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PubMed1994

Dorsal and circumferential sheath reconstructions for flexor sheath defect with concomitant bony injury.

Dorsal and circumferential flexor sheaths were reconstructed by autogenous sheath graft in flexor tendon repair in 28 white leghorn chickens. The effect of the sheath reconstructions was evaluated by use of an experimental model of tendon transection associated with bony injury, superficial tendon excision, and 3 weeks of immobilization. Six weeks after reconstruction, the gliding excursion was assessed and adhesion formation, tendon healing, and survival of the grafted sheath were evaluated both macroscopically and histologically. Dorsal and circumferential sheath grafts resulted in tendon gliding that was significantly better than the group with sheath defect not reconstructed. The adhesion formation was apparently less severe, and tendon healing was better in the groups with sheath reconstruction than in the group without reconstruction. The group with dorsal sheath reconstruction did not differ significantly from that with circumferential reconstruction in gliding excursion and adhesion formation. This study demonstrates that separation of the injured tendons from the bony surface by autogenous sheath grafts may be beneficial to tendon gliding and for reducing adhesion formation.

Animals↗

PubMed2004

Long term results of reconstruction plates in lateral mandibular defects. Revision of nine cases.

OBJECTIVE: Although microsurgical bone transplant is still the gold standard, mandibular reconstruction plates (MRP) were for several years considered a fast and safe way to restore mandibular continuity without using a bone graft. New plate designs with locking screws have been recently introduced, and these may overcome some of the complications related to previous designs. We review the results of mandibular reconstruction plates in our institution from 1991 to 1995. METHODS: The records of nine cancer patients who underwent lateral mandibular resections (with preservation of both condyle and symphysis) followed by reconstruction with a mandibular reconstruction plate, were retrospectively reviewed. Patients were treated between 1991 and 1995 with regular Synthes and Leibinger plates (without locking screws). Immediately after tumour resection, the bone defect was reconstructed with an MRP without bone grafting. Three cases required soft tissue coverage: two flaps and one buccal fat pad flap. RESULTS: There was immediate orocervical fistula in six cases, one of which required surgical closure; and late complications were common. One patient died due to distant metastasis 13 months after surgery without symptoms related to the plate. The remaining eight patients had their plates removed at between 9 and 52 months after reconstruction, due to screw loosening (four cases), plate exposure (one case), or both (three cases). CONCLUSION: Lateral mandibular reconstruction with non-locking screws and regular profile plates is no longer recommended. New plates with improved designs are currently available. Their low profile and locking screws are the usual characteristics of these new plates. More clinical experience is necessary before plate reconstruction can be recommended over microvascular bone transfer.

Aged↗

PubMed2005

[Breast reconstruction by DIEP free flap: about 100 cases].

Autologous breast reconstruction was stigmatised because the muscular sacrifice of the rectus abdominis muscle. This problem could be avoided by the DIEP flap as much for immediate as delayed reconstruction with the creation of an aesthetic and natural shaped reconstructed breast. This retrospective study about 100 cases performed between January 1997 and June 2002 concern 94 patients, 88 unilateral reconstructions and six bilateral. The reconstruction was delayed in 83%, immediate in 8% or realised after failed attempt to reconstruct the breast with implant in 9%. Risk factors were also present: smokers (66%), one or more abdominal scars (40%), obesity (30%). The recipient vessels were the internal mammary vessels (86%), the circumflex scapular vessels (10%) and the subscapular vessels (4%). We noted four total flap loss, 5% of partial loss and 2% localized liponecrosis. Mean operating time was 6 hours 28 minutes for unilateral reconstruction and 9 hours 30 minutes for bilateral reconstruction. Mean hospital stay was 7,3 days. Two moderated abdominal bulging were noted. The tedious dissection of small vessels of the DIEP flap allowed for a similar rate of complication as the free TRAM flap, by respecting of the integrity of the rectus abdominis muscle, to reduce morbidity of harvest with less postoperative pain, shorter hospital stay and faster recovery.

Adult↗

PubMed2006

[Bilateral breast reconstruction with the autologous latissimus dorsi flap (a retrospective study of 31 consecutive cases)].

