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Biomedical subjects

B Mayou

Publications and source records attributed to B Mayou.

10 recordsLinked to original sources

Free vascularised fibular grafts for congenital pseudarthrosis of the tibia.

We describe 11 patients with congenital pseudarthrosis of the tibia treated by a free vascularised fibular graft (FVFG) and followed up from 10 to 64 months (mean 38). Bony union was achieved in nine of the 11 cases: two failures required amputation. The mean time for union in the successful cases was five months. Nine of the 11 patients had had an average of four surgical procedures before the FVFG, so the graft was a salvage procedure for which the only alternative was amputation. FVFG is recommended as a primary procedure for the treatment of congenital pseudarthrosis of the tibia if there is a large tibial defect (over 3 cm) or shortening of more than 5 cm. The primary use of this operation is not advised for cases in which standard orthopaedic procedures are expected to succeed. For a small defect with a favourable prognosis (Boyd and Sage 1958), we recommend conventional bone grafting, intramedullary nailing and electrical stimulation.

Adolescent

Experimental microvascular autogenous vein grafts for arterial defects: II. A histopathologic study of the grafts.

Twelve autogenous vein grafts, of average diameter 1.5 mm, which had been used to bridge defects in the contralateral femoral artery of adult rabbits by a minimally traumatic technique, were examined over a 12-week postoperative period. Each graft remained widely patent but showed fibroelastic intimal thickening with time. Further evidence of arterialisation was the development of a prominent subintimal layer of smooth muscle. Also noted was the presence of medial fibrosis, with both calcification and ossification. This latter is suggestive of damage due to disruption of the vasa vasorum. It would appear that arterialisation of microvascular vein grafts occurs independently of surgical trauma and is therefore difficult to avoid. However, these pathologic changes were not as severe, nor was there as much luminal narrowing, as at the previously described anastomotic sites. The most important cause of these changes appears to be arterial pressure.

Animals

Experimental microvascular autogenous vein grafts for arterial defects: a study of anastomotic sites.

Autogenous femoral vein grafts with an average external diameter of 1.5 mm and an average length of 2.87 cm have been used to bridge defects in the contralateral femoral artery of 15 adult New Zealand white rabbits. An experimental microvascular technique to minimise trauma to the graft was performed, by which clamps were never applied to the graft itself. Patency was assessed over a 12-week period, and the overall graft success rate, excluding one technical failure, was 86%. Each of the three failures resulted from thrombosis. Histologic examination of the patent anastomoses showed marked medial damage at 1 week, complicated by fibrosis and calcification by 4 weeks; thereafter the intima developed prominent fibroelastic thickening. This led to a degree of luminal narrowing by 12 weeks. However, the underlying medial damage, attributable to operative trauma, did not seem to diminish luminal patency.

Animals

Oral and gastrointestinal manifestations of epidermolysis bullosa.

The mouth, oesophagus, and anus are often involved in dystrophic and junctional epidermolysis bullosa, but the frequency is unknown. Among 246 patients with epidermolysis bullosa, dysphagia developed in 76% of those with recessive dystrophic, in 20% of those with dominant dystrophic, in 15% of those with junctional, and in 2% of those with simplex forms. Lingual adhesions or microstomia occurred in dystrophic epidermolysis bullosa only, but were eight times more common in recessive than in dominant subtypes. These lesions are provoked by the trauma of eating and further reduce food intake, which exacerbates constipation caused by anal blisters and results in malnutrition. Management requires specialised multidisciplinary care.

Adolescent