The effect of catheter use on vein grafting of a peripheral nerve defect: an experimental study.

BACKGROUND: Since vein grafts have been used in the repair of nerve defects, studies regarding this procedure have accumulated, and after coming into clinical use, it was noticed that there is a problem of collapse in the vein graft. METHODS: Forty Sprague-Dawley rats were used, divided into five groups. No surgical intervention was performed in the first group. The defect was created in the sciatic nerve in Group 2 and left unrepaired. In Group 3, the defect was repaired with a nerve graft. In Group 4, the defect was repaired with a vein graft, while in Group 5, the repair was performed using a vein graft with an inserted catheter. In order to evaluate functional recovery and nerve regeneration, walking track analysis, electrophysiologic and histomorphometric analyses were done at the end of the 12th week. RESULTS: Although there were no functional differences between Groups 5 and 4, comparisons regarding nerve conduction velocity demonstrated that the results obtained in Group 5 were better than those in Group 4. When the number of axons on the distal part of the sciatic nerve and mid-segment of the repaired area was taken into account, no significant difference was found between Groups 3 and 5, whereas there was a significant difference between Groups 4 and 5. CONCLUSION: In our study, it was experimentally shown that the problem of collapse of a vein graft occurring after its use in the reconstruction of a nerve defect can be overcome by placing a catheter into the vein graft. Consequently, this method may eliminate the need for the use of a nerve graft in selected cases.

Severe hand injuries in children related to farm tractors: a report of 70 cases.

BACKGROUND: The purpose of this study was to review tractor-related childhood hand injuries. METHODS: Seventy children (53 males, 17 females; range 1 to 11 years) were admitted to our unit. Patients were analyzed according to sex, age, pattern of injury, type of treatment and functional results. The first step of the treatment included extensive debridement and irrigation. Patients with complex tissue defects were treated with multi-stage reconstruction procedures. Patients with amputations or partial amputations were treated with amputation of the devascularized digits. RESULTS: The most common injuries were amputations and complex tissue defects. Other types of injuries were fractures, partial amputations and skin defects. In 20 cases, skin defects were covered with split-thickness skin grafts and the functional results were good. In 40 cases with complex soft tissue injuries, skin defects were covered with flaps. The functional results were good in 30 and fair in 10. In 50 digits with complete amputations, attempts at revascularization immediately after injury failed in all patients. The functional results were good in 40, fair in 5 and poor in 5. All fractures healed in 6 weeks and no complications related with bone healing were observed. CONCLUSION: The concepts of aggressive debridement, fracture reduction, and early soft tissue coverage are central to the care of these hand injuries.

Use of an intact sensory nerve to bridge a motor nerve defect: an experimental study.

OBJECT: End-to-side neurorrhaphy has recently became popular for peripheral nerve repair. Although this method is mainly indicated in nerve defects in which there is an absent proximal nerve stump, bridging a motor nerve defect by coapting the proximal and distal ends of the defect to a neighboring mixed nerve in an end-to-side fashion has been another experimental use of this method. In this situation, however, the source of the regenerating axons is unclear because the axons in both the proximal end of the defect and the bridging intact nerve have the capacity for regeneration. The goal of this study was to identify the source of the regenerating axons. METHODS: In this experimental study, the authors used a sensory nerve to bridge a motor nerve defect so that they could elucidate the source of the regenerating motor axons in the distal part of the motor nerve. One advantage of using a sensory nerve was that it eradicated the risk of damaging another motor nerve. Tests used in the analysis included gait evaluation, electrophysiological tests, and histological assessment. CONCLUSIONS: Results of this study showed that, in the rat model, a sensory nerve can be used to bridge a motor nerve defect, thereby eliminating the need for nerve grafting.

Titanium mesh fracture in mandibular reconstruction.

Mandibular reconstruction is important for providing good functional and cosmetic results after the resection of a mandibulary segment. Reconstruction plates and titanium meshes are usually used to reconstruct the bony defects in mandible. Although their complications are well known there is not a report on the fractures of a titanium mesh after mandible reconstruction in the literature. We reported a case of a broken titanium mesh after mandible reconstruction.

End-to-side nerve coaptation: is an additional proximal coaptation useful when available?