PURPOSE OF THE STUDY: The purpose of this study was to analyse the advantages, disadvantages and results of bilateral breast reconstruction by autologous latissimus dorsi flap. MATERIAL AND METHOD: Thirty-one two-stage consecutive bilateral breast reconstructions were performed by the same operator between 1993 and 2001. All the reconstructions, in immediate or delayed manner, were indicated after radical or skin sparing mastectomy for breast cancer. We used the autologous latissimus dorsi flap for all cases. The reconstruction of the second breast was always delayed of a few months to avoid back's complications. We reviewed the charts of these patients retrospectively. Preoperative data, postoperative complications, dorsal seroma occurrence, morphological results and patient's satisfaction were evaluated. Median follow-up was 22 months. RESULTS: The results confirm the procedure's reliability. Comparative rates of postoperative complications are not significantly different between first and contralateral breast reconstruction. Functional after-effects of bilateral latissimus dorsi harvesting are moderate. The aesthetics results have been judged as very good in 84% of cases and good in 16%. The satisfaction rate of the patients is high: 90,3% are pleased, 6,5% are satisfied and 3,2% are moderately satisfied. CONCLUSION: The autologous latissimus dorsi flap allows a two-stage bilateral breast reconstruction. This procedure is not indicated for simultaneous bilateral breast reconstruction; it is the main drawback of this technique. So we believe that this procedure is an excellent alternative in all the indications of sequential bilateral breast reconstructions.

Adult↗

PubMed2003

Posterolateral reconstruction using split Achilles tendon allograft.

Injury to the cruciate ligaments of the knee commonly occurs in association with posterolateral instability, which can cause severe functional disability including varus, posterior translation, and external rotational instability. Failure to diagnose and treat an injury of the posterolateral corner in a patient who has a tear of the cruciate ligament can also result in the failure of the reconstructed cruciate ligament. Unlike isolated posterior cruciate ligament injury, there seems to be a consensus of opinion that injury to the posterolateral corner, whether isolated or combined, is best treated by reconstructing the posterolateral corner along with the coexisting cruciate ligament injury, if combined. Commonly proposed methods of reconstructing the posterolateral corner have focused on the reconstruction of the popliteus, the popliteofibular ligament, and the lateral collateral ligament. We introduce a new technique for reconstructing the posterolateral corner using a split Achilles tendon allograft. Our method reasonably addresses the several pitfalls in the reconstruction of the posterolateral corner, including (1) concurrent reconstruction of important posterolateral structures, (2) regaining the isometry of the lateral collateral ligament, (3) repositioning the reconstructed popliteus into its original position, and (4) providing a secure fixation method.

Achilles Tendon↗

PubMed2004

Arthroscopic evaluation of the articular cartilage after anterior cruciate ligament reconstruction: a short-term prospective study of 105 patients.

PURPOSE: Several reports have shown the progression of degenerative osteoarthritis after anterior cruciate ligament (ACL) reconstruction. No report has been published about early cartilage change after ACL reconstruction. The purpose of this study was to evaluate the articular cartilage after ACL reconstruction in a short postoperative period by arthroscopy. TYPE OF STUDY: Case series. METHODS: We examined the status of articular cartilage of 105 patients who received ACL reconstruction and second-look arthroscopy. Cartilage lesion was evaluated arthroscopically in the 6 articular surfaces independently, and these features were classified by modified Outerbridge's classification. We compared the articular cartilage at reconstruction and at second-look arthroscopy. RESULTS: A significant worsening of the status of the articular cartilage was seen after ACL reconstruction. This worsening was seen at all articular surfaces except the lateral femoral condyle. Most of the change involved softening or fibrillation. Anterior laxity and meniscal lesion had no correlation with a progression of degenerative change of articular cartilage. Patient's age influenced the progression of articular cartilage damage after reconstruction significantly in our cases. CONCLUSIONS: The status of articular cartilage was significantly worsened after ACL reconstruction. Potent risk factors causing articular cartilage damage include female gender and age of 30 years or older. LEVEL OF EVIDENCE: Level IV.

Adolescent↗

PubMed2006

Combined anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner reconstruction with autogenous hamstring grafts in chronic instabilities.

