A retrospective study of 130 digital replantations was analyzed to identify factors influencing success rates. At the amputation between the middle phalanx and distal interphalangeal joint, it was found that type of injury and number of anastomosed vessels and veins were the most important factors. Amputations caused by mechanical crush reduced the number of available vessels for anastomoses. Having an anastomosed artery without any anastomosed vein significantly reduced the success rate compared with cases of amputation by knife or sawing machine, where at least an artery and a vein could be anastomosed. In replantation at the distal phalanx, only one anastomosed artery without any anastomosed vein could also result in high success. And in most cases of amputation between the proximal phalanx and proximal interphalangeal joint, there was no difficulty in finding at least an artery and a vein. Knowledge of anatomical transitions is therefore important for surgeons.

Purpose Three-dimensional computerised tomography (3DCT) can provide comprehensive patho-anatomy of complex bone on a single image. Though important, the key articular quadrilateral [Q] surface has not been a part of the systems developed for classifying acetabulum fractures. The purpose of the study was to simplify the complexity of classification by the direct sign of the broken Q surface which lies opposite the entire floor of the acetabulum. Methods The study reviewed 84 acetabular fractures using 3DCT images of the interior lateral view (IL) taken between June 2002 to December 2009. Fractures were traditionally classified using the anatomical disruption, plane of the fracture line breaking through or not through the bone column described by Judet and Letournel. Results The 3D images clearly show the primary site of impaction acting on the acetabulum and the whole course of fracture. The image could not illustrate disruption of the lips of acetabulum and congruity of hip joints in 20 cases of wall (W) fracture. There were 30 transverse (T) fractures classified when the acetabulum was divided horizontally from front to back into upper and lower parts and 34 cases of column (C) fracture when the main vertical lines run and collide along the anterior and posterior column. Conclusions This study showed that the well-known complex fractures can be satisfactorily classified with the broad flat inner plane of the Q surface.

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A retrospective analysis of the records of 107 free flap transplants in 94 patients operated on between May of 1992 and September of 1997 at the Center for Microsurgery of Extremities, Nopparatrajathanee Hospital, was conducted to study the risk factors leading to free flap failure. These factors were periods of operation to reflect the experience of the surgeon, locations of the defects, anastomotic techniques, and the use of vein grafts. Chi-square, Fisher's exact test, and multiple logistic regression analysis were used to determine the significance of the data. The overall vascular complication rate was 28 percent (30 of 107 transplants) and the re-exploration rate was 13 percent (14 of 107 transplants), the flap salvage rate was 50 percent (7 of 14 flaps), whereas the overall failure rate was 15 percent (16 of 107 transplants). The significant factors that caused free flap failure were the experience of the surgeon and the use of vein grafts. The most important experience was in the choice and preparation of the recipient vessel. When the surgeon gained more experience in the past 2 years (from October of 1995 to September of 1997), the success rate improved significantly. Moreover, the use of vein grafts no longer affected the outcome. Therefore, in this investigation the most important factor that improved the outcome of free tissue transplantation in the extremities was the experience of the surgeon in choosing and preparing the recipient vessels.