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The authors report a case of arterial pseudoaneurysm occurring 3 months after reimplantation of the hand in contact with the radial anastomosis. This complication, related to the initial mechanism of avulsion, although nonspecific, required rapid surgical revision as only one patent artery was present.
The results of two animal studies are presented in which ureteroneocystostomy is performed in the absence of urinary flow. No stents were used. In Group 1 ureterovesical stenosis resulted in 2/7 defunctionalized ureters in animals with an otherwise intact bladder. In Group 2 seven animals had bilateral urinary diversion with reimplantation of 14 diverted ureters into a defunctionalized bladder. Ureterovesical stenosis did not occur in any in this second group. There was a 9.5 per cent incidence of ureterovesical stenosis over-all. This would not support the clinical impression that "dry" ureteroneocystostomy inevitably results in ureterovesical stenosis.
Three fingers have been reimplanted at present, bij means of microsutures of digital arteries and veins. The help of the surgical microscope is essential to this technique. In case of traumatic amputation of many fingers, with a neat minimal section, the chances of success are particularly good with a low risk of infection.
Results of two techniques of ureteroneocystostomy were evaluated in a series of 400 consecutive living renal transplantations. In the first 150 patients (group A) PAQUIN ureteroneocystostomy was utilized and in the second 250 (group B) DE CAMPOS-FREIRE technique was performed. Significant urological complications were seen in 13 (8.6%) patients of group A and in 10 (4%) of group B. Bladder leak occurred in 5 patients of group A and in only 1 of group B (P < 0.05). Complications related to ureteral stenosis and ureteral necrosis were comparable in the two groups. High pressure vesicoureteral reflux was demonstrated in 2 of 85 patients of group A and in 15 of 160 of group B (P < 0.05). Abnormalities of intravenous urography were significantly higher in group A. The incidence of immediate and delayed post-transplant urinary infection was not statistically different among the two groups. We advocate the use of DE CAMPOS-FREIRE approach over the PAQUIN reimplantation, not only because of the marginal differences in the incidence of urological complications, but also because of the technical advantages offered by the former approach.
When we evoked the indications of microsurgery in Traumatology, at first, we think reimplantations performed in emergency and also secondary management of soft tissues or complex defects. In fact, we resort to microsurgery in many other circumstances. Early microsurgical reconstruction of complex trauma of the extremities yield better results than delayed free flaps. In 7 cases, free flaps were performed on the lower extremities, in 2 cases on the upper extremities. Many advantages are credited with this offensive attitude which requires an appropriate organisation of the Departments of Traumatology, the intimate collaboration of surgeons called orthopedic or plastic surgeons, improperly divided by too administrative compartmentalization of the surgical specialties.
The aim of this study is to present our experience with two-stage reimplantation in the management of the infected hip arthroplasty. Between January 1993 and December 2001 the replacement of the total hip arthroplasty in two stages was performed in 18 patients. There were 7 male and 11 female patients and the average age was 62 years. The mean follow-up after revision was 3.5 years. The mean postoperative Harris Hip Score averaged 78 (50-96) points. None of 18 patients had a recurrence of the infection. Two-stage reconstruction of the infected hip is preferred to one-stage exchange arthroplasty at our department because of higher rate of eradication of the infection.
Our experience with nine total replacement of the ascending aorta with reimplantation of the coronary arteries has led us to advocate this as the technique of choice for curative treatment of ascending aortic aneurysms when these involve the sinus of Valsalva, and of acute dissecting aneurysms of the aorta when the tear in the intima is situated in the ascending portion. An endo-aneurysmal approach simplifies the operation and considerably reduces the blood loss during surgery.
In order to determine the feasibility of reimplantation of upper inversely impacted incisor, we enlarged the interdental distance by orthodontic appliance, then replanted the impacted incisor after extraction. 13 of 15 cases had good results. It was a good method to replant inverse impacted incisor after extraction which avoid extracting the tooth simply.
INTRODUCTION: Circumcision, the most frequent operation in boys, is performed by various persons and is responsible for a considerable number of documented or non-documented complications. CASE REPORT: The authors report a case of accidental traumatic amputation of the glans during ritual circumcision performed by a nurse on a 5-year-old boy. Reimplantation was successfully performed after suture of the glans. In the light of this case and a review of the literature, the authors describe the treatment and prevention of this type of lesion. CONCLUSION: Circumcision is not a completely benign operation. Iatrogenic lesions are frequent but rarely serious. The best treatment is prevention, which requires education of the population about the importance of medicalized circumcision.
This case report deals with the histologic examination of an avulsed tooth that was reimplanted in a socket where a distal root defect was augmented with hydroxyapatite. The 6-year results showed a "repair" type of connective tissue attachment. There were areas of ankylosis present on the distal root above an area of prior cystic debridement. The hydroxyapatite particles present demonstrated biocompatibility and encapsulation by new bone growth. There was a longer junctional epithelium present on the distal root than on its mesial counterpart. Histology of the distal root demonstrated fibrous repair, ankylosis, and osseous formation around the hydroxyapatite particles. This type of result was not apparent on the mesial root, devoid of hydroxyapatite, where a "splicing" type of healing occurred in the periodontal ligament.
In order to evaluate the clinical utility of autologous splenic transplantation in the omental pouch, a pneumococcal challenge was performed in 3 groups of rats, after demonstration of vitality of the intraperitoneal inoculum: Group A: splenectomized rats; Group B: reimplanted rats; Group C: sham operation. No statistically significant difference was found between the first two groups regarding resistance against infection (p less than 0.982), while normal rats proved more resistant (p less than 0.031). Between group A and B significant differences (p less than 0.001) exists only for a more precocious mortality in the first group. The poor clinical utility of the technique is demonstrated.
