1/7. Bilateral hand transplantation: bone healing under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone.PURPOSE: Little is known about bone healing after composite tissue transplantation that requires pharmacologic immunosuppression. Bone integration and callus development were assessed in bilateral hand transplantation. methods: In this study the course of callus development and callus maturation were assessed by color Doppler sonography and radiography in a double hand transplant and compared with forearm replantation. RESULTS: After hand transplantation, ingrowth of small vessels at the bone junction was observed at week 3, calcified callus became visible at month 4, and bone union was completed at month 11. A similar time course of bone integration was observed after replantation. Plating offered sufficient stability. A recipient periostal flap is thought to have improved blood supply and favored development and induction of callus. CONCLUSIONS: Bone healing after hand transplantation under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone is identical to that after forearm replantation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. Intravascular bullet migration: a report of two cases.In the trauma setting, penetrating vascular injuries secondary to gunshot wounds need to be addressed promptly and carefully. By identifying the entry and exit sites, the pathway of injury can usually be determined. Vessel injury is typically related to direct vascular trauma or secondary blast injury. On rare occasions, the involved vessels can serve as conduits, transporting projectiles to various locations remote from the entry wounds. The cases described demonstrate different manifestations of bullet embolism within the arterial and venous systems. We provide a literature review and we discuss therapeutic options available in these unique scenarios.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. Functional total and subtotal heel reconstruction with free composite osteofasciocutaneous groin flaps of the deep circumflex iliac vessels.Functional and esthetic reconstruction of the bony and tendinous structures with a stable, sensate soft tissue integument after complex posttraumatic defects of the heel is demanding. Cases are rare in the literature and hardly comparable due to their heterogeneity. The reconstructive approach has to consider both patient profile and the reconstructive tree, with free microvascular flaps playing a primary role. The goals are the reconstruction of both osteotendinous structures and slender soft tissue lining for proper shoe fitting for ambulation and mechanical and thermal protection. The flap should be sensate in weightbearing areas to optimize gait and to prevent long-term complications by ulcers. The osteofasciocutaneous deep inferior circumflex artery (DCIA) flap is especially suitable for complex heel defects with subtotal or total loss of the calcaneal bone as all components (iliac bone, groin skin, and fascia lata) can have a wide range of size and shape. We operated on 2 cases with this variable composite flap. One patient had a complete heel defect by war shrapnel. The complete calcaneus, soft heel, and achilles tendon were reconstructed. The second patient had an empty os calcis after a comminuted fracture and a lateral crush-induced soft tissue defect. In both patients, a stable wound closure, osseous integration, and weightbearing ambulation could be achieved.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
4/7. Bilateral hand reconstruction: report of three cases.Although it has been established that a single lost hand can be reconstructed by autogenous bilateral toe transplantation, the problem of how to reconstruct bilateral hand loss still remains. The authors present a novel approach to solve this intricate problem. A big toe free skin-nail flap, along with the second digital ray or second and third digital rays, with a common vascular pedicle, is taken from the donor foot and transferred to the forearm stump by microsurgical technique, thereby creating a hand with two or three digits. Either a piece of the iliac bone or an ulna block cut during the preparation of the forearm stump is used to substitute for the lost first metacarpus and phalanges of the thumb. The operative technique is described. Three patients have undergone this procedure and have had both lost hands reconstructed. Among the six reconstructed hands, two had two digits in each and the others had three digits. One reconstructed hand failed to survive subsequent to vascular thrombosis which might have been due to degeneration and thickening of the vessel wall. Partial failure occurred in another, where the transferred big toe skin-nail flap necrosed and was replaced by a pedicled skin tube. All five surviving hands were followed up for more than one year and showed satisfactory functional recovery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/7. Oral blast injury caused by an accident.Blast trauma within the oropharyngeal cavity may be associated with superficial or deep injuries. Superficial injury generally needs only observation; deeper injury that violates the retropharyngeal space may produce dissecting emphysema into the neck and mediastinum followed by prevertebral soft tissue infections and mediastinitis. Injury involving the parapharyngeal space might damage vital cervical vessels. life-threatening complications may result unless treatment is adequate. Three children who sustained oropharyngeal blast injury are presented. The direct cause was the blast effect of a new, spoiled, orange-flavor beverage just released on the market. The bottle cap of the soft drink and its effervescent liquid "exploded" into their mouths while they were trying to open the bottle with their teeth. Obviously, the failure to observe due precautions, as frequently happens among children, contributed to the occurrence of the accidents. This paper describes the diagnosis, management, and relevant educational and preventive measures of the problem.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/7. The reconstruction of major femoral vessels in a four-year-old girl wounded with shrapnel.A four-year-old girl who sustained an explosive injury to the femoral artery and vein underwent vascular reconstruction. An allograft was used as a substitute conduit for both the artery and the vein. Eight months after reconstruction there was no pulse deficit and decrease in systolic blood pressure, nor were there any signs of venous obstruction.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
7/7. Traumatic arteriovenous fistula. Case report and overview.The difficulties in detecting vascular injuries associated with penetrating limb trauma are greater than generally appreciated. Any delay in diagnosis will compromise management and potentially may lead amputation. Traumatic arteriovenous fistulas (AV fistula) produce several profound pathophysiological and structural changes in the circulatory dynamic of the vessel associated with fistula. Most of the changes are reversible after surgery. However, in longstanding AV fistulas, irreversible degenerative changes occur in the arterial wall and result in dilation and thrombosis. This can make late closure technically difficult. This report presents a case of a femoral AV fistula persisting for three years durations.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |