Pelvic ring reconstruction with a vascularized bone flap of femur

Three patients developed acute colitis, either de novo, or as an exacerbation of pre-existing colitis, following the use of oral acyclovir, prescribed for Herpes zoster or Herpes simplex infection. Rechallenge with oral acyclovir was performed in one patient, and resulted in a recurrence of colitic symptoms. It is speculated that acyclovir can have a direct irritant effect on large bowel mucosa.     

Experience with the rectus abdominis myocutaneous flap with vascularized hard tissue for immediate orbitofacial reconstruction

We have previously reported (Badolato, R., J.M. Wang, W.J. Murphy, A. R. Lloyd, D.F. Michiel, L.L. Bausserman, D.J. Kelvin, and J.J. Oppenheim. 1994. J. Exp. Med. 180:203; Xu, L., R. Badolato, W.J. Murphy, D.L. Longo, M. Anver, S. Hale, J.J. Oppenheim, and J.M. Wang. 1995. J. Immunol. 155:1184.) that the acute phase protein serum amyloid A (SAA) is a potent chemoattractant for human leukocytes in vitro and mouse phagocytes in vivo. To identify the signaling mechanisms, we evaluated patterns of cross-desensitization between SAA and other leukocyte chemoattractants. We found that the chemotactic bacterial peptide, N-formyl- methionyl-leucyl-phenylalanine (fMLP), was able to specifically attenuate Ca2+ mobilization in human phagocytes induced by SAA, but only at very high concentrations, suggesting that SAA uses a low affinity fMLP receptor. Here we demonstrate that SAA selectively induced Ca2+ mobilization and migration of HEK cells expressing FPRL1, a human seven-transmembrane domain phagocyte receptor with low affinity for fMLP, and high affinity for lipoxin A4. Furthermore, radiolabeled SAA specifically bound to human phagocytes and FPRL1-transfected 293 cells. In contrast, SAA was not a ligand or agonist for FPR, the high affinity fMLP receptor. Thus, SAA is the first chemotactic ligand identified for FPRL1. Our results suggest that FPRL1 mediates phagocyte migration in response to SAA.     

The reconstruction of a dorsal digital defect using a reverse homodigital island flap incorporating vascularized tendon

Hypertension as a complication of Henoch-Sch?nlein purpura (HSP) is almost uniformly accompanied by evidence of renal involvement, either decreased renal function or urinary abnormalities. We report a 4.5-year-old male with HSP who developed severe hypertension without other manifestations of glomerulonephritis, including no decline in renal function and no development of urinary abnormalities. Extensive evaluation for other identifiable causes for his hypertension was not productive. His hypertension resolved with the resolution of his HSP. This case demonstrates that patients with HSP may on occasion develop severe hypertension without other evidence of nephritis. An extensive evaluation for other causes of severe hypertension may be deferred in this setting until well after all other manifestations of HSP have resolved.     

Auricular reconstruction with a postauricular myocutaneous island flap: flip-flop flap

Surgical defects of the concha-helix part of the ear larger than 2 cm may pose a reconstructive challenge. Split- or full-thickness skin grafts or local flaps may be used, and a number of these have been described. Yet cosmetic results are often unsatisfactory. Our experience with a postauricular myocutaneous island flap is described. Eleven patients (12 ears), aged 48 to 89 years, underwent the procedure under local anesthesia following excision of conchal bowl malignant tumors that included the cartilage underlying the skin. The surgical technique is described in detail. Few complications were encountered, and cosmetic results were excellent. In four ears, resection margins extended into the ear canal, and that portion was allowed to heal satisfactorily by secondary intention. We recommend the use of this flap for practical, safe, and early good cosmetic results.     

Breast reconstruction in a male with a transverse rectus abdominis flap

The TRAM flap may be the best choice in male breast reconstruction not just because it can replace the missing skin and fat but also because it may be a source of hair-bearing skin similar to the native breast skin.     

Pelvic reconstruction with a free fillet lower leg flap

Orthostatic tremor (OT) is a rare movement disorder that consists of involuntary shaking of the legs and trunk present only on standing. Although the origin and the mechanism of this condition are not well understood, the neurophysiologic abnormalities and PET studies suggest a central origin. We describe the clinical and radiologic features of two patients with symptomatic OT and associated pontine lesions, and conclude that OT may arise from dysfunction of the cerebellum or related pontine structures.     