The aim of this experimental study was to evaluate the effects of end-to-side coaptation of the proximal end of a severed nerve to the same intact nerve, in addition to traditional end-to-side coaptation of the distal end, with an aim to use the intact nerve as a nerve conduit in a rat model and to compare the functional and histologic results of this modality to those obtained after nerve grafting and traditional end-to-side nerve coaptation. In group A, a peroneal nerve defect measuring 1 cm was created in the left hind limb, and a nerve graft 1 cm long was used to bridge the defect. In group B, only the distal stump of the peroneal nerve was coapted to the intact tibial nerve. In group C, both ends of the peroneal nerve defect were coapted to the intact tibial nerve in an end-to-side fashion 1.5 cm apart from each other, and in group D, the peroneal nerve defect was left unrepaired. Group E was consisted of nonoperated peroneal nerves that were used to obtain normative data. Although significantly higher myelinated axon densities were observed in groups B and C compared with group A and group E, total number of the myelinated axons was significantly higher only in group C. Peroneal functional index assessments demonstrated that nerve recovery in the peroneal nerve was similar in groups A and C, and both were better than those observed in groups B and D. Collectively, these results suggest that end-to-side coaptation of both ends of a severed nerve to an intact nerve, in case of a nerve defect in this length, may serve as an alternative for nerve grafting.

The effect of delayed admission in burn centers on wound contamination and infection rates.

BACKGROUND: Since wound infection rates in patients with delayed admission seemed to be significantly higher, a retrospective study of bacteriology in 320 burn patients, over a 5-year period was carried out in order to analyze the relation between delayed admission and wound infection rates in our Burn unit of Uludag University, Faculty of Medicine. METHODS: The patients were separated into moderate or major burn groups according to burn severity. Wound infection and contamination frequencies were analyzed according to time-delay between burn injury and hospitalization time. RESULTS: Delayed admission was found to be an important factor that causes an increase in wound infection and contamination frequency. This increase was significant especially among patients with moderate burn wounds. In patients with severe burns, wound infection and contamination frequencies were found to be higher for all admission time points. CONCLUSION: Systemic antibiotic prophylaxis should be discussed in patients with moderate burns whose admission-delay is more than 78 hours. Wound infection and contamination rates were high in patients with major burns independent of the admission time. Therefore, systemic antibiotic prophylaxis should also be discussed in this group of patients, although it results in elimination of the normal skin flora.

Longitudinally-split radial forearm flap.

We have applied the split flap concept to a distally-pedicled radial forearm flap to cover separate dorsal defects of the fingers in two cases. The rationale is that there are the vascular plexuses inside and around the sensory nerve that permit surgical splitting of the flap. In the split design, the first segment is supplied by the radial artery itself. The second segment is supplied by the neurocutaneous artery of the medial cutaneous nerve.

A single tensor fasciae latae musculocutaneous and fascia flap for composite reconstruction of urogenital and groin defect.

The tensor fasciae latae flap is a well known musculocutaneous flap used for many indications in the field of plastic surgery. The flap has some modifications to fit different reconstructive requirements of the defects. Osseous-muscle flap, osseous musculocutaneous flap, muscle flap, muscle-fascial flap and musculocutaneous-fasciocutaneous flap are some known alternatives. We used a modification of this well-known flap as musculocutaneous and fascia flap for a composite reconstruction of groin and urogenital defect. We reconstructed the groin defect with musculocutaneous part of the flap, and the defect over neourethra with the fascial extension and grafting. The aim of this modification was to reconstruct a genital defect with a thin and more pliable tissue to overcome the problem of distortion, kinking and thickness of the flap.

Umbilicus reconstruction with modified 'unfolded cylinder' technique.

Many techniques have previously been reported for reconstruction of the umbilicus. The common goal of reconstruction is to obtain a stable and aesthetically pleasing umbilicus with sufficient depth. Presented here is the reverse application of an 'unfolded cylinder' design, which has previously been reported for nipple reconstruction. The procedure can be applied with local anaesthesia on an outpatient basis and the drawing of the design is simple. Since the walls of the neoumbilicus are consisted of flaps, which are brought together without any twisting or tension, long-term use of a stent is unnecessary and the result is mostly stable and lasting. Moreover, the depth of the neoumbilicus is adjustable by widening the top rectangle in its design, which can increase it. Therefore, the procedure is suitable for thin as far patients.

Delay in neurovenous flaps: experimental and clinical experience.

