Samuel Chittaranjan

Computed tomographically guided biopsy of the spine.

Study Design Efficacy of the percutaneous biopsy of the spine under computed tomographic guidence was investigated, Seventy-five patients, ranging in age from 7 to 72 years, underwent this procedure. Objectives To determine the usefulness of computed tomographically guided biopsies in the treatment of patients with spinal disorders. Summary of Background Data The results of 68 biopsies (90.6%) were judged to be accurate insofar as the samples of tissue obtained could be diagnosed as specific types of enoplasm, infective lesions, reactive lesions of nonspecific type, or noramal bone. Methods Biopsies that yielded a specific abnormality were categorized as true positives. The “normal” biopsies were followed for 6–8 months and were than deemed true negatives. Nondiagnostic ones were considered false negatives. Results The results are acceptable with an accuracy rate of 90.6%. It is a safe and simple procedure with a short learning curve. Conclusions Computed tomographically guided biopsy of the spine is recommended as a procedure of choice, especially in cervical and thoracic lesions. Computed tomography is superior to fluiorascopy when dealing with small, deep-seated lesions especially in the cervical and thoracic regions and with lesions picked up on bone scan only, radiographs being negative. Needle biopsy under computed tomographic guidance is safe and precise.

Single-stage reconstruction of soft-tissue defects including the Achilles tendon using the dorsalis pedis arterialized flap along with the extensor digitorum brevis as bridge graft.

Open ruptures of the Achilles tendon with loss of the tendon and the overlying skin are very difficult to treat. They pose the problems of (1) combating infection, (2) providing soft-tissue cover, and (3) bridging the gap in the tendon. They are generally managed as multi-staged procedures. Once the infection is brought under control with debridement and antibiotics, skin cover is provided by local transposition flaps, distant pedicle flaps, or free-tissue transfer with microvascular anastomoses. The tendon itself is repaired later by one of the conventional techniques. More recently, composite free-tissue transfers repairing the skin and tendon in a single stage have been reported. We describe a simple and very reliable procedure using a dorsalis pedis island flap which provides a vascularized, innervated musculotendinous unit (i.e., extensor digitorum brevis) to bridge the gap in the Achilles tendon and thin, mobile skin and fascia to close the defect in the skin. Two cases are presented, including the technical details, advantages, and limitations of this procedure.

Reconstruction of the quadriceps apparatus following open injuries to the knee joint using pedicled gastrocnemius musculotendinous unit as bridge graft

The objectives of treating open knee joint injuries with disruption of the distal quadriceps mechanism are to ensure rapid wound healing and to restore joint function. For this it is necessary to provide soft tissue cover, control infection, restore full extension of the knee by reconstruction of the extensor apparatus and prevent joint stiffness by early mobilisation. Two cases are presented where the gastrocnemius (medial half) musculotendinous unit has been used to reconstruct, in one stage, the extensor apparatus and at the same time to provide soft tissue cover.

Open infected Achilles tendon injury--reconstruction of tendon with fascia lata graft and soft tissue cover with a reverse flow sural flap.

We present a patient with an open, infected Achilles tendon injury with a soft tissue defect of 12 cm x 5 cm and a tendon defect of 10 cm. He underwent a two-stage procedure. A first stage debridement of tendon and soft tissue was followed by a second stage tendo Achilles reconstruction using fascia lata graft and soft tissue cover with a reverse flow sural flap. He had a good functional outcome with minimal donor site morbidity.

Vascularized extensor digitorum brevis to reconstruct the Achilles tendon: A case report

We have used the extensor digitorum brevis musculotendinous unit elevated on its neurovascular pedicle and transposed it to reconstruct the Achilles tendon in a case of neglected rupture.

Managing Skin Necrosis and Prosthesis Subluxation After Total Knee Arthroplasty

Skin necrosis and prosthetic subluxation are dreaded complications after total knee arthroplasty. It can result in deep infection with subsequent failure of prosthesis. The incidence of infection in patients with rheumatoid arthritis who undergo knee arthroplasty is high when compared to patients with primary osteoarthritis. The gastrocnemius muscle flap has been described for cover of proximal tibia and tendon loss because of malignancy and has been used as a bridge graft in trauma patients with patellar tendon loss. We describe a patient with total knee arthroplasty with anterior knee skin necrosis and prosthesis subluxation because of attenuation and loss of continuity of patellar tendon. This was managed by using gastrocnemius bridge grafting. Here, the gastrocnemius bridge graft was used as a soft tissue cover as well as a dynamic anterior stabilizer for the prosthesis.