Tracheal transplantation for carinal reconstruction in dogs

Subcellular localisation of xanthine oxidoreductase (XOR) was determined by indirect immunofluorescence using confocal microscopy in human endothelial and epithelial cell lines and in primary cultures of human umbilical vein endothelial cells. XOR was diffusely distributed throughout the cytoplasm but with higher intensity in the perinuclear region. In non-permeabilised cells, XOR was clearly seen to be asymmetrically located on the outer surfaces, showing, in many cases, a higher intensity on those faces apposed by closely neighbouring cells. Such specific distribution suggests a functional role for the enzyme in cell-cell interactions, possibly involving signalling via reactive oxygen species.     

Facial reconstruction using a retroauricular-temporal free flap

Large and deep soft-tissue defects of the face usually require resurfacing by free-tissue transfer. An appropriate free flap for facial reconstruction may be harvested from the retroauricular and temporal region utilizing two arterial pedicles (superficial temporal artery and posterior auricular artery). This flap provides normal color, texture, and thickness and thus is an optimal anatomic and aesthetic reconstruction with minimal donor-site morbidity.     

One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap

This is the first series of total penile reconstructions with the free sensate osteocutaneous fibula flap. The main advantages of this flap lie in its intrinsic rigidity, its superior donor-site location, and its long vascular pedicle. The fibula flap provides better bone volume than does the radial forearm flap, which commonly results in a floppy phallus in the absence of bone. Penile prostheses in other flaps have enjoyed limited success. Forearm donor-site complications can be avoided. The donor site in the lower extremity can be readily covered with a sock. The vascular pedicle of the fibula flap is of sufficient length to allow end-to-side anastomosis of the flap to the femoral artery. Interpositional vein grafts are unnecessary, and dissection of the inferior epigastric artery system to serve as a donor artery may be avoided. The appearance of the neophallus is excellent. We present only the first four continuous cases of the six we have performed because sufficient follow-up data are available only for these four. The advantages and disadvantages of fibula and forearm donor sites, the long-term fate of the bony component, the importance of sensation, and the vascularized urethral reconstruction are discussed. High patient satisfaction and the advantages of the technique convince us that the fibula osteocutaneous flap is superior for total penile reconstruction.     

Microsurgical reconstruction of the Achilles tendon with a fascia lata flap

MATERIAL AND METHODS: During ten years, 890 operations of cataract with anterior chamber intraocular lens implantation were performed. TWO GROUPS OF EYES WERE OBSERVED: Eyes after planned intracapsular cataract surgery and eyes in which intraoperative complications occurred making impossible to apply posterior IOL. PURPOSE: To evaluate late complications and functional status of the eye. RESULTS: Our results indicate that anterior chamber intraocular lens implantation yields in many cases good visual acuity and, although not free of complications, is a safe procedure.     

应用游离腓骨复合组织瓣行功能性重建上颌骨缺损

上颌骨是面部中份的基石,是面部中份外形和功能最重要的骨骼结构,参与眼眶、颧上颌复合体、鼻腔、口腔等各种面部中份重要结构的组成.由于肿瘤切除、外伤、炎症及先天畸形所致的上颌骨缺损不仅严重影响外形,而且直接影响语言、咀嚼、吞咽等多项生理功能.由于上颌骨及面部中份解剖结构和功能的复杂性,使上颌骨缺损的修复与重建成为临床医师面临的挑战性难题.     

Sideburn reconstruction with an expanded supraauricular trapezoidal flap

Although loss of the sideburn and temporal scalp with subsequent alopecia is relatively frequent as a consequence of traumatic, surgical, and iatrogenic processes, not many techniques of sideburn reconstruction have been reported. We present a two-stage technique to correct the long-sideburns when there is an associated temporal alopecic defect due to trauma or surgery by means of an expanded supra-auricular trapezoidal flap. The method can achieve not only a satisfactory appearance of the sideburn but also a normal capillary line from the occipital to the frontal region.     

Postauricular chondrocutaneous flap in auricular reconstruction

We report an unusual case of a 1 cm papillary renal cell carcinoma arising from the outer surface of the free wall of a radiographically simple renal cyst. Most malignancies arising from the wall of a renal cyst are present along the inner surface, usually adjacent to underlying renal parenchyma. While this is a rare occurrence, it does reinforce the need to explore even small solid renal masses.     

