Dysphagia is a common complication of anterior surgery of the cervical spine. The incidence of post-operative dysphagia may be as high as 71% within the first two weeks after surgery, but gradually decreases during the following months. However, 12% to 14% of patients may have some persistent dysphagia one year after the procedure. It has been shown that female gender, advanced age, multilevel surgery, longer operating time and severe pre-operative neck pain may be risk factors. Although the aetiology remains unclear and is probably multifactorial, proposed causes include oesophageal retraction, prominence of the cervical plate and prevertebral swelling. Recently, pre-operative tracheal traction exercises and the use of retropharyngeal steroids have been proposed as methods of reducing post-operative dysphagia. We performed a systematic review to assess the incidence, aetiology, risk factors, methods of assessment and management of dysphagia following anterior cervical spinal surgery.

This paper describes the successful reconstruction of badly injured thumbs in nineteen patients with transposition of a neurovascular pedicle island flap from the dorsum of the index finger. The flap has a consistent arterial supply (the first metacarpal artery), good sized veins, and terminal branches of the superficial radial nerve. Five patients had either palmar, dorsal, or circumferential loss of soft tissue from the thumb. Twelve patients had acute traumatic amputations requiring distal thumb reconstruction, and two patients had distal amputations with late reconstruction. In both immediate and late reconstruction, we maintained length and skin coverage with good circulation and sensation. This one-stage operation requires less postoperative care than many other procedures currently in use and may be employed in a wider variety of cases.

Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedics. However, no study has investigated TXA in complex tibial plate surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of IV (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the IV group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution before 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared for the three groups. Results Baseline data were comparable for all groups. The IV group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 29.4 ml, 219.3 ± 33.4 ml, respectively, all p values < 0.001). The topical group performed excellently with regard to postoperative vascular events, wound complications, and adverse reactions, but there was no statistical significant in the incidence of these between the groups. Conclusion This study presents the first information to show that both IV TXA and topical TXA are safe and effective for complex tibial plateau fractures. The IV regimen effectively reduced blood loss during the perioperative period, whereas the topical regimen had a better safety profile.

Case records of 166 patients with 180 major arterial limb injuries inflicted between 1959 and 1991 were reviewed. A total of 167 (95.4%) repaired arteries initially remained patent. Nine patients developed ischaemic contracture of their limbs, which required amputation. Late follow-up of 6 months — 30 years (mean 5 years) was obtained for 75 patients; 73 of these repairs remained patent. Early diagnosis, prompt treatment, complete débridement, appropriate coverage of the repaired vessels, fasciotomy when indicated and simultaneous treatment of concomitant injuries are crucial factors in successful limb salvage and in maintaining patency of the repaired vessels.