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At least 127 records · Page 7Linked to original sources

PubMed2001

Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intra-articular reconstruction.

From 1986-1992, a total of 21 ACL reconstructions were completed in 20 skeletally immature athletes with an average age of 13.7 years (range: 11.8-15.6 years). Fifteen patients underwent operative reconstruction with hamstring tendons with wide open physes and 6 patients with bone-patellar tendon-bone (BPTB). All grafts were anatomically placed through transphyseal bone tunnels in the femur and tibia. Nineteen of 20 patients (20 of 21 reconstructions) returned for follow-up at an average of 34 months (range: 17-89 months). All patients had reached skeletal maturity at follow-up. No patient had limb-length discrepancy >1 cm postoperatively. No change in tibiofemoral alignment was noted (average 4.5 versus 4.25, P=.69). Modified Lysholm score was 93/95, and 19 of 20 athletes returned to preinjury level sports activity. Ligament laxity side-to-side difference was <3 mm in 16 patients, 3-6 mm in 2 patients, and >6 mm in 2 patients. One patient developed recurrent symptomatic laxity and was lost to follow-up. Two late graft ruptures (1 hamstring and 1 BPTB graft) occurred after major reinjury during sports. In this group of patients, ACL reconstruction through bone tunnels successfully eliminated instability although the failure rate, including late graft ruptures, was higher than that usually reported for adults. No limb length or angular deformity developed as a result of the transphyseal tunnels.

Adolescent↗

PubMed1992

Reconstruction of traumatic absence of the thumb by alternative microsurgical methods of reconstruction.

Because of the improved predictability, relative lack of donor morbidity, and excellent cosmetic appearance associated with the various forms of toe-to-hand transfers, these operations have become the procedure of choice in the reconstruction of a traumatically amputated thumb. However, a transfer from the foot may not always be available. If severe injuries, such as burns, have occurred to the feet, although a transfer may be technically feasible, it should be avoided. Occasionally, a patient will refuse to sacrifice a portion of his or her foot for either cosmetic or cultural reasons. If the presence of significant peripheral vascular disease is documented in the patient, the anatomy and suitability of the vessels supplying the toes becomes entirely unpredictable, and alternative methods for thumb reconstruction should be considered. In the acute trauma setting, first consideration as a source of donor tissue for thumb reconstruction should be given to any other digits, either ipsilateral or contralateral. Any digit amputated or severely injured at or proximal to the proximal interphalangeal joint may be considered as a possible donor digit. Careful examination of the neurovascular structures in this situation is essential to demonstrate that the zone of injury does not prohibit an appropriate repair at the recipient thumb bed. In the nonacute setting, occasionally, digits on the same or opposite hand are a valuable donor source for thumb reconstruction. Any digit found to be nonfunctional for reasons related to its location may be available for amputation and transfer to the thumb.(ABSTRACT TRUNCATED AT 250 WORDS)

Amputation, Traumatic↗

PubMedDate not supplied

[Surgical treatment of calcanear fractures (103 cases). Reconstruction-arthrodesis, or reconstruction (author's transl)].

In a twelve-year period, 103 calcanear fractures (thalamus) were operated on, either by the Stulz procedure (calcanear Reconstruction-subtalar Arthrodesis [83 cases]), or by Reconstruction (20 cases). During the first seven years, the Stulz procedure had been performed systematically. During the following five years, indications were shaded between 28 reconstruction-arthrodesis and 20 reconstructions. A complete preoperative radiological study, including especially horizontal calcanear tomography enables to precise what type of injuries affects the four different parts of the calcaneus, and to choose between either procedure.

Adolescent↗

PubMed1984

Intra-articular reconstruction of the anterior cruciate ligament. An experimental study of length changes in different ligament reconstructions.

An anatomic model was developed to test different types of intra-articular anterior cruciate ligament reconstructions. Four cadaver knees were tested in an identical fashion. In each knee 12 different positions were tested. The results indicate that over-the-top repair is not suitable for anterior cruciate ligament reconstruction from a mechanical standpoint. It is likely that this type of repair in human knees will lead to excessive stretching and insufficiency of the reconstructed tissue. A posterior approach through the lateral femoral condyle is more desirable. The position of the tibial tunnel is less crucial, but a more anterior tunnel is preferable. When the tunnels are properly drilled, fixation of the reconstructed ligament is advocated with the knee in 45 degrees-90 degrees of flexion. Postoperative immobilization in 45 degrees of flexion is suggested.

Adult↗

PubMed1994

Allograft reconstruction after proximal tibial resection for bone tumors. An analysis of function and outcome comparing allograft and prosthetic reconstructions.

