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At least 307 records · Page 17Linked to original sources
PubMed1977

Emergency care of the reimplantation patient.

Emergency care of the reimplantation candidate involves care of the patient as well as the severed part. The part should be cooled rapidly to 0-4 C (32-39.2 F) after gentle cleansing with normal saline solution or Ringer's lactate. The stump should be gently irrigated with normal saline and pressure dressing applied. The suitability of the reimplantation candidate, chances for survival of the amputated part, and likelihood of eventual rehabilitation should be evaluated.

Amputation Stumps↗
PubMed1990

Treatment of infected total knee arthroplasty. Irrigation and debridement versus two-stage reimplantation.

The results of 24 cases of deep wound infection after total knee arthroplasty were reviewed. Twenty-one knees were initially treated with irrigation and debridement. Infection recurred in 15 knees. An increased infection rate occurred after irrigation and debridement in patients in whom the index prosthesis was in place more than 2 weeks. Nine knees (including 7 that had removal after irrigation and debridement) were treated with removal of the infected prosthesis, intravenous antibiotics, and delayed reimplantation. Immediate exchange was done in one knee. There were no recurrences in this group (P less than .001). The final status of the patients included 8 with fusions or resection arthroplasties and 16 with a prosthesis. The average Hospital for Special Surgery knee rating was 41 in patients without a prosthesis and 75 in patients with a prosthesis (P less than .001). The authors conclude that irrigation and debridement is not likely to be successful for treatment of infections when used more than 2 weeks after the initial arthroplasty. Also, two-stage reimplantation for the treatment of infected total knee arthroplasties gives a reliably low recurrence rate and provides a superior clinical result, compared to arthrodesis or resection arthroplasty.

Debridement↗
PubMed1999

Cementless fixation in 2-stage reimplantation for periprosthetic sepsis.

Twenty-five patients with documented infection of the hip were reviewed. All patients underwent reconstruction in a 2-stage fashion with cementless implants. The average follow-up in this group was 41 months. The average time to reimplantation was 4.8 months. Of the 25 living patients, 22 retained their implants. There were 2 recurrences of infection, for an infection recurrence rate of 8% (2 of 25). The average postoperative Harris Hip Score was 81. Bone ingrowth was confirmed radiographically via the Engh fixation score in all but 1 of the surviving implants. Cementless fixation in 2-stage reimplantation can result in acceptable eradication rates, while supplying predictable fixation, provided that appropriate cementless revision implants are used.

Aged↗
PubMed2000

Carotid endarterectomy with reimplantation of the internal carotid artery: perioperative risk, and incidence of recurrent stenosis in 167 procedures.

Between 1990-1998, 167 carotid endarterectomies with reimplantation were performed on 153 patients. Indications for operation were asymptomatic stenosis >60% (50.2%), transient ischemic attacks (17. 4%), amaurosis fugax (14.4%) and previous stroke (18%). Our method involves transection of the internal carotid artery at its origin, standard endarterectomy without any eversion maneuver and reimplantation. Our results showed one postoperative stroke, which occurred at the contralateral side and no deaths with an overall perioperative morbidity and mortality rate of 0.59%. In addition, two (1.19%) transient ischemic attacks and one (0.59%) temporary ataxic event were noted with complete resolution of the symptoms. The 5-yr primary patency rate was 96% with a 95% 5-yr freedom from ipsilateral stroke. The mean follow up period was 22 months. In conclusion, we believe that our method, is relatively easy to perform, it has excellent results and it eliminates some of the disadvantages associated with the eversion technique.

Aged↗
PubMed1991

Studies on heat treatment for immediate reimplantation of resected bone.

Extracorporeal heat treatment for devitalizing the tumour-infiltrated bone segment without destroying its regenerative potential was investigated for the purpose of immediate reimplantation of the resected bone. Effects of heat treatment on cell viability and bone inductive properties were studied in cultured tumour cells and animal models. Heat treatment at 65 degrees C for 30 to 120 minutes resulted in complete devitalization of cells, preserving osteogenetic properties of the allogenic bone implant in the rabbit. The results of the experiments indicate that this procedure has advantages in devitalizing the resected bone for its immediate reimplantation and justify clinical application. The clinical application of this heat treatment in 3 cases is presented.

Adult↗
PubMed1999

Common sheath reimplantation with ureteral plication: a useful technique for the management of ectopic ureterocele.

BACKGROUND: When salvaging the upper pole kidney in duplex ectopic ureterocele, primary bladder level surgery with common sheath ureteral reimplantation has the definite advantage of allowing the reconstruction of the entire collecting system through a single lower abdominal incision. However, there are several complications associated with a common sheath reimplantation in a child with a very dilated upper pole ureter, such as vesicoureteral reflux or ureterovesical stenosis. METHODS/RESULTS: To avoid these complications, ureteral plication over the common ureteral sheath in two children with duplex ectopic ureterocele was used. Postoperatively, neither child showed reflux or recurrent urinary tract infection and both showed a marked improvement of the upper pole collecting system. CONCLUSION: This technique allows for a simple and definitive reconstruction in cases of duplex ectopic ureterocele, particularly with dilated upper pole ureter.

