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Despite their benign nature some symptomatic aggressive vertebral haemangiomas (AVH) require surgery to decompress spinal cord and/or stabilise pathological fractures. Preoperative embolisation may reduce the considerable blood loss during surgical decompression. This systematic review investigated whether preoperative embolisation reduced surgical blood loss during treatment of symptomatic AVH. PubMed Medline, Web of Science, and Ovid Medline were searched for case reports and clinical studies on surgical AVH treatment. Included were cases from all publications on surgical treatment of AVH where the amount of surgical blood loss and the use of preoperative embolisation were documented. 51 cases with surgically treated AVH were retrieved from the included studies. Blood loss in the embolised treatment group (980±683 mL) was lower than the non-embolised control group (1,629±946 mL). This systematic review found that embolisation prior to AVH resection reduced surgical blood loss (level of evidence, very low) and can be recommended (strong recommendation).

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Vascular injury in lumbar disk disease is a common complication reviewed in the literature. In our study, we reviewed the rare complication of vascular injury that occurs during lumbar microscopic tubular discectomy. The patient is a 46-year-old male, diabetic, hypertensive and a smoker who presented with a history of backache and right-sided radiculopathy to S1 dermatome for 6 weeks. Conservative measures failed, and we planned and performed microscopic tubular discectomy at the level of L5-S1. Immediately postoperatively, the patient developed acute, sharp, burning pain in the left leg, partially relieved on hip flexion, with diminished distal pulsation of dorsalis pedis, popliteal and femoral. Urgent consultation with a vascular surgeon included a computed tomography angiography which confirmed a vascular injury of the left iliac artery and vein near the bifurcation. The plan involved urgent retroperitoneal exploration of the left iliac vessels, and primary repair with synthetic graft was done with distal embolectomy to regain distal pulsation postoperatively. Further follow-up revealed that the repair was successful.

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Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding. ABSTRACTBackground: Flexible flatfoot is a physiological variation of normality that does not need correction unless it becomes symptomatic1. The objective of this study was to assess the value of Lateral Calcaneal lengthening osteotomy in Symptomatic flexible Flat foot in children and adolescents to improve structural alignment while maintaining hind foot motion, which may further protect the function of adjacent motion segments. We performed this procedure on 36 feet of 22 patients where Achilles tendon lengthening is also done. Postoperative follow-up showed significant improvement in both clinical and radiological parameters and ankle foot score. Methods: In a prospective study conducted in abo aresh, Cairo University or orthopedic department in zagzaig University Hospital, 36 feet of 22 patients were operated for symptomatic flexible Flat foot from January 2010 and February 2014. All the cases were treated as per protocol. There were 12 female (54.5℅) and 10 males (45.5℅). Mean operation age was 10 years 4 months, range from 7 years 6 months to 17 years 2 months. There were 14 bilateral cases (63.6℅) and 8 unilateral cases (36.4℅). The average follow up duration was 18.7 months (SD 80.5) (ranging from 6 to 37 months). Inclusion criteria included painful, passively correctable pes planovalgus (No symptomatic arthritis in the subtalar, calcaneocuboid and talonavicular joints.). Exclusion criteria included fixed pesplanovalgus, osteoporosis of the calcaneum, advanced degenerative arthritis of the subtalar, talonavicular or calcaneocuboid joints, Paralytic condition affecting foot and ankle Severe bone metabolism disorder (e.g., poorly controlled insulin-dependent diabetes mellitus with neuropathy), severe trophic skin disorders and Standard contraindications to any surgery such as poor circulation, unhealthy or...

Background: Anterior cervical discectomy with fusion or arthroplasty is a common procedure and has been associated with satisfactory outcomes. However, the incidence of complications, although uncommon, needs to be taken into consideration. Aim of Study:Our aim is to raise awareness on anterior cervical disc procedures associated complications, their prophylactic measures proper management.Patients and Methods: Our prospective study conducted on 156 patients; 99 males (63.5%) and 57 females (36.5%); their age range was 26 to 65 years (mean, 45.2; SD, 12.5). The study started from January 2014 to December 2019. The follow-up was for at least 1 year, and we evaluated the clinical and radiographic signs of complications.Results: Thirteen patients (8.3%) had transient dysphagia and three patients (1.9%) had adjacent segment syndrome. two patients (1.3%) each had a post-operative hematoma and a dural tear, and two of fusion (1.4%) cases had pseudoarthrosis. One patient (0.6%) each had an esophageal injury, Recurrent laryngeal nerve palsy, post-operative weakness, Horner syndrome, wound infection, and slippage of artificial disc prosthesis. Conclusion:Punctilious knowledge and early recognition of the anterior cervical disc surgery-segment syndrome, hematoma, and pseudoarthrosis were the most common complications in our study, and their incidence relatively increases in multiple level cases associated with comorbidity. Appropriate management was done in the most majority of our cases with good functional outcomes.

Background: In peripheral nerve injury, end-to-side neurorrhaphy involves cooptation of the distal stump of a transected nerve to the trunk of an adjacent donor nerve. It has been proposed as an alternative technique when the proximal stump of an injured nerve is unavailable or the nerve gap is too long to be bridged by a nerve graft. End-to-side neurorrhaphy was first documented in the 19th century [1] . However; the technique has not been a clinical routine for almost a century. In early 1990s, Viterbo et al., [2] demonstrated successful nerve regeneration and muscle re-innervation in a rat end-to-side neurorrhaphy model. Aim of Study:A prospective experimental study was done to study, evaluate, and compere the histological results of neurorrhaphy in rats using end-to-end, end-to-side and endto-side long contact neurorrhaphy. Thereby presenting a different techniques and for the first time a comparative analytic study for the end-to-side long contact neurorrhaphy. Material and Methods:The experiment carried out on 74 male rats, divided into three groups. After two months all rats were evaluated histologically with immunohistochemistry staining.Results: The repaired grafts from the three groups were obtained from the animals for histological examination.Conclusion: End-to-side neurorraphy presently does not replace a sound primary nerve suture. It should be seen as an excellent, viable option when planning to address difficult peripheral nerve injuries.