Combination of cable ties and barbed sutures for fasciotomy closure - two case reports.

While fasciotomy is the only urgent treatment option for compartment syndrome, the resulting open wound leaves room for complications. Closure of the wound can be done by different techniques, including split-thickness skin grafts, negative pressure therapy, an absorbable barbed suture system and a cable ties system. The aim of this paper is to demonstrate how a combined application of these methods can reduce their respective individual disadvantages. Our combined method was tried in two patients, one with an open tibial fracture and the other who underwent ulnar nerve reparation. Both patients started exhibiting signs of compartment syndrome within 3 hrs after surgery. Firstly, absorbable barbed suture systems were positioned with the running intradermal technique. Following this the cable ties were inserted and the limb in question was placed in an elevated position. Complete closure of the patient's wounds was achieved within 2 weeks without complications. This result is a testament to the added benefit of a combination of these methods in comparison with the results they produce individually.

Long-term aesthetic outcome of fingertip reconstruction in complete syndactyly release.

An aesthetically pleasing fingertip is an important but often under evaluated goal in syndactyly release. We assessed the aesthetic fingertip outcome in 26 patients with complete syndactylies, with a total of 84 separated digits, using a four-grade scale based on the quality of the lateral nail fold, nail plate definition, symmetry and pulp fullness. Fingertips with complete simple syndactylies released with the use of full-thickness skin grafts achieved a significantly better aesthetic result then fingertips with complete complex syndactylies released with the use of Buck-Gramcko pulp flaps. Fingertips involved in complex syndactylies achieved significantly better aesthetic results when reconstructed using Buck-Gramcko flaps in comparison with those reconstructed with full-thickness skin grafts. We recommend the use of Buck-Gramcko flaps in complete complex syndactylies, while reserve the traditional zig-zag and full-thickness skin graft closure for cases of complete simple syndactylies. We also propose a grading system for the aesthetic outcome of the fingertip following syndactyly release.

A case of duplicated right renal artery and triplicated left renal artery.

A rare anomaly of the vessels supplying the kidney of a 65 year-old male cadaver was found during a routine dissection. The right kidney received two renal arteries from the aorta that were similar in diameter, both entering through the hilus. The left kidney had three arteries originating from the aorta, one at its usual hilar position and two entering the renal cortex at its upper and lower poles. The upper pole of the left kidney also gave rise to an additional tributary of the renal vein.

TGF-beta and basement membrane matrigel stimulate the chondrogenic phenotype in osteoblastic cells derived from fetal rat calvaria.

Primary cultures of fetal rat calvarial cells contain a spectrum of osteogenic phenotypes including undifferentiated mesenchymal cells, osteoprogenitor cells, and osteoblasts. We recently demonstrated that rat calvarial osteoblast-like cells grown on basement membrane undergo profound morphological changes resembling a canalicular network in bone. In the present study, we examined the effect of reconstituted basement membrane Matrigel on chondroblastic versus osteoblastic differentiation of different cell subpopulations obtained by five consecutive enzymatic digestions of rat calvarial cell populations. We found that the appearance of canalicular cell processes decreased with the later digests. When cells from the fourth and fifth digest were grown on top of Matrigel for 7 days, the majority of the cell aggregates displayed chondrocytic characteristics but none of the cells became hypertrophic. When individual chondroblastic cell aggregates were subsequently transferred from Matrigel to plastic, they started expressing types I and X collagens, alkaline phosphatase, and osteocalcin. Within the next 7 days (days 8-14 of the experiment), the majority of cells increased in size, and at day 17 on plastic (day 24 of the experiment) mineralized bone nodules formed. The chondroblastic differentiation of calvarial cells grown on Matrigel could be inhibited by a specific transforming growth factor-beta 1 (TGF-beta 1) but not by a TGF-beta 2 antibody. Addition of recombinant TGF-beta 1 to similar cultures promoted the appearance of chondroblastic cell aggregates. The cartilage phenotype could not, on the contrary, be promoted by growing the cells on other extracellular matrices such as a collagen I gel. We suggest that TGF-beta 1 in concert with the basement membrane extracellular matrix induces chondroblastic differentiation of rat calvarial osteoprogenitor cells.

Articular chondrocytes interact with basement membrane Matrigel through laminin active binding sites.

Laminin-like molecules are detected during the differentiation of embryonic mesenchyme into cartilage and in cartilage during amphibian limb regeneration and fracture repair. Since primary articular chondrocytes in culture recognize and respond to laminin from basement membrane, the author studied the effect of laminin-derived peptides, which are thought to be responsible for biological activities of laminin. The biologically active peptides from both the laminin B1 and A chains containing YIGSR, RGD and IKVAV sequences all promoted chondrocyte attachment, and blocked laminin mediated cell attachment, with the IKVAV-containing peptide being the most effective. Laminin promoted cell migration with a maximum activity at 20 micrograms/ml. YIGSR at 100 micrograms/ml was the most active peptide exhibiting about 48% of the chemotactic activity of laminin, whereas the IKVAV-and RGD-containing peptides were much less active. When added in solution to the primary chondrocytes grown on Matrigel, YIGSR-containing peptides prevented cell alignment, whereas in the presence of peptides containing IKVAV sequence the cells spread rapidly and proliferated for 24 h. RGD-containing peptides had no effect on cell behavior on Matrigel.

Gastric lesion development in normal and pylorus ligated rats after cervical vagotomy.

The main purpose of this study was to further investigate the effects of vagotomy on gastric lesion development. In contrast to the usual subdiaphragmal vagotomy, a different vagotomy at the level of the trigonum caroticum was used both alone and in combination with pylorus ligation (done immediately after vagal transection). The animals were killed 15 min, 30 min, 1 h and 6 h following vagotomy. No damaging effects of sham-vagotomy, or obvious negative effects of cervical vagotomy were noted. Prominent lesions appeared after 1 h in rats subjected to cervical vagotomy and significantly increased lesions in the early period of pylorus ligation were noted. No further aggravation in pylorus ligated rats (even an apparent amelioration at 1-h interval) and no lesions in rats with cervical vagotomy in the latter period could be explained in terms of a lack of reactivity due to exhaustion preceding fatal outcome. Consistent with this, the rats subjected to cervical vagotomy died shortly after the 6-h period.