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Background Contralateral C7 (CC7) nerve transfer has successfully restored hand function in patients with spastic hemiplegia from chronic central nervous system injuries. However, little is known about the morphology and anatomy of the donor C7 nerve root in patients undergoing this procedure. This study quantified intraoperative measurements of donor C7 nerve roots during CC7 transfer surgery for spastic hemiplegia in patients treated at a high-volume center to describe observed anatomical variations for successful direct anastomosis. Methods A database of images from 21 patients (2 females, 19 males) undergoing CC7 surgery was searched for photographic data that contained a standard ruler measuring donor C7 nerve root length after surgical sectioning and before transfer. Two independent observers analyzed these images and recorded C7 nerve root diameter, length, and branch lengths. Results Mean (SD) values of donor C7 nerve measurements were length, 53.5 (8.0) mm; diameter, 5.1 (0.9) mm; branch length following surgical sectioning, 18.3 (6.3) mm. Right-sided donor C7 nerve roots yielded significantly longer branches compared with left-sided donor C7 nerve roots (P = 0.01). Other patient factors such as age, sex, or laterality of brain injury did not influence intraoperative anatomy. Conclusions We report detailed intraoperative measurements of the donor C7 root during CC7 nerve transfer for spastic hemiplegia. These findings describe existing variation in surgical C7 nerve root anatomy in patients undergoing this procedure and may serve as a general reference for the expected donor C7 length in successful direct anastomosis.

Polydactyly of the foot occurs in 1.7 cases per 1000 live births, comprising 45% of congenital abnormalities of the foot. Most reported cases of polydactyly of the foot are postaxial, and 15% are preaxial; of those, tarsal type preaxial polydactyly (a true prehallux) occurs in only 3% of cases. Because of this rarity, there is minimal literature available to guide management or surgical reconstruction. Two newborns presented with similar tarsal type preaxial polydactylies in the context of multiple congenital anomalies at a single institution. Patient 1 presented at birth with an accessory digit arising medially from the right foot at the medial malleolus. Two weeks later, genetically unrelated, patient 2 presented at birth with an accessory digit arising medially from the right foot at the talus. Both patients underwent resection of the extra digit and reconstruction including transfer of the accessory anterior tibial tendon arising from the preaxial extra digit to the remaining first ray. Two years after surgery, both patients are walking well with preserved dorsiflexion strength. Given the rarity of true prehallux cases, reported surgical treatment and outcomes are lacking. This case demonstrates the management of 2 patients to better guide future patient care. Although nonsurgical treatment with shoewear modification is an option, surgical reconstruction facilitated wearing typical shoes while preserving ambulatory ability. Both patients in this series had an accessory anterior tibial tendon. Surgical transfer of the tendon prevented loss of dorsiflexion strength and foot drop postoperatively.

This study aimed to compare the efficiency of non‐surgical embryo transfer (ET) using a newly developed catheter, which enables transferring embryos into a proximal site of the uterus (mostly uterine body), and surgical ET of vitrified porcine embryos. In Experiment 1, the catheter was inserted into 12 gilts, with each half of the group allocated to skilled or novice operators. The time required for insertion into the uterus did not differ between skilled and novice operators (4 min 9 s and 4 min 6 s, respectively). In Experiment 2, 12 gilts were used as recipients for non‐surgical and surgical ET with vitrified embryos (n = 6, each). There was no significant difference in the rate of piglet production based on the number of transferred embryos between surgical and non‐surgical ET (25.8% vs. 15.4%, p = .098). The results suggest that non‐surgical ET catheter allowed for easy insertion and transfer of embryos without special training. Although the catheter is effective for deposition of embryos into the proximal site of uterus, the efficiency of piglet production is not enhanced compared with surgical ET. The ET method using this catheter, being labor‐saving and less‐invasive, may contribute to the improvement of ET in pigs.

The research aimed to construct a rehabilitation program for the muscles working on the arm after carpal tunnel release of the middle nerve of the hand to identify the effect of the program on some physical and physiological variables The researcher used the experimental method in a multiple measurements method. The research sample consisted of (10) individuals who had the carpal tunnel release process and the results were positive in improving the rate of carriage of nerve fibers to the middle nerve as there was an improvement in the strength of the muscles working on the arm. The researcher used the experimental method as it suits the nature and purpose of the research by using the pre and post experimental design with one experimental group system. Theresearch community was deliberately selected from the ulnar nerve patients, the number of (4) individuals infected with ulnar nerve from the age (30 - 45) years, after the consent of the injured as well as the approval of the doctors and all health authorities to implement the rehabilitation program after full review and allow the completion of measurements of the sample accurately and health care and after adjusting the research variables for one experimental group Thenature of this research requires that the sample members meet the following conditions: 1- Agree to conduct theresearch experiment. 2- Attend a proposedrehabilitation program throughout the duration of the experiment. 3- No injury to the individualaffecting the implementation of the proposed rehabilitation units in the program. 4- The sample should not besubjected to any other program during the research sample experiment. 5- Volunteer in conductingthe experiment and regularity in the rehabilitation units of the programthroughout the study period. 6- The research sample to bediagnosed by a doctor who specializes in ultrasound (radiologist).

