Treatment of Multiple Digit Amputation in an Infant Using an Abdominal Pocket Combined with Composite Grafts of the Amputated Distal Phalanxes and Nails

2020 ◽  
Vol 25 (03) ◽  
pp. 364-367
Author(s):  
Shinsuke Takeda ◽  
Michiro Yamamoto ◽  
Yosuke Takeichi ◽  
Tatsuya Hara ◽  
Toshikazu Kurahashi ◽  
...  
Keyword(s):  
Composite Grafts ◽  
Digit Length

Retention of the distal phalanxes is important in the treatment of multiple digit amputations in infants to preserve the digit length and nail for functional and cosmetic reasons. We report the case of a 22-month-old boy with multiple digit amputations of his left index, middle, and ring fingers, which were severely mangled and not suitable for replantation. We propose the usefulness of the abdominal pocket method combined with composite grafts of the amputated phalanxes and nails and report the outcome of our case, with 2-year follow-up.

scholarly journals Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience

2014 ◽  
Vol 47 (03) ◽  
pp. 333-339 ◽  
Author(s):  
Rajeev B. Ahuja ◽  
Rajat Gupta ◽  
Pallab Chatterjee ◽  
Prabhat Shrivastava
Keyword(s):  
Informed Choice ◽  
Composite Graft ◽  
Nasal Reconstruction ◽  
Composite Grafts ◽  
Alar Base ◽  
Split Skin ◽  
Nasal Defects ◽  
Long Term Experience

ABSTRACT Introduction: Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients). Patients and Methods: Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm × 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months. Results: All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts. Conclusion: In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of ‘warm ischemia time’ for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of differing opinions that should facilitate a surgeon in making an informed choice.

scholarly journals Equivalency of Saphenous Vein and Arterial Composite Grafts: 5-Year Angiography and Midterm Clinical Follow-Up

2016 ◽  
Vol 102 (2) ◽  
pp. 580-588 ◽  
Author(s):  
Ho Young Hwang ◽  
Kyung-Hak Lee ◽  
Jung Wook Han ◽  
Ki-Bong Kim
Keyword(s):  
Saphenous Vein ◽  
Composite Grafts

scholarly journals Digit ratio (2D:4D) and amniotic testosterone and estradiol: an attempted replication of Lutchmaya et al. (2004)

2021 ◽  
pp. 1-6
Author(s):  
Gareth Richards ◽  
Wendy V. Browne ◽  
Mihaela Constantinescu
Keyword(s):  
Amniotic Fluid ◽  
Digit Ratio ◽  
Second Trimester ◽  
Left Hand ◽  
Digit Ratios ◽  
Hormone Exposure ◽  
The Right ◽  
Digit Length ◽  
Attempted Replication

Abstract The ratio of length between the second (index) and fourth (ring) fingers (digit ratio or 2D:4D) is frequently employed as a retrospective marker of prenatal sex hormone exposure. Lutchmaya et al. (2004) reported that the ratio of testosterone (T) to estradiol (E) present in second-trimester amniotic fluid was negatively correlated with digit ratios for the right hand (but not the left hand) in a sample of 29 children at 2-year follow-up. This observation is frequently cited as evidence for the measure’s validity but has not been replicated. We therefore present the findings of another study of amniotic T and E that did not find evidence for these effects at 4½-year follow-up. The confidence intervals were large, the direction of correlations observed was generally erratic, and the overall findings question the premise that second-trimester sex hormones affect the development of digit length ratios in humans.

scholarly journals Reopening of the Occluded Saphenous Vein Composite Grafts After Coronary Artery Bypass Grafting

2021 ◽  
Author(s):  
Min-Seok Kim ◽  
Ki-Bong Kim
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Composite Grafts ◽  
Artery Disease ◽  
One Year

