201 hips with the Harris-Galante Porous (HGP) system and 41 hips with Hybrid system were compared both clinically and radiographically. According to the radiogram taken at follow-up, radiopaque lines around the stem, which is called “clear zones”, were frequently seen in zone 4, 10, 11 or 12. It was likely that the patients did not have thigh pain when these clear zones appeared exclusively in zone 4, 10, 11, or 12. On the other hand, however, the patients seemed to have thigh pain when the clear zones also appeared in other areas and zone 4, 10, 11, or 12. Thirty-six patients (23%) with osteoarthritis who had HGP system complained of thigh pain. In the group with Hybrid system, only two patients (6%) had thigh pain. However, this thigh pain in the HGP group had a tendancy to disappear gradually and remained in only two patients (6%). Sinking and micromovement of the stem may be one of the causes of the thigh pain.An optimal method for fixation of the femoral component has not been established. The results obtained from our short-term follow-up showed that smaller number of patients had thigh pain in the group of HGP system in comparison with previous reports. However, long-term follow-up study may be still necessary to draw some definite conclusion upon this matter.
In this study, the vascular architecture of rectus abdominis free flaps nourished by deep inferior epigastric vessels was investigated using an ex vivo intraoperative angiogram. Oblique rectus abdominis free flaps were elevated and isolated from the donor site. In 11 patients, the vascular architecture of these flaps was analyzed before the flap was thinned. Radiographic study identified an average of 2.1 large deep inferior epigastric arterial perforators in each flap. In nine of the 11 flaps, the axial artery was visible. In four flaps, the axial artery originated from the perforator of the lateral branch of the deep inferior epigastric artery; in five others, it originated from the medial branch. In each flap, the angle of the axial perforator from its anterior rectus sheath in the vertical plane was measured; its mean was 50.6 degrees. All flaps survived, although three showed partial necrosis in the distal portions. In two of these three flaps, the axial artery was not visible in the angiograms, and the third revealed a one-sided distribution of axial flap arteries. Using ex vivo intraoperative angiography, the architecture of the individual flap, its axial perforator, and its connecting axial flap vessel could be investigated. This information can help the surgeon safely thin and separate the flap. (Plast. Reconstr. Surg. 109: 2247, 2002.)
The effects of spinal anesthesia with 0.5% Marcaine® (0.5% bupivacaine) was studied in 107 lower extremity surgeries. In Marcaine spinal anesthesia group, other anesthetic agents and vasopressors were not significantly less often used than in Carbocaine® (mepivacaine) epidural anesthesia group. In hip, lower leg and foot surgeries, analgesic duration was significantly longer in the former group than in the latter group. Cephalad spread was greater in the latter group than in the former group. We conclude that 0.5% Marcaine spinal anesthesia is as safe and useful for the lower extremity surgery as Carbocaine epidural anesthesia, especially for elderly and hip surgery.