Background Tertiary care centers often operate above capacity, limiting access to emergency surgical care for patients at nontertiary facilities. For nontraumatic surgical emergencies there are no guidelines to inform patient selection for transfer to another facility. Such decisions may be particularly difficult for gravely ill patients when the benefits of transfer are uncertain. Methods To characterize surgeons' decision-making strategies for transfer, a qualitative analysis of semistructured interviews was conducted with 16 general surgeons who refer and accept patients within a regional transfer network. Interviews included case-based vignettes about surgical patients with high comorbidity, multisystem organ failure, and terminal conditions. An inductive coding strategy was used, followed by performance of a higher-level analysis to characterize important themes and trends. Results Surgeons at outlying hospitals seek transfer when the resources to care for patients' surgical needs or comorbid conditions are unavailable locally. In contrast, surgeons at the tertiary center accept all patients regardless of outcome or resource considerations. Bed availability at the tertiary care center restricts transfer capacity, harming patients who cannot be transferred. Surgeons sometimes transfer dying patients in order to exhaust all treatment options or appease families, but they are conflicted about the value of transfer, which displaces patients from their local communities and limits access to tertiary care for others. Conclusion Decisions to transfer surgical patients are complex and require comprehensive understanding of local capacity and regional resources. Current decision-making strategies fail to optimize patient selection for transfer and can inappropriately allocate scarce tertiary care beds.

We investigated the feasibility of piglet production by non‐surgical embryo transfer (Ns‐ET) of vitrified porcine blastocysts and expanded blastocysts transported to commercial farms and warmed on site (V/T/W embryos). Ns‐ET was performed by depositing 11–20 vitrified and warmed embryos at a proximal site within the uterus via a catheter. In Experiment 1, the effect of donor–recipient estrous cycle asynchrony on the efficiency of Ns‐ET of vitrified and ordinary warmed embryos was investigated at the experimental facility. With a 1‐day delay recipients relative to that of donor, the farrowing rate was 50.0% and the survival rate to term was 21.1%. In Experiment 2, Ns‐ET using recipients with a 1‐day delay and vitrified embryos after one‐step warming and dilution was evaluated at the experimental facility. Although the resulting farrowing rate was 42.9%, the survival rate was 6.4%. In Experiment 3, Ns‐ET was conducted using V/T/W embryos at four commercial farms, where piglets derived from them were produced. When artificial insemination was conducted prior to Ns‐ET, the farrowing and survival rates obtained using V/T/W embryos were 75.0%, and 21.3%, respectively. These results show that Ns‐ET of V/T/W embryos using this protocol would be feasible for piglet production at farms.

Background Patient-derived xenograft (PDX) involve the direct surgical transfer of fresh human tumor samples to immunodeficient mice. This systematic review aimed to identify publications of head and neck cancer PDX (HNC-PDX) models, describing the main methodological characteristics and outcomes. Methods An electronic search was undertaken in four databases, including publications having used HNC-PDX. Data were analyzed descriptively. Results 63 articles were yielded. The nude mouse was one most commonly animal model used (38.8 %), and squamous cell carcinoma accounted for the majority of HNC-PDX (80.6 %). Tumors were mostly implanted in the flank (86.3 %), and the latency period ranged from 30 to 401 days. The successful rate ranged from 17 % to 100 %. Different drugs and pathways were identified. Conclusion HNC-PDX appears to significantly recapitulate the morphology of the original HNC and represents a valuable method in translational research for the assessment of the in vivo effect of novel therapies for HNC.

Definition and prevalence of xerostomia were shortly presented. Radiosensitivity of the salivary glands, mechanism, diagnostics, and possible prediction methods of the intensity of xerostomia in the pre-radiotherapy period are widely discussed. Prevention of xerostomia: salivary gland sparing radiotherapy, cytoprotective agents, preservation by stimulation with cholinergic muscarinic agonists, surgical transfer of submandibular glands according to ASCO Management Guidelines and Quality of Life Recommendations were cited. Oral Care Study Group (2010) therapeutic approaches for relieving xerostomia are referred. Current therapies, restricted to symptom relief such as oral hygiene with fluoride agents, antimicrobials to prevent dental caries, saliva substitutes to relieve symptoms, and sialogenic agents to stimulate saliva were also discussed.

