Congenital pseudarthrosis of the forearm: treatment of six cases with vascularized fibular graft and a review of the literature.

Six cases of pseudarthrosis of the forearm are reported. One involved only the radius, one the ulna alone, and four both forearm bones. There was associated neurofibromatosis in five cases. All the cases were treated by wide resection and free vascularized fibular graft. In two cases, a single-bone forearm was created. In all cases, good results were achieved, with moderate forearm shortening. The literature suggests electrical stimulation, corticoperiosteal graft, osteotomy of the involved bone, and free vascularized bone grafting as treatment alternatives. Vascularized free bone grafting appears to be more successful than other treatments. The use of microsurgical sutures permits this treatment in young patients.

[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.

Vascularized fibular graft for management of severe osteomyelitis of the upper extremity.

The authors analyzed 14 patients with severe osteomyelitis of the upper extremity between 1985 and 1992, managed with the vascularized fibular graft. Eleven radii, two humeri and one ulna were reconstructed. Bone loss after resection ranged from 6 to 12 cm (mean 8.14 cm). Follow-up ranged from 8 months to 7 years and 10 months (mean 3 years and 3 months). The therapeutic applications of the vascularized fibular graft in severe bone infections of the upper extremity were discussed and the good results of this surgical procedure established it as a good option for treatment. Morbidity at the donor site was minimal.

Extraplexual neurotization of brachial plexus.

The authors reviewed 62 neurotizations of the brachial plexus in 71 patients performed between 1974 and 1989. The nerves used were the accessory, the motor or sensory branches of the cervical plexus, and the intercostals. Twenty-five suprascapular nerves, 19 musculocutaneous, 4 medial roots of the median nerve, and 12 lateral roots of the median nerve were neurotized. The authors concluded that useful results can be achieved using extraplexual neurotizations.

[Wrist arthroscopy]. / Artroscopia do punho.

Wrist arthroscopy was performed in 12 patients that complained of wrist pain for four months and in whom the diagnosis not established. The instruments and the technique of the procedure is described. In two patients the wrist pain diminished and in eight it disappeared. In other two patients the pain was not relieved. There were no complications.

[Surgical approach to giant cell tumors of the distal radius]. / Abordagem cirúrgica do tumor de células gigantes da extremidade distal do rádio.

The authors review 15 patients with giant cell tumor of the distal part of the radius in the period from 1980 to 1993. Pain was always present. The treatment of stage 2 with marginal resection and methylmethacrylate yielded excellent result. In the treatment of stage 3 the authors emphasize the need of wide resection. In these patients the best functional results were obtained with the use of vascularized proximal epiphyseal fibular graft, preserving some painless mobility of the wrist and forearm.

[Retrospective study of traffic accident victims: incidence after the new National Traffic Code implantation]. / Estudo retrospectivo dos pacientes vítimas de acidente de trânsito: incidência após a introdução do novo código nacional de trânsito.

The authors present a study about the frequency of the injuries caused by traffic accidents on the orthopedic patients admitted to the emergency of Institute of Orthopedics and Traumatology at the Hospital das Clínicas of the School of Medicine São Paulo University, before and after the new National Traffic Code. They found a decreased number of polytraumatized patients and severe injuries after the beginning of this new legislation.

[Contribution to the anatomical study of medial arm flap]. / Contribuição ao estudo anatômico do retalho medial do braço.

The reports of transfer of the medial arm flap have been inconsistent, and confusion remains about its anatomy and use. The advantages of this donor site, however, justify new researches about the vascular anatomy of the flap. In this study, the vascular supply to the medial side of the arm was analysed in fifteen fresh cadaver dissections. The methods, the anatomical bases, and the technique of elevation of the flap were detailed. Methylene blue injection studies showed the extent of the medial arm flap. The authors found that, in most cases, the superior ulnar collateral artery was the main vessel of this flap, giving cutaneous branches to medial arm skin. The diameter of the superior ulnar collateral artery was measured and considered adequate for microsurgical transfer. If no major cutaneous branches are noted from superior ulnar collateral artery, then a significant direct cutaneous branch from the brachial artery will be always present. With this in mind, the dissection must initially proceed carefully, preserving all vessels that may contribute to cutaneous perfusion. The authors conclude that with knowledge of its anatomical variations, the medial arm flap is a plausible reconstructive option.

[Validation of an ELISA for the measurement of human IgG against serogroup B Neisseria meningitidis protein]. / Validación de un ELISA para la cuantificación de IgG humana antiproteína de Neisseria meningitidis serogrupo B.

An indirect ELISA test was optimised in which B meningoccocus outer membrane proteins included in the Cuban Vaccine known as VA-MENGOC-BC were used as capture antigents. Specific antibodies in serum samples from vaccinated individuals were detected using a human anti-IgG conjugate, i.e. alklayne phosphatase, thus the reaction developed with a specific substrate called p-nitrophenilphophate. Standard serum was obtained from a reference standard, the gage curve range was 625 to 20,000/mL. The control serum was selected from the most interesting areas for the samples, hence, assay characteristics were determined. Intra-assay, inter-assay and total inaccuracies were lower than 10% in the most linear area of the curve. Detectability was 700/mL. Recovery, paralelism and linearity studies showed an under 10% inaccuracy.

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

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