Transplantation of vascularized allogeneic skeletal muscle for scalp reconstruction in a renal transplant patient

We studied the effect of complete spinal cord transection (SCT) on gastric emptying (GE) and on gastrointestinal (GI) and intestinal transits of liquid in awake rats using the phenol red method. Male Wistar rats (N = 65) weighing 180-200 g were fasted for 24 h and complete SCT was performed between C7 and T1 vertebrae after a careful midline dorsal incision. GE and GI and intestinal transits were measured 15 min, 6 h or 24 h after recovery from anesthesia. A test meal (0.5 mg/ml phenol red in 5% glucose solution) was administered intragastrically (1.5 ml) and the animals were sacrificed by an i.v. thiopental overdose 10 min later to evaluate GE and GI transit. For intestinal transit measurements, 1 ml of the test meal was administered into the proximal duodenum through a cannula inserted into a gastric fistula. GE was inhibited (P < 0.05) by 34.3, 23.4 and 22.7%, respectively, at 15 min, 6 h and 24 h after SCT. GI transit was inhibited (P < 0.05) by 42.5, 19.8 and 18.4%, respectively, at 15 min, 6 h and 24 h after SCT. Intestinal transit was also inhibited (P < 0.05) by 48.8, 47.2 and 40.1%, respectively, at 15 min, 6 h and 24 h after SCT. Mean arterial pressure was significantly decreased (P < 0.05) by 48.5, 46.8 and 41.5%, respectively, at 15 min, 6 h and 24 h after SCT. In summary, our report describes a decreased GE and GI and intestinal transits in awake rats within the first 24 h after high SCT.     

Distal femur reconstruction with vascularized fibular graft: indications and surgical technique]

OBJECTIVES: Assessment of and effect of training on reliability of esophageal Doppler (ED) versus thermodilution (TD) for cardiac output (CO) measurement. DESIGN: Prospective study. SETTING: Intensive care unit of a university hospital. PATIENTS: 64 consecutive critically ill patients requiring a pulmonary artery catheter, sedation, and mechanical ventilation. INTERVENTIONS: Esophageal Doppler CO measurements were performed by the same operator, whereas TD CO measurements were carried out by other independent operators. A training period involving the first 12 patients made the operator self-confident. In the remaining patients, the reliability of ED was assessed (evaluation period), using correlation coefficients and the Bland and Altman diagram. Between training and evaluation periods, correlation coefficients, biases, and limits of agreement were compared. MEASUREMENTS AND RESULTS: During training and evaluation periods, 107 and 320 CO measurements were performed in 11 out of 12 patients and in 49 out of 52 patients, respectively. Continuous CO monitoring was achieved in 6 out of 11 patients and in 38 out of 49 patients during training and evaluation periods, respectively. Between the two periods, correlation coefficients increased from 0.53 to 0.89 (p < 0.001), bias decreased from 1.2 to 0.1 l x min(-1) (p < 0.001), and limits of agreement decreased from 3.2 to 2.2 l x min(-1) (p < 0.001). CONCLUSION: A period of training involving no more than 12 patients is probably required to ensure reliability of CO measurement by ED.     

Microsurgical reconstruction of facial defects using a forearm flap

The perforating facial defects are often results of the removal of malignant tumours and less commonly are caused by accidents and shotgun injuries. The advent of musculocutan flaps and the microvascular tissue transplantation has made essential changes in the treatment of full thickness cheek defects during the last decade. The authors describe three cases, where the reconstruction has been made with free radial forearm flaps.     

Long-term results of total penile reconstruction with a prefabricated lateral arm free flap

Trifluoroethanol (TFE) is often used to increase the helicity of peptides to make them usable as models of helices in proteins. We have measured helix propensities for all 20 amino acids in water and two concentrations of trifluoroethanol, 15 and 40% (v/v) using, as a model system, a peptide derived from the sequence of the alpha-helix of ribonuclease T1. There are three main conclusions from our studies. (1) TFE alters electrostatic interactions in the ribonuclease T1 helical peptide such that the dependence of the helical content on pH is lost in 40% TFE. (2) Helix propensities measured in 15% TFE correlate well with propensities measured in water, however, the correlation with propensities measured in 40% TFE is significantly worse. (3) Propensities measured in alanine-based peptides and the ribonuclease T1 peptide in TFE show very poor agreement, revealing that TFE greatly increases the effect of sequence context.