No abstract

The goal of this study was to establish a rat model that can be used to determine the variables in influencing induction of tolerance to composite tissue allografts. An anti T-cell depleting agent (R73) and 15-deoxyspergualin were given in different doses and schedule to four groups of Lewis rats receiving a limb transplant from Brown-Norway donors. Graft survival prolongation was maximal combining a single dose of R73 and a 20-day administration of 15-deoxyspergualin. Long-term survivors accepted a skin graft from Brown-Norway donors at 80 days, but rejected grafts from an unrelated donor. Skin grafting did not influence survival of the transplanted limb. Mixed allogeneic chimerism was not detectable in peripheral blood by flow cytometry, but immunohistochemistry identified donor-derived cells in the thymus of tolerant recipients at 100 days. These results suggest a state of donor-specific, dynamic tolerance, with potential for future application in human composite tissue allotransplantation.

This article describes the treatment of 56 early and late vascular complications of native arteriovenous fistula (AVF) in patients with end-stage renal disease, between January 1987 and January 1999. Twenty-six were arteriovenous aneurysms and 2 pseudoaneurysms; 25 were thromboses. We also observed two cases of periarteritis associated with systemic lupus erythematosus (SLE) and one complex iatrogenic lesion caused by an attempt at percutaneous restoration of potency. We applied microsurgical principles, instruments, and techniques. It was possible to restore a vascular access at the original site, using the same vessels in 45 cases (80.4%). In 10.7% of cases, we were able to rescue the original AVF by microsurgical revision. A new vascular access had to be created proximally in the same limb or in the contralateral forearm in 11 cases of aneurysms (19.6% of the total, 42% of the aneurysms). After a minimum follow-up of 8 months, a total of four patients had to be reoperated for further complications (7.2%). Our data support the idea that microsurgical treatment of vascular complications of native AVF is highly successful compared with results obtained by conventional surgery and, in a defined subgroup of patients, permits salvage of the fistula.Si descrive il trattamento di 56 complicanze vascolari precoci e tardive di fistole arterovenose in pazienti uremici, fra il gennaio 1987 ed il gennaio 1999: ventisei aneurismi arterovenosi, 2 pseudoaneurismi e 25 trombosi. Abbiamo anche osservato due casi di periarterite associata a LES ed una complessa lesione iatrogena causata durante un tentativo di disostruzione percutanea. Abbiamo applicato i principi, gli strumenti e le tecniche della Microchirurgia. È stato possibile ripristinare un accesso nel sito originario, utilizzando gli stessi vasi, in 45 casi (80.4%). Nel 10.7% dei casi si è potuta recuperare la fistola originaria per mezzo di una revisione microchirurgica. In 11 casi di aneurisma (19.6% del totale, 42% degli aneurismi) è stato creato un nuovo accesso vascolare prossimalmente nello stesso lato o sull'altro avambraccio. Dopo un follow-up minimo di 8 mesi, il 7.2% dei pazienti è stato rioperato per ulteriori complicanze. I nostri dati supportano l'idea che il trattamento microchirurgico delle complicanze vascolari delle fistole arterovenose sia estremamente efficace in confronto ai risultati della chirurgia convenzionale, consentendo in un sottogruppo di pazienti il salvataggio della fistola originaria.

This article describes the treatment of 56 early and late vascular complications of native arteriovenous fistula (AVF) in patients with end‐stage renal disease, between January 1987 and January 1999. Twenty‐six were arteriovenous aneurysms and 2 pseudoaneurysms; 25 were thromboses. We also observed two cases of periarteritis associated with systemic lupus erythematosus (SLE) and one complex iatrogenic lesion caused by an attempt at percutaneous restoration of potency. We applied microsurgical principles, instruments, and techniques. It was possible to restore a vascular access at the original site, using the same vessels in 45 cases (80.4%). In 10.7% of cases, we were able to rescue the original AVF by microsurgical revision. A new vascular access had to be created proximally in the same limb or in the contralateral forearm in 11 cases of aneurysms (19.6% of the total, 42% of the aneurysms). After a minimum follow‐up of 8 months, a total of four patients had to be reoperated for further complications (7.2%). Our data support the idea that microsurgical treatment of vascular complications of native AVF is highly successful compared with results obtained by conventional surgery and, in a defined subgroup of patients, permits salvage of the fistula. Si descrive il trattamento di 56 complicanze vascolari precoci e tardive di fistole arterovenose in pazienti uremici, fra il gennaio 1987 ed il gennaio 1999: ventisei aneurismi arterovenosi, 2 pseudoaneurismi e 25 trombosi. Abbiamo anche osservato due casi di periarterite associata a LES ed una complessa lesione iatrogena causata durante un tentativo di disostruzione percutanea. Abbiamo applicato i principi, gli strumenti e le tecniche della Microchirurgia. È stato possibile ripristinare un accesso nel sito originario, utilizzando gli stessi vasi, in 45 casi (80.4%). Nel 10.7% dei casi si è potuta recuperare la fistola originaria per mezzo di una revisione microchirurgica. In 11 casi di aneurisma (19.6% del totale, 42% degli aneurismi) è stato creato un nuovo accesso vascolare prossimalmente nello stesso lato o sull'altro avambraccio. Dopo un follow‐up minimo di 8 mesi, il 7.2% dei pazienti è stato rioperato per ulteriori complicanze. I nostri dati supportano l'idea che il trattamento microchirurgico delle complicanze vascolari delle fistole arterovenose sia estremamente efficace in confronto ai risultati della chirurgia convenzionale, consentendo in un sottogruppo di pazienti il salvataggio della fistola originaria. © 2000 Wiley‐Liss, Inc. MICROSURGERY 20:252–254 2000

Lateral malleolus avulsion is uncommon, and fusion of the syndesmosis of the ankle joint is usually performed in such cases. Others have reported successful reconstruction of the lateral malleolus with a vascularized fibular head. A case of reconstruction in a 17-year-old girl, with a free scapular apophysis flap, is presented and compared with alternative flaps available. The anatomy and development of the scapular crest with its cartilaginous apophysis are discussed.