The objective of this study was to examine the effects of the standard surgical delay in the flaps based on the cutaneous branches of the vascular axis around a superficial sensory nerve. The delay procedure was experimentally tested in rats and subsequently used in patients. In the experimental study, the survival of a delayed inferior epigastric neurovenous flap was compared with that of a nondelayed inferior epigastric neurovenous flap. One type of clinically applicable delay pattern (standard bipedicled technique) was employed. A 3 x 3 cm flap was raised in 20 female Wistar rats assigned randomly to 2 groups. Each group consisted of 20 flaps. The standard bipedicled delay pattern increased the percentage survival of the delayed inferior epigastric neurovenous flap. The survival percentage of the delayed flaps was 59.8 +/- 185.0 (P < 0.5). The histologic findings of the skin revealed that our delay procedure enhanced the perfusion of the flap by dilating the arterial network. Stimulated by our experimental findings, we used the island bipedicled surgical flap delay or combined strategic-standard delay in the distally pedicled sural flap successfully on 9 cases.

Free rectus abdominis muscle flap with plantar skingraft--a combined method of aesthetic and functional reconstruction of the heel.

A 16-year-old girl presented with a contusion of the left calcaneus that was treated by combined free rectus abdominis muscle flap and plantar skin graft. The main advantages of this procedure are that it replaces weight-bearing skin of the heel with histologically similar skin from the instep, and the fibrofatty pad of the heel with muscle; it provides a good cosmetic result in the heel, and the scars of the donor site are well-hidden.

Effects of human amniotic fluid on cartilage regeneration from free perichondrial grafts in rabbits.

After the chondrogenic potential of free grafts of perichondrium was shown in several experimental studies, perichondrium has been used to reconstruct cartilage tissue in various clinical situations. This study investigates the effects of human amniotic fluid on neochondrogenesis from free perichondrial grafts in a rabbit model. Since this fluid contains high concentrations of hyaluronic acid, hyaluronic acid-stimulating activator, growth factors, and extracellular matrix precursors during the second trimester, it may have a stimulating effect on neochondrogenesis. Perichondrial grafts, measuring 20 x 20 mm2 were obtained from the ears of 144 New Zealand young rabbits and were sutured over the paravertebral muscles. The rabbits were randomly divided into three groups with 48 rabbits per group. In group 1, 0.3 ml human amniotic fluid, and in group 2, 0.3 ml saline were injected underneath the perichondrial grafts. Group 3 formed the control group in which no treatment was given. Histologically, neochondrogenesis was evaluated in terms of cellular form and graft thickness at 2, 4, 6, and 8 weeks after surgery. In group 1, the mature cartilage was generated quickly and the cartilage plate in this group was significantly thick and extensive when compared with groups 2 and 3 at 8 weeks ( p<0.05 ANOVA). In conclusion, our study shows that human amniotic fluid enhances neochondrogenesis from free perichondrial grafts. The rich content of hyaluronic acid and growth factors possibly participate in this result.

Proximally pedicled musculocutaneous anterior interosseous flap for cubital fossa reconstruction.

Based on preexisting anatomic studies and our experience related to the upper extremity flaps, a proximally pedicled anterior interosseous flap was developed and used in 1 patient for the reconstruction of skin defect of cubital fossa and the biceps brachii muscle. The distal half of the brachioradialis muscle was included in the flap. The recovery of the elbow was excellent, with a full range of movement. The important conclusion from this case is that the superior perforating branch of the anterior interosseous artery may be used as the basis of an alternative regional flap for the cubital fossa.

[Clinical evaluation and treatment results of 30 patients with necrotizing fasciitis]. / Nekrotizan fasiitli 30 hastanin klinik degerlendirilmesi ve tedavi sonuçlari.

BACKGROUND: We retrospectively evaluated patients who underwent treatment for necrotizing fasciitis within a five-year period. METHODS: Thirty patients (4 females, 26 males; mean age 55 years; range 19 to 78 years) with necrotizing fasciitis were evaluated with respect to age, sex, etiology, predisposing factors, localization of infections, culture results, and treatment methods and results. RESULTS: The most common etiologic and predisposing factors were anorectal lesions (36.7%) and diabetes (53.3%), respectively. Wound cultures yielded Pseudomonas aeruginosa in 50% of the patients. Two strains of aerobic bacteria were isolated in three patients. All patients underwent extensive surgical debridement and received antibiotic therapy. Twenty-nine patients (96.6%) required more than one debridement, with a mean of 4.5 debridements. The ensuing skin defects following debridement were reconstructed with grafts or local flaps. No complications were encountered in the postoperative period. CONCLUSION: Early diagnosis and treatment result in decreased morbidity and prevent mortality in necrotizing fasciitis.