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PubMed2003

Ureteral reimplantation for inadvertent ureteral injury during radical perineal prostatectomy.

We report on a rare case of bilateral ureteral injury in a patient undergoing radical perineal prostatectomy and a unique approach to his treatment. Potential risk factors for such an injury include previous prostatic cryotherapy, transurethral resection, or radiotherapy. Intraoperative recognition of the injury is paramount and may be facilitated by intravenous administration of indigo carmine. While distal ureter ligation, urinary diversion, and delayed ureteroneocystostomy may be regarded as standard management for ureteral injury during radical perineal prostatectomy, this case was treated with a primary bilateral transperineal ureteral reimplantation. Although technically challenging, the described case demonstrates the feasibility and success of such an approach.

Adenocarcinoma↗
PubMed1991

[Microsurgical emergencies with the exception of reimplantations].

Although reimplantations are very well defined operations, the indications for emergency free flaps and the management of nerve injuries are much less so. Using several examples, the authors define the conditions in which a free flap is justified and the most useful procedures for nerve repair. An emergency free flap should constitute the best solution, with a reasonable chance of success, without compromising other possibilities of reconstruction in the event of failure. The authors present the three situations observed in the case of nerve lesions: clean nerve sections, nerve defects, cases with an unclear diagnosis and cases in which the conditions are unsuitable for immediate permanent repair.

Adult↗
PubMed1989

[Is it necessary to continue to reimplant all or part of the terminal phalanx of the finger? Apropos of a homogenous series of 38 cases (35 patients)].

The authors present their experience with the very distal reimplantations: an homogenous series of 38 cases is presented. G. Foucher at SOS Mains Strasbourg showed this technique to the authors in 1980. The authors present their technique, which is adapted with the level of distal amputation, then their postoperatively attitude is presented in detail, particularly for "the bleeding maintained" and for the iterative surgery when necessary. Then the failures are precised. Finally functional results are studied: mobility is often good, sensibility is precised with the Weber test, cold pain is frequent, stop of work average is two months. Finally unsatisfactory nail and distal tip are precised.

Amputation, Traumatic↗
PubMed1997

Tissue expansion for staged reimplantation of infected total knee arthroplasty.

Resection arthroplasty of a chronically infected total knee arthroplasty resulted in thin and contracted anterior skin. Expansion of skin using Silastic reservoirs (McGhan Medical, Santa Barbara, CA) facilitated wound closure and rehabilitation following staged total knee reimplantation. Prophylactic expansion of skin around the knee avoided salvage soft tissue procedures such as local and distant tissue flaps.

Aged↗
PubMed1995

Mandibular reconstruction by secondary reimplantation of resected segments: a preliminary report.

This paper presents a new method of reconstructing the mandible after ablative surgery for cancer. This method uses autogenous grafts consisting of the respected part of the mandible, which is hollowed out, defatted in chloroform/methanol, sterilized with ethylene oxide, irradiated with beta-radiation (dose 25 kGy), and stored for 7-10 months. At reimplantation, they were filled with compressed, autogenous, particulate cancellous bone. All grafts took, and four of six host-graft junctions healed.

Aged↗
PubMed1999

Replacement of ascending aorta with aortic valve reimplantation: midterm results.

OBJECTIVE: Aneurysms of the aortic root lead to aortic valve incompetence due to dilatation of the sinotubular junction and annuloaortic ectasia. Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft corrects annular ectasia as well as dilatation of sinotubular junction and aortic sinuses. Durability of this valve repair with respect to increased mechanical stress on valve cusps is discussed controversially and is yet unknown. METHODS: Since 7/93, replacement of the ascending aorta with repair of the aortic valve was performed in 48 patients (34 male, 14 female; 47+/-20 years) with aortic insufficiency and aneurysm of the aortic root. Fifteen patients (31%) had Marfan's syndrome and five patients (10%) had an aortic dissection type A (two acute, three chronic). In 11 patients (23%), concomitant replacement of the aortic arch was necessary utilizing elephant trunk technique in two patients. Additionally, one patient required mitral valve repair and two other patients coronary artery bypass grafts. Clinical and echocardiographic follow-up was performed in 6-12 month intervals for a cumulative study period of 100 patient years. RESULTS: There were no operative deaths. Two patients (4%) died 5 and 20 months postoperatively. One additional patient experienced a TIA within the first postoperative week. Three patients (6%) with an early postoperative aortic insufficiency (AI) > 1 required aortic valve replacement after 9, 11, and 14 months due to progressive AI. In these patients, distortion of the aortic root geometry led to valve incompetence. All other patients have no or mild aortic insufficiency. The repair now remains stable for up to 63 months (mean 25+/-18 months). Other valve related complications did not occur. CONCLUSIONS: Our results demonstrate that this type of aortic valve repair achieves excellent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace AI at initial echocardiography seems to be essential for durability.

