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Biomedical subjects

W N Ueng

Publications and source records attributed to W N Ueng.

14 recordsLinked to original sources
PubMed2001

Reconstruction of posttraumatic long bone defect with free vascularized bone graft: good outcome in 48 patients with 6 years' follow-up.

We analyzed our clinical results in 48 patients (40 men) treated during 1990-1993 with free vascularized bone-graft reconstruction for bone defects, the follow-up being an average 6 (5-8) years. The bone defects were located in the femur (10), tibia (32), humerus (2), and forearm (4). We performed 41 fibula transfers, 4 iliac transfers, and 3 rib transfers in these patients. 3 patients required early revision surgery due to venous thrombosis. The average time needed for radiographic bone union was 4.2 months. Bone transfers to the lower extremity showed significantly more hypertrophy than those in the upper extremity. The functional outcome was good in 43 patients.

Adolescent↗
PubMed1998

Total hip arthroplasty in Salmonella coxitis: four cases report.

Suppurative coxitis induced by salmonella is rarely reported in the literature. Furthermore, reconstruction with a total hip arthroplasty (THA) in such patients has never been reported. However, in this study, we present 4 cases; 2 normal male patients and 2 female patients with underlying systemic lupus erythematosus (SLE). The ages range from 26 to 61 years. All 4 cases revealed growth of group B salmonella from the cultures of synovial fluid. They all received THA after the infections were eradicated. The functional assessment of pain, range of motion, walking ability together with the radiographic assessment were used according to the new hip score system. After a minimum follow-up of 2 years, all of the reconstructed hips showed good to excellent results since no infections recurred during this period. Although the long-term results are uncertain, the short-term clinical advantage of THA in the treatment of quiescent salmonella coxitis is encouraging.

Adult↗
PubMed1997

Free fibula osteoseptocutaneous graft for reconstruction of segmental femoral shaft defects.

Seventeen major reconstructions of the femoral shaft using vascularized fibula osteoseptocutaneous grafts were performed from August 1984 to September 1993. Patients were 14 males and 3 females, with an average age of 34 years. All patients had sustained high-energy trauma in motor vehicle crashes and had bone defects averaging 10 cm. The skeletal defect was primary attributable to bone loss at the time of injury (2 cases) or secondary after infection and sequestrectomy (15 cases). Vascularized fibular transfer was performed at an average of 6 months after trauma. The fibular graft was inserted as a single strut in 10 cases and as a double-barrel composite in 7 cases. Patients were evaluated at an average of 43 months after surgery. All grafts eventually united, and no patient showed evidence of recurrent or persistent infection. The average time to radiologic union was 8 months, and the average time to full weight bearing was 14 months. Secondary bone grafting and internal fixation were required in five cases because of delayed union, stress fracture, or screw loosening. All cases of delayed union and stress fracture were in those reconstructed by single-strut fibular graft. Four cases (24%) required quadriceps plasty and arthrolysis. The final average arc of active knee motion was from 0 to 80 degrees. Limb length discrepancy ranged from 0 to 7 cm (average, 3 cm). Five cases (29%) had varus deformity averaging 30 degrees. The fibular graft hypertrophied to 100% of the femoral circumference in cases followed for 3 years. Donor site morbidity was negligible. At the time of final follow-up, 13 patients had returned to their original jobs, two were permanently disabled because of below-knee amputation, and two were retired. The study suggests that vascularized fibula osteoseptocutaneous transfer is a valuable procedure for reconstruction of large, previously infected femoral shaft defects.

Adolescent↗
PubMed1995

Pulmonary tuberculosis as a source of infection after total hip arthroplasty. A report of two cases.

Two cases of septic loosening due to a tuberculosis infection occurred 18 months and 14 years after total hip arthroplasties. The primary source was pulmonary tuberculosis. Treatment was by removal of the prosthesis and radical debridement with the local implantation of gentamicin PMMA beads, followed by antituberculosis chemotherapy for one year. In the first case, a revision arthroplasty was carried out 20 months later; the second was reconstructed with a vastus lateralis transposition one month later. There was no recurrence of infection after a follow up of 3 and 2 years respectively. Although this is a rare complication, the possibility must be born in mind. Early diagnosis and treatment of pulmonary tuberculosis may prevent the secondary infection of a total hip arthroplasty.

