Four groups of microvenous grafts of 2, 4, 6, and 10 cm were used to determine whether length under normal tension affects patency rates in bridging arterial defects. Tension was evaluated by allowing the grafts to assume their normal orientation and length by filling them with blood, under physiological pressure, after the completion of the proximal anastomosis. The length was estimated through the normal range of motion such that the graft would not be too loose and/or tortuous following final anastomosis. The patency rates in the four length groups of this study ranged between 80% and 83%, with no statistical difference between groups. No statistically significant correlation was found between graft length and patency rate. It was concluded that the length of venous autografts does not affect patency.

No abstract

Seventy-one patients with thumb amputations, 45 complete and 26 incomplete nonviable, have been treated at the Microsurgical Unit of the Department of Orthopaedic Surgery at the University of Ioannina Medical School over the past 15 years. Of these thumb amputations, which included crush, avulsion, and guillotine injuries, three cases involved amputation of both thumbs. The three patients with complete bilateral thumb amputations are presented. Because of the importance of the thumb, microsurgical replantation efforts were made which proved successful for two of the patients. Replantation efforts in the third patient, who had severe crush injuries of both thumbs, were not successful. Bilateral thumb amputation is a serious and disabling injury. When replantation is attempted by a team of surgeons well trained in microsurgery, the final result can be impressive, with exceptionally good function of the replanted thumbs.

This study was undertaken in order to evaluate the usefulness of the forearm flap in reconstruction of severe injuries of the upper and lower extremities. A total of 34 patients with extensive skin defects of the upper and lower extremities were treated using radial forearm flaps during the last 4 years. Twenty-four patients had lower extremity injuries, while the remaining ten had upper extremity reconstruction. In two patients, the radial forearm flap was used as an island flap in retrograde direction for coverage of skin defects of the dorsum of the hand. In two patients, the palmaris longus tendon was included in the flap to reconstruct the extensor tendon of the index finger. In one patient, it was used as an innervated flap to cover a skin neurotrophic defect of the sole of the foot. None of the patients had the bony portion of the radius included. Of the 34 flaps, 29 survived. Of the remaining 5, 3 failed totally and 2 partially. The 2 partially failed flaps required reoperation and revision of the venous anastomosis, which was found to be occluded. The patients, eight women and twenty-six men, were examined and questioned regarding the cosmetic appearance of the donor site. The final cosmetic appearance was acceptable to all patients. We conclude that the radial forearm flap is a useful, easily elevated flap, suitable for skin defects of upper and lower extremities. Major advantages of the flap are its ability to be used as an island flap and that the surgery can be performed under axillary block anaesthesia.

The lumbar spines of twenty-one dogs were used as an experimental model. The animals were divided into three groups. In the first group, selective damage to the perimeningeal blood vessels was induced and the resultant hematoma was left untouched in the spinal canal. In the second group, the posterior longitudinal ligament was incised, and in the third group, the posterior longitudinal ligament was incised and damage induced to the perimeningeal blood vessels. The pathology examination revealed: (1) the hematoma itself did not lead to the formation of perineural fibrosis, (2) the incision of the posterior longitudinal ligament led to the formation of a limited amount of fibrosis, and (3) the coexistence of hematoma and incision of the posterior longitudinal ligament led to the formation of extensive perineural fibrosis. When discs are removed using microsurgical techniques, it is possible to avoid the formation of the postoperative hematoma and consequently to eliminate the perineural fibrosis.