Reperfusion injury by the abrupt restoration of circulation after the prolonged ischemia has been remained unsolved problem in the reconstructive microsurgery. We tested the hypothesis that a procedure of intermittent interruption of reperfusion, i.e., postconditioning (post-con) attenuates ischemia/reperfusion (I/R) injury of rat epigastric skin flap. A complete 4 hours of ischemia was generated by occlusion of the pedicle of dissected flap. The post-con procedure was started at the end of ischemia. A cycle of 15 seconds of full reperfusion, followed by 15 seconds of complete reocclusion was repeated six times (3 min of total intervention) prior to the unlimited reperfusion. Flap necrosis area of post-con group was compared with sham (no ischemic exposure) and control (4 hours of ischemia followed by full reperfusion without intervention) groups at postreperfusion day 5. Histology and MPO activities of flaps were evaluated. The post-con group showed significantly reduced flap necrosis at the end of 5 days of reperfusion compared with the control. Decreased inflammatory cell infiltration and MPO activity indicated post-con attenuated acute inflammatory reaction caused by I/R. This study reports for the first time that ischemic post-con effectively attenuates skin flap I/R injury. With further study, post-con may eventually be clinically applicable for the I/R injury as an "after-injury strategy."
Minimally invasive plate osteosynthesis (MIPO) has been used for humeral shaft fractures, but concerns exist about soft tissue injuries. The purpose of this study was to report the surgical technique and clinical outcomes of MIPO using a helical plate for metadiaphyseal complex humeral shaft fractures. Twelve patients with acute displacement involving proximal and middle third humeral shaft fractures (AO type C) were treated using the MIPO technique with a helical plate. Fracture union, complications, and functional outcomes were evaluated using the Constant-Murley score and Mayo Elbow Performance Score (MEPS) at final follow-up. All fractures united at an average of 17.9 weeks. No major complications, such as neurovascular injury, infection, and nonunion, were observed. Mean Constant-Murley and MEPS scores at final follow-up were 88.6 and 97.9, respectively. A MIPO technique using a helical plate can be a useful surgical option for metadiaphyseal complex fractures of the humeral shaft.
We reviewed 22 children with cubitus varus who had been treated by a reverse V osteotomy and fixation by cross-pinning and wiring. The mean pre-operative humeral-elbow-wrist angle was -16.9 degrees (-25 degrees to +9 degrees ) and at the latest follow-up it was +7.3 degrees (-2 degrees to +14 degrees ). No child had a lateral prominence greater than 5 mm after correction. An excellent result was achieved in 20 children and a good result in two. We believe that this osteotomy has the advantages of better inherent stability, the avoidance of a prominent lateral condyle after correction and firm fixation allowing early movement.
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