18 p.-3 tab., Surgical transfer of embryos is carried out daily in animal facilities worldwide for the rederivation of mouse strains/lines, among other purposes. Current protocols described in laboratory manuals recommend using a high number of embryos during transfer, typically in the range of 15 up to 25. To optimize the use of resources it is necessary to estimate and relate the effort required and the yield obtained. Here, we analyse the balance between the number of embryos transferred (the effort), and the yield as the number of born pups obtained from surgical embryo transfer. To accomplish this, we have analyzed data obtained during rederivation of nearly one hundred lines of mice to a new animal facility. Our results confirm that the use of increasing numbers of embryos per transfer increases the yields of born pups, as has been described previously in the literature, but they also highlight the disproportionate effort required, i.e. in the number of embryos that needed to be transferred. An estimate of the mean expected yields of surgical transfers and their comparison with the actual observed yields indicated that the balance between effort and yield is optimized when using lower numbers of embryos than in currently used protocols, in the range of 8 to 12. Given the heterogeneous nature of the data presented and analyzed here, which is from a population of mice that may be considered as representative of any animal facility, our optimization approach should help save resources in similar facilities and improve the yields of embryo transfer procedures., This research was sponsored with core funding derived from the user fees of the CIB animal facility.

Nonsurgical embryo transfer (NSET) of blastocysts to pseudopregnant female recipients provides many benefits over surgical implantation with less distress for the mice, no anesthesia or analgesia required and a considerable reduction in implantation time per mouse. Although a disposable device to perform NSET is on the market since 2009, it is not generally used in transgenic facilities, most likely because surgical implantation is efficient and inexpensive. Here, we report that with several refinements to the original protocol, the NSET method becomes very attractive and outperforms the traditional surgical transfer on basis of pregnancy rate, birth rate and implantation-related discomfort. Furthermore, repeated use of the same NSET device on several recipient females reduces the costs to a reasonable level. The data presented covers all embryo transfers over the last 5 years at the transgenic facility of the Netherlands Cancer Institute, of which the last 2 years were performed exclusively with NSET. Electronic supplementary material The online version of this article (doi:10.1007/s11248-014-9802-3) contains supplementary material, which is available to authorized users.

Cryopreservation is the long-term storage of viable cells/tissue in liquid nitrogen. The present study was conducted to freeze 8-cell- to morula-stage mouse embryos from the ACTREC Laboratory Animal Facility using a "slow freezing and fast revival" method. In all, 4,088 embryos were collected from 495 donor female mice of ten different strains. An average recovery of 8 embryos per donor mouse were recorded. Of the 4,088 embryos, 3,946 embryos of normal morphology were frozen in 173 straws. They were cooled down using a controlled-rate freezing assembly, and the straws were directly plunged into liquid nitrogen for long-term storage. Out of these 3,946 frozen embryos, 2,650 were found to be viable after fast revival. The highest survival rate, 81%, was recorded in B6D2F1 hybrid mice, whereas the lowest rate, 51%, was recorded in the S/RV/Cri-ba mutant strain. Out of 2,650 viable embryos, 2,359 embryos (89%) developed to the blastocyst stage after 24 h of incubation in a CO(2) incubator. The developed blastocysts were transferred surgically into 101 pseudopregnant female mice, of which 49 (48.5%) females were found to be pregnant. The highest percentage of pregnancy, 75%, was recorded in C57BL/6NCrl and NIH-III mice, whereas no pregnant recipients were recorded in Ptch, C3H/HeNCrl and NOD SCID mice. Based on the deliveries of these 49 females, an average of 4 young were delivered per female. Improvement in efficiency of freezing, thawing, and surgical transfer of embryos into pseudopregnant females is one of the challenges in such studies.

ZusammenfassungDie angeborene Tibiapseudarthrose ist eine selteneFehlbildung noch unbekannter Atiologie. Derfreie vas­kularisierte Fibula-pro-Tibialransfererlaubt wahrend ei­nes Eingriffs eine Defektuberbruckung und zugleichKorrektureiner Beinverkurzung. Im folgenden wird dererfolgreiche freie vaskularisierte Fibulatransfer mit Plat­tenosteosynthese bei einem 5jahrigen Madchen mit an­geborener Tibiapseudarthrose beschrieben. Bei derKontrolle 5 Jahre postoperativ kann die Patientin ohneorthopadische Hilfsmittel das Bein voll belasten, sie ist'subjektiv beschwerdefrei, es besteht kein Beinlangenun­terschied. Die Einheilungsraten liegen nach den aktuel­len Literaturangaben hoher als nach herkommliehenVertahren.