Seventeen patients (age, 12-63 years; median, 22 years) treated with proximal tibial allografts were identified. Nine cases were intercalary and eight were osteoarticular allografts. Complications, number of operations, and oncologic and functional results were reviewed. The functional results of the allografts were compared with a prior cohort of patients who had endoprosthesis at the same institution by the same surgeons. There were 14 malignant tumors, two benign aggressive tumors, and one sclerosing osteomyelitis mimicking osteosarcoma. Twelve of 17 patients had complications, the most common being fracture, deformity, and infection. Six patients required more than one procedure, and three had amputations after allograft reconstruction. The ultimate function was excellent in three patients, good in seven, fair in six, and poor in one. There were 14 patients with endoprosthetic reconstruction. Wound problems followed by prosthetic loosening were the most common complications. Of the eight patients requiring a second procedure, three had an amputation. Three had excellent, seven good, and four fair functional results at the final evaluation. No patient in either group had a local recurrence. Allograft provides an alternative to endoprosthetic reconstruction; however, the high incidence of complications makes the outcome unpredictable. Allograft or prosthetic reconstruction provides better functional results than amputation without sacrificing oncologic results.

Adolescent↗

PubMed2003

Impact of skin-sparing mastectomy with immediate reconstruction and breast-sparing reconstruction with miniflaps on the outcomes of oncoplastic breast surgery.

BACKGROUND: The aim of this study was to compare the outcomes of skin-sparing mastectomy (SSM) with immediate myocutaneous flap reconstruction and partial mastectomy with latissimus dorsi miniflap reconstruction (LDMF) for breast cancer. METHODS: Some 106 disease-free patients (57 SSM, 49 LDMF) who had breast reconstruction between 1991 and 1999 participated in this retrospective review. The mean duration of follow-up was 42 (range 6-102) months. Measured outcomes included surgical complications, functional disability, cosmetic result and psychological morbidity. RESULTS: SSM outcomes were less favourable than LDMF outcomes with regard to postoperative complications (14 versus 8 per cent), further surgical interventions (79 versus 12 per cent), nipple sensory loss (98 versus 2 per cent), restricted activities (73 versus 54 per cent) and cosmetic outcome by panel assessment. Anxiety about residual cancer and ease of breast self-examination were similar in both groups. CONCLUSION: LDMF was associated with fewer adverse surgical and physical sequelae than SSM, without compromising local control or cosmetic outcome. Both operations were associated with low psychological morbidity.

Adult↗

PubMed2006

Vaginal reconstruction: an algorithm approach to defect classification and flap reconstruction.

Vaginal defects from oncologic resection present a complex array of reconstructive challenges. Increased use of adjuvant radiation and chemotherapy demands uncomplicated wound healing. As patients are being diagnosed at earlier stages of disease and at younger ages, maintenance of sexual function and body image are fundamental goals. This review provides an algorithm approach to defect classification and flap reconstruction. Carefully appreciation of the specific defect facilitates flap choice. There are two basic defect types partial (Type I) and circumferential defects (Type II) 1. These defect types can be further subclassified. Type IA defects are partial and involve the anterior and/or lateral wall. Type IB defects are also partial, but involve the posterior vaginal wall. Type IIA defects are circumferential, involving the upper two-thirds of the vagina. Type IIB defects represent circumferential, total vaginal resection, most commonly following pelvic exenteration. Using this method of defect classification, three pedicled flaps can be used to successfully reconstruct the majority of defects: the Singapore (or pudendal thigh) flap, the rectus flap, and the gracilis flap. With appropriate flap choice and a multidisciplinary approach to patient care, rapid wound healing, restoration of the pelvic floor, and re-establishment of sexual function may be most reliably achieved.

Algorithms↗

PubMed2003

[Role of a sensory innervated plantar fillet free flap for reconstruction of sacral pressure sores in paraplegic patients. Last resort for reconstruction of sacral pressure sores in paraplegics].

Sensory denervation is the key factor for the high rate of recurrent sacral pressure sores in paraplegic patients. This paper summarizes the results after reconstruction of recurrent sacral pressure sores using a sensory innervated plantar fillet free flap. Five plantar fillet free flaps were utilized for defect reconstruction of sacral pressure sores in five male patients during a 9-year period (1989-1998). Data were analyzed retrospectively. Patients'age ranged between 32 and 51 years. The level of spinal cord injury was between T10 and L1. The average defect size was 20 x 16 cm. All flaps were microsurgical free tissue transfers. The posterior tibial nerve was coapted to two intercostal nerves from above the spinal cord injury level. All patients developed sensation within 3-6 months. A stable sensate coverage was achieved in each case. The data show that the concept of a sensory innervated plantar fillet free flap may facilitate defect reconstruction in most complex or even seemingly hopeless cases.

Adult↗

PubMedDate not supplied

Lip reconstruction of comparatively large defect including the commissure using remaining lip tissue: a modification of reconstructed method.

