The salvage of knee-exposed prosthesis using neurofasciocutaneous sural flap.

Prosthetic exposure is a severe complication of total knee arthroplasty. Many factors are responsible for failed wound healing, and successful salvage of total knee arthroplasty requires early identification of infection, antecedent events related with wound healing failure, aggressive surgical debridement and early appropriate soft-tissue coverage with local skin, fasciocutaneous, muscle, neurocutaneous or perforator flaps. In this report, we present 15 cases of exposed knee prosthesis treated with island sural neurocutaneous flap. Follow-up showed favorable clinical outcomes: all flaps survived and only two cases of hematoma and one of aseptic phystula occurred. According to our results, the island neurofasciocutaneous sural flap represents a sensate reconstructive alternative for providing fine and dependable soft tissue for covering skin defects around the knee.

Second toe transplantation to reconstruct digits.

In congenital absence of fingers or in post-traumatic amputations of the thumb or fingers, reconstruction by microsurgical toe-to-hand transfer is becoming a common treatment for these difficult problems. In case of congenital absence of the thumb, fingers, or both, these transfers can provide acceptable growth, function and sensation of the transferred toes with a current success rate usually greater than 95%. The most commonly transplanted toe is the second toe, since it is the longest toe and combines all the useful characteristics of a finger (such as joint, a nail, sensitive pulp tissue, and the ability to growth) with a good reliable blood supply. In this article, we discuss the rationale for this treatment approach, by considering the indications to treatment, the patient's preoperatory assessment, and the long-term results. We also report a case of a 4-year-old female child, suffering from congenital partial absence of second finger of the left hand, who underwent reconstruction by transfer of the second toes of foot.

The preservation of a spare hemi-abdominal flap in unilateral breast reconstruction with abdominal free flap in high risk patients.

BACKGROUND: Unilateral breast reconstruction with a free abdominal TRAM or DIEP flap restores the shape of the amputated breast with acceptable donor site morbidity. In patients with small breasts and ample lower abdominal tissue this can be achieved by using only a hemi-abdominal flap. In these cases, the contra-lateral flap is usually discarded, but it could potentially be left in situ as a "spare" hemi-abdominal flap, especially in patients at high risk for contra-lateral breast cancer or flap failure. We report our early experience with this preservation technique. MATERIAL AND METHODS: The authors report two cases of unilateral breast reconstruction with hemi-abdominal DIEP free flaps in women at high risk for contra-lateral breast cancer and/or flap failure, who opted not to have prophylactic contra-lateral mastectomies. They consented to having the unused "spare" hemi-abdominal deepithelialized flap left in situ in case the need for a secondary flap arose. RESULTS: The "spare" hemi-abdominal flap was used for immediate reconstruction as an SIEA free flap when the first patient's original flap necrosed secondary to microcirculation problems. The second patient's spare flap was left in situ by burying it after de-epithelialization. CONCLUSIONS: We believe that patients undergoing unilateral breast reconstruction who are at high risk for contra-lateral breast cancer and/or free flap failure, and who choose not to undergo an immediate contra-lateral prophylactic mastectomy, should have the "spare" hemi-abdominal flap buried. This tissue could be used as a potential bailout flap in cases of original flap failure or for contralateral breast reconstruction at a later date.

Characterization of Erysipelothrix rhusiopathiae isolated from an opossum (Didelphis virginiana) with septicemia.

Erysipelothrix rhusiopathiae was isolated from a wild-caught opossum (Didelphis virginiana). The opossum was quarantined in isolation and removed from contact with other animals. After a 2-mo period it was found dead in its cage, and presented for postmortem examination. Pure cultures of Erysipelothrix rhusiopathiae (SLU isolate) were recovered from heart blood, liver, spleen and lungs. To compare pathogenicity, an experimental infection was attempted in CF1 mice with a single dose of 1.5 x 10(7) organisms of both an ATCC standard strain and SLU isolate of E. rhusiopathiae. Similar signs, lesions and results of culture were found for both strains. The findings suggest that opossums can be infected with E. rhusiopathiae.

Valvular endocarditis associated with experimental Erysipelothrix rhusiopathiae infection in the opossum (Didelphis virginiana).

Intravenous inoculation of a wild type isolate of Erysipelothrix rhusiopathiae in opossums resulted in valvular endocarditis in all infected animals. Opossums were inoculated once a week for 3 weeks. Lesions became visible with cardiac ultrasound by week four post-inoculation. Opossums remained clinically normal throughout the experiment, and preinfection body weight was maintained. Other lesions of chronic erysipelas including skin necrosis and arthritis were not found in infected opossums.

Comparison of Track XI fluorometric immunoassay with Bio-EnzaBead enzyme-linked immunosorbent assay for detection of serum antibody to mouse hepatitis virus.

The Track XI system (Microbiological Associates, Bethesda, Md.) was compared with the Bio-EnzaBead assay (Organon Teknika, Durham, N.C.) for the detection of antibody to mouse hepatitis virus (MHV). Strain A/J mice were inoculated intranasally with MHV type 3. Sera were collected at 1, 2, 4, and 9 weeks postinoculation and tested. Individual serum samples were retested twice by each method. The results suggested that the Track XI system was more sensitive and reliable than the Bio-EnzaBead assay in detecting antibody to MHV type 3 in individual serum samples from A/J mice.

A comparison of three ELISA systems for the detection of Mycoplasma pulmonis antibody in rats.

Barrier maintained and conventionally reared rats were tested for the presence of antibody to M. pulmonis using three ELISA test systems. Agreement between the two commercial test kits was 100% for both the barrier maintained and conventionally reared rats. Agreement between the kits and the non-commercial ELISA was 96% for barrier maintained rats, but only 56% for conventionally reared rats. Procedural differences or the presence of reactive substances in the sera of conventionally reared rats could have accounted for the discrepancy between the non-commercial and commercial tests.

Francisella tularensis infection in captive, wild caught prairie dogs.

An adult, wild caught prairie dog was found dehydrated and ataxic, with severe diarrhea. Gross necropsy lesions consisted of scattered pinpoint white foci throughout the liver and spleen. A massive, purulent bronchopneumonia was found also. Direct fluorescent antibody tests and culture of spleen and liver samples confirmed a diagnosis of tularemia.

Evaluation of micro serum separator tubes for obtaining serum specimens suitable for serologic testing.

Paired blood samples from Sprague Dawley rats were collected in micro serum separator tubes and in conventional 2 ml volume blood collection tubes. Commercially available ELISA test kits for Mycoplasma pulmonis and Sendai virus were used to compare the two collection systems. No significant differences were found in the optical density values between the two collection systems.