PURPOSE: The purpose of this study was to evaluate the clinical outcome after 1-stage reconstructions of the anterior and posterior cruciate ligaments (ACL, PCL) with reconstruction of the posterolateral corner (PLC) structures using autogenous hamstring grafts in chronic knee injuries. TYPE OF STUDY: Prospective case series. METHODS: We reviewed 17 patients (13 men and 4 women) with chronic multiligamentous injuries after a minimum follow-up of 2 years (range, 24 to 66.3 months). Arthroscopically assisted combined ACL/PCL reconstructions with autogenous semitendinosus-gracilis tendon grafts were performed using the single-incision endoscopic ACL technique and the single femoral tunnel, single-bundle transtibial tunnel PCL technique. The PLC was reconstructed with a free autogenous semitendinous tendon graft. The primary outcome measures were the International Knee Documentation Committee (IKDC) score and stress radiography. As secondary outcome measure, all patients were evaluated with a subjective questionnaire, physical examination, radiologic assessment, and KT-1000 arthrometer testing. RESULTS: The mean time from injury to the reconstructive procedure was 70.2 +/- 96.7 months (range, 5.1 to 312.6 months). At final IKDC evaluation, 4 patients (29.4%) were graded level B (nearly normal), 10 patients (58.8%) level C (abnormal), and 2 patients (11.8%) level D (grossly abnormal). The mean postoperative subjective IKDC score was 71.8 +/- 19.3 points. Mean posterior tibial displacement as measured through stress radiography at 90 degrees of knee flexion was reduced from -15.06 +/- 4.68 mm preoperatively to -7.12 +/- 3.37 mm postoperatively (P < .001). Mean anterior tibial displacement was 0.94 +/- 2.75 mm preoperatively compared with -1.59 +/- 3.50 mm postoperatively (P < .01). Three patients had a fixed posterior tibial subluxation (posterior tibial displacement < or = -3 mm on anterior stress radiographs) postoperatively. Severe subjective instability was reduced significantly by the operative procedure (P < .001). The mean postoperative total anterior-posterior side-to-side difference with the KT-1000 arthrometer testing was 2.00 +/- 2.23 mm (range, -4 to 7 mm). CONCLUSIONS: Combined chronic ACL/PCL/PLC instabilities can be successfully treated with 1-stage arthroscopic cruciate ligament reconstruction combined with PLC reconstruction using autogenous hamstring grafts. Although current reconstruction techniques are not able to restore normal tibiofemoral kinematics, most patients recover a functionally stable knee and have considerably improved knee function compared with their preoperative status, based on subjective parameters and objective criteria. LEVEL OF EVIDENCE: Level IV, case series, no historical or control group.

Adolescent↗

PubMed2006

Radiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: an argument about timing.

OBJECTIVE: To conduct a systematic review to gather the available evidence on the optimum timing of the radiotherapy in relation to autologous breast reconstruction. MATERIAL AND METHODS: The data was extracted from scientific databases, and a manual follow-up of references. The studies were selected which included at least 20 patients with any method of autologous breast reconstruction who were treated with adjuvant radiotherapy either before or after their reconstruction, and had addressed the effects of radiotherapy on the cosmetic outcome in their results. The principal outcome was cosmetic appearance. Secondary outcomes were immediate and delayed complications. RESULTS: We could not find any randomised controlled trial on this topic. Ten studies were included, most were retrospective, heterogeneous in terms of control groups, radiation doses, follow-up duration, and outcome measurements. Two studies included no control groups, and four studies compared the outcomes of patients with radiotherapy either before (n=3) or after (n=1) autologous breast reconstruction. The overall incidence of complications was increased in patients with radiotherapy in three out of these four studies. Only four studies directly compared the outcomes of patients who received radiotherapy before with patients who received radiotherapy after autologous breast reconstruction and two out of these reported worse outcomes associated with post-reconstruction radiotherapy. CONCLUSIONS: Despite the paucity of the published data, the current evidence suggests that the radiation has a deleterious effect on autologous flap reconstruction. Until better methods of radiation delivery can be devised to minimise the long term radiation sequelae in the irradiated tissue, delayed reconstruction seems to be a safe option in most of the cases. However, the findings from these studies should be interpreted with great caution before generalising from their results.

Adult↗

PubMed2006

Melanoma of thumb: retrospective study for amputation levels, surgical margin and reconstruction.

