[Liver transplantation from living related donors] / Transplante hepático com doador vivo familiar.

OBJECTIVES: To present the experience with the first 12 living related liver transplants performed at Hospital Sírio-Libanês in São Paulo. METHODS: The donors were the fathers (6) and the mothers (6) with age ranging from 30 to 48 years. All candidates for donation were submitted to a full informed consent form, clinical and radiological evaluation and had blood withdrawn for autotransfusion. Recipient age ranged from 7 months to 10 years whereas recipient weight varied from 6.3 to 34 kg. Six patients were considered as high risk due to complications of advanced liver disease and were submitted to urgent transplantation. RESULTS: Mean donor hospital stay was 10 days with no mortality. Technical complications were observed in 4 recipients. Seven patients presented at least one episode of bacterial, viral or fungal infection. One or more biopsy proven rejection episodes were disclosed in 7 patients. Overall recipient survival was 67%, being 83% for elective cases and 50% for urgent cases. Long term follow up ranged from 8 to 25 months. Seven out of 8 survivors present excellent quality of life and normal liver function. The other patient is currently under reduced immunosuppression due to Epstein-Barr virus infection.CONCLUSIONS: These results demonstrate the safety and viability of living related liver transplantation which, in face of the current donor scarcity, should be considered as a valid option for the treatment of children with end stage liver disease.

[Treatment of osteoarthritis of the carpometacarpal joint of the thumb by ligament reconstruction and tendon interposition arthroplasty]. / Tratamento da osteoartrose da base do polegar com artroplastia de interposição tendinosa e reconstrução ligamentar.

Total trapezium resection and palmar oblique ligament reconstruction combined with tendon interposition arthroplasty using the entire flexor carpi radialis tendon were performed in 21 patients (23 thumbs) who developed advanced osteoarthritis of the thumb basal joint. All patients were females and the age ranged from 42 to 73 years. Good results were achieved in 21 thumbs. These procedures improved pinch and grip strength and restored the thumb web space. No deterioration of function, instability or pain has been noted over the time.

[The use of microvascular free flaps in the repair of the skin of the upper limb]. / O emprego de retalhos microcirúrgicos na reparação do revestimento cutâneo do membro superior.

Between 1980 and 1992 microsurgical free flaps were used in 35 patients for the repair the of skin defects in the upper limb. Twenty six patients were male and nine female. The scapular flap was done in 16 cases, the lateral flap in seven, the dorsalis pedis in four, the neurovascular first web space in four, the latissimus dorsi in two, the radical forearm flap in one and the gracilis in other one. The survival rate in this series was 88.57%. Early free flaps were performed in 12 patients of whom one developed infection at the recipient site. Two-point discrimination was achieved in four thumbs reconstructed with the neurovascular first web flap. No complications occurred at the donor areas.

Reconstruction of the foot with microvascular free flaps.

Reconstruction of the foot using microvascular flaps has been widely performed in the last 15 years but the choice of flap to repair some areas in the foot remains controversial. We present a series of 128 free flaps to the foot performed during the period of 1975-1990. One hundred and seventeen had a successful outcome (91%). The etiology of the problem was traumatic in 94, congenital in 10, tumor in 9, and chronic ulcerations due to vascular problems in 15. The indications for a specific flap depended on the site and extension of the foot problem, and were divided into four groups: 1. Dorsum of the foot. Cutaneous parascapular flap was the best choice. 2. The sole-weight-bearing area. We favored the use of the latissimus dorsi muscle flap covered with a split thickness skin graft, done immediately. A proper tailoring of the flap and postoperative care by the patient are very important to maintain the result without ulceration. Tactile sensation does not seem to be essential. 3. The area over the calcaneus tendon. We have used cutaneous flaps such as the parascapular and lateral arm flap or fascial flaps covered by split thickness skin grafts (STSG). The fascia used were the serratus or the parascapular. 4. Complex trauma problems with extensive skin loss or chronic ulcerations due to vascular diseases: the latissimus dorsi musculocutaneous or muscle plus STSG was mostly used. The overall number of donor areas were 5 groins, 48 parascapular, 2 gluteal fold flaps, 4 lateral arm, 61 latissimus dorsi, and 8 fascial flaps.

Replantation of digits: factors influencing survival and functional results.

Immediate survival and functional results were studied in 60 finger replants performed from 1980 to 1990. The follow-up ranged from 1 to 5 years with the mean of 2 years and 8 months. The survival rate achieved was 70% and was not related to the patient's age, the mechanism of injury, the level of amputation, the total ischemia time, the number of arteries and veins repaired or the type of vascular reconstruction. Sensory return was related to the mechanism of amputation and the total active motion was strongly correlated with the level of amputation. Of the 16 digits that had only one artery anastomosed, there were 10 survivals (62.5%), and in 15 digits with anastomosis of two arteries, the success rate was 86.66% (P = 0.1244). The success rate in those cases in which vascular grafts were employed was 62.96% (P = 0.4161). In replantations with one, two or three veins anastomosed, the survival rate was 50%, 79.16% and 100%, respectively (P = 0.1324).

Treatment of congenital pseudarthrosis of the tibia by microsurgical fibula transfer.

