Free microvascular iliac crest flap for extensive talar necrosis--case report with a 16-year long-term follow up.

Atraumatic osteonecrosis of the talus can be extremely painful and lead to significant functional impairment. Although clinical, radiographic, and demographic characteristics of atraumatic osteonecrosis of the talus have been well documented, the diagnosis is frequently missed or delayed; the most common causes are use of corticosteroids and the presence of immune disorders. Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome.

The posterior interosseous artery in the distal part of the forearm. Is the term "recurrent branch of the anterior interosseous artery" justified?

In 1993 Angrigiani raised the question as to whether the distal part of the posterior interosseous artery (AIP) is a recurrent branch of the anterior interosseous artery (AIA) and forms a "choke"--anastomosis with the AIP in the middle of the forearm. A dissection study was conducted on 66 upper extremities to evaluate the diameters of the dorsal branch of the anterior interosseous artery, the anastomotic branch, the diameter of the posterior interosseous artery at the point of origin of the septocutaneous perforators in the middle of the forearm and the diameter of the posterior interosseous artery at the point of emergence in the dorsal compartment. We further tried to identify different forms and types of the "distal" anastomosis and the connections to the dorsal carpal arch and the ulnar artery.

The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery.

The pedicled lower trapezius musculocutaneous flap is a standard flap in head and neck reconstruction. A review of the literature showed that there is no uniform nomenclature for the branches of the subclavian artery and the vessels supplying the trapezius muscle and that the different opinions on the vessels supplying this flap lead to confusion and technical problems when this flap is harvested. This article attempts to clarify the anatomical nomenclature, to describe exactly how the flap is planned and harvested, and to discuss the clinical relevance of this flap as an island or free flap.

Clinical application of the retrograde arterialized venous flap.

Retrograde arterialized venous flaps were applied to skin and soft-tissue defects in 13 patients with an average age of 34.4 years. Ten defects were located on the hand, and three on the lower leg.

Retrograde arterialized venous flap: an experimental study.

An experimental model was established to study circulation in retrograde arterialized venous flaps (RAVF). Venous flaps measuring 7 x 4 cm with a matching venous system were harvested from both forearms of 10 fresh human cadavers. In each trial, both flaps were simultaneously perfused with heparinized human blood driven by a pulsatile circulation model.

Vacuum-assisted wound closure for cheaper and more comfortable healing of pressure sores: a prospective study.

Pressure sores are a common complication of patients with spinal injuries. The vacuum-assisted closure technique is widely used to induce and promote wound healing. We tested our clinical impression that pressure sores healed faster with vacuum-assisted closure, and compared it with the traditional wet-to-dry/wet-to-wet technique with gauze soaked in Ringer's solution changed three times a day.

Hand surgery and the internet: results of a worldwide survey.

The opportunities offered by the Internet are employed increasingly in medicine. To obtain data on the extent to which the Internet is used by hand surgeons, survey forms were sent to 1043 participants of the Congress of the IFSSH in Vancouver in 1998. Ninety-four per cent of the respondents use the Internet.

Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy.

Objective: Besides other factors, the choice of reconstructive method for full thickness thoracic wall defects depends on the morbidity of preceding surgical procedures. The pedicled latissimus dorsi flap is a reliable and safe option for reconstruction of the thorax. A posterolateral thoracotomy, however, results in division of the muscle.

[Water jet dissection in fatty tissue].

Background: The first report about the use of water-jet dissection in surgery dates 1982. The advantage compared to conventional cutting is the preservation of vessels and nerves, thus facilitating the precise coagulation thereafter. Devices of the new generation with coherent jet are used in liver surgery in order to reduce blood loss.

[Iatrogenic necrosis of the large toe after tourniquet placement--clinical course and reconstruction].

We present a necrosis of the big toe in a 20-year-old woman with an ingrowing toenail after wedge-shaped excision in the big toe. The reason for the necrosis was a tourniquet that was left in place after the operation. The ischemia, which lasted for 2 days, resulted in subtotal necrosis of the big toe.

[The lower trapezius muscle island flap. Anatomic principles and clinical relevance].

Up to now, there is no uniform anatomic description neither of the branches of the subclavian artery nor of the pedicle of the lower myocutaneous trapezius flap. A dissection study was carried out on 140 necks in 70 cadavers. Variations of the subclavian artery and its branches, vessel diameter at different levels, the course of the pedicle under the levator scapulae muscle, the arc of rotation of the island flap, and the variations of the segmental intercostal branches to the lower part of the trapezius muscle were examined.

[The posterior interosseous flap--review and personal experience].

The posterior interosseous flap was first introduced by Zancolli and Angrigiani (1985) and short time later by Penteado and Masquelet (1986). The flap is used for soft tissue reconstruction in the hand but has not gained wide acceptance due to tedious pedicle dissection and venous problems. In 1993, Angrigiani et al.

Venous thrombosis in a replanted finger with underlying factor V Leiden mutation.

Resistance to activated protein C (APC resistance) was described recently as a cause for thrombophilia. APC inactivates coagulation co-factors Va and VIIIa. A single base-pair mutation changing Arg506 to Gln at the APC cleavage site of the factor V gene leads to a factor V Leiden variant, which is the most frequent cause of APC resistance.

Transsection of the peroneal nerve complicating knee arthroscopy: case report and cadaver study.

We report the case of a 36-year-old male patient who sustained a hyperextension trauma of the left knee. After performing diagnostic arthroscopy (partial tear of the anterior cruciate ligament) and partial resection of the anterior cruciate ligament, the patient experienced a complete paralysis of the peroneal nerve. One year after the first surgical procedure, a reconstructive repair of the peroneal nerve and a transfer of the anterior tibial muscle was performed.

Life-saving muscle flaps in tracheobronchial dehiscence following resection or trauma.

Objective: In the presence of acute inflammation and necrosis of the wall, tracheo-bronchial defects are difficult to manage. The absence of adequate vascularization and the contaminated area prevent successful direct re-suturing.

Methods: In order to restore a sufficient blood supply we used a pedicled latissimus dorsi or a pectoralis major flap that was entered into the thorax after a 10-cm resection of the second rib.

Reconstruction of a complex defect on the foot with an osteotendofasciocutaneous lateral arm free flap. Case report.

A one-stage reconstruction of a complex defect of the dorsum of the foot was undertaken with an osteotendofasciocutaneous lateral arm free flap in a 21 year old man. A vascularised strip of the triceps tendon with the adjacent part of the olecranon was used to reconstruct a missing tibialis anterior tendon with the insertion into the medial cuneiform bone. Recovery was uneventful and he was discharged from hospital after two weeks.

[Abdominal fibromatosis in a 58-year-old male patient].

We report on a 58 year-old male patient, in whom abdominal fibromatosis occurred 3 years after laparotomy and irradiation on account of rectal cancer. Abdominal fibromatosis are very rare tumour-like fibrous lesions of the anterior muscular abdominal wall, mainly affecting fertile females. Men, however, are only rarely affected and without age preponderance.