IntroductionThe thoracic duct is the primary lymphatic vessel and it collects the lymphatic fluid from all the minor lymphatic vessels. Its distal dilated origin is known as cisterna chyli and it is usually located on the anterior surface of the first or second lumbar vertebra. It extends superiorly and usually drains into the left subclavian vein [3,7]. Thoracic duct injury and chylous leakage is a rare complication in spine surgery. However, lymphatic injury after spinal operations [10,12,17] Abstract The aim of this study is to localize and document the anatomic features of the thoracic duct and its tributaries with special emphasis on the spinal surgery point of view. The thoracic ducts were dissected from nine formaldehyde-preserved male cadavers. The drainage patterns, diameter of the thoracic duct in upper, middle and lower thoracic segments, localization of main tributaries and morphologic features of cisterna chyli were determined. The thoracic duct was detected in all cadavers. The main tributaries were concentrated at upper thoracic (between third and fifth thoracic vertebrae) and lower thoracic segments (below the level of ninth thoracic vertebra) at the right side. However, the main lymphatic tributaries were drained into the thoracic duct only in the lower thoracic area (below the level of the tenth thoracic vertebra) at the left side. Two major anatomic variations were detected in the thoracic duct. In the first case, there were two different lymphatic drainage systems. In the second case, the thoracic duct was found as bifid at two different levels. In formaldehyde preservation, the dimensions of the soft tissues may change. For that reason, the dimensions were not discussed and they may not be a guide in surgery. Additionally, our study group is quite small. Larger series may be needed to define the anatomic variations. As a conclusion, anatomic variations of the thoracic duct are numerous and must be considered to avoid complications when doing surgery.
Sixty-nine lower extremities of 45 patients (mean age, 10 years 8 months) with tibia vara were treated with the Ilizarov circular external fixator and distraction osteogenesis. Twenty-four of the patients had bilateral involvement, six of whom had simultaneous surgery and the remaining 18 had staged operations 8 to 12 months apart. In 11 limbs with femoral valgus deformity greater than 10 degrees simultaneous corrections were done. Active movements of the joints of the extremity were encouraged the day after surgery and partial weightbearing began 2 days later. All patients were followed up 27 to 178 months (mean, 80 months) after surgery. No neurovascular complications, delayed union, or nonunions were observed. The mean 28.6 degrees varus tibiofemoral angle preoperatively (range, 15 degrees -45 degrees ) improved to 7.5 degrees valgus (range, 0 degrees -18 degrees ) postoperatively. The preoperative internal torsion angle also improved from 20.7 degrees (range, 0 degrees -48 degrees ) to 3.5 degrees external torsion (range, 0 degrees -9 degrees ) postoperatively. Residual deformity was seen in six patients, and they had successful revision surgery using the same technique. The Ilizarov method allows early weightbearing and motion and allows all components of the deformity to be corrected.
The RUST scoring system appears to be a reliable tool for the evaluation of clinical outcomes in management of tibial fracture.
Seven children with a post-traumatic cubitus varus deformity were treated using the Ilizarov technique of distraction osteogenesis. The outcome was rated as excellent in each case and all were satisfied with the cosmetic appearance. No complications had been encountered by the latest follow-up at a mean of 66.7 months. This technique seems reliable for the treatment of such deformities, provided that it achieves full correction by gradual distraction. Nerve palsy and unsightly scars are avoided, and the range of movement of adjacent joints is preserved.
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