Biomedical subjects

A S Touliatos

Publications and source records attributed to A S Touliatos.

10 recordsLinked to original sources

PubMed1997

Surgical management of tibial plateau fractures.

From 1992 to 1996, 49 patients with 49 tibial plateau fractures underwent operative treatment at the First Orthopaedic Department of the General Hospital of Athens. There were 3 type I fractures, 12 type II, 5 type III, 9 type IV, 5 type V and 15 type VI according to Schatzker's classification. 7 of the type VI fractures were open (5 grade II and 2 grade IIIA). All fractures were managed with open reduction and internal fixation and were followed to complete healing which averaged 4 months. 28 patients had excellent results, 13 good, 6 fair and 2 poor results. The fair and poor results were in polytrauma patients and in patients with open (grade II and grade IIIA) type VI fractures. Open reduction and internal fixation, when not strongly contraindicated, was found to be the preferred treatment in displaced tibial plateau fractures.

Bone Plates↗

PubMed1995

Current indications for single digit replantation.

The functional outcome of 67 successfully replanted single digits (excluding the thumb) involving 31 complete and 36 incomplete nonviable amputations was found to be strictly related to the level of the amputation. While the survival rate was higher in patients with incomplete nonviable amputations (89 percent), compared to those with complete amputations (81 percent), the ability of the patient to use their digit was almost uniform among both groups of patients. All except 2 of the 9 digits with complete amputations at the level of the proximal phalanx or at the proximal interphalangeal joint (PIP) resulted in limited motion (less than 20 degrees-30 degrees) at the PIP and distal interphalangeal (DIP) joints. Only 9 from the group of patients with incomplete nonviable amputations at the proximal phalanx exceeded flexion greater than 40 degrees at the PIP joint. From these results, we conclude that the indications for replantation of a single digit amputation should be as follows: 1) amputation distal to the insertion of the flexor digitorum sublimis; 2) ring injuries type II and IIIa; and 3) amputations at the level of or distal to the DIP joint.

Adolescent↗

PubMed1995

Complete versus incomplete nonviable amputations of the thumb. Comparison of the survival rate and functional results.

81 patients with 84 complete (55) or incomplete (29) nonviable amputations of the thumb were studied to compare the survival rate and functional results between the two groups. 3 of these patients had bilateral thumb amputations. Of the 55 completely amputated thumbs, 43 survived (78 percent), while of the 29 incomplete nonviable amputations, 25 were salvaged (86 percent). Excluding patients with an amputation at the level of or distal to the interphalangeal (IP) joint, motion at the IP joint which did not exceed 40 degrees flexion even when a secondary procedure was done, did not show a statistical difference between the 2 groups. Average two-point discrimination was 14 mm for patients with complete amputations and 11 mm for patients with incomplete nonviable amputations. We conclude that incomplete nonviable amputations of the thumb are associated with a higher survival rate and better sensibility than complete thumb amputations, while motion at the IP joint does not differ between the two groups of patients.

Activities of Daily Living↗

PubMed1995

Alternative techniques for restoration of bony segments in digital replantation.

We present our experience from 108 partially or totally amputated digits in 87 patients which were replanted or revascularized successfully by the Orthopaedic Microsurgical Team at the University of Ioannina Medical School in Greece, during the period from 1978 to 1994. The majority of the patients were men involved in occupational accidents. Bone shortening always preceded the osteosynthesis and the vessel anastomosis, and most of the available methods for osteosynthesis were used, including small plates, single lag screws, crossed Kirschner wires, a combination of intraosseus cerclage wires and Kirschner wires, and intramedullary Kirschner wires. Our findings suggest that the most appropriate method for bone fixation in digital replantation is the insertion of one intramedullary Kirschner wire, supplemented by another wire which is inserted at the end of the procedure. This technique was found superior for the following reasons: 1) it's simplicity and the speed of the technique reduced the ischemic time; (2) less bone exposure was required; (3) less skeletal mass was needed for fixation; and (4) prior to the insertion of the second Kirschner wire, rotation of the replanted part was possible if it was necessary to re-align the vessels or to correct any rotational deformity.

Amputation, Traumatic↗

PubMed1995

Adamantinoma of the olecranon. A report of a case with serial metastasizing lesions.

Adamantinomas are slow-growing, invasive malignant tumors. Although the majority of cases have arisen in the tibia, these aggressive tumors have been reported in most of the long bones. This is the first known report of a patient with adamantinoma of the olecranon, an unusual site for this lesion. However, the patient not only had a novel site of appearance of the tumor and local recurrence of the disease, but also had a series of distant, isolated, bony tissue metastases before a fatal metastasis to the lung within a 9-year period. Although metastasis to other bony sites has been reported, a series of metastases to bony and soft tissues is unusual.

Ameloblastoma↗

PubMed1994

Bilateral thumb amputation.