For the treatment of melanoma of thumb, the evidence about amputation level (IP joint or MP joint) and cutaneous excision margin has not been fully presented. And reconstructions for lost thumbs need to be balanced against functional and aesthetic requirements of individual patients and overall prognosis. We report 15 patients, who underwent primary excision and reconstruction for thumb melanoma between 1986 and 2004 at Department of Plastic and Reconstructive Surgery, University of Hokkaido at Sapporo, Graduate School of Medicine. The patients were reviewed to evaluate the prognostic significance of variables including age and sex of the patient, tumour thickness, staging, level of amputation, and cutaneous excision margin. Our 15 cases were divided into two groups according to amputation level (MP or IP) and cutaneous excision margin (<40 mm or >or =40 mm) and prognosis was analysed statistically. The stage and thickness were identified as prognostic factors for disease-free survival; however, IP amputation and 10-30 mm margin did not compromise disease-free survival. Amputated thumb was reconstructed by pollicization, free toe to thumb transfer, reverse forearm flap, local flap, and skin graft. No major complication of reconstructed thumb occurred. Seven of eight cases of MP amputation were reconstructed by pollicization. On the other hand, five cases of IP amputation were reconstructed by volar skin flap in two cases, reverse forearm flap in two cases, and trimmed first toe transfer in one case. Although a small number of cases, our study is the first attempt focussing on melanoma of thumb, and evaluating amputation level and cutaneous margin separately. The reconstructive algorithm for the amputated thumb is proposed and has various tools including free toe to thumb transfer.

Adult↗

PubMed2006

Dynamic measurement of patellofemoral contact pressure following reconstruction of the medial patellofemoral ligament: an in vitro study.

BACKGROUND: Surgical reconstruction of the medial patellofemoral ligament used to stabilize the patella against lateral dislocation may concomitantly produce alteration of the patellofemoral contact pressure distribution. Two different tendon transfer techniques of reconstructing the medial patellofemoral ligament, one dynamic and one static, as well as a proximal soft tissue realignment of the patella were investigated. METHODS: Eight human knee specimens were mounted in a kinematic knee simulator and isokinetic extension motion was simulated. Patellofemoral pressure was measured using a pressure sensitive film while a 100 N laterally directed dislocation load was applied to the patella. The specimens were evaluated in a physiologic state, as well as after dynamic reconstruction of the medial patellofemoral ligament using a distal transfer of the semitendinosus tendon, following static reconstruction using a semitendinosus autograft, and following proximal soft tissue realignment of the patella. FINDINGS: Following both reconstruction techniques of the medial patellofemoral ligament patellofemoral contact pressure was not significantly (P=0.49) altered. In contrast, after proximal realignment a trend (P=0.07) towards higher contact pressure near knee extension was observed. In the absence of a lateral dislocation load dynamic and static reconstruction resulted in a medialization (P=0.04) of the center of pressure, whereas under the application of a 100 N dislocation load the center of pressure showed no significant alteration. Following proximal realignment the center of pressure was significantly medialized without (P<0.01) and with a dislocation load (P=0.01) throughout the entire range of knee motion. INTERPRETATION: Static and dynamic ligament reconstruction of the medial patellofemoral ligament did not alter patellofemoral pressure. Proximal realignment, on the other hand, resulted in a constant medialization of the patellofemoral pressure. The data suggest that the reconstruction techniques would be associated with a low risk of causing premature cartilage degeneration due to excessive patellofemoral contact pressure, whereas proximal realignment could cause medial overload of the patellofemoral joint.

Aged↗

PubMed2006

Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: a finite element analysis.

