent extensive subperiosteal dissection of the mandible, bilateral coronoidectomy, and TMJ exploration. An intraoperative opening of 18 mm was achieved. The patient remained intubated until postoperative swelling resolved. He was extubated in the operating room 6 days later. The patient continued to improve with physical therapy. He had a 25-mm mouth opening at 12 months of follow-up.     

Surgical correction of chondromanubrial deformity (Currarino Silverman syndrome)

Chondromanubrial (arcuate) pectus carinatum is the rarest protrusion deformity of the chest. Its surgical correction was first described by Ravitch in 1952. We have recently encountered five patients with this deformity who have provided additional insight into the anatomy and optimal repair of this condition. It is notable for a short nonsegmented sternum with marked posterior angulation at the site of the normal chondromanubrial junction. It is optimally corrected by subperichondrial resection of the second to the seventh costal cartilages with a broad wedge-shaped osteotomy through the anterior cortex of the sternum at the point of maximal angulation. Anterior displacement of the sternum is achieved by closing the osteotomy with heavy silk sutures while the costal cartilages are regenerating.     

Arthrodesis of the subtalar and talonavicular joints for correction of symptomatic hindfoot malalignment

BACKGROUND: Triple arthrodesis has long been used for the treatment of painful malalignment or arthritis of the hindfoot. However, the effect of fusion on adjacent joints has sparked interest in a more limited arthrodesis in patients without involvement of the calcaneocuboid joint. METHOD: Results of 16 feet in 14 patients who had a modified double arthrodesis for symptomatic flatfoot, cavovarus deformity, or hindfoot arthritis were reviewed retrospectively with a minimum followup of 18 (range 18 to 93) months. The most common diagnosis contributing to the hindfoot deformity was pes planovalgus. All operations were done with a consistent technique using rigid internal fixation with screws. In 15 feet, a concomitant gastrocnemius recession for equinus contracture was done at the time of the primary surgery. Clinical evaluation was based on the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale in addition to subjective assessments of pain, function, shoewear, cosmesis, and overall satisfaction. Radiographic evaluation included measurements of the anterior-posterior talo-second metatarsal angle, lateral talocalcaneal angle, and lateral talo-first metatarsal angle, and notation of arthritic changes of the ankle, calcaneocuboid, and midfoot joints, as well as an assessment of time to union of all arthrodeses. RESULTS: The average AOFAS Ankle-Hindfoot Scale improved from 44.7 preoperatively to 77.0 postoperatively (p < 0.01). Subjectively, patients experienced improvements in pain, function, cosmesis, and shoewear. Overall, all patients were satisfied and would have the procedure again under similar circumstances. Radiographically, all parameters statistically improved. There was an increase in arthritic scores for six ankle, six calcaneocuboid, and five midfoot joints. One talonavicular joint nonunion occurred in a rheumatoid patient, requiring revision arthrodesis. CONCLUSIONS: We have concluded that simultaneous arthrodesis of the talonavicular and subtalar joints is a reasonable treatment in the subset of patients with symptomatic hindfoot malalignment whose calcaneocuboid joints are not involved in the primary disease.     

Surgical correction of damage in complex treatment of patients with metabolic syndrome

The authors have analyzed results of treatment of 407 patients subjected to different bariatric interventions. In 359 out of them there were different bariatric operations, in 48 patients intragastric balloons were placed. Correcting plastic operations were fulfilled in 36 patients within 1-2 years after bariatric intervention. It was found that bariatric intervention fulfilled in earlier age groups would prevent the development of metabolic syndrome (MS) in patients with obesity at later date. Combined operations are most effective bariatric intervention compared with all main elements of MS. Correcting plastic operations are expedient after bariatric interventions against the background of stabilized decrease of body mass that allows getting valuable therapeutic and esthetic effect, improvement of quality of life of patients.     

Surgical correction and rehabilitation for children with "Prune-belly" syndrome

Until the recent past, patients born with congenital absence of the abdominal musculature, and associated deformity of the urinary collecting system, have often had an unhappy life and an early death. Twelve years ago, a treatment protocol was devised in our institution which included the following major steps: 1) bilateral tubeless pyelostomy immediately after birth; 2) serial evaluation of renal status during the first year of life; 3) laparotomy at one year of age with orchiopexy, reconstruction of the urinary collecting system and reconstruction of the abdominal wall; 4) serial electromyographic evaluation of the growth and development of the lateral abdominal musculature; 5) serial studies of renal function; 6) secondary revision of the abdominal wall and of the urinary drainage system as needed. Nine patients so treated have been followed from the third through the twelfth years of life. All are alive and growing well. Four patients had chronic urinary infection treated with long-term antibiotics; three of these have required a second surgical correction of some aspect of the urinary drainage system. Three patients have required additional surgery on the abdominal wall, but have recaptured enough function so that corsets and other devices have not been necessary. Electromyographic studies show good growth and development of some aspects of the lateral abdominal musculature which has been used in the repair. The outcome in these patients is highly encouraging for this constellation of anomalies. The cause remains controversial.     

Surgical correction of severe hammer digit syndrome: a case report.

Survivors of a stroke are forever in a battle for complete recovery. Signs and symptoms of the initial stroke may remain. Patients who has had a stroke may retain some of their initial manifestations, e.g., hemiparesis. Limbs that were initially paralyzed will usually retain signs of upper motor neuron damage. This patient demonstrated such a situation, and we felt that the proper treatment in this case of severe hammer digit syndrome was modified Lambrinudi fusions.