We present two reconstructed cases after malignant skin tumor of comparatively large defects of lip including the commissure using remaining lip tissue alone. After resecting a tumor including wedge-shaped full-thickness lip tissue, a full thickness oblique incision is made at the site 5 mm distant from the contralateral commissure. The rhomboid-shaped lower lip flap is created, transposed to the defect, and sutured with the defect margin, including the upper lip, to reconstruct the commissure. The cross lip flap is created at the contralateral side of the lower lip, 5 mm from the commissure, and the defect is closed with the crosslip flap. Although our method is applicable only to selected cases, we believe that it is useful in terms of maintaining symmetry of the lip and function of the commissure in the reconstruction of comparatively large defects including the commissure.

Aged↗

PubMed1986

Three-dimensional image reconstruction of helical aggregates of trypsin modified elongation factor EF-Tu from Escherichia coli: comparison with the reconstructed image of intact EF-Tu.

The three-dimensional structure of trypsin-modified EF-Tu polymers was analyzed to a resolution of 30 A with electron image reconstruction techniques after negative staining. In a 70% saturated ammonium sulfate solution the modified protein forms cylindrical aggregates with a diameter of about 340 A. The repeat distance of the structure along the cylindrical axis is 448 A. The large number of subunits in one repeat hampers the assessment of the helical symmetry. The Fourier analysis and three-dimensional synthesis were therefore carried out with three different selection rules. The three reconstructed density distributions show marked differences. In all of them twofold axes perpendicular to the cylindrical axis are present. The half unit cell content of one of the reconstructions shows a striking similarity with the shape of intact EF-Tu.GDP previously proposed in a similar study. We suggest that in the assemblies investigated here dimers of trypsin-modified EF-Tu.GDP are arranged along a one-start basic helix with 15.4 subunits per turn and a pitch of 64 A. The shape of the monomeric proteolyzed EF-Tu.GDP in this helical arrangement is very similar to that of the intact molecule in cylindrical assemblies studied at this resolution.

Escherichia coli↗

PubMed2004

Navigation-aided reconstruction of medial orbital wall and floor contour in cranio-maxillofacial reconstruction.

The reconstruction of the anterio-posterior inclination of the medial aspect of the orbital floor, despite a wide 360 degrees exposure, including coronal and conjunctival incisions, is a challenging task in severe injuries of the orbit with massive comminution and complete displacement of the medial orbital wall and orbital floor. Out of a total of 20 patients with orbital fractures, five underwent a surgical intervention of repositioning the medial aspect of the orbital floor and especially the transition area between the orbital floor and medial orbital wall, using navigation-aided procedures. Using the mirroring tool of the Stryker-Leibinger STN-system, post-operative CTs indicated an average difference of the globe position of -4.9% between the operated side and the unaffected side, depending on the position of the medial aspect of the orbital floor. Navigation-aided procedures proved to be an essential precondition for achieving precise and predictable results in orbital reconstruction. In such cases, unlike those with an intact medial orbital wall remnant as a surgical target, bone grafts for reconstruction of the orbital floor cannot be implanted as onlay grafts.

Adult↗

PubMed2005

The orthogonal tilt reconstruction method: an approach to generating single-class volumes with no missing cone for ab initio reconstruction of asymmetric particles.

Generating reliable initial models is a critical step in the reconstruction of asymmetric single-particles by 3D electron microscopy. This is particularly difficult to do if heterogeneity is present in the sample. The Random Conical Tilt (RCT) method, arguably the most robust presently to accomplish this task, requires significant user intervention to solve the "missing cone" problem. We present here a novel approach, termed the orthogonal tilt reconstruction method, that eliminates the missing cone altogether, making it possible for single-class volumes to be used directly as initial references in refinement without further processing. The method involves collecting data at +45 degrees and -45 degrees tilts and only requires that particles adopt a relatively large number of orientations on the grid. One tilted data set is used for alignment and classification and the other set--which provides views orthogonal to those in the first--is used for reconstruction, resulting in the absence of a missing cone. We have tested this method with synthetic data and compared its performance to that of the RCT method. We also propose a way of increasing the level of homogeneity in individual 2D classes (and volumes) in a heterogeneous data set and identifying the most homogeneous volumes.

DNA Polymerase I↗

PubMed1993

A-O reconstruction plate and sternal osteomyocutaneous flap in primary mandibular reconstruction.

