The purpose of this study was to evaluate histological changes occurring in the microcirculation of a muscle flap following prolonged ischemia and to correlate them with the flow hemodynamics. The cremaster muscle flap model was used for direct in vivo studies of the microcirculation. In 45 rats, vascular clamps were applied to the iliac and femoral vessels following flap isolation. Flaps were subjected to various periods of ischemia, ranging from 4 to 6 hours, and 2 hr of reperfusion. In vivo observations of the microcirculation and vessel diameter measurements were taken at 1 hour intervals for an 8 hr period. With prolonged ischemia, return of circulation to the flap was delayed and no flow was observed following 6 hr of ischemia. Morphologic changes at 6 hr revealed red cell and platelet thrombi formation within the capillaries, marked dilatation of postcapillary venules, endothelial swelling in the capillaries, and microhemorrhage formation around the venules.
Aim: The aim of the study was to evaluate the elongation and improvement of cosmetic appearance of hypoplastic fingers and to estimate the influence of non-vascularized middle toe phalanx transfer on the structure and function of the foot. Material and methods: This study analysed 32 patients who underwent free middle toe phalanx transfer to the hand, 128 toe phalanges were transferred. Age at the time of operation ranged from 6 months to 9 years (mean 35 months). Patients were divided into three groups: Abefore 12 months, B -12 to 24 months and C -older than 24 months. The follow-up period ranged from 2 to 8 years (average 63 months). Phalanges were excised extraperiosteally. The operation was performed through the dorsal approach either on the hand or feet. Both transferred phalanges and toes they were taken from were stabilized with ''K'' wires. The growth of phalanges was measured based on standard X-rays with markers. Toe shortening was measured based on standard X-rays with markers and on the clinical examination. Results: Mean growth rate 70% (from 0%-200%) was dependent on the age of child operated on. Group A: 95.6%; group B: 90.8%; group C: 45.8%. Mean toe shortening was 4 mm (2-8 mm). In five cases (16%) change in donor toe axis was observed. In six cases subluxation or luxation of the phalanx required reduction. Despite this, none of the patients complained of pain or walking disorders in the follow-up period. Nearly all the patients and their parents were satisfied with the improvement of the cosmesis of the hypoplastic finger and the feet function. Conclusions: Non-vascularized middle toe phalanx transfer is a good method to improve cosmetic appearance of the hypoplastic finger mainly because of elongation and does not significantly change the structure and function of the foot.Background: Pollicization is performed sufficiently infrequently that there are few large series with outcomes analysed.
Background:Little is known about the long-term results of lunate revascularization or replacement by vascularized bone transfer in Kienbo¨ck's disease. Method: Thiety-seven patients were reviewed (follow-up: 11.275.0 years) to analyse results after lunate revascularization or replacement by vascularized pisiform transposition in relation to Lichtman stage. Results: In 24 patients no carpal collaps was seen on preoperative X-ray representing Lichtman's stage IIIa or less. On follow-up the average Mayo-score was
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