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The technique of reimplantation as it relates to bone defect.

Bone loss is the principal problem in hip prosthesis revision surgery; repair of this loss may identify the method itself of reimplantation. In light of thirteen years of hip reimplantation surgery the authors propose a classification of bone loss that correlates pathologic anatomy with surgical strategy. Thus, three types of acetabular bone loss and four types of femoral bone loss are distinguished, to which correspond just as many surgical strategies, aimed at an attempt to obtain stability of the revision implant and its longer duration in time.

Bone Resorption↗

Indications and limits of acetabular reimplantations using screwed prostheses.

The clinical and radiographic results of 95 acetabular reimplantations performed between 1984 and 1992 are presented. A screwed acetabular prosthesis was used in 56 patients, the acetabulum was cemented in 15, and a press-fit acetabulum stabilized by screws (1 case without screws) was used in 24. Mean clinical follow-up was 35.6 +/- 24 months, ranging from 7 to 94 months. Clinical results were good and excellent (> or = 5 points according to Merle D'Aubigné) in 77% of the cases for pain, in 70% for walking, and in 71% for joint movement. Forty months after surgery 48% of the screwed acetabula and 44% of the cemented ones were osteointegrated. The incidence of loosening for the screwed acetabula was 24%. The preliminary results 24 months after the press-fit acetabula with screws had been inserted showed 100% osteointegration. Radiographic results of the screwed acetabula were satisfactory (92% osteointegration) only in reimplantations performed in patients with minimum acetabular osteolytic injury (Paprosky types I and IIA). The use of homoplastic bone grafts did not improve the radiographic results of the screwed acetabula in the cases with severe osteolysis: 57% of the acetabula screwed on grafts distributed throughout the acetabulum were, in fact, loosened.

Acetabulum↗

[Microsurgical reimplantation of scalp: case report].

With the introduction of modern techniques in plastic surgery, severe injuries concerning the extremities and scalp are now amenable to surgical treatment. Successful reimplantation of the scalp either total or partial have been rarely reported in the literature. We treated a patient with avulsion affecting 2/3 of the scalp, the right ear and a cutaneous flap on right side of the face. We report here the initial care and operative procedure. The avulsed scalp was revascularized through microanastomoses of the temporal artery and vein. The reimplantation was well succeed and cosmetic results were satisfactory.

Accidents, Occupational↗

Whole-muscle reimplantation with microneurovascular anastomoses. A functional and histological study.

Whole tibialis anterior muscles were removed from a number of dogs and were then reimplanted in the original sites. Microsurgical anastomoses of the major nerve, artery, and vein were performed. Biopsy revealed some minor regenerative changes in the muscle a few weeks after the operation. Electromyographic recordings 6-9 months after implantation showed near-complete functional recovery of the muscles. This was confirmed histologically. The study demonstrates not only that whole-muscle reimplantation is technically feasible but that a functionally satisfactory result may be expected.

Animals↗

Intraoperative fractures of the femur in prosthetic hip reimplantations.

A total of 19 cases of intraoperative fractures of the femoral diaphysis occurring during prosthetic hip reimplantation are described. Incidence, predisposing factors, treatment, and influence on long-term results are discussed. The pre-existence of osteolysis or narrowing of the femoral cortex, often associated with primary cemented implantation with a metal-polyethylene combination, constitutes a factor that predisposes the patient to fracture. Fracture consolidation occurs in most cases with minimum treatment, at times without instrumentation; fracture, however, always means a delay in weight-bearing and a slowing down in recovery times. Long-term clinical evaluation shows functional results that are worse for reimplantations complicated by fracture as compared to those where there are no complications. The differences in the radiographic results instead do not reveal statistical significance.

Aged↗

[Anti-reflux ureterocysto-reimplantation in treatment of ectopic ureters: report of 51 cases].

From 1974 to 1994, anti-reflux ureterocysto-reimplantation was performed on 51 children (1 boy, 50 Girls) aged from 10 months to 13 years. The follow-up duration of 45 cases was 3 months to 14 years. The clinical symptoms of frequency of urination, lumbago and repeatedly fever, etc, were not observed except urinary incontinence in 2 cases. The results showed that ureterocysto-reimplantation is simple and traumatic. Some important aspects such as preoperative location and intraoperative identification of the unilateral or bilateral ectopic ureters were analyzed.

Adolescent↗

Ureteral tailoring in situ: a practical approach to persistent reflux in the dilated reimplanted ureter.

PURPOSE: We evaluated a new simplified technique for secondary surgical correction of persistent reflux in a reimplanted dilated ureter. MATERIALS AND METHODS: Four patients a median of 3 years old with recurrent vesicoureteral reflux after initial reimplantation of ureters greater than 9 mm. in diameter underwent in situ excisional ureteral tailoring. RESULTS: Followup ranged from 15 to 27 months (mean 22). Within 3 months postoperatively ultrasound confirmed no ureteral obstruction, and at 3 to 6 months voiding cystourethrography revealed no vesicoureteral reflux in any case. CONCLUSIONS: Our study highlights the surgical details and safety of this technique for preserving the vascularity of the reconstructed ureter and avoiding injury to the contralateral ureter.

Adolescent↗

Reimplantation of the papilla of Vater.

Detachment of the papilla of Vater from the duodenum may happen (a) deliberately, during duodenal resection for tumour without concomitant resection of the pancreatic head, and (b) accidentally in the course of gastrectomy for duodenal ulcer, when attempts to exteriorize the ulcer are made. In this report two case histories are cited encompassing both of these circumstances, in which the ampulla was successfully reimplanted into a Roux loop.