Adolescent↗
PubMed2001

Efficacy of laser Doppler flowmetry for the diagnosis of revascularization of reimplanted immature dog teeth.

UNLABELLED: This study was performed to assess if laser Doppler flowmetry (LDF) is an improved method for the detection of revascularization of replanted teeth. Teeth were extracted and reimplanted under different experimental conditions. LDF readings were taken before extraction and weekly for 3 months. In control teeth, LDF baseline readings were taken and then repeated after the apical blood vessels were cut surgically. At the end of 3 months it was determined radiographically and histologically whether revascularization had occurred, i.e. vitality had returned. RESULTS: LDF readings correctly predicted the pulp status (vital vs. non-vital) in 83.7% of the readings. 73.9% (17 of 23) were correct for the vital teeth and 95% (19 of 20) were correct for the non-vital teeth. Fisher's exact test (2-tail) indicated that there was no significant association between the efficacy of LDF and tooth type (P = 0.166), although P2 was the least accurate tooth tested. Wilcoxon's matched-pair signed rank test demonstrated that in the revascularized (vital) teeth, the flux value between the baseline and week 2 dropped significantly (P = 0.0001), increased significantly from week 2 to week 4 (P = 0.0001) and then decreased steadily until week 12. However, at week 12 the flux was still significantly higher than at week 2 (P = 0.010). In the teeth that failed to revascularize, the flux value dropped significantly by weeks 1 and 2 (P = 0.004 and P = 0.0001, respectively). Flux values did not increase from week 2. A Fast Fourier Transform (FFT) analysis confirmed a pulse of dominant frequency of 2 Hz in the teeth that returned to vitality and the lack thereof in those that stayed non-vital. One tooth in which the flux value evaluation indicated a non-vital tooth but the radiographic/histologic findings showed vital (false negative) possessed a pulse of dominant frequency and proved by this method to have successfully revascularized.

Animals↗
PubMed2002

Rate of infraposition of reimplanted ankylosed incisors related to age and growth in children and adolescents.

In growing individuals, infraposition of a reimplanted, ankylosed tooth may disrupt normal alveolar development and compromise prosthetic treatment. The aims of this study were to analyze the rate of infraposition of ankylosed incisors in growing subjects and to provide guidelines for the timing of extraction. The subjects comprised 30 boys and 12 girls, selected consecutively from patients on annual post-trauma follow-up, and observed for periods ranging from 1 to 10 years. Only patients with one replanted ankylosed maxillary central incisor were included, the homologous teeth with healthy periodontal ligaments serving as controls. Growth intensity was evaluated from analyses of annual body height measurements. The following four periods were established: before the growth spurt, from initial to maximal growth spurt, from maximal growth spurt to the end and after the growth spurt. In 11 patients, cephalograms were taken at diagnosis and at extraction. Progression of infraposition varied individually. Diagnosis before the age of 10 or before the growth spurt was associated with very high risk of severe infraposition. In these cases the ankylosed tooth should be removed within 2-3 years. If ankylosis develops during the growth spurt, the tooth should be monitored regularly, but no intervention is indicated provided the adjacent teeth do not tilt and infraposition is minor or stable. Annual body height measurements, indicating the intensity of skeletal growth, are an aid to assessment. Cephalometric radiographs are important for evaluating the direction of growth of the jaws since there is a difference between horizontal and vertical growers.

Adolescent↗
PubMed2003

Reimplantation of inflatable penile prosthesis into scarred corporeal bodies.

Reimplantation of an inflatable three-piece prosthesis in a patient with severe corporeal fibrosis represents a formidable surgical challenge. In the past, a variety of techniques have been offered to facilitate implantation in these difficult patients including the use of instruments to produce a channel in which cylinders can be placed and choosing multiple surgical sites, including the use of surgical sites that have not previously been used. The author of this communication describes newer tools and techniques to enhance placement of an inflatable device in patients with severe fibrosis. This includes the use of specially designed cavernotomes for dilating fibrotic corpora, the use of downsized prosthetic cylinders, alternative procedures to fix cylinders in the face of perforation as opposed to primary closure of the perforation, and replacing the original cylinders after 1 y after the modified cylinders have served as tissue expanders. Details of these newer techniques are presented by an experienced surgeon.