Seventy-one patients with thumb amputations, 45 complete and 26 incomplete nonviable, have been treated at the Microsurgical Unit of the Department of Orthopaedic Surgery at the University of Ioannina Medical School over the past 15 years. Of these thumb amputations, which included crush, avulsion, and guillotine injuries, three cases involved amputation of both thumbs. The three patients with complete bilateral thumb amputations are presented. Because of the importance of the thumb, microsurgical replantation efforts were made which proved successful for two of the patients. Replantation efforts in the third patient, who had severe crush injuries of both thumbs, were not successful. Bilateral thumb amputation is a serious and disabling injury. When replantation is attempted by a team of surgeons well trained in microsurgery, the final result can be impressive, with exceptionally good function of the replanted thumbs.

Adolescent↗

PubMed1992

Forearm flap in orthopaedic and hand surgery.

This study was undertaken in order to evaluate the usefulness of the forearm flap in reconstruction of severe injuries of the upper and lower extremities. A total of 34 patients with extensive skin defects of the upper and lower extremities were treated using radial forearm flaps during the last 4 years. Twenty-four patients had lower extremity injuries, while the remaining ten had upper extremity reconstruction. In two patients, the radial forearm flap was used as an island flap in retrograde direction for coverage of skin defects of the dorsum of the hand. In two patients, the palmaris longus tendon was included in the flap to reconstruct the extensor tendon of the index finger. In one patient, it was used as an innervated flap to cover a skin neurotrophic defect of the sole of the foot. None of the patients had the bony portion of the radius included. Of the 34 flaps, 29 survived. Of the remaining 5, 3 failed totally and 2 partially. The 2 partially failed flaps required reoperation and revision of the venous anastomosis, which was found to be occluded. The patients, eight women and twenty-six men, were examined and questioned regarding the cosmetic appearance of the donor site. The final cosmetic appearance was acceptable to all patients. We conclude that the radial forearm flap is a useful, easily elevated flap, suitable for skin defects of upper and lower extremities. Major advantages of the flap are its ability to be used as an island flap and that the surgery can be performed under axillary block anaesthesia.

Adult↗

PubMed1992

Post-discectomy perineural fibrosis: comparison of conventional versus microsurgical techniques.

The lumbar spines of twenty-one dogs were used as an experimental model. The animals were divided into three groups. In the first group, selective damage to the perimeningeal blood vessels was induced and the resultant hematoma was left untouched in the spinal canal. In the second group, the posterior longitudinal ligament was incised, and in the third group, the posterior longitudinal ligament was incised and damage induced to the perimeningeal blood vessels. The pathology examination revealed: (1) the hematoma itself did not lead to the formation of perineural fibrosis, (2) the incision of the posterior longitudinal ligament led to the formation of a limited amount of fibrosis, and (3) the coexistence of hematoma and incision of the posterior longitudinal ligament led to the formation of extensive perineural fibrosis. When discs are removed using microsurgical techniques, it is possible to avoid the formation of the postoperative hematoma and consequently to eliminate the perineural fibrosis.

Animals↗

PubMed1992

Experimental evaluation of the length of microvenous grafts under normal tension.

Four groups of microvenous grafts of 2, 4, 6, and 10 cm were used to determine whether length under normal tension affects patency rates in bridging arterial defects. Tension was evaluated by allowing the grafts to assume their normal orientation and length by filling them with blood, under physiological pressure, after the completion of the proximal anastomosis. The length was estimated through the normal range of motion such that the graft would not be too loose and/or tortuous following final anastomosis. The patency rates in the four length groups of this study ranged between 80% and 83%, with no statistical difference between groups. No statistically significant correlation was found between graft length and patency rate. It was concluded that the length of venous autografts does not affect patency.

Anastomosis, Surgical↗

PubMed1989

Evolution and present status of orthopedic microsurgery in Greece.

Replantation of complete or incomplete nonviable amputations of digits, hands, and major limbs along with a number of reconstructive microsurgical procedures reflect the work that has been done in the field of orthopedic microsurgery in Greece during the last ten years. The history of trauma microsurgery in Greece starts in the mid-1970s, when the first attempts were directed toward patients with complete or incomplete nonviable amputations of digits and hands. Few cases of major limb replantations without the aid of an operating microscope or other means of magnification have been reported for the years 1965-1975. The first successful digital replantation was performed in 1979 on a female patient with multiple digit amputations; only the little finger was successfully replanted. More than 310 replantations and revascularization procedures have been performed during the past decade, mainly in two major replantation centers, with an overall success rate of 85% for complete and 90% for incomplete nonviable amputations. Reconstructive microsurgical procedures are mainly related to free skin flaps, vascularized bone grafts, toe-to-thumb transfer, and peripheral nerve microsurgery.

Greece↗