Amiram Sagi

Improved survival of island flaps after prolonged ischemia by perfusion with superoxide dismutase.

Perfusion of rat groin flaps after 10 and 11 hours of complete ischemia with superoxide dismutase, an oxygen free-radical scavenger, significantly improved the survival of these flaps. This finding provides further evidence for the important role that oxygen-derived free radicals play in ischemic injury. The study also demonstrates that while restoration of blood supply alone is not enough to ensure tissue survival after prolonged ischemia, chemical agents can be utilized to achieve viable flaps beyond what was believed to be “a point of no return.”

Long-term follow-up of high-pressure injection injuries to the hand

Background: High-pressure injection injury is an injury caused by accidental injection of substances by industrial equipment. This injury may have devastating sequelae. The goal of this study was to assess the long-term outcome of high-pressure injection injury to the hand. Methods: In this historical prospective study, patients who had previously sustained high-pressure injection injury were examined. Assessment included measurement of grip and pinch strength, range of motion, two-point discrimination, and use of a questionnaire regarding present complaints and return to the work force. Results: Twenty-three patients were examined. Follow-up length was on average 8.5 years. The injured hand was most often (43 percent) the right dominant hand, the index in 65 percent, the thumb in 25 percent, and other locations in 10 percent. Only 43 percent of patients returned to their previous employment. Patient complaints were, in descending frequency, cold intolerance, hypersensitivity, paresthesias, constant pain, and impairment of activities of daily living. Metacarpophalangeal range of motion was decreased on average by 8.1 percent (p = 0.019), proximal interphalangeal joint range of motion was decreased by 23.9 percent (p = 0.001), and distal interphalangeal range of motion was decreased by 29.7 percent (p= 0.018). Maximum grip was decreased compared with the expected grip by 12 percent (p = 0.023). Pinch was decreased by 35 percent (p < 0.001). Two-point discrimination was increased by 49 percent (p < 0.007). Conclusion: This study confirms the fact that high-pressure injection injury to the hand is a significant problem. Virtually all patients suffer sequelae of this injury. The injury has significant repercussions for future function and reintegration into the work force.

The fate of tendon healing after restoration of the integrity of the tendon sheath with autogenous vein grafts

This experimental study in the chicken model compares the results of sheath closure during primary tendon surgery. Sheath closure after tendon grafting was accomplished by trapdoor of the original sheath, vein patch, and vein conduit. After casting in flexion for 14 days, the operated foot and digits were taken through a full passive range of motion every 3 days. At the 28th postoperative day, all immobilization was removed and free active range of motion and daily perching began. Active flexion was measured after death by continuous traction on the proximal profundus tendon: simulated active flexion. The unoperated contralateral foot served as the control. All operated middle toes achieved significantly greater functional return when the sheath was restored either with trap-door closure, vein conduit, or vein patch compared with simple excision of the sheath. The results indicate the efficacy of sheath closure as well as the possibility of utilizing vein patches or conduits during primary tendon repair.

A simple, rapid, reproducible tie-over dressing

A simple and quickly performed technique for the construction of tie-over dressings is described. After adjustment of the graft to the skin defect, skin staples are used to tack simultaneously the graft and looped silk threads circumferentially. Securing the threads is achieved by using a shortened disposable syringe cylinder through which the threads are passed and held in place by the adjusted piston. A stable fixation is easily achieved in all cases using one or more of these devices depending on the size of the defect. This technique enables the subsequent application of the dressing if needed.

The role of the gastrocnemius muscle flap in limb-sparing surgery for bone sarcomas of the distal femur : A proposed classification of muscle transfers

&NA; Limb‐sparing surgery for bone and soft‐tissue sarcomas involves three phases: (1) resection of the tumor with free margins, (2) reconstruction of the bone and joint defect, and (3) reconstruction of the soft tissues. This presentation focuses on the third phase. Between January of 1988 and January of 1994 we performed 33 distal femoral resections, 32 for malignant and 1 for benign tumors. There were 19 men and 14 women aged from 6 to 78 years (mean age 28 years). Twenty‐seven patients had gastrocnemius muscle flap transfers, 24 having “primary” transfers and 3 having “secondary” transfers. The lateral gastrocnemius muscle was used in 18 patients, the medial in 8 patients, and both in 1 patient. We propose a classification of the transfers based on the size of the soft‐tissue defect above the prosthesis needing coverage and the length of the neurovascular bundle of the muscle. Twenty‐six of the 27 muscles survived; one patient had necrosis of the skin and muscle. Two patients had persistent sinuses at the scar that were managed successfully (one of them was before a secondary muscle transfer). Six patients did not have gastrocnemius muscle flap transfers. Two of them had persistent sinuses for years, and one patient had titanium “synovitis” and needed repeated operations including removal of the prosthesis and revision. The particular vascularization of the gastrocnemius muscle (one pedicle at the level of the knee joint) situated close to its origin, the size of the muscle belly, and the fact that it is situated in the dissection field and its transfer does not affect the function of the spared limb make it particularly suitable for the coverage of wide areas of skin and muscle loss at the knee region. In the classification that we propose, type I is reserved for coverage of small areas, while types II and III are used for coverage of larger areas. Flap transfer should be performed primarily at the time of the resection in order to avoid complications of wound healing and to reduce delays in chemotherapy protocols. (Plast. Reconstr. Surg. 99: 751, 1997.)