Adult↗
PubMed1995

Double-rib composite free transfer to reconstruct a single-spared lower extremity defect.

The case of a 43-year-old man is reported in which a 15-cm defect of the tibia sustained 8 months previously was treated by the double-rib composite microvascular free transfer. The fracture site united, and the grafted ribs showed some hypertrophy at 1 year. He returned to his job. At 5 years follow-up, the x-ray film showed good hypertrophy of the grafted ribs.

Adult↗
PubMed1995

Ilizarov femoral lengthening in adults.

From January 1990 to December 1991, we treated 12 cases of length discrepancy due to femoral inequality with the technique of Ilizarov femoral lengthening. The patients' ages ranged from 20 to 33 years (average, 28 years). Of these, nine patients were men and three were women. Corticotomy was performed either at the distal metaphysis or at the junction of distal metaphysis and diaphysis. After a latency of seven to ten days, distraction commenced at a rate 0.25 mm every six to twelve hours. Bone generation was obtained in all patients without the need of bone grafting. The average length gained in femoral bone was 4.7 cms (range, 3 to 7 cms). The average duration of total treatment was 10.1 months (range, 7 to 15 months). The healing index was 2.2 (number of months per 1 cm elongation) on average. All patients were satisfied with the results, but all felt that it was an uncomfortable procedure. According to our experience, we conclude that the method of Ilizarov is an useful technique for femoral lengthening. However, it is an uncomfortable and tedious procedure.

Adult↗
PubMed1994

Semiopen cancellous bone grafting. A 2 step method for closing small infected tibial bone defects.

Thirteen infected small tibial bone defects with overlying skin loss were treated with a 2 stage procedure. In the 1st stage, antibiotic impregnated polymethylmethacrylate bead chains were used to obliterate the debrided osseous cavity and a meshed porcine skin graft was used for temporary wound coverage. In the 2nd stage, the bead chains were replaced with autogenous cancellous bone graft, and the wound was again covered with a meshed porcine skin graft. All wounds and bone grafts healed without the need for an additional autogenous skin or bone graft. The patients were hospitalized an average of 23 days. The length of time to the completion of secondary epithelialization of the wound ranged from 2 to 5 months (average, 3 months). The length of time to bone union ranged from 5 to 8 months (average, 6.4 months). An additional application of porcine skin graft was required in 3 patients. Minor pin tract infections were seen in 2 patients. There was no recurrence of osteomyelitis during an average followup of 37 months (range, 24-54 months). This method was helpful in securing the closure of infected tibial bone defects with small skin losses and avoided both prolonged hospitalization and the morbidity usually accompanying free tissue transfer or the Papineau method of open cancellous bone grafting.

Adolescent↗
PubMed1994

Hematogenous osteomyelitis with inflammatory cyst formation mimicking a soft-tissue tumor.

Reported is a case of hematogenous osteomyelitis of the femur with inflammatory cyst formation mimicking a soft-tissue tumor. A 15-year-old boy with a three-year history of a gradually enlarging soft-tissue mass of his left thigh was found to have an aborted acute hematogenous osteomyelitis complicated by an inflammatory cyst that was probably caused by inadequate antibiotic therapy. The osteomyelitis and its inflammatory cyst were treated with excisional debridement and six weeks of antibiotic therapy. The patient remains well five years later, with no clinical or radiologic evidence of recurrence. This is a new variant of chronic osteomyelitis that has not previously been reported.

Adolescent↗
PubMed1993

Squamous cell carcinoma complicating tibial osteomyelitis treated with local wide excision and staged microvascular reconstruction.

Squamous cell carcinoma is a complication of chronic tibial osteomyelitis treated with limb-preserving surgery. A 61-year-old man with 42-year history of chronic osteomyelitis of the left tibia was found to have malignant change. A curettage procedure was performed by a general surgeon. He then was referred to the osteomyelitis service; local wide excision was followed by staged microvascular latissimus dorsi muscle flap and fibular osteoseptocutaneous flap transfer. The patient remains well 36 months later with no clinical or radiologic evidence of local recurrence or distant metastasis. This kind of limb-sparing treatment is an excellent alternative treatment for malignancy.

Carcinoma, Squamous Cell↗
PubMed1993

Treatment of segmental femoral shaft fractures.