Background. We have observed reopening of the occluded “no-touch” saphenous vein (NT SV) composite grafts on follow-up angiograms in patients who underwent coronary artery bypass graftings (CABG). Methods. Between 2008 and 2018, 1283 patients received NT SV conduits without or with surrounding pedicle tissue as composite grafts based on the in situ left internal thoracic artery (ITA) for CABG and underwent early postoperative angiographies. Among the 1283 patients, 53 patients showed 55 occluded SV conduit anastomoses, and 46 patients who had 48 occluded SV anastomoses were re-evaluated by 1-year postoperative angiographies. Results. Early postoperative angiographies in 1283 patients demonstrated overall occlusion rates of 1.2% (56/4518); occlusion rates of the ITA and SV were 0.08% (1/1259) and 1.7% (55/3260), respectively. One-year angiograms demonstrated that 14 occluded SV anastomoses (29.2% [14/48 occluded SV]) of 14 patients became patent. Reopening of occluded SV conduits occurred more frequently in NT SV with pedicle tissue than in NT SV without pedicle tissue (45.0% [9/20] versus 17.9% [5/28]; P=0.057). When we examined the preoperative and 1-year postoperative angiograms, reopening of the occluded SV conduits was not related with progression (P=0.258) or preoperative reversibility score (P=0.115) of native target coronary artery disease. Conclusions. More than a quarter of the occluded SV composite grafts on early postoperative angiograms were patent in the 1-year angiograms. The reopening rates were higher in patients who had received NT SV conduits with pedicle tissue than those who had received NT SV conduits without pedicle tissue.

scholarly journals Digit Ratio (2D:4D) and Amniotic Testosterone and Estradiol: An Attempted Replication of Lutchmaya et al. (2004)

2020 ◽  
Author(s):  
Gareth Richards ◽  
Wendy V. Browne ◽  
Mihaela Constantinescu
Keyword(s):  
Amniotic Fluid ◽  
Digit Ratio ◽  
Second Trimester ◽  
Left Hand ◽  
Digit Ratios ◽  
Hormone Exposure ◽  
The Right ◽  
Digit Length ◽  
Attempted Replication

AbstractThe ratio of length between the second (index) and fourth (ring) fingers (digit ratio or 2D:4D) is frequently employed as a retrospective marker of prenatal sex hormone exposure. Lutchmaya et al. (2004) reported that the ratio of testosterone (T) to estradiol (E) present in second trimester amniotic fluid was negatively correlated with digit ratios for the right hand (but not the left hand) in a sample of 29 children at 2-year follow-up. This observation is frequently cited as evidence for the measure’s validity but has not been replicated. We therefore present the findings of another study of amniotic T and E that did not find evidence for these effects at 4½-year follow-up. The confidence intervals were large, the direction of correlations observed was generally erratic, and the overall findings therefore question the premise that second trimester sex hormones affect the development of digit length ratios in humans.

scholarly journals A modified technique for nipple-areola complex reconstruction

2011 ◽  
Vol 44 (01) ◽  
pp. 076-080
Author(s):  
Shoeib A. Mohamed ◽  
Peir Camillo Parodi
Keyword(s):  
Patient Satisfaction ◽  
Nipple Reconstruction ◽  
Modified Technique ◽  
Composite Grafts ◽  
Areola Complex ◽  
Classical Technique ◽  
Minimal Complication ◽  
Implant Reconstruction ◽  
Reconstructed Breast

ABSTRACT Background: From a historical perspective, many techniques of nipple reconstruction have been performed, including a graft from the contralateral nipple, composite grafts such as toe pulp or earlobe tissue and even an intra-dermal tattoo alone. This is the final stage of breast reconstruction, and is carried out only when the surgeon is confident that acceptable symmetry and shape of the reconstructed breast has been achieved. The technical challenges of nipple reconstruction include correcting position, maintaining adequate projection and creating an inconspicuous scar. An alternative to a surgically reconstructed nipple is the use of silicone prosthetic nipples. Materials and Methods: From August 2006 until September 2007, 80 cases of nipple/areola reconstruction were performed in our department (UDINE UNIV.) following mammary reconstruction or conservative breast surgery. Forty cases were carried out with the classical technique and another 40 cases with the introduction of our modification in the form of deepithelization of a semicircular area of the adjacent skin at the base of the flap. Postoperative follow-up as regards the nipple size, site, projection, symmetry and donnar scar were assessed. Patient satisfaction was also addressed and evaluated. Results: There were good to excellent results as regards nipple size, symmetry and projection. The technique is suitable for different autologous and implant reconstruction. The technique is an outpatient procedure, is easy and is not consuming time. Areolar graft from the contra-lateral areola is colouur matching and shows nearly no deference from the opposite one. Conclusions: Simple technique and not time consuming. Maintains the consistency and projection of the new nipple. Patient satisfaction. Minimal complication.