Mandibular arch reconstruction remains a functional and aesthetic challenge for the head and neck surgeon. The recent popularity of vascularized free composite flaps has made them a first choice for many surgeons. However, the increased operating time, high failure rate, frequent need for operative rescue, specialized postoperative care and facilities, and specialized training required to perform them have prompted many extirpative surgeons to attempt other techniques or to leave the mandible unreconstructed. Six sternal osteomyocutaneous flaps, a variant of the familiar pectoralis major myocutaneous flap, were utilized to reconstruct mandibular defects of up to 10 cm in patients undergoing composite resection for cancer, with or without preoperative radiotherapy. The use of the A-O reconstructive plate to secure the bony portion of the flap to the unresected mandible has considerably simplified and speeded the procedure over external fixation as originally described. When both soft tissue and bone are required to rehabilitate the operative defect, the sternal osteomyocutaneous flap has proven to be a reliable and time-effective procedure.

Adult↗

PubMed1998

Performance evaluation of filtered backprojection reconstruction and iterative reconstruction methods for PET images.

The filtered backprojection (FBP) algorithm and statistical model based iterative algorithms such as the maximum likelihood (ML) reconstruction or the maximum a posteriori (MAP) reconstruction are the two major classes of tomographic reconstruction methods. The FBP method is widely used in clinical setting while iterative methods have attracted research interests in the past decade. In this paper we studied the performance of the FBP, the ML and the MAP methods using simulated projection data. The experiment showed that the MAP algorithm generated superior image quality in terms of the bias, the variance, and the average mean squared error (MSE) measures.

Algorithms↗

PubMed1988

Primary reconstruction of the mandible in cancer surgery. A report of 13 reconstructions according to the principles of rigid internal fixation.

This study comprises 30 patients with extensive oral cancer invading the mandibular bone. In each case, large segmental composite resections were performed and the mandibles primarily reconstructed, according to the principles of rigid internal fixation. All but one of the reconstructions were successful and the functional and cosmetic results were excellent or good in 12 patients. The results indicate that primary reconstruction can be performed without major complications. Bone transplantation may be omitted or postponed to a later date. The fact that tracheostomy and intermaxillary fixation can be avoided, is a major advantage for these patients.

Adult↗

PubMed2001

Reconstruction of anterior cruciate ligament deficient knees in soccer players with an iliotibial band autograft. A prospective study of 132 reconstructed knees followed for 4 (2-7) years.

One hundred and thirty-two consecutive soccer players (117 males and 15 females, median age 23, range 16-39 years) underwent primary reconstruction of the anterior cruciate ligament (ACL) with an iliotibial band (ITB) autograft. All patients were followed prospectively for a minimum of 2 years. One hundred and eighteen patients (89%) attended an independent observer follow-up after a median of 47 (24-92) months. The time before participating in soccer was a median of 7 (5-24) months. At a median of 4 years, 80 (68%) were still active soccer players, while 38 had changed activity to a lower level. Twenty-five gave up soccer playing for reasons unrelated to the knee, and 13 (11%) gave up due to problems from the reconstructed knee. The Lysholm score improved from a median of 82 (range 42-99, mean [SD] 80.5 [+/-11.9]) points prior to the operation to a median of 99 (range 57-100, mean [SD] 94.6 [+/-8.5]) at follow-up. The Tegner score improved from a median of 3.5 (0-7) preoperatively to 9 (1-10). Four patients (3%) sustained a rupture of the graft: three ruptures occurred among the 15 females (20%), and one was seen among the 117 males (0.8%) (P=0.01). Eight per cent had predominantly minor cosmetic complaints from the donor-site hernia, while 51% had temporary discomfort from the staples used for graft fixation. Using the ITB autograft for ACL reconstruction, we found excellent and good results in soccer players with ACL deficiency and high demands for optimal knee function. The failure rate in general was comparable with other methods, and the majority was still active in soccer sports at a median of 4 years after surgery. An unacceptably high rerupture rate was registered in female players.

Adolescent↗

PubMed1997

Chest wall reconstruction using a titanium hollow screw reconstruction plate.

A 43-year-old male had cancer of the right lung which had invaded the 2nd to 4th ribs. After right upper lobectomy and combined resection of the chest wall, the 3rd and 4th ribs were reconstructed using titanium hollow screw reconstruction plates (THORP). THORP completely prevented postoperative paradoxical respiration. The postoperative course was satisfactory. Postoperatively radiation therapy was performed, and the patient is now alive, without recurrence, 7 months after surgery. THORP is simple and eminently applicable in reconstructing the large chest wall.

Adult↗

PubMed1994

[Restoration of sound transmission in the middle ear by reconstruction of the ossicular chain in its physiologic position. Results of incus reconstruction with ionomer cement].

We report the use of an ionomeric based bone substitute to reconstruct the ossicles in their normal position. To reconstruct small defects of the incudo-stapedial joint, this bone replacement material is applied to the long process of the incus and the head of the stapes. After setting and hardening a stable contact to the adjacent bone is formed. The audiological results after reconstruction of small incus defects with ionomeric cement are discussed in comparison to stapedectomy and tympanoplasty.

Adult↗