Resume Le traitement des luxations et instabilites patellaires chez l’enfant et l’adolescent est encore discute. Le transfert ligamento-perioste ou « baguette molle » est une technique de reaxation distale de l’appareil extenseur du genou adaptee a l’enfant. Ce travail se propose d’evaluer ses resultats. Entre 1979 et 2000, trente-cinq enfants (50 genoux) ont ete operes par cette technique de reaxation, toujours associee a une section du retinaculum patellaire lateral et a une myoplastie mediale. Certains gestes complementaires ont ete necessaires (allongement du quadriceps, trochleoplastie, liberation du quadriceps). L’âge moyen a l’intervention etait de 11 ans avec des extremes de 5 a 15 ans. Tous nos patients ont ete revus a maturite osseuse avec un recul moyen de 7,5 ans. La revision a comporte un bilan fonctionnel (selon les criteres de la fiche IKDC), et radiologique (cliches des genoux de face et de profil en appui monopodal et un defile femoro-patellaire a 30°). Un scanner morphologique et/ou une IRM ont ete realises en preoperatoire et au dernier recul. Nous avons distingue deux groupes de patients : les luxations patellaires majeures (permanente ou habituelle) et les luxations patellaires recidivantes. Les resultats sont bons sur le plan fonctionnel respectivement dans 76 % et 86 % des cas. On deplore 8 recidives de luxation vraie : cinq genoux ont ete reoperes avec un bon resultat. L’angle trochleen a ete ameliore dans les deux groupes, de maniere plus importante dans le groupe des luxations majeures. Nous avons observe une pente tibiale inversee (-2°) et deux pentes annulees. Nos resultats fonctionnels sont equivalents a ceux des series publiees, mais la comparaison est souvent difficile car les cohortes de patients sont heterogenes. Le remodelage trochleen, gage d’une bonne stabilite, est meilleur si l’enfant est opere tot (avant l’âge de 10 ans). A contrario, chez l’adolescent, si l’instabilite patellaire est majeure une trochleoplastie complementaire doit etre associee au geste de recentrage. Nous avons constate une diminution de la pente tibiale de faible amplitude dans 11 cas. Il semble donc exister un « effet epiphysiodese » de cette technique, mais sans consequence fonctionnelle. La technique du transfert ligamento-perioste, associee a des gestes « a la carte », est une methode de choix permettant une stabilisation du systeme extenseur avec une normalisation de l’angle trochleen si l’enfant est opere tot. Le remodelage de la tuberosite tibiale pourrait etre du a un trouble vasculaire transitoire.

Posttraumatic fingertip reconstruction with free toe pulp transfer was first described in 1979. Several studies have tested the sensibility of the reconstructed digits using the two-point discrimination test. The goal of this study was to comprehensively assess the functional outcome of the reconstructed fingertips after free toe pulp transfer.There were 15 flaps in 14 male patients in this retrospective study. Objective sensory recovery was assessed with two-point discrimination and Semmes-Weinstein monofilament tests. Pinch power of the reconstructed digits and subjective pain and discomfort were also evaluated.Six flaps had good results, six had fair results, and three could perceive only one point. The Semmes-Weinstein monofilament test revealed diminished light touch in six flaps, diminished protective sensation in eight flaps, and loss of protective sensation in one flap. There was strong correlation between static and moving two-point discrimination (gamma = 0.78747, p = 0.0005) but weak correlation between static two-point discrimination and the Semmes-Weinstein monofilament test (gamma = 0.34240, p = 0.2116). There was a significant difference in static two-point discrimination (p0.01) but no significant difference in Semmes-Weinstein results between the contralateral toes and flaps. The mean difference in pinch power between the dominant and nondominant hands was 6.72 percent with involvement of the dominant hand and 34.16 percent with involvement of the nondominant hand. There was no significant difference between the pinch power of the reconstructed digits and adjusted values.After free toe pulp transfer, the reconstructed digits had equal sensory threshold as the donor toes, but functional sensibility varied. Pinch power was restored. Free toe pulp transfer restored the sensibility, stability, and durability of the finger pulp and achieved functional recovery of the traumatized digits.

Porcine embryo transfer (ET) technology has been in demand for decades because of its potential to provide considerable improvements in pig production with important sanitary, economic, and animal welfare benefits. Despite these advantages, the commercial use of ET is practically nonexistent. However, the two main obstacles hindering the commercial use of ET in pigs in the past several decades (i.e., surgical transfer and embryo preservation) have recently been overcome. A technique for nonsurgical deep-uterine (NsDU) ET of nonsedated gilts and sows, which was seemingly an impossible challenge just a few years ago, is a reality today. The improvements in embryo preservation that have been achieved in recent years and the excellent reproductive performance of the recipients after the NsDU-ET technique coupled with short-term and long-term-stored embryos represent essential progress for the international trade of porcine embryos and the practical use of ET by the pig industry. This review focuses, with an emphasis on our own findings, on the recent advances in embryo preservation and NsDU-ET technologies, which are starting to show potential for application under field conditions.