Cicatrix↗
PubMed2003

Repair of pulmonary artery sling by reimplantation without cardiopulmonary bypass.

A 20-month-old girl successfully underwent repair of pulmonary artery sling through a median sternotomy by division of the left pulmonary artery and its reimplantation into the main pulmonary artery without cardiopulmonary bypass or tracheal reconstruction. The patient is doing well on 18 months follow-up with unobstructed pulmonary blood flow and dramatic reduction of tracheal stenosis. Simple repair of pulmonary artery sling is feasible with good results in selected cases without tracheomalacia.

Abnormalities, Multiple↗
PubMed1987

[Subtotal bone resorption following reimplantation of a bone flap. 2 case examples].

This is a report on two cases of an extensive absorption of bone following reimplantation of an osteoplastic flap of the cranial vault. Although it is not yet possible to give a final explanation of the phenomenon, this complication must always be considered as a possible event in this kind of cranial vault implant and the patient should therefore be informed about such an eventuality.

Adult↗
PubMed1981

Experience of the Cohen method for ureteral reimplantation in complicated cases.

Thirty-seven infants and children (41 ureters), a majority with complicating factors (low age, neurogenic bladder, duplication, reoperative surgery), were treated with ureteral reimplantation according to Cohen. The results were good in 90% of the cases. Minor deviations from the original technique, i. e. Dexon instead of chromic catgut as suturing material, catheter splinting of ureter in only 40% and short length of submucosal tunnel in some cases, did not seem to have a negative influence on the results. The method, which is easy and safe to perform, is recommended, particularly in complicated cases.

Adolescent↗
PubMed2005

Laparoscopic repair of ureterovaginal fistula: successful outcome by laparoscopic ureteral reimplantation.

We describe our technique of laparoscopic repair of ureterovaginal fistula in a 34-year-old woman who developed a vaginal leak of urine 15 days after laparoscopic hysterectomy. Laparoscopy and extravesical ureteral reimplantation with a stent was carried out. Cystoscopy and stent removal was done after 6 weeks. The patient was dry. To our knowledge, laparoscopy for the repair of ureterovaginal fistula has not been described. This distressing condition can be corrected laparoscopically with obvious benefit to the patient.

Adult↗
PubMed2005

Laparoscopic extravesical ureteral reimplantation in adults using intracorporeal freehand suturing: report of two cases.

BACKGROUND AND PURPOSE: Laparoscopic extravesical neoureterocystostomy is an infrequently described technique in adults. It is a technically demanding procedure, especially when the intracorporeal freehand suturing technique is used. Our aim is to describe two cases where we used the intracorporeal freehand suturing technique successfully for performing laparoscopic extravesical transperitoneal ureteral reimplantation. We describe the preliminary results of these cases. PATIENTS AND METHODS: We performed this surgery in two female patients. The first patient had a low ureterovaginal fistula after abdominal hysterectomy. We performed a laparoscopic extravesical neoureterocystostomy by the refluxing technique. The second patient had a lower-third ureteral stricture. We performed a laparoscopic extravesical neoureterocystostomy with detrusorrhaphy and supported it with a psoas hitch. RESULTS: The average surgical time was 235 minutes. The average blood loss was 50 mL. The average stay was 48 hours, and the average time to starting oral intake was 12 hours. The average requirement for postoperative analgesia was one injection of diclofenac sodium, followed by oral ibuprofen. Follow-up urography showed good clearance of the kidney and ureter. The second patient, in whom the detrusorrhaphy was performed, did not show any reflux on the postoperative cystogram. CONCLUSION: Laparoscopic extravesical neoureterocystostomy using intracorporeal freehand suturing technique, combining detrusorrhaphy and psoas hitch, is a feasible procedure in adults for various indications. The detrusorrhaphy was effective in preventing reflux, but the long-term results need to be evaluated.

Adult↗
PubMed1994

Improvement in left ventricular dysfunction after aortic reimplantation in 11 consecutive paediatric patients with anomalous origin of the left coronary artery from the pulmonary artery. Early results of a serial echocardiographic follow-up.

