RESUMO
INTRODUCTION: An incongruence of the distal tibiofibular joint (TFJ) after treatment of upper ankle joint injury represents a prearthrotic deformity and must be corrected. The objectives of this study were to analyze postoperative CT scans after surgical treatment of unstable syndesmotic injuries, and to determine the prevalence of syndesmotic malreduction and its contributing factors. The specific parameters of three-dimensional imaging for objective detection of malreduction should be identified as a helpful intraoperative imaging threshold. MATERIALS AND METHODS: Postoperative CT scans of 57 patients were analyzed by identifying cases requiring correction. Factors that influenced the reduction result (patient age, sex, fracture type and surgeon qualifications) were evaluated. The following CT measurements were determined: anterior (AD) and posterior tibiofibular distance (PD), TFJ width, anteroposterior fibular translation (APT), length and rotation of the fibula, position of the malleoli to the talar joint surface. A confidence interval of 95% was assumed (significance level p < 0.05). RESULTS: A very high proportion of the cases required revision (38.5%). Age (p=0.199), sex (p=0.752), body mass (p=0.722), and fracture type (p=0.266) had no significant influence on the reduction result. The risk of requiring correction was slightly lower for well-experienced trauma surgeons. The measurements revealed the following thresholds: AD: ø 3.2 mm (±2.2), PD: ø 5.1 mm (±2.2), TFJ: ø 3.4 mm (±1.4), APT: ø 7.9 mm (±3.5), and rotation: ø 10.7° (±6.8). The fibula was too long in 4 cases (7%) and too short in 8 cases (14%). There was a malleolar incongruence in 5 cases (8.7%). The analysis revealed a significant correlation between the ratio of the anterior and posterior tibiofibular distances and a need for correction. CONCLUSION: The ratio between the anterior and posterior tibiofibular distances in the axial sectional image is an aid for intraoperative assessment of the correct reduction in the TFJ.
RESUMO
OBJECTIVE: To describe a new technique of suturing microvessels with persistent perfusion via a temporary intraluminal microshunt. METHODS: Experiments were conducted in Wistar rats. Abdominal aorta grafts were explanted from donor rats. A soft silicon microcatheter was introduced into the lumen of this graft. The abdominal aorta of a recipient rat was prepared for end-to-side microvascular anastomosis. Acland clamps (S&T AG, Neuhausen, Switzerland) were applied, and a linear arteriotomy was made. One end of the graft-clad microcatheter was introduced into the lumen and occluded with a fenestrated Acland clamp. At a more distal part, a similar arteriotomy was performed, and the other end of the microcatheter was introduced into the lumen and clamped with a fenestrated Acland clip. This created a temporary shunt through the graft-clad microcatheter. Then, the graft was anastomosed to the arteriotomies at both ends, over the microcatheter, in an end-to-side manner. The microcatheter was explanted from the vessel lumen through an arteriotomy in the middle of the graft. The graft was clipped short to close this arteriotomy. The mean total occlusion time before perfusion was reestablished amounted to 3.7 minutes. This experiment was repeated in 12 animals (6 with and 6 without heparin) without technical complications. As controls, conventional anastomoses were made in 2 animals. RESULTS: Suturing microvessels mandates their occlusion during the period of anastomosis. Although ischemia is well tolerated by other tissue types, the brain is quite sensitive to even short windows of ischemia. Nonocclusive anastomotic techniques have been developed recently. These are confined to vessels with luminal diameters greater than 3 mm. We have evolved a novel technique that can be used with microvessels, as pertinent to superficial temporal artery-to-middle cerebral artery bypass. CONCLUSION: We have described a new technique for performing microvascular anastomoses over a temporary intraluminal microcatheter shunt.
RESUMO
OBJECTIVE: To describe a new technique of suturing microvessels with persistent perfusion via a temporary intraluminal microshunt. METHODS: Experiments were conducted in Wistar rats. Abdominal aorta grafts were explanted from donor rats. A soft silicon microcatheter was introduced into the lumen of this graft. The abdominal aorta of a recipient rat was prepared for end-to-side microvascular anastomosis. Acland clamps (S&T AG, Neuhausen, Switzerland) were applied, and a linear arteriotomy was made. One end of the graft-clad microcatheter was introduced into the lumen and occluded with a fenestrated Acland clamp. At a more distal part, a similar arteriotomy was performed, and the other end of the microcatheter was introduced into the lumen and clamped with a fenestrated Acland clip. This created a temporary shunt through the graft-clad microcatheter. Then, the graft was anastomosed to the arteriotomies at both ends, over the microcatheter, in an end-to-side manner. The microcatheter was explanted from the vessel lumen through an arteriotomy in the middle of the graft. The graft was clipped short to close this arteriotomy. The mean total occlusion time before perfusion was reestablished amounted to 3.7 minutes. This experiment was repeated in 12 animals (6 with and 6 without heparin) without technical complications. As controls, conventional anastomoses were made in 2 animals. RESULTS: Suturing microvessels mandates their occlusion during the period of anastomosis. Although ischemia is well tolerated by other tissue types, the brain is quite sensitive to even short windows of ischemia. Nonocclusive anastomotic techniques have been developed recently. These are confined to vessels with luminal diameters greater than 3 mm. We have evolved a novel technique that can be used with microvessels, as pertinent to superficial temporal artery-to-middle cerebral artery bypass. CONCLUSION: We have described a new technique for performing microvascular anastomoses over a temporary intraluminal microcatheter shunt.