Aims: To present a modified technique for the preparation of glabellar skin flaps to reconstruct medial canthal defects. Methods: Ten consecutively treated patients were included who had skin defects after resection of skin tumours like basal cell carcinomas in the medial canthal area of a medium vertical diameter of 2.5 cm. The defects were closed by preparation of a modified glabellar flap. The pedicle of the flap was guided through a skin tunnel prepared diagonally at the root of the nose. The pedicle was resected 4 weeks after the initial surgery. Results: In all 10 cases, the procedure was adequate for reconstruction of the defect. There were no flap necroses and the cosmetic results were favourable in all cases. The resection of the pedicle could be performed easily in an out-patient procedure 4 weeks after the operation. Conclusion: Glabellar flaps are established procedures to reconstruct medium to large defects of the medial canthus. Skin distortion in the area of the flap pedicle leading to a skin bulge and visible scars at the root of the nose and medial transposition of the eye brows can be reduced by a modification of the surgical technique preparing a skin tunnel for the flap pedicle. In our hands, the cosmetic results are better with the modified technique in comparison to the original procedure.

The authors report the advantages of the groin osteoadiposal flap for facial augmentation, which include the possibility of a conjoint type of flap harvesting with one main set of vessels (usually, the superficial circumflex iliac vessels); one-stage augmentation without secondary defatting; a donor scar in a concealed area; and rigid flap fixation with bone plating.

In multiple digital amputations with severe crush injury, replantation of digits with a poor prognosis is often fruitless. Those digits with a favorable prognosis should be selectively replanted in positions that provide optimal functional outcome, regardless of their anatomic origins: this is the principle of transpositional replantation. The authors present a case of right-hand crush injury with amputation of all five digits. Basic hand function was restored by double transpositional digital replantations without additional reconstructive procedures. In properly selected cases, such procedures can preserve greater hand function and reduce the necessity for secondary operations. It is suggested that transpositional replantation should be considered when multiple digital amputations are encountered.

The specific relationship between force and length is one of the most important characteristics of vertebrate muscle. The only accurate method to measure the force-length characteristics is to generate a set of isometric force-time plots at different muscle lengths. In humans, such force-length characteristics mostly are based on indirect measurements that have their limitations. A method of direct, in vivo measurement of force-length characteristics of the human flexor carpi ulnaris muscle using relatively simple equipment during transposition surgery is presented. The method is proven reproducible, with an overall estimated error of 2.8%.

Microsurgery and free tissue transfer play a vital role in the modern practice of reconstructive surgery. Prior to the advent of microsurgical free tissue transfer pedicle flaps were the workhorse of a reconstructive surgeon. We report a case of thumb reconstruction by pedicled transfer of the second toe with functional and aesthetic outcome. This case was performed in Pakistan where microsurgical facilities were not available.

Background and purpose: Xerostomia is a significant morbidity of radiation treatment in the management of head and neck cancers. We hypothesized that the surgical transfer of one submandibular salivary gland to the submental space, where it can be shielded from radiation treatment (XRT), would prevent xerostomia. Materials and methods: We conducted a prospective Phase II clinical trial and the patients were followed clinically with salivary flow studies and the University of Washington Quality of Life questionnaire. Results: We report the results on 76 evaluable patients. The salivary gland transfer was done in 60 patients. Nine patients (of 60) did not have postoperative XRT and in eight patients (of 60) the transferred gland was not shielded from XRT due to proximity of disease. The median follow up is 14 months. Of the 43 patients with the salivary gland transfer and post-operative XRT with protection of the transferred gland, 81% have none or minimal xerostomia, and 19% developed moderate to severe xerostomia. Three patients (6.9%) developed local recurrence, five patients (11.6%) developed distant metastases and five patients (11.6%) have died. There were no complications attributed to the surgical procedure. Conclusion: Surgical transfer of a submandibular salivary gland to the submental space preserves its function and prevents the development of radiation induced xerostomia.

Hintergrund. Die pra- und postoperativen Befunde bei Patienten mit ein- und beidseitiger Abduzensparalyse werden vorgestellt.

Fifty-three cases of cubital tunnel syndrome were treated by anterior subcutaneous transposition of the ulnar nerve. All patients were assessed by an independent examiner at a mean follow-up of 32 months. McGowan’s rating scale, as modified by Goldberg, was used preoperatively and at follow-up. Preoperatively, five cases were classified grade I, 37 grade IIA, eight grade IIB and three grade III. Thoracic outlet syndrome was also present in 7 cases. At follow-up, 44 cases were grade 0, three grade I, five grade IIA and one grade IIB. Forty-four of the 53 cases had resolved and the other nine had improved. Subcutaneous transposition is a reliable and effective surgical option. The result is less satisfactory if a thoracic outlet syndrome is also present.

The authors offer a new technique that provides a better long-term upper pole fullness to the shape of the breasts following reduction mammoplasty, thus creating an overall more satisfactory aesthetic appearance for both breasts.

