Kwang Suk Lee

Free vascularized osteocutaneous fibular graft to the tibia.

We reviewed the clinical results of reconstruction performed for extensive tibial bone and soft tissue defect with a free vascularized osteocutaneous fibular graft in 46 patients (43 male and 3 female). The mean duration of follow‐up was 30 months (range 13–76 months). The mean age at the time of reconstruction was 41 years (range 15–66 years). In the 46 consecutive procedures of free vascularized osteocutaneous fibular grafts, bony union was achieved in 43 grafted fibulae at an average of 3.75 months after operation. There were two delayed unions and one non‐union. Forty‐four cutaneous flaps survived, and two cutaneous flaps failed due to deep infection and venous insufficiency. One necrotized cutaneous flap was replaced with a latissimus dorsi free flap and the other with a soleus muscle rotational flap without replacing the grafted fibulae; unions were obtained without significance complications. All grafted fibulae hypertrophied during the follow‐up periods. The most common complication was fracture of the grafted fibulae in 15 patients, and it occurred at an average of 9.7 months after the reconstruction. The fractured fibulae were treated with long leg above‐the‐knee cast immobilization or internal fixation with conventional cancellous bone graft. Free vascularized osteocutaneous fibular graft is a good treatment modality for the reconstruction of extensive bone and soft tissue defect in the leg. Fracture of the grafted fibula, one of the most common complications after this operation, can easily be treated with cast immobilization or internal fixation with conventional cancellous bone graft.

Thumb reconstruction with a wrap‐around free flap according to the level of amputation

In 1980, Morrison and OBrien reported their experiences with the reconstruction of an amputated thumb using a wrap‐around neurovascular free flap from the great toe, but its indication has been limited distal to the metacarpophalangeal (MP) joint (Morrison et al., J Hand Surg 5:575–583, 1980). We have performed 37 wrap‐around free flaps from the great toe for the reconstruction of thumbs amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. The amputation was distal and proximal to the MP joint in 25 and 12 cases, respectively. Pinching and grasping power, two‐point discrimination, and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the results of two‐point discrimination was better in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In the 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of 30° flexion and 45° internal rotation. However, in the other six cases in the fixation of 30° flexion and 30° internal rotation, the opposition of the reconstructed thumb to the ring and little fingers was impossible in five cases and only to the little finger in one case. In this study, we concluded that amputation proximal to the MP joint is not an absolute contraindication to the wrap‐around free flap procedure for thumb reconstruction. However, for a better functional outcome, we recommend iliac bone block fixation in the position of 30° flexion and 45° internal rotation.

Congenital pseudarthrosis of the ulna treated by free vascularized fibular graft--a case report.

Congenital pseudarthrosis of the ulna is very rare. We have experienced a case of pseudarthrosis of ulna to be treated with the vascularized fibular graft in a seven-years-and-three-month-old boy.

THE EFFECT OF ASPIRIN AND PROSTAGLANDIN E1 ON THE PATENCY OF MICROVASCULAR ANASTOMOSIS IN THE RATS

The purpose of this study was to evaluate the effect of oral prostaglandin E(1)(PGE(1)) on the patency of the microvascular anastomosis of the carotid artery in rat. A total of 48 rats were used, and divided into three groups. The first group (A) was used as a control with no medical agent being used after anastomosis, the second group (B) was medicated with aspirin, and the third group (C) was medicated with oral PGE(1). In each group, four rats were sacrificed serially on every post-operative 3, 5, 10 and 15 days after arterial anastomosis. Patency and histologic evaluations at the anastomotic site were observed. The results revealed that the PGE(1) therapied group showed highest patency rate (100%), lesser formation of mural thrombosis, and also minimal changes in the intimal hyperplasia and medial fibrosis. From these findings, we could conclude that PGE(1) has superior effect on maintaining the patency after microvascular surgery.

METASTATIC HEPATOCELLULAR CARCINOMA OF THE DISTAL PHALANX OF THE THUMB: A CASE REPORT

A case of metastatic hepatocellular carcinoma of the distal phalanx of the thumb is presented. This case illustrated a rare example of acrometastasis of hepatocellular carcinoma.

Biomechanical Analysis of Tendon Suture Techniques

The relative strength of three suture methods of lacerated tendon were measured by mechanical disruption in effort to determine the strength of suture technique. Fifty-four calcaneal tendons of 27 New Zealand white rabbits were transected at mid-portion and repaired with the three suture techniques: group 1: Kessler suture; group 2: Penningtons modified-Kessler suture; and group 3: augmented-Becker suture technique. Each group was composed of 18 calcaneal tendons. Three groups of rabbits, 9 in each, were, respectively, sacrificed immediately after suture, at 2 weeks postoperatively and at 4 weeks postoperatively. The augmented-Becker repair was strongest in tensile strength and maximum stress at immediate operation, 2 weeks postoperatively and 4 weeks postoperatively. The augmented-Becker repair had the highest modulus of elasticity at time of suture, at 2 and at 4 weeks postoperatively. Tensile strength, maximum stress and modulus of elasticity gradually increased from the time of operation to 4 weeks, but the difference was not of statistical significance at 4 weeks.