Child, Preschool↗
PubMed2005

Implications and outcome of permanent coronary sinus lead extraction and reimplantation.

OBJECTIVE: We examined the implications and outcome of coronary sinus (CS) lead removal including the feasibility of laser use within the CS. BACKGROUND: Cardiac anatomy and lead interactions are more complex with the advent of biventricular pacemakers and atrial cardioverters requiring permanent lead/shocking coil placement in the coronary sinus and its branches. METHODS: Fifty-five permanent cardiac leads were extracted during 2003 in 28 consecutive patients. Our study population included a 10/55 (18%) subset (all males; age 73 +/- 6 years; EF = 0.24 +/- 0.09) that underwent CS (1/10) or vein branch (9/10) lead extraction. Leads were extracted with an excimer laser sheath (n = 4) or by direct traction (n = 6). Median times between implantation and lead removal were 9.5 months (range 5-59) in the laser group and 3 months (range 3-4) in the direct traction group. Indication for extraction was infection (n = 4), dislodgement (n = 3), diaphragm stimulation (n = 2), and elevated threshold (n = 1). The CS was divided into distal, mid, and proximal segments by venogram. RESULTS: Entry of the laser sheath into the CS was necessary in three of four laser patients. The two distal CS laser cases (left lateral CS coil and anterior-lateral left ventricular (LV) lead) required both 14- and 12-Fr sheaths, separately. The proximal CS laser case (posterior-lateral LV lead) required a 12 Fr sheath. The remaining laser patient required a 12-Fr sheath to pass to the mid SVC. There were no procedural complications as a result of CS lead extraction. Reimplantation of a CS lead was attempted in 7/10 patients at a median of 4 days (range 1-300). CS venograms were available for review in patients before initial implantation (6/10) and after extraction (7/10). The postextraction venograms demonstrated complete occlusion of the vein from which the lead was extracted, and its distal branches, which were unusable in 5/10 (50%). The vein occlusions were present in patients with indwelling leads for greater than 3 months and were independent of extraction method. CONCLUSIONS: Laser lead extraction in the coronary sinus appears feasible in carefully selected cases with mandatory indications. However, special intraoperative monitoring and echocardiographic imaging with surgical backup ready is strongly recommended. Target vein selection may be limited for the purpose of reimplantation when leads are indwelling for greater than 3 months.

Aged↗
PubMed2001

Aspergillus fumigatus infection in a mega prosthetic total knee arthroplasty: salvage by staged reimplantation with 5-year follow-up.

Fungal infection after total joint arthroplasty is an extremely serious complication and a challenge to the treating physician. When a fungal infection is compounded by a massive allograft or a metallic segmental replacement of the femur or other long bone, treatment options become increasingly limited and commonly have led to arthrodesis or amputation of the infected limb. We present the first case report of a low-grade osteosarcoma treated with a segmental distal femoral allograft prosthetic composite knee arthroplasty, which was complicated by infection with Aspergillus fumigatus. This complication was treated successfully with a staged reimplantation procedure, intravenous amphotericin, and oral fluconazole suppression. At 5 years after reimplantation, the patient has had no evidence of infection, no pain, and excellent range of motion without extensor lag. The Knee Society knee score improved from 50 to 100, and the function score improved from 40 to 100 (for both scores, 100 is the maximum).

Adult↗
PubMed2003

Successful reimplantation of total femoral prosthesis after deep infection.

A 16-year-old boy developed a deep infection with methicillin-resistant Staphylococcus aureus 6 months after total femoral replacement including knee and hip joints. The deep infection was eradicated by the use of débridement with continuous irrigation and removal of all prosthetic components followed by insertion of an antibiotic-impregnated cement spacer. Six weeks later, the total femoral prosthesis could be successfully reimplanted with both acetabular and tibial components. Two and half years later, the patient remained free of infection. Débridement with continuous irrigation and an antibiotic-impregnated cement spacer can be a feasible technique for the treatment of deep infection after large prosthetic replacement. Furthermore, reimplantation should be performed after a short waiting period. Such treatment should be considered before deciding on amputation.

Adolescent↗
PubMed2003

Rapid communication: pure robot-assisted laparoscopic ureteral reimplantation for ureteral stricture disease: case report.