Hintergrund. Tumorexzisionen im medialen Lidwinkel fuhren oft zu grosen Hautdefekten, deren Deckung mittels verschiedener plastischer Rekonstruktionsverfahren erfolgen kann. Patienten und Methoden. Um Aufschlusse uber die Indikation, Komplikationen sowie funktionellen und asthetischen Ergebnisse der unterschiedlichen Verfahren zu erhalten, analysierten wir retrospektiv 39 an unserer Klinik von August 1995 bis Januar 1998 durchgefuhrte plastische Rekonstruktionen im medialen Lidwinkel. Ergebnisse. Vier kleinere Defekte konnten primar verschlossen werden, 15 mittelgrose Defekte wurden mittels freiem Transplantat und 18 ausgedehnte Defekte mittels Lappenplastik gedeckt. Zwei Defekte heilten durch spontane Granulation. Tumorrezidive fanden wir nicht. Die funktionellen und asthetischen Ergebnisse waren insgesamt gut, wobei die Narbenbildung bei den Schwenklappenplastiken auffallender war und bei 5 Patienten mit einem leichten medialen Ektropium einherging. Patienten mit sekundarer Wundheilung benotigten eine intensivere und langere Wundpflege. Schlussfolgerung. Nach Exzision medialer Lidwinkeltumoren stellen freie Transplantate bei kleineren und mittelgrosen sowie Schwenklappen bei groseren Defekten ein effektives Verfahren mit einfacher postoperativer Versorgung sowie guten funktionellen und asthetischen Ergebnissen zur plastischen Rekonstruktion dar. Wundheilung durch spontane Granulation stellt bei Patienten in schlechtem Allgemeinzustand eine Therapiealternative dar.

Symmetrical anatomy of the chest wall is the aesthetic goal in any technique for nipple-areola complex positioning in post-burn patients. In 15 patients, a new surgical technique was applied by transposition of two subcutaneously pedicled flaps, one of which carries the malpositioned nipple-areola complex. The long-term results of this procedure were found to be satisfactory in all patients.

Zur Rekonstruktion groserer Defekte der auseren Ohrmuschel haben sich trotz des groseren Aufwandes Mehrschrittechniken mit autologem Rippenknorpel bewahrt. Fur die unterschiedlichen Lokalisationen von solchen Defekten besteht jedoch keine einheitliche Vorgehensweise. Insbesondere die kaudale Ohrmuschelhalfte stellt aufgrund der anatomischen Beschaffenheit ein besonderes Problem dar. In einer retrospektiven Studie wurden verschiedene Rekonstruktionstechniken von Teildefekten der Ohrmuschel auf ihre plastischen Ergebnisse untersucht und eine Systematik je nach Lokalisation des Defekts erarbeitet. Bei groseren Defekten des Ohrmuschelrandes uber 30% Substanzverlust haben sich wegen der groseren Stabilitat Gerustrekonstruktionen mit autologem Rippenknorpel bewahrt. In Abhangigkeit von Lokalisation und Grose des Defekts stehen fur die Rekonstruktion der Ohrmuschelruckseite verschiedene regionare Lappen zur Verfugung: Defekte der kranialen Abschnitte konnen mit einem Faszienspalthautlappen gedeckt werden, bei kaudalen Defekten mit Lobulusrekonstruktion setzen wir einen infraaurikularen Transpositionslappen ein. Dysplasien II. Grades konnen bei intakten Reststrukturen, die in die Rekonstruktion mit integriert werden konnen, wie Ohrmuscheldefekte eingestuft und therapiert werden. Zusammenfassend haben sich fur die Rekonstruktion groser peripherer Ohrmuscheldefekte Techniken mit Knorpelgerusten aus autologer Rippe in Verbindung mit Lappenplastiken bewahrt, die nach Lokalisation des Defektes modifiziert werden konnen.

The traditional rhomboid transposition flap has been widely used in reconstructive surgery. The authors have modified the original technique by eliminating the creation of the rhomboid defect and by directly transposing the flap into the original postexcisional defect. These changes allow maximum flexibility in flap design and minimize normal tissue loss. The authors retrospectively reviewed the charts of patients who underwent periocular reconstruction with flaps from 1990 through 1995. The authors selected those patients in whom the modified rhomboid flap was used. Functional and cosmetic results and complications were reviewed. Two hundred thirty-two patients were identified in whom 242 flaps were performed. The modified rhomboid flap was used in 101 patients (41.7%). Complications occurred in 23 patients (23%), 19 of whom (19%) were treated medically and four of whom (4%) required an additional surgical procedure. Cosmetic and functional results were classified as very good or excellent in 96 patients (96%). The use of a modified rhomboid flap in the reconstruction of the periocular area offers ample versatility in flap design and minimal normal tissue loss. Functional and cosmetic results are satisfactory in the vast majority of cases.

A new technique using the released medial intramuscular septum as a fascial or fasciodermal sling to prevent posterior subluxation of the ulnar nerve following subcutaneous transposition is described. The technique is simple and prevents subluxation, yet it still allows free excursion of the ulnar nerve and postoperative rehabilitation is begun immediately.