Distal latero-circumflex arteries (DLCA) and posterior descending artery (PDA) are anatomically too far and cannot be revascularized with internal mammary artery (IMA) by a conventional procedure. The reimplantation of the right IMA into the left IMA in situ increases (2 times) the length of right IMA graft available. Fifty-five patients underwent this technique. Their preoperative status was: 22 males, 3 females; mean age: 57 years, 38% myocardial infarction (MI). Coronary angiography showed: stenosis of the left main coronary artery: 3; stenosis of 3 vessels: 15; 2 vessels: 10; 2.3 anastomoses by patient were performed with Y right and left IMA procedure: 24 LDA, 8 diagonals, 25 DLCA and 1 PDA anastomosis. No deaths were observed in this short series. Morbidity was: 1 MI, 2 sternal sepsis, 1 bilateral phrenic paralysis (all were cured without sequelae). To date (March 90) 15 patients have been followed for 3 to 12 months, 12 are angina-free, 3 are significantly improved, 11 have a negative exercise test. Thallium test is normal in the revascularized area in 14 patients. Seven angiographies have been performed (6 months to 1 year) and all Y right IMA are patent.
Distal latero-circumflex arteries (DLCA) and posterior descending artery (PDA) are anatomically too far and cannot be revascularized with internal mammary artery (IMA) by a conventional procedure. The reimplantation of the right IMA into the left IMA in situ increases (2 times) the length of right IMA graft available. Fifty-five patients underwent this technique. Their preoperative status was: 22 males, 3 females; mean age: 57 years, 38% myocardial infarction (MI). Coronary angiography showed: stenosis of the left main coronary artery: 3; stenosis of 3 vessels: 15; 2 vessels: 10; 2.3 anastomoses by patient were performed with Y right and left IMA procedure: 24 LDA, 8 diagonals, 25 DLCA and 1 PDA anastomosis. No deaths were observed in this short series. Morbidity was: 1 MI, 2 sternal sepsis, 1 bilateral phrenic paralysis (all were cured without sequelae). To date (March 90) 15 patients have been followed for 3 to 12 months, 12 are angina-free, 3 are significantly improved, 11 have a negative exercise test. Thallium test is normal in the revascularized area in 14 patients. Seven angiographies have been performed (6 months to 1 year) and all Y right IMA are patent.
Cases of complete traumatic amputation of the auricle successfully treated by reimplantation are rare. The author used the Baudet technique: it consist of suppression of the skin cover of the posterior aspect of the mutilated fragment and creation through the cartilage of appropriately sized and arranged windows. This mutilated fragment is then sutured by its anterior edge to the remaining portion of the auricle and by its peripheral rim to a posteriorly based mastoid flap.
Tooth reimplantation experiences through 20 years are reported on. On basis of his results the tooth maintaining method is suggested to be employed by practicing dentists.
In order to improve the early postoperative pulmonary dysfunction caused by the reimplantation response after single lung transplantation, prostaglandin I2 (PGI2) and superoxide dismutase (SOD) were administered to dogs whose left lungs were subjected to complete hilar-stripping and then exposed to warm ischemia, or resected and replaced with allograft. Doppler flow probes were placed on the ascending aorta and on the left main pulmonary artery, and a Swan-Ganz catheter was introduced into the pulmonary trunk. Twenty five dogs were divided into 4 groups. Hilar stripping of the left lung with division and reanastomosis of the left main bronchus was performed in 7 dogs (Group 1). Hilar stripping of the left lung with division and reanastomosis of the left main bronchus was exposed to additional warm ischemia for one hour in 6 dogs (Group 2). Same surgical procedure as Group 2 with additional treatment by using PGI2 (1 micrograms/min/kg for 30 min). and SOD (20 mg/kg) was performed in 6 dogs (Group 3). Single lung transplantation with PGI2, SOD and immunosuppressive treatment (CyA 10 mg/kg and AZ 4 mg/kg daily for 2 weeks) was performed in 6 dogs (Group 4). The pulmonary arterial blood flow of the left lung and the cardiac output were serially measured by means of Doppler flow method for two weeks for studying the graft function in the early postoperative period. Findings of chest X-ray films and arterial blood gases were also studied for two weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Ten reimplantations at the level of the distal interphalangeal joint (DIP) or the terminal phalanx were reviewed. The cosmetic results were excellent, the recuperation of sensibility was only partial, and the duration of work incapacity was about 10 weeks.
PURPOSE: To analyse a 10-year experience with the Bentall and De Bono technique for surgical treatment of aneurysms of ascending aorta. PATIENTS AND METHODS: From January 1980 to December 1989, the Bentall and De Bono technique was employed in 38 patients. Twenty-two patients had aneurysm of ascending aorta with aortic insufficiency; 14 had chronic aortic dissections. Four patients were operated on previously by other techniques. RESULTS: The immediate mortality was 5.2%; one patient due to low-output syndrome and one had neurological complications. Five patients (13.1%) died late postoperatively. The surviving 31 patients were followed up from two to 72 months (mean 25). Of these, 29 (93.5%) were in functional class I and two in class II. Sixteen patients had late evaluation by one or more of the following methods: digital angiography, chest computerized tomography, echocardiography, or conventional angiography, 6 to 60 (mean 33) months after operation. All of them had good conditions of composite valve graft and coronary artery reattachment. The immediate and late results were similar in patients with aneurysms and aortic dissections. CONCLUSION: The aortic valve and aortic ascending portion replacement with reimplantation of coronary arteries is of low mortality and fairly good late outcome.