BACKGROUND AND PURPOSE: The role of the da Vinci robot is slowly being defined in minimally invasive urologic surgery. We report its use in the management of ureteral stricture disease. CASE REPORT: A 42-year-old man with recurrent kidney stone disease was found to have a left distal-ureteral stricture. After failure of endoscopic treatment, a robot-assisted laparoscopic ureteral reimplantation was performed. The total operative time was 210 minutes. The estimated blood loss was <50 mL. There were no intraoperative or postoperative complications. Total analgesic use was 30 mg of morphine. The hospital stay was 5 days. CONCLUSION: Pure robot-assisted laparoscopic ureteral reimplantation is a safe and feasible approach to the management of ureteral stricture disease.

Adult↗
PubMed2006

Laparoscopic ureteroneocystostomy with vesicopsoas hitch: nonrefluxing ureteral reimplantation using cystoscopy-assisted submucosal tunneling.

PURPOSE: We described laparoscopic nonrefluxing ureteral reimplantation with a psoas hitch using a submucosal tunneling technique combined with cystoscopy. PATIENTS AND METHODS: We performed this operation on two female patients. The first patient had a right lower-ureteral stricture after a laparoscopy-assisted vaginal hysterectomy, and the second patient had a left distal-ureteral stricture after a left laparoscopic oophorectomy, which was performed for endometriosis. We performed laparoscopic intravesical ureteral reimplantations with a psoas hitch using submucosal tunneling after a submucosal injection of normal saline was provided under cystoscopy. RESULTS: The operative times were 325 and 280 minutes, respectively. The estimated blood loss was 300 mL in the first case and 120 mL in the second. The hospital stays were 5 and 3 days, respectively. There were no postoperative complications. Follow-up voiding cystourethrography and intravenous urography demonstrated normal compliance and function of the kidneys and ureters with no vesicoureteral reflux. CONCLUSIONS: Laparoscopic intravesical nonrefluxing ureteroneocystostomy with a psoas hitch is a safe and feasible procedure. Cystoscopic submucosal injection of normal saline during submucosal tunneling is beneficial.

Adult↗
PubMed1998

Patellar component resection in revision and reimplantation total knee arthroplasty.

Between 1979 and 1995, 34 knees in 31 patients had a revision or reimplantation total knee arthroplasty in which the patellar component could not be reinserted. The patellar bone stock in each of those cases was compromised markedly and precluded adequate prosthetic fixation. The mean followup after the revision operation was 3.5 years (range, 2-14 years). The Knee Society knee score improved from a mean of 59 points preoperatively to a mean of 75 points postoperatively. The function score improved from a mean of 46 points preoperatively to a mean of 69 points postoperatively. Complications occurred in five patients: one patient sustained a patellar fracture that required no additional treatment; one experienced intermittent episodes of patellar subluxation; one had a recurvatum deformity develop and was treated with a brace; one had persistent knee stiffness and had four manipulations; and one patient had an extensor lag of 30 degrees develop. Twenty-six patients were satisfied with the results of their revision operations and five were dissatisfied. Ten patients had persistent knee symptoms referable to the patellofemoral articulation: mild pain in three; moderate pain in six; and severe pain in one. This study suggests that resection of the patellar component during revision or reimplantation total knee arthroplasty may be a reasonable approach for patients with markedly compromised patellar bone stock; however, mild or moderate anterior knee pain can be expected to persist in as much as 1/3 of these patients.

Arthralgia↗
PubMed2003

Complications associated with reimplantation after girdlestone arthroplasty.

Complications associated with reimplantation of a total hip arthroplasty after resection or Girdlestone arthroplasty for treatment of an infected hip are not well-documented. Forty-four hips in 44 patients with a minimum 2-year followup (range, 2-9 years) from the time of reimplantation total hip arthroplasty were evaluated retrospectively. The average Harris hip score changed from 40 preoperatively to 78 at the latest followup. One patient had persistent infection requiring rerevision surgery, and another patient had rerevision surgery for recurrent dislocation. Complications related to the prosthesis consisted of dislocations in five patients (11.4%), recurrent infection in one patient (2.3%), trochanteric nonunion in four patients (9.1%), hematoma in one patient, heterotopic ossification in one patient, and postoperative wound drainage in one patient. Resection arthroplasty of the hip is highly effective in eradicating infection. In the current series, 97.7% of patients were free of infection at the latest followup. However, with an 11.4% dislocation rate and 39% of patients having a persistent limp, alternative approaches need to be evaluated which might reduce these complications.

Adult↗
PubMed1992

Auditory perception changes after reimplantation in a child cochlear implant user.

The ability to remove cochlear implants from children and subsequently reimplant a more complex device in the same ear was the concern of this single case study. A postlinguistically deafened child, J.L., received a single-channel cochlear implant 1 yr after contracting meningitis and suffering a profound bilateral sensorineural hearing loss. After 3 yr of successful implant use, J.L. suffered an internal coil failure. She was then explanted and reimplanted with a multichannel cochlear implant in the same ear. This case report details her speech perception skills with her single-channel cochlear implant, a vibrotactile aid, and a multichannel cochlear implant. Results from auditory perceptual measures suggest that the explantation/reimplantation process was technically feasible with no adverse effects on J.L.'s ability to utilize a more sophisticated device and to exceed her previous performance levels.