BACKGROUND: Intra-articular techniques (single and double bundles) are the most widely used procedures for the anterior cruciate ligament reconstruction. Lemaire introduced in 1967 the extra-articular techniques, and combined intra-articular and extra-articular reconstruction, to better restore the stability of the knee. However, the effectiveness of these procedures (intra-articular, extra-articular combined or not with intra-articular) seems to be controversial. METHODS: In the present study, we developed numerical models of a knee joint to evaluate the effects of these different procedures on the kinematics and biomechanics of the knee during an internal rotation test. Six cases were simulated: intact anterior cruciate ligament, intra-articular reconstructed anterior cruciate ligament (single and double bundles), extra-articular reconstructed anterior cruciate ligament alone, and combination of extra- and intra-articular reconstructions. The loading condition was an internal tibial torque of 2 N m at 0 degrees, 15 degrees, 30 degrees and 45 degrees of knee flexion. Internal rotation of the tibia and forces within the grafts and the ligaments were calculated. FINDINGS: This study showed that both single and double bundles intra-articular reconstructions restore similar internal rotation control and biomechanics of the soft structures as the intact anterior cruciate ligament situation. On the other hand, our results indicate that extra-articular reconstruction reduces appreciably the internal rotation and modifies the charges distribution in the soft structures when compared to the intact anterior cruciate ligament. INTERPRETATION: The extra-articular procedure alters the kinematics of the knee, which might overconstraint the ligaments and the femorotibial joints, leading to the failure of the anterior cruciate ligament reconstruction.

Anterior Cruciate Ligament↗

PubMed2004

The relationship between the auditory brain-stem response and its reconstructed waveforms following discrete wavelet transformation.

OBJECTIVE: To examine the relationship between the auditory brain-stem response (ABR) and its reconstructed waveforms following discrete wavelet transformation (DWT), and to comment on the resulting implications for ABR DWT time-frequency analysis. METHODS: ABR waveforms were recorded from 120 normal hearing subjects at 90, 70, 50, 30, 10 and 0 dBnHL, decomposed using a 6 level discrete wavelet transformation (DWT), and reconstructed at individual wavelet scales (frequency ranges) A6, D6, D5 and D4. These waveforms were then compared for general correlations, and for patterns of change due to stimulus level, and subject age, gender and test ear. RESULTS: The reconstructed ABR DWT waveforms showed 3 primary components: a large-amplitude waveform in the low-frequency A6 scale (0-266.6 Hz) with its single peak corresponding in latency with ABR waves III and V; a mid-amplitude waveform in the mid-frequency D6 scale (266.6-533.3 Hz) with its first 5 waves corresponding in latency to ABR waves I, III, V, VI and VII; and a small-amplitude, multiple-peaked waveform in the high-frequency D5 scale (533.3-1066.6 Hz) with its first 7 waves corresponding in latency to ABR waves I, II, III, IV, V, VI and VII. Comparisons between ABR waves I, III and V and their corresponding reconstructed ABR DWT waves showed strong correlations and similar, reliable, and statistically robust changes due to stimulus level and subject age, gender and test ear groupings. Limiting these findings, however, was the unexplained absence of a small number (2%, or 117/6720) of reconstructed ABR DWT waves, despite their corresponding ABR waves being present. CONCLUSIONS: Reconstructed ABR DWT waveforms can be used as valid time-frequency representations of the normal ABR, but with some limitations. In particular, the unexplained absence of a small number of reconstructed ABR DWT waves in some subjects, probably resulting from 'shift invariance' inherent to the DWT process, needs to be addressed. SIGNIFICANCE: This is the first report of the relationship between the ABR and its reconstructed ABR DWT waveforms in a large normative sample.

Adult↗

PubMed2006

A 7 year experience with immediate breast reconstruction after skin sparing mastectomy for cancer.

Skin sparing mastectomy (SSM) is a procedure that has gained popularity for patients who elect to have a mastectomy as the treatment for carcinoma of the breast. Reconstruction of the breast after SSM yields the best aesthetic results since it preserves most of the skin envelope and the inframammary fold. The purpose of this study was to evaluate the oncologic safety and aesthetic results for SSM and immediate breast reconstruction. One hundred and five patients treated between April 1997 and December 2004 were reviewed. The mean age of the patients was 40 years. The mean follow up was for 48 months, considered from the time of SSM and reconstruction. Reconstructive techniques included pedicled transverse rectus abdominis muscle (TRAM) flap (n: 70 patients), tissue expanders and implants (n: 29 patients), latissimus dorsi flaps and implants (n: 6 patients). Aesthetic results were judged by an independent plastic surgeon and by the patient as excellent, good, fair or poor. The findings of this study demonstrate that SSM and immediate breast reconstruction can be safely performed. Detection and treatment of recurrences were not inhibited by the reconstructions. In this experience the best results were seen after TRAM flap reconstructions. The general level of satisfaction expressed by the patient was correlated with a good appearance of the reconstructed breast and the physical comfort.