Aged↗

Spontaneous secure reimplantation of a dislodged pacemaker electrode onto the right ventricular outflow tract, reestablishing a sufficient pacing condition.

A 62-year-old woman underwent cardiac pacemaker implantation for sick sinus syndrome with bradycardia, and the tip of an endocardial tined lead was positioned to the right ventricular apex. On the fifth postoperative day, an incomplete pacing failure, lasting about 10 min, was observed transiently on 24-h monitoring. This event, however, was not considered to be a clinical manifestation of the ensuing complication until the patient visited our pacemaker clinic 2 months postoperatively. At that time, a chest x-ray demonstrated that the electrode tip had migrated markedly to the right ventricular outflow tract (RVOT), but presented a sufficient pacing condition. The reimplantation site appeared to be very insecure for pacing, raising the potential risk of repeat dislodgement since the lead was not provided with a helix. At the second operation, performed to assess the problem, the ventricular excitation threshold measured at 1.3 V with a 0.5 ms pulse width. Furthermore, it was unexpectedly disclosed that the electrode tip was so tightly anchored at the site that it could not be withdrawn, eliminating the possibility of repeat dislodgment. Consequently, the entire original pacing system could be used as before and no further complications were observed. Although the situation encountered was very rare and seemed to be problematic, careful observation might be an alternative to surgical intervention even when a tined tip without helix has been used.

Electrodes↗

Highly efficient lentiviral vector-mediated transduction of nondividing, fully reimplantable primary hepatocytes.

Gene therapy is an attractive approach for the treatment of liver disease. We demonstrate that a so-called third-generation human immunodeficiency virus (HIV)-derived vector system can govern the efficient delivery, integration, and stable expression of a transgene into primary human hepatocytes in the complete absence of cell division. We also show that rodent hepatocytes exhibit a significant degree of resistance to HIV vector-mediated transduction, a phenotype that is particularly pronounced in murine hepatocytes and that results from a block in the immediate-early phase of infection. We finally describe a methodology, that allows very high rates of transduction through minimal in vitro manipulation, in which hepatocytes are kept in suspension and reimplanted within a few hours of harvest with a fully preserved engraftment potential. These results have immediate implications for the treatment of liver diseases by the transplantation of genetically modified hepatocytes, an approach that could be applied to a number of hereditary and acquired hepatic disorders.

Animals↗

Basic vascular anatomy and the reimplantation of the amputated hand through the palm.

Thirty adult upper extremities were used to study the blood vessels of the hand by angiography, cross-sectional measurement and operative microscopic dissection. The arteries in the middle segment of the palm are arranged in three planes, while in the upper or lower segment there are two planes only. The division of the territories of the radial and ulnar arteries are not same in the three different layers. There are three main anastomotic pathways between the radial and ulnar arteries in the radial-ulnar direction, while in the palmar-dorsal direction there are three anastomotic zones between the palmar and dorsal planes. According to the rate of appearance, sources, cross-sectional area, irrigation territories and anastomoses of the arteries in the three segments, the clinical significance in the reimplantation of the amputated hand through the palm has been discussed.

Amputation, Traumatic↗

[Reimplantation of splenic tissue after neonatal abdominal trauma (author's transl)].

Loss of the spleen in children frequently results in overwhelming infection caused by pneumococci. In order to preserve splenic function the reimplantation of splenic tissue into the abdominal wall and the greater omentum was performed in a newborn child and six other children up to the age of thirteen. Postoperatively the complete absence of Jolly's bodies could be observed, while a continuous increase of IgM was noted. The otherwise mandatory antibiotic prophylaxis over 2 years could be reduced to 5 months in the newborn.

Birth Injuries↗

Operative treatment of bilateral vesicoureteral reflux by our own method of ureter reimplantation.

The results of treatment of 50 patients with bilateral vesicoureteral reflux (VUR) are presented. In all patients our own method of reimplantation of the ureters consisting in making a single, common submucosal tunnel situated on the back wall of the bladder was employed. The observations made and the results obtained prove the usefulness of the described operative technique in the treatment of bilateral vesicoureteral reflux.

Adolescent↗

Bladder spasm in children after surgery for ureteric reimplantation.

The primary aim of this study was to prospectively investigate whether there was an association between the duration of post-operative catheterisation and the incidence of bladder spasm in children following ureteric reimplantation surgery. A secondary aim was to investigate whether other surgical and post-operative factors had an effect on the incidence of bladder spasm.

Adolescent↗

Reimplantation of oesophageal bronchus following a type III oesophageal atresia repair.

Oesophageal atresia can be associated with communicating bronchopulmonary foregut malformations, the most common being the oesophageal bronchus. Lung resection may be mandatory, but conservative treatment correcting the abnormal airway has been proposed, raising the difficult issue of perioperative ventilatory support. The authors report a case of successful reimplantation of oesophageal bronchus revealed after surgical cure of an oesophageal atresia with tracheo-oesophageal fistula.

Bronchi↗

Alternatives to splenectomy in adults after trauma. Repair, partial resection, and reimplantation of splenic tissue.

Splenectomy results in a lifelong risk of overwhelming infection in the adult as well as the child. This has prompted our current enthusiasm for splenic salvage in trauma patients. A number of alternatives to total splenectomy exist; however, the complications that result from splenic salvage must not exceed the risk incurred by loss of this organ. Splenorraphy can be performed safely in the majority of patients despite associated intraabdominal injuries. When splenectomy is necessary, reimplantation of splenic tissue is feasible. The efficacy of this technique is preventing postsplenectomy sepsis remains to be established.

Adolescent↗