The aim of this study was to investigate potential morbidity associated with vascularized bone grafts (VBGs) in the elderly. We reviewed the charts of 33 patients 60 years of age (60-81 years, mean 67 years) who had been treated with a VBG because of intractable nonunion in an extremity. Preoperatively, we recorded their ages, presence / absence of infection at the site of nonunion, and physical status. Intraoperatively, we noted the grafting technique (pedicled or free), operating time, amount of surgical blood loss, and amount of perioperative transfusion. Postoperatively, bone union and surgical and systemic complications were assessed. Relationships between postoperative vascular complications or poor results and other factors were analyzed statistically. The patients who had postoperative vascular complications were older than those who did not (p=0.041, Mann-Whitney U-test). Postoperative vascular complications were related to the grafting method: Patients with free VBGs tended to have vascular complications more often than those with pedicled grafts (p=0.008,χ2 test). The pedicled VBG is therefore preferable in the elderly, although the indications are limited because of the condition of the graft site. Meticulous preoperative evaluation, atraumatic surgical procedure, and proper postoperative care are needed for good VBG results in the elderly.
Electroactive polymer artificial muscles are an emerging class of transducers with properties not found in exiting actuators, generators, or sensors. A particularly promising class of electroactive polymers is dielectric elastomers. Dielectric elastomers are based on the electrochemical response of a rubbery material located between compliant electrodes. Properties of dielectric elastomers that are relevant for medical applications include softness similar to biological tissues, actuation stroke and force similar to biological muscles, use of biocompatible materials, high energy efficiency, the ability to form arrays on a single substrate, and extremely low material costs. These properties may be exploited for a variety of medical applications both in devices for the human body such as prosthetics, assistives, or diagnostics as well as in devices for diagnosis and medical research in laboratories or clinics. Specific examples of dielectric elastomer devices under development include artificial muscles for prosthetic limbs, soft skins for haptic stimulation and sensing, disposable microfluidic devices with embedded pumps and valves, and prosthetic and orthotic organ devices such as artificial diaphragm and heat assist devices. Some lifetime and packaging issues remain, but we expect to see devices based on electroactive polymer artificial muscles with new capabilities in medicine within the next few years.
We have experienced lymphedema patients who were treated by microsurgical lymphovenous anastomosis just on peripheral 1/3 of lower limbs. In the results, lymphedema on not only the lower limb but also the thigh has been improved. Thus, such cases who were treated after 2011 and followed over 18 months were analyzed in this paper. Four legs of three patients were employed for this study. In the results, outer perimeter of lower leg was improved over 10% in two of four legs. Moreover, outer perimeter of thigh was improved over 10% in two of four legs. Thus, it was suggested that microsurgical lymphovenous anastomosis on peripheral 1/3 of the lower leg were effective as rapid and less-invasive surgery for lymphedema.
We evaluated reliability of the free flap for head and neck reconstruction and postoperative complications in elderly patients. From 1999 to 2012, in Osaka National Hospital, 161 patients underwent reconstruction of defects at sites ranging from the oral cavity to the hypopharynx using free flap transfer. They comprised 23 patients aged ≥ 75 years ( group I ) and 138 patients aged <75 years ( group II ). The effects of age on microvascular anastomosis, and on local and general complications were assessed. There were approximately twice the number of general complications and an increase in local complications in group I relative to group II, but these were not statistically significant differences. The microvascular anastomosis success rate was identical in the two groups with a flap survival rate of 100% in both. Logistic regression showed that advanced age did not affect microvascular anastomosis or local and general complication rates. History of surgical invasion to the reconstructed site had an effect on local complications. There was no statistically significant intergroup difference in local and general complication rates, although group I had a higher rate of general complications. The free flap is a safe and reliable method for the elderly.
Open lacerations of the extensor tendon are typically managed by debridement and tendon repair. Injuries involving the loss of a large amount of skin, soft tissue, and tendons may require skin coverage procedures with tendon grafts. We performed reconstruction for severe dorsal finger injuries using an arterialized venous flap combined with the palmaris longus tendon. The clinical course and findings are reported. This series included 10 fingers of 4 men and 2 women. The average age was 32.3 years, ranging from 19-65 years. The reconstructed sites were the DIP joint in 5 cases ( 6 fingers ), IP joint in 1 case, and PIP joint in 2 cases ( 4 fingers ). One flap required a reoperation for congestion. All of the flaps survived. The average range of motion was 18.3º ( range 0 ∼ 40º) in the DIP joint, 84.3º ( range : 62 ∼ 105º) in the PIP joint, and 50°in the IP joint. This flap technique is a useful alternative for severe dorsal finger injuries.
We report a case of jejunal lipoma identified while performing a free jejunal transfer for esophagopharyngeal reconstruction. A 74-year-old man was hospitalized with hypopharyngeal carcinoma. After pharyngo-esophagectomy, his cervical esophagus was reconstructed using a free jejunal graft. A submucosal tumor was identified while performing the free jejunal transfer. The 28 × 12 × 10mm tumor was oval, non-pedunculated, and yellowish and was covered by a thin membrane. Jejunal lipoma was diagnosed on the basis of its appearance. We excised a part of the free jejunal graft including the lipoma and reconstructed the cervical esophagus. The patient had a history of recurrent ileus. Jejunal lipoma has been reported as a possible cause of ileus. However, jejunal transfer is generally performed without preoperatively analyzing the jejunum. In the present case, the lipoma possibly caused some gastrointestinal obstruction after the reconstruction surgery. A few cases of jejunal neoplasm, including jejunal lipoma, have been reported. However, in cases of recurrent ileus, as observed in our patient, the use of diagnostic imaging (computed tomography, etc.) to examine the intestines before free jejunal transfer is important. Furthermore, medical practitioners should check for the presence of intestinal tumors during the reconstruction surgery.