Adult↗

PubMed2006

The value of reoperative procedures after unusual reconstructions in the gastrointestinal tract associated with substantial morbidity.

Reconstructive procedures of the gastrointestinal tract after resection or for bypass surgery are well established and almost completely standardized but still may cause significant morbidity. Deviations from standard reconstructive procedures have pitfalls, especially when complex reconstructions are required, and may lead to substantial morbidity. Scientific evidence for the indication to reoperate as well as the best methods to be applied is lacking and surgical experience indispensable. We report on 10 reoperative cases between 1999 and 2003 after uncommon reconstructive procedures in the gastrointestinal tract associated with substantial morbidity. In five cases (five of seven), operative correction of uncommon reconstructions in the upper gastrointestinal tract after gastrectomy, completion gastrectomy, or distal gastric resection could completely alleviate the complaints including reflux esophagitis, whereas incomplete relief of symptoms was achieved in the remaining two cases (two of seven). Corrective procedures used end-to-side esophagojejunostomy or end-to-side gastrojejunostomy with a retrocolic isoperistaltic jejunal Roux-en-Y loop and end-to-side jejunojejunostomy approximately 40 cm distal to the proximal anastomosis for biliary and exocrine pancreatic drainage. After biliodigestive anastomosis, problematic cholangitis could be completely alleviated in three cases (three of three) using end-to-side hepaticojejunostomy with a retrocolic isoperistaltic jejunal Roux-en-Y loop and end-to-side jejunojejunostomy 40 cm distal to the hepaticojejunostomy for reconstruction of the continuity of the gastrointestinal tract. Compliance with well-established standard reconstructive procedures is of elementary importance in the gastrointestinal tract. Operative correction of uncommon reconstructions associated with morbidity is usually indicated.

Aged↗

PubMed2006

Durability of portal venous reconstruction following resection during pancreaticoduodenectomy.

Venous resection and reconstruction is becoming more common during pancreaticoduodenectomy (PD). There are multiple options for reconstruction of the mesenteric venous system ranging from primary repair to grafting with autologous or synthetic material. Few studies report on the patency rates and long-term morbidity of these repairs. We sought to describe our experience with venous reconstruction during PD with specific attention to patency and long-term morbidity and mortality. Thrombosis rates of mesenteric venous reconstruction during PD are low, with low associated morbidity. In this retrospective cohort, clinical, operative, and pathologic data were collected from consecutive patients for 1988 through 2003. Graft patency on follow-up imaging studies was determined, and short- as well as long-term morbidity and mortality were recorded. Sixty-four patients underwent PD with venous resection/reconstruction from 1988 through 2003. Mean patient age was 63 years, with pancreatic ductal adenocarcinoma as the pathology in 88%. Reconstruction consisted of primary lateral venorrhaphy in 29 (45%), PTFE graft in 18 (28%), primary end-to-end repair in 13 (20%), and autologous vein graft in 4 (6%). There was one perioperative death (2%). Follow-up imaging to assess patency was available for a mean of 12.2 months postoperatively. Eleven thromboses were diagnosed at a mean of 11.9 months. Three thromboses (5%) were noted within 30 days and full anticoagulation was chosen. Fifty-three percent of patients received anticoagulation with aspirin, warfarin, or clopidogrel based upon surgeon preference. There was no difference in thrombosis rates between those receiving anticoagulation and those who did not (P=0.65). In those patients with thrombosis outside the acute time period, morbidity was limited to ascites in three patients and splenic vein thrombosis with uncomplicated esophageal varices in another patient. Mesenteric venous resection and reconstruction during PD has a high patency rate, and those reconstructions that do thrombose are associated with a low morbidity. The majority of reconstruction thromboses that occurred late were associated with recurrence.

Carcinoma, Pancreatic Ductal↗

PubMed2004

Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy.