Acoustic Stimulation↗
PubMed1998

An alternative ureteroileal reimplantation used in augmentation cystoplasty for neurogenic bladder with bilateral vesicoureteral reflux.

PURPOSE: We describe the use of a serous lined extramural tunnel for ureteral reimplantation during augmentation of a neurogenic bladder to prevent reflux. MATERIALS AND METHODS: A 46-year-old male C6 spinal cord injury patient presented with a high pressure bladder, detrusor-sphincter dyssynergia and bilateral grade II/III vesicoureteral reflux. Despite maximal anticholinergic therapy and intermittent catheterization, detrussor pressures were between 80 and 100 cm. water at volumes of 100 to 150 cc with consistent leakage between catheterizations. Preoperative ultrasound and voiding cystourethrogram demonstrated moderate bilateral hydronephrosis and a heavily trabeculated bladder. Augmentation cystoplasty with the formation of 3 cm. extramural ureteral tunnels as described by Ghoneim was performed. The serosa of the adjacent limbs of the ileal segment were opposed to form the back wall of a serosal lined tunnel. RESULTS: At 3 weeks postoperatively a cystogram demonstrated no extravasation or reflux. At 8 weeks an excretory urogram showed prompt function and excretion bilaterally with marked improvement of preoperative hydronephrosis. CONCLUSIONS: Subserosal ureteral tunnels can be used as an alternative antireflux technique during augmentation cystoplasty when ureteral reimplantation is required. Two advantages of this technique include the elimination of staples and avoidance of ischemic problems associated with an afferent intussuscepted nipple valve.

Humans↗
PubMed2000

Are postoperative studies justified after extravescial ureteral reimplantation?

PURPOSE: We evaluated the usefulness of postoperative imaging studies after extravesical ureteroneocystostomy and identified patient subsets in which these studies are necessary. MATERIALS AND METHODS: Records of 438 patients who had undergone extravesical ureteroneocystostomy from 1991 to 1997 were reviewed retrospectively. Study inclusion criterion was primary reflux with at least 1 year of postoperative followup. Grades I to III reflux were defined as low, and grades IV and V were defined as high. All patients were on prophylactic antibiotics. Evaluation included ultrasound and a voiding cystourethrogram 3 months postoperatively, and if reflux persisted the studies were repeated at 12 months. RESULTS: A total of 438 patients (723 renal units) underwent extravesical ureteral reimplantation. At 3 months the procedure was successful in 93.2% of ureters (91.3% patients), and at 12 months the success rate increased to 97.9% of ureters (95.4% patients). There were 49 renal units in 38 cases that were refluxing at 3 months, 11 of which were contralateral. At 12 months reflux resolved spontaneously in 20 of 38 ipsilateral and 8 of 11 contralateral ureters. Of the remaining 18 ipsilateral units reflux was high grade preoperatively in 12 and persisted postoperatively in 4. There was a statistically significant difference in the success rate at 1 year between high (94%) versus low (99%) grade reflux (p = 0.007). Age and preoperative bladder function did not significantly affect the success rates but males had a lower success rate. Hydronephrosis was noted in 7.2% of ureters at 6 weeks and in only 0.005% at 12 months. CONCLUSIONS: Extravesical reimplantation is successful in treating vesicoureteral reflux. Postoperative voiding cystourethrogram should be reserved for high grade reflux. Limiting these studies will help reduce patient discomfort and the cost of treatment.

Child↗
PubMed2003

Treatment of the patella at reimplantation for septic total knee arthroplasty.

The results of treatment of the patella at the time of aseptic revision of a total knee arthroplasty (TKA) have been better with resurfacing of the patella than other modes of treatment such as leaving a bony shell. Treatment of the patella at the time of reimplantation of a TKA has not been addressed in prior studies. The ability to resurface the patella will be determined by the amount of bone remaining, integrity of the patella, vascularity, the location of the joint line, and soft tissue coverage for wound closure. The current review addresses the technique of patellar resurfacing and patellar bone defect treatment at the time of reimplantation of a TKA.

Arthroplasty, Replacement, Knee↗
PubMed2004

Reimplantation and immediate loading of an accidentally avulsed beaded implant: case report.

We present a case of reimplantation of an accidentally avulsed beaded Endopore (Innova Corp., Toronto, Canada) implant. The technique of immediate splinting and pharmacotherapy is described together with the clinical and radiologic evaluation for reosseointegration. This single case of reimplantation with immediate functional loading would suggest that, contrary to the manufacturer's recommendation, the Endopore implants can be successfully loaded immediately, functionally or nonfunctionally.

Accidents↗