Recurrent giant-cell tumours of bone have a higher risk of malignancy than primary giant-cell tumours of bone, and giant-cell tumours of bone in the hand are more likely to recur than those that arise elsewhere. Therefore, en bloc resection and reconstruction, or amputation, have been the accepted treatments for recurrent giant-cell tumours of bone in the hand. We describe two cases of successful transplantion of a metatarsal to a metacarpal, which was the site of a recurrent giant-cell tumour. The patients had satisfactory results 3 years later without problems in the foot. En bloc resection of the tumour and reconstruction with an autograft should be considered in the treatment of recurrent giant cell tumour of the hand.

The authors report 42 subcutaneous transpositions of arterialized deep upper arm veins for hemodialysis angioaccess: 37 basilic (BaF) and 5 brachial (BrF) fistulas, done in 38 patients, 18 of them diabetics, with local anesthesia. Indications for BaF and BrF creation were surgically exhausted forearm veins and/or severe arteriosclerotic changes of distal arteries. No neurologic or circulatory complications were seen. Cumulative patency rates for all fistulas was 100% at the first month and 82% one year after surgery. BaF and BrF are optimal autogenous alternatives to synthetic grafts.

An objective of this study was to find a culture medium and a temperature range suitable for in vitro maintenance of adult Schistosoma japonicum during surgical transplantation experiments. Adult S. japonicum were cultivated in four different media (NCTC 135, NCTC 109, RPMI 1640 and 0.85% physiological saline) supplemented with 10% heat-inactivated normal pig serum (hiNPS) at either 4 degrees C, 22-25 degrees C (room temperature) or 37 degrees C. Based on survival and morphologic evaluation, NCTC 135 at room temperature was found to be the best medium/temperature combination for maintenance of worms. An additional objective was to develop a method for transplanting adult S. japonicum from experimentally infected donor pigs to naïve recipient pigs. Six Landrace/Yorkshire crossbred pigs were used as donors to supply worms for two recipient pigs. Worms for transplantation were obtained by perfusion of the mesenteric veins of the donor pigs and maintained for a maximum of 3 h in NCTC 135 + 10% hiNPS at room temperature. A total of 148 and 132 worms were surgically transferred by way of an infusion tube into caecal veins of the two recipients. Six weeks after transplantation, 14% and 36% of the transferred worms were recovered by perfusion and subsequent manual inspection of the mesenteric veins of the two recipient pigs, respectively. The successful results suggest that surgical transfer of S. japonicum worms from donor to naïve recipient pigs may be useful for future studies on population genetics, dynamics and regulation in the pig/S. japonicum model.

The reversed gastric tube provides a relatively simple method of esophageal replacement in children. A thirty year experience of this technique is described together with the long-term results in 34 patients. Complications such as anastomotic leakage and stricturing have responded well to treatment and only one patient died. The reversed gastric tube remains a useful alternative to other methods of esophageal substitution.

Injury to a peripheral nerve in the hand can result in loss of motor and sensory function. In addition, incomplete or abnormal regeneration can cause painful sequelae. The approach to neuromas in the hand requires familiarity with the basic aspects of nerve regeneration as well as the neurophysiology of pain mechanisms.

Background. Defects of the distal nose are particularly challenging to reconstruct because of this area's unique texture, lack of elasticity, and possible distortion of the alar rim. The bilobed flap has been criticized for having a high incidence of “trapdooring,” flap necrosis, dog ears, and prominent suture lines. Methods. Patients who underwent bilobed flap repairs of the distal nose (n = 171) were reviewed for complications and cosmetic results. The modifications from the traditional design include minimizing the angle of transposition between lobes, thinning of the flap, basing the pedicle on the lateral aspect of the nose, and creating the lobes of the flap to be of equal diameter to the defect. Results. There was a 3% incidence of infection, 7% incidence of partial flap necrosis, and 5% incidence of “trapdooring” and contour distortion. Color match and contour were excellent for all other patients. Conclusions. The modified bilobed flap is an excellent choice for reconstruction of defects of the lower nose because of the good skin match and low incidence of complications.

The authors review 29 toes transfers on 24 patients with injury of long fingers between 1985 and 1990. The series contains 16 complete toes and 13 partial toes transfers. The results, inconvenience and indications are discussed.

The authors present 40 cases of multidigital amputations with a "bank-finger" reconstruction. They use of flaps, tendons, nerves grafts .... from the injured finger. Moreover, they propose a guide in the use of heterotopic implantations, in emergency and in secondary. The indications of the digital translocation is discussed about the priority finger and the localisation of the others fingers to be reimplanted. They make mention of the rare possibility of temporary ectopic implantation.