PURPOSE: To report our institution's experience of complications and cosmetic results among patients who underwent modified radical mastectomy followed by reconstruction and radiation therapy (RT). METHODS AND MATERIALS: Between 1987 and 2002, 85 patients with breast cancer underwent modified radical mastectomy, breast reconstruction, and postoperative RT. Reconstruction consisted of tissue expander/implant (TE/I) in 50 patients and an autologous transverse rectus abdominis myocutaneous (TRAM) flap in 35 patients. The primary end point of this study was the actuarial incidence of major and minor complications involving the reconstruction. Cosmesis was also assessed at each follow-up visit. RESULTS: The median follow-up from reconstruction was 28 months. The 5-year major complication rate was 0% in the TRAM group vs. 5% in the TE/I group (p = 0.21). The 5-year minor complication rate was 39% for the TRAM group vs. 14% for the TE/I group (p = 0.04). None (0%) of the TRAM complications required any corrective surgery, whereas 2 (33%) of the TE/I complications required implant removal. Of the TRAM patients with complications, 100% had superior cosmetic scores of excellent/good compared to only 17% of the TE/I patients who had complications (p = 0.003). Use of our custom-fashioned bolus resulted in a lower complication rate compared with standard bolus (p = 0.05). CONCLUSIONS: Patients treated with breast reconstruction and RT can experience a very low rate of major complications. We demonstrate no significant difference in the overall rate of major complications between TRAM and TE/I patients. Bolus can be safely used during postmastectomy RT with reconstruction, and we advocate the use of a custom wax bolus in the treatment of these patients. Postmastectomy RT should be considered in all eligible patients, even in the setting of reconstruction.

Adult↗

PubMed2005

Reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint: a cadaver study.

PURPOSE: The purpose of this study was to compare the stiffness and strength of the native ulnar collateral ligament with 4 methods of static ulnar collateral ligament (UCL) reconstruction at the thumb metacarpophalangeal (MCP) joint. METHODS: Eleven fresh-frozen cadaver specimens were amputated at the carpometacarpal and interphalangeal joints and all soft tissues were removed except for the extensor pollicis brevis tendon, the proper and accessory collateral ligaments, and the volar plate. Each thumb metacarpal was potted in cement and the native UCL was loaded to failure at 30 degrees of MCP flexion. Ulnar collateral ligament reconstructions as described by Strandell, Osterman, Fairhurst, and a modification of the Glickel procedure then were performed. Each specimen was again loaded to failure and the moment at failure, stiffness, and angle at failure were calculated. RESULTS: None of the reconstructions duplicated the strength or stiffness of the native UCL. The modification of the Glickel procedure with interference knot fixation had a significantly higher moment at failure and was significantly stiffer than any of the other procedures. The differences in strength and stiffness between the Strandell, Osterman, and Fairhurst reconstructions were not statistically significant. There were no significant differences in angle at failure for any of the reconstructions. CONCLUSIONS: No static ligament reconstruction restores the normal stability characteristics of the thumb UCL. The anatomic reconstruction of the UCL with interference knot fixation of the tendon graft has far better strength and stiffness than any of the other reconstructions tested. These characteristics may allow for early motion at the MCP joint.

Cadaver↗

PubMed2004

A new theory and algorithm for reconstructing helical structures with a seam.

Conventional helical reconstruction is a general method to obtain three-dimensional structures of many filamentous biological macromolecules. The method assumes helical symmetry, and generates the three-dimensional structures from two-dimensional projection images. However, the theory is inadequate to describe filamentous structures discontinuities, which are called seams in the case of microtubules or perturbations in the case of tobacco mosaic virus or the bacterial flagellar filament. To study such structures, a new theory and algorithm are required. To this aim, we developed a new algorithm, namely, asymmetric helical reconstruction, which is based on our new theory that describes a "helical" object with a seam. In the theory, "helical" objects with a seam are indexed with a non-integral order of nu. Like the conventional helical reconstruction, the layer-line data are extracted from the Fourier transform of the images. We show that the Fourier-Bessel transform using the Bessel functions of fractional order can, to good approximation, reconstruct the three-dimensional structure of the object. To test the new algorithm, we reconstructed three-dimensional structures of a kinesin-microtubule complex with a seam from both model data and experimental data from cryo-electron microscopic images. The reconstructed structures are almost identical with those reconstructed from conventional helical reconstruction demonstrating the validity of the algorithm. The algorithm enables the analysis of various "helical" specimens with seams and also significantly improves the throughput and the resolution of kinesin-microtubule complexes.

Algorithms↗