To study the potential for recovery of left ventricular function in patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) after aortic reimplantation, serial two-dimensional echocardiographic examinations were performed before and up to 9 months after operation in 11 consecutive paediatric patients (group 1: six infants; group 2: five children above the age of 1 year). End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), myocardial volume (MV), ratio of myocardial volume/end-diastolic volume (MVI), and regional wall motion of the left ventricle (LV) were studied. Pre-operatively, mean LVEDV was 339% of normal in group 1 and 289% in group 2 (P < 0.001); mean LVMV was about twice the normal value in both groups (P < 0.001); LVMVI was 0.79 +/- 0.23 in group 1 and 0.83 +/- 0.3 in group 2; LVEF was 28 +/- 10% in group 1 and 46 +/- 18% in group 2; regional wall motion was normal in two group 2 patients, the other showed uniform reduction in segmental shortening fraction. Postoperatively, mean LVEDV tended to become normal after 2 weeks in group 1 and after 3 months in group 2. In both groups mean LVEF reached the normal range after 3 months; LVMV as well as LVMVI normalized after 9 months. Three months after the operation, all infants had a nearly normal pattern of regional wall motion, while in three group 2 children a residual reduced shortening fraction could be observed in anterior or lateral segments.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Thoracic↗
PubMed1984

Coronary artery changes 3 years after reimplantation of an anomalous right coronary artery.

In this paper we report the sequelae of a patient with an anomalous right coronary artery (RCA) originating from the pulmonary artery (PA) in association with a normal heart, operated upon at the age of 13 years. Three years after the end-to-side reimplantation of the RCA, with a rim of the PA, into the aorta, the surgical result has been evaluated by cineangiography. Before operation both coronary arteries were tortuous and increased in size. Afterwards the left coronary artery showed a normalized calibre, although the RCA remained tortuous with no decrease of the internal diameter. The notable postoperative changes in shape and size of the LCA may be due to the disappearance of the steal phenomenon. The lack of involutive changes in the RCA could be explained by its thinner wall. Left ventricular wall motion, evaluated under resting conditions and during an atrial pacing stress test, was found to be normal.

Adolescent↗
PubMed2000

Ketorolac suppresses postoperative bladder spasms after pediatric ureteral reimplantation.

UNLABELLED: We evaluated the efficacy of ketorolac in suppressing postoperative bladder spasms after ureteroneocystostomy (ureteral reimplantation). Twenty-four pediatric patients undergoing intravesical ureteroneocystostomy were enrolled prospectively to receive either ketorolac or placebo via double-blinded randomization. Twelve patients in each group shared similar preoperative characteristics. All were maintained on an epidural infusion of bupivacaine (0.1%) with fentanyl (2 microg/mL) throughout the study. Patients were given either ketorolac (0.5 mg. kg(-1). dose(-1)) or placebo (equivalent volume saline) IV after surgery and every 6 h thereafter for 48 h. Parents were instructed to record bladder spasm episodes prospectively by using a standardized time-flow diary. Three patients (25%) in the ketorolac group experienced bladder spasms, compared with 10 patients (83%) in the placebo group (two-sided P < 0.05). The median severity score for the ketorolac group was 1.2 (mild = 1.0, severe = 3.0), compared with 2.6 for the placebo group (P = 0.003). We conclude that IV ketorolac reduces the frequency and severity of postoperative bladder spasms after intravesical ureteroneocystostomy. IMPLICATIONS: We studied the efficacy of ketorolac, a prostaglandin synthesis inhibitor, in the treatment of bladder spasm after ureteroneocystostomy (antireflux operation). Patients were randomized in a double-blinded manner to receive either ketorolac or placebo after the surgery. We demonstrate that ketorolac reduces the frequency and severity of postoperative bladder spasm.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Reimplantation of a contaminated and devitalized bone fragment after autoclaving in an open fracture.

This case report describes a technique for dealing with open fractures with segmental bone loss and a critical need for restoration of anatomical alignment. In the majority of cases, autogenous bone graft can and should be used successfully. Regardless of the treatment option chosen though, meticulous debridement and sound judgment in regards to wound care and bony stabilization remain the foundation to a successful outcome. Autoclaving a devitalized bone fragment with subsequent reimplantation as described in this case report, although not the procedure of choice, does offer the orthopaedist another option in dealing with the difficult segmental fracture.

Adult↗