Resume Cette etude a ete realisee dans le but de demontrer que les benefices lies a l’application d’une solution composee de peroxyde d’hydrogene (H 2 O 2 ) a 8 % et de dimethylsulfoxyde (DMSO) a 50 % limitent la survenue de necrose au niveau des lambeaux myocutanes pedicules. L’etude a ete conduite sur 40 lapins New Zealand munis de deux lambeaux myocutanes (pannicolus carnosus) paravertebraux symetriques (10 × 2,5 cm). Les 80 lambeaux ainsi obtenus ont ete partages en quatre groupes de 20 lapins : un groupe temoin et trois groupes experimentaux. Les lambeaux ont ete traites par une application topique d’une solution saline (groupe A), par du H 2 O 2 8 % (groupe B), par du DMSO 50 % (groupe C), et par un melange de DMSO 50 % + H 2 O 2 8 % (groupe D). Chaque solution etait appliquee en quantite de 20 cc. trois fois par jour pendant une semaine apres l’intervention. La tension transcutanee d’oxygene (Ptc O 2 ) des lambeaux a ete enregistree 72 h apres l’intervention. Le taux de survie des zones cutanees a ete determine sept jours apres le debut des experimentations. Le taux de survie des zones cutanees des lambeaux du groupe A (temoin) etait de 71 %, chez le groupe B (traite par H 2 O 2 ) de 72 %, chez le groupe C (traite par DMSO) de 76 % et chez le groupe D (traite par un melange de DMSO + H 2 O 2 ) de 92 %. Statistiquement, il n’existait pas de difference significative entre le taux de survie des lambeaux traites par H 2 O 2 , celui des lambeaux traites par DMSO et celui du groupe temoin, tandis qu’une difference significative entre le taux de survie des lambeaux traites par DMSO et H 2 O 2 et celui du groupe temoin etait observee (superieure a 20 %). De meme, il existait une difference significative entre la Ptc O 2 des lambeaux traites par solution DMSO et H 2 O 2 et celle des lambeaux du groupe temoin.

Background. The closure of large cutaneous defects of the upper face can be challenging, often requiring the use of large rotation, advancement, or transposition flaps or skin grafts. Objective. To describe the use of the spanning suspension suture, a technique we have adapted to facilitate closure of large cutaneous defects of the upper face. Methods. Report of an illustrated case. Results. A large full-thickness defect of the temple was successfully reconstructed using the spanning suspension suture. Conclusion. Use of the spanning suspension suture permits recruitment of skin from the lower cheek and neck in the closure of large wounds of the upper face, avoiding the need for transposition or rotation flaps and grafts.

The aim of this study is to evaluate the accuracy of a surgical template-aided implant placement produced by rapid prototyping using a DICOM dataset from cone beam computer tomography (CBCT). On the basis of CBCT scans (Sirona® Galileos), a total of ten models were produced using a rapid-prototyping three-dimensional printer. On the same patients, impressions were performed to compare fitting accuracy of both methods. From the models made by impression, templates were produced and accuracy was compared and analyzed with the rapid-prototyping model. Whereas templates made by conventional procedure had an excellent accuracy, the fitting accuracy of those produced by DICOM datasets was not sufficient. Deviations ranged between 2.0 and 3.5 mm, after modification of models between 1.4 and 3.1 mm. The findings of this study suggest that the accuracy of the low-dose Sirona Galileos® DICOM dataset seems to show a high deviation, which is not useable for accurate surgical transfer for example in implant surgery.

The effect of anterior transposition of the insertion of the inferior oblique muscle was compared with the results from conventional inferior oblique muscle recession in 50 patients. Even though both groups of patients had a similar degree of overaction preoperatively, postoperative inferior oblique muscle action was weaker (P.01) and upgaze more limited P.01) in the anterior transposition group. These data suggest that anterior transposition serves to convert the inferior oblique muscle from an elevator to a depressor on attempted elevation. Because anterior transposition is such a powerful weakening operation, we suggest that it be reserved for patients with moderate to severe inferior oblique muscle overaction. To avoid postoperative hypotropia in upgaze, anterior transposition should be performed in both eyes for bilateral inferior oblique muscle overaction and not unilaterally.

We report the results of a new surgical procedure for spastic equinovarus deformity due to cerebral palsy. This is the transfer of the anterior half of the split tibialis posterior to the dorsum of the foot through the interosseous membrane. We performed the operation on 23 feet in 18 children. All patients were assessed before operation and at follow-up at a mean of 8.4 years postoperatively. Using the criteria of Kling et al (1985), excellent results were obtained in 14 feet, good results in eight, and a poor result in only one.

In this article are discussed several minor reconstructive pelvic procedures that should be a part of the gynecologic surgeon's armamentarium, specifically the following: Z-plasty, full-thickness skin grafting, skin flaps, W-plasty, and transposition skin flaps. These procedures are essential in both primary reparative and reoperative surgery. These procedures are widely used in other surgical specialties and can be adapted for use in gynecologic surgery.