Admission Cell Free DNA as a Prognostic Factor in Burns: Quantification by Use of a Direct Rapid Fluorometric Technique

Background. Despite great advances in the treatment of burn patients, useful prognostic markers are sparse. During the past years there has been increasing interest in circulating plasma cell free DNA as a potential marker for tissue injury. We have developed a rapid direct fluorescent assay for cell free DNA quantification that allows obtaining accurate, fast, and inexpensive measurements. Objective. To use this technique for measuring plasma cell free DNA levels in burn patients and to further explore the use of cell free DNA as a potential marker of patient outcome in burns. Methods. Cell free DNA levels obtained from 14 burn victims within 6 hours of injury and 14 healthy controls were quantified by a direct rapid fluorometric assay. Results. Patient admission cell free DNA levels were significantly elevated compared with that of controls (1797 ± 1523 ng/mL versus 374 ± 245 ng/mL, P = 0.004). There are statistically significant correlations between cell free DNA admission levels and burn degree (Spearmans correlation = 0.78, P = 0.001), total body surface area (Spearmans correlation = 0.61, P = 0.02), and total burn volume (Spearmans correlation = 0.64, P = 0.014). Conclusions. Admission cell free DNA levels can serve as a prognostic factor in burns and future routine use can be made possible by use of our direct rapid fluorometric assay.

pH-balanced solutions with superoxide dismutase (SOD): an attempt to increase island groin flap survival in rats.

Balanced salt solution (BSS) and balanced salt solution plus (BSS+), alone and in combination with heparin or superoxide dismutase (SOD), were used as irrigation solutions for rat groin flaps after prolonged ischemia. SOD always improved flap survival when it was present in solution, although when combined with BSS and BSS +, it was less effective than when combined with Ringers lactate. The physiological pH solutions BSS and BSS + had no advantages over Ringers lactate in any of the tested combinations.

Maqua (therapeutic burn) as an indicator of underlying disease.

The origin and nature of the maqua (the Arabic therapeutic burn) is presented together with our clinical experience of patients previously treated by this traditional method. Maquas are small deep burns inflicted in areas either in proximity to a diseased organ or in points related traditionally to the original basic problem. These relationships may be rooted in historical ties between old Arab medicine and traditional Oriental, antique Egyptian, and Greco-Roman medicines. Maquas alone only rarely present a threat to the patient, but in many cases they may serve as an indicator of the original underlying disease. This and other folklore treatment modalities, together with the healers themselves, should be acknowledged by us, as markers for health problems or maybe for potential healing methods and doctor-patient relationships.

A Simple Device to Control the Amount of Vasoactive Drugs Topically Applied to Blood Vessels During Experimental Studies

A simple, readily available, inexpensive device is presented that makes research of topically applied vasoactive drugs more accurate and reproducible. It is possible to recollect the drug or wash it away from the vessel. Reversal drugs can also be used in the immediate vicinity of the vessel wall.

Polydactyly in the multiethnic 'Negev' population at southern Israel.

The objective of this study was to characterize the prevalence, ethnic mix, and associated malformations of polydactyly in a multiethnic population. A retrospective analysis of 189 polydactyly patients was carried out. The incidence of polydactyly was 0.5/1000 live births and was higher in the Bedouin population. Preaxial polydactyly was 10 times more prevalent in the Jewish population and sporadic, and postaxial polydactyly was more prevalent in the consanguineous Bedouin population and associated with other malformations. We conclude that the pathologies in embryogenesis leading to preaxial and postaxial polydactyly vary, with the former occurring sporadically compared with the latter, which predominates in consanguineous families and syndromes.