In a prospective study, 35 segmental femoral shaft fractures were treated either with closed intramedullary nails (most were Grosse-Kempf interlocking nails) or an open method technique (most were open Küntscher nails with supplementary wires). The follow-up period was at least one year. There was an 82.9% (29/35) union rate and a union period of 6.1 +/- 1.9 months. Knee range of motion was on average 125 degrees. Although there was no statistical difference, the closed intramedullary nailing group showed superiority to the open method group. Complications were not particularly different from those in other type fractures, but could be managed better. Closed nailing technique can be improved with training and experience. Whenever possible, with adequate indications, closed intramedullary nailing is better than open treatment for segmental femoral shaft fractures.

Adolescent↗
PubMed1993

Squamous cell carcinoma arising in chronic osteomyelitis--clinical analysis of 7 cases.

Retrospectively, we analyzed 7 cases of chronic osteomyelitis complicated with squamous cell carcinoma (SCC), who had been treated consecutively in Chang Gung Memorial Hospital from April 1983 to Jan. 1991. There were 6 males and one female, with the age between 43 and 80 years (average 57 years). The distribution of these lesions was 5 in the lower legs and 2 in the thighs; one had another hip lesion. The duration of discharging sinus presented before malignant change was from 4.5 years to 50 years (average 30 years). The pathological findings were all well-differentiated squamous cell carcinoma. Amputation was performed in 5 of them. Limb salvage procedure was selectively done in one case. Chemotherapy and regional irradiation without surgery was given in the remaining case. Follow up examination showed that the short term results were satisfactory in all cases. Six cases had at least one year of follow-up; the longest follow-up was 8 years.

Adult↗
PubMed1992

Management of infected tibial plate osteosynthesis using a staging system for infected fractures.

Osteomyelitis following plate osteosynthesis of a tibial shaft fracture was managed in 23 patients through a staging system and prospective treatment protocol. The staging system, which is arranged in an upstaging disease progression and downstaging treatment protocol, is composed of the status of osseous continuity (Type I to II) and the dead space created by the debridement surgery (Classes A to D). The follow-up period ranged from 20 to 48 months (average, 31.5 months). Staphylococcus aureus (35.5%) and Pseudomonas aeruginosa (29%) were the most commonly involved organisms. Twenty-two infections were initially arrested by one debridement, and one infection was arrested by three sequential debridements. There were seven Stage IA, one Stage IB, seven Stage IIA, two Stage IIB, three Stage IIC, and three Stage IID fractures in this study. The average number of surgical procedures were 1, 2, 2.1, 4, 4.7 and 6, respectively. The difficulty of treatment increased with the severity of the disease. The average time to bone union for Stage IIA, IIB, IIC and IID fractures were 11, 9, 20.3 and 21.5 months, respectively. A tibial osseous defect longer than 4 cm is a major prognostic factor for prolonged disability time. Important complications were nonunion one, bone graft stress fractures (two), and recurrence (three).

Adolescent↗
PubMed1992

Management of infected tibial intramedullary nailing using an organized treatment protocol.

Twenty cases of osteomyelitis, following intramedullary nailing of tibial shaft fractures, were managed with a prospective treatment protocol, comprising intramedullary reaming debridement, antibiotic-bead depot, external skeletal fixation, microvascular muscle flap and early cancellous bone grafting. The follow-up period ranged from 25 to 48 months (average, 34.3 months). Pseudomonas aeruginosa (37.5%) and Staphylococcus aureus (20.8%) were the organisms most commonly involved. There were eight united and 12 ununited fractures after reaming debridement surgery. Nineteen infections were initially arrested by one debridement. One infection was arrested by two Sequential debridements. All 12 ununited fractures were stabilized by Hoffmann unilateral external fixation until the fracture healed. The time spent in external fixation ranged from three to seven months (average, 5.2 months). Early cancellous bone grafting was successfully accomplished for nine ununited fractures with major debridement bone loss. The average union time of the nine fractures with bone grafting was 6.5 months (range, from six to eight months). We believe that this treatment protocol gives a predictable and rapid recovery. The complications were infection recurrence in two cases at the old tibial shaft fracture sites, minor Hoffmann pin tract infection in two cases and stiffness in two ankles and one knee.

Adolescent↗