scholarly journals Long-term follow-up of Bentall procedure using the Perimount bioprosthesis and the Valsalva graft

2020 ◽  
Vol 30 (5) ◽  
pp. 679-684
Author(s):  
Ilaria Chirichilli ◽  
Francesco Giosuè Irace ◽  
Salvatore D’Aleo ◽  
Giulio Folino ◽  
Luca Paolo Weltert ◽  
...  
Keyword(s):  
Aortic Root ◽  
Composite Graft ◽  
Root Diameter ◽  
Composite Grafts ◽  
Bentall Procedure ◽  
Structural Valve Deterioration ◽  
Long Term Follow Up ◽  
The Mean

Abstract OBJECTIVES Bentall procedure is the gold standard for aortic root pathologies when valve repair is not feasible. The development of durable bioprosthetic valves and improved vascular conduits allowed the implementation of bioprosthetic composite grafts; hereby, we performed a retrospective analysis of long-term follow-up of Bentall procedure using the Valsalva graft and the Perimount Magna Ease prosthesis. METHODS From June 2000 to March 2019, 309 patients received an aortic root and valve replacement with a bioprosthetic composite graft. The mean age was 69 ± 6.9 years, and the majority were men (88%); most of them were affected by aortic stenosis (86%) and the mean aortic root diameter was 48.6 ± 5.5 mm. RESULTS Freedom from cardiac death was 76.8% [confidence interval (CI) 32.5–94.0] at 16 years. Freedom from thromboembolism, haemorrhage, structural valve deterioration and infective endocarditis was 98.2% (CI 96.0–98.9), 95.2% (CI 87.1–98.2), 87.5% (CI 63.2–97.1) and 79.6% (CI 45.3–95.6) at 16 years, respectively. Freedom from reoperation was 74.7% (CI 41.9–90.6). CONCLUSIONS These data indicate that, in experienced centres, the Bentall procedure is a safe and effective intervention. This is the first long-term follow-up that analyses the results after implantation of a composite graft made with the Perimount Magna Ease aortic valve and the Valsalva graft.

scholarly journals Development of an Immunoprivileged Site to Prolong Islet Allograft Survival

2002 ◽  
Vol 11 (6) ◽  
pp. 547-552 ◽  
Author(s):  
Tatsuya Kin ◽  
Ray V. Rajotte ◽  
Jannette M. Dufour ◽  
Gregory S. Korbutt
Keyword(s):  
Sertoli Cells ◽  
Critical Role ◽  
Graft Function ◽  
Allograft Survival ◽  
Islet Allograft ◽  
Mouse Islet ◽  
Systemic Immunosuppression ◽  
Composite Grafts ◽  
Islet Allografts

Sertoli cells (SC) play a critical role in the maintenance of the immunoprivileged environment of the testis. We hypothesized that preengrafting SC would allow one to develop a vascularized immunoprivileged ectopic site that provides protection for mouse islet allografts. SC, prepared from 9-day Balb/c mice, were transplanted under the kidney capsule in adult Balb/c mice. After SC engraftment (~30 days), mice were rendered diabetic and subsequently implanted with Balb/c or CBA/J islets directly adjacent to the established SC grafts. Preengrafted SC (5.7 ± 0.2 × 106) had no adverse effect on syngeneic islet graft function. When allogeneic islets were transplanted into the immunoprivileged ectopic site created by preengrafting 6.4 ± 0.3 × 106 SC, mean graft survival was slightly prolonged (32.4 ± 6.0 days) compared with control mice that received allogeneic islets alone (16.3 ± 1.5 days; p = 0.329). In contrast, when 4.8 ± 0.4 × 106 SC were preengrafted, islet allograft survival was significantly prolonged (66.1 ± 9.8 days; p = 0.001). Four of eight mice, preimplanted with 4.8 ± 0.4 × 106 SC, remained normoglycemic throughout the follow-up period (83.8 ± 8.6 days) and returned to a diabetic state only when the kidneys bearing the composite grafts were removed. Transplantation of islets into an immunoprivileged ectopic site created by preengrafting SC did not affect islet function and, moreover, provided a means of developing an immunopriveliged ectopic site that permits prolonged islet allograft survival without systemic immunosuppression.

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