Aims: The purpose of this study is to to assess the surgical results, complications, and long-term results of vascularized fibula in the treatment of congenital pseudarthrosis of the tibia. Methods: Seven patients who had congenital pseudarthrosis of the tibia were treated consecutively at our clinic between 1992 and 2000 with free vascularized fibular graft. There were four females and three males. The mean age at the time of operation averaged 6.5 years (range 1–12 years). Four left tibias and 3 right tibias were involved. Stability was maintained with internal fixation in four patients, external fixation in two patients and intramedullary pin in one patient. Results: The average follow-up was 2.6 years (range 6 months to 8 years). In five patients, both ends of the graft healed primarily within 2.7 months (range 1.5 to 3 months), and hypertrophy of the fibular graft occurred rapidly with a well-formed medullary canal. In one patient the distal junction did not unite and although required three subsequent operations still not healed. Stress fracture occurred in one patient underwent four additional operations before union achieved. Conclusions: Despiting the continuing problems and the relatively high complication rate, the ultimate results with free vascularized fibula transplant are generally good specially as compared with published series in whom conventional grafting techniques had failed. However, even achieving union of pseudarthrosis is not enough for the resolution of this disease and is only half of the problem; the other half is to maintaining

Purpose: Vascular injuries occur in approximately 3% of all patients with major civilian trauma and peripheral vascular injuries account for 80% of all cases of vascular trauma. Upper extremity arterial injuries represents about 30% of all cases arterial trauma. The present study was designed to document and analyze the respective role of arterial damage and associated injuries on functional outcomes after upper extremity arterial trauma.

Material and Methods: Excluding the arterial injuries resulting in immediate amputation there were 57 patients who sustained arterial trauma of the upper extremity. Their mean age was 33 years (range 4–68 years), and 40 were males and 19 were females. The most frequently injured vessel was the ulnar artery (42%) followed by the brachial artery (29.8%), radial artery (26.3%) and axillary artery (1.7%). Concomitant fractures or nerve injuries were present in 54% and 45% respectively.

Results: An average of 5.6 hours elapsed between the time of injury and the time of vessel reconstruction. The most common method of surgical management was end to end anastomosis. Twenty one autogenous vein grafts were employed. Primary nerve repair was carried out in 29 patients and in another 18 secondary repair was performed. None of patients had any residual compromise from the arterial injury.

Discussion: Vascular injuries are potentially limb threatening. Improvements in the technical ability to revascularize injured extremities and advances in microsurgery, resulting in the low present day limb loss rate associated with attempted vascular repairs. Associated injuries, rather than vascular injuries, cause long-term disability in the trauma of the upper extremity. Persistent nerve deficits, joint contractures and pain are principal reasons for functional impairment

Purpose: The first 50 free flap operations performed at our clinic by the same surgical team were reviewed and assessed as to the cause and location of the defects, donor sites, complications and results. An attempt was then made to determine what could be learned from this experience.

Material and Methods: There were 46 males and 4 females who underwent free flap operations (mean age, 28.5 years; range 6 to 56 years). The lower extremity was the most frequent site of defect (72.5%). The next most frequent sites were the arm and the hand (27.5%). Trauma was by far the most common cause. Latissimus dorsi and forearm flap were the most useful flaps. Fractures in the wound were present in 26 patients.

Results: The fate of the flaps has been analysed. In two latissimus dorsi flap emergency re-exploration was performed and were successfully managed. Two flaps, underwent necrosis, due to thrombosis at the site of arterial anastomosis. Two flaps were lost due to inappropriate blood flow of the recipient vessels. Other complications included pressure ulcer, infection, and hematoma. The overall survival rate of the 50 cases was 92%.

Discussion: Limb reconstructive surgery has significantly improved and expanded with the use of microsurgical techniques. Evaluation of the recipient vessels is always the first priority. The choice of the flap, specially regarding the length and size of the pedicle is also very crucial in order to achieve good results. In addition important factors seemed to be: improvement in techique of micro-vascular anastomosis, diseased vessels, vascular spasm, hypotension, postoperative edema, and hematoma. We believe that an “orthoplastic” approach in covering soft tissue defects is beneficial.