Conventional methods for the treatment of congenital pseudarthrosis of the tibia (CPT) often lead to unsatisfactory results and so microsurgical fibula transfer (MFT) has appeared as an option to treat this challenging problem. In this series of 27 patients with CPT, we obtained satisfactory results in 23 as assessed by the timing of bone union and bone hypertrophy of the fibular transplant. The overall functional results were also good; in 18 patients, the residual shortening was less than 2 cm (with no limb shortening in 4) and in 7, shortening ranged between 2 and 4 cm. All 25 patients resumed normal walking without the help of braces after an average of 12 months. This report suggests that microvascular fibula transfers provide superior results in the treatment of CPT, especially when considering that many of such cases represented previous surgical failures.

Finger replantation.

The objective of this study was to determine the influence of the following factors on the survival rate of replanted digits: patient's age, type and level of amputation, time of ischemia, number of arteries and veins anastomosed and type of vascular repair. A total of 60 digits were replanted by the author from 1980 to 1990. The results showed no significant correlation between the survival rate and the factors studied. However, the surgeon's experience played an important role in the survival rate of replanted digits.

Sutura direta retardada na "zona de ninguem" dos flexores dos dedos da mao. / Delayed direct suture in \"no man's land\" of the finger flexors

Os autores apresentam a experiencia obtida em 37 casos de sutura retardada dos tendoes flexores dos dedos na "zona de ninquem", no periodo de 1973 a 1982. A idade dos pacientes variou entre 6 a 59 anos de idade e a cirurgia foi realizada de 7 a 90 dias apos a lesao. Os resultados foram avaliados pelo teste de Van't Hof (distancia polpa-palma). Os resultados foram bons e regulares em 93% dos casos

"Palmaris profundus": anomalia muscular rara causando sindrome do tunel do carpo / \"Palmaris profundus\": a rare muscular abnormality causing carpal tunnel syndrome

Os autores apresentam um caso de sindrome do tunel do carpo causada por musculo anomalo e raro denominado palmaris profundus, associado com a ausencia do palmaris longus. Quando a sindrome do tunel do carpo e causada pela presenca desse musculo, a cirurgia com a sua resseccao promove alivio dos sintomas e excelentes resultado funcional

Reimplante de membros.Resultados imediatos e funcionais. / Extremities reiplantation: immediate and functional results

Apresentamos a experiencia obtida no Hospital da Universidade de Sao Paulo com 86 reimplantes de membros superiores (excluidos dedos e polegar) no periodo de 1972 a 1982. Procurou-se correlacionar os resultados tanto da sobrevida do segmento reimplantado como da funcao obtida com o tipo de trauma, nivel de amputacao e tempo de isquemia. Concluiu-se terem os reimplantes ao nivel de braco, cotovelo e antebraco proximal pior prognostico que os mais distais. A funcao medida pelo criterio de avaliacao funcional de Chen mostrou que 72% dos membros reimplantados apresentaram funcao regular, boa e excelente, justificando-se portanto a cirurgia. Os reimplantes ao nivel de antebraco distal, punho e mao, em vista da boa funcao que propiciam, devem ser sempre indicados

Emprego de tubo de polietileno no preparo de enxertia de tendao flexor de dedo. / Use of polyethylene tubes in preparing grafts for finger flexor tendon

Os autores apresentam experiencia inicial com o emprego de tubos de polietileno, comumente usados como equipos para infusoes endovenosas, como substitutos de bastoes de silicone. Foram utilizados nas mesmas indicacoes daqueles, ou seja, em graves lesoes de tendoes flexores na chamada "zona de ninguem" da mao. Entre as vantagens apresentadas estao o menor custo e a maior facilidade de obtencao em hospitais gerais, proporcionando resultados semelhantes

Tecnica para correcao da deformidade em "pescoco de cisne" dos dedos: nota previa. / Technic for the correction of the swan-neck deformity of fingers preliminary report

Os autores apresentam modificacao na tecnica cirurgica de Littler para correcao dos dedos em "pescoco de cisne".Consideram como principal vantagem da modificacao a fixacao mais dinamica das articulacoes interfalangicas

Transplante microcirurgico de dedo de pe para reconstruir dedo da mao.Relato de caso. / Microsurgical tol transplantation for hand reconstruction.Report of a case

A reconstrucao de dedos ausentes congenitamente ou perdidos por amputacao traumaticas constitui ainda problema dificil para o cirurgiao de mao. Dentre as diferentes opcoes tecnicas que podem ser utilizadas, a transferencia de dedos do pe para a mao a custa de anastomoses microvasculares representa a mais nova conquista que pode ser empregada em casos especiais. Apresenta-se descricao de paciente que havia sofrido amputacao traumatica de todos os dedos de uma mao e de quatro dedos da outra, restando somente o polegar. O transplante do segundo dedo do pe para a mao permitiu a recuperacao da preensao e grande melhoria funcional

Transferencia microcirurgica do musculo gracil para o tratamento de sequela de sindrome de Volkmann. / Microsurgical transfer of the gracilis muscle for the treatment of sequela of Volkmann's syndrome

Os autores apresentam paciente portador de sequela de sindrome de Volkmann no membro superior. Para a reconstrucao da musculatura flexora do antebraco, realizou-se transferencia microcirurgica do musculo gracilis, revascularizando-o no antebraco a custa de anastomoses microcirurgicas e reinervando-o por sutura em ramo nervoso motor intacto do nervo mediano. O bom resultado obtido nesse paciente foi superior ao que poderia ser conseguido com tecnicas convencionais e abre grandes perspectivas para outras condicoes clinicas caracterizadas por ausencia de grupos musculares