INTRODUCTION: Further development of extensive spinal surgical techniques forced surgeons to find drugs helpful in reducing blood lose during surgery. These drugs are necessary in surgical treatment in patients with congenital or acquired bleeding disorders. Recombinant FVIIa appears to be an efficient haemostatic product for surgery in patients suffering from bleeding disorder. Recombinant activated factor VII (rFVIIa) has recently been introduced for improving haemostasis in non-haemophiliac patients during extensive surgical procedures.

AIM: The present study evaluates the use of low dose of recombinant factor VIIa during scoliosis surgery and its influence on blood coagulation tests and haemostasis.

MATERIAL AND METHODS: 22 patients from evaluated group were treated with Cotrell-Dubosset distraction method with posterior spondylodesis and gibectomy during the same surgical procedure with bone grafts taken from patients iliac crest received a single 10 micrograms/kg dose of recombinant FVIIa given as a i.v. bolus.

Control group consists of 30 patients treated with use of identical surgical technique but without any factors influencing blood coagulation. Fibrinogen value, prothrombine time, APTT and INR value altogether with thrombocytes count were measured day before operation and 15 minutes, two, four and 12 hours after administration of rFVII.

RESULTS: Authors report effective haemorrhage control, decrease in prothrombine time and INR value, reduced thrombocytes count and stabile patients haemodynamics parameters. Changes in these parameters occurred 15 minutes after intravenous administration of recombinant VIIa factor, remained unchanged up to four hours after dosage and its normalisation were observed 12 hours after single intravenous bolus of 10 micrograms/kg of body mass. APTT and fibrinogen value remained unchanged.

CONCLUSION: Authors conclude that use of small doses of recombinant VIIa factor causes short and fast thrombin activation by relived tissue factor (TF), what effectively reduces bone ant tissue bleeding during extensive surgical procedures.

The use of recombinant VIIa factor shortens operation time and reduces number of blood transfusions.

The aim of the work was to evaluate long-term results of posteromedial release in the treatment of congenital clubfoot. The posteromedial release – which includes capsuloligamentothomy of the tibiotalar and tibio-calcaneal joints from the posterior and medial aspects and “Z” lengthening of the Achilles and posterior tibial muscle tendons with Steindler procedure – has been the basic treatment of choice for many years in cases of congenital clubfoot in the Child Orthopaedic Clinic of the Pomeranian Medical Academy. In some cases transfer of the anterior tibial muscle tendon was also included in that procedure.

Between 1979 and 1990, a total of 135 children were treated with posteromadial release at the author’s institution. Thirty-five patients were excluded from the study because of incomplete medical documentation or because of a possible different origin of the deformity, i.e., subtle spastic cerebral palsy or arthrogryphosis, etc. The study group consisted of 100 patients with 135 clubfeet. At the final follow-up, 46 patients were evaluated with 61 clubfeet. Mean age at the time of surgery was 12.3 months (5–48). All patients had been treated conservatively at the author’s clinic before operative treatment started. Average age of the beginning of the manipulative treatment (followed by cast application in weekly intervals) was 4.3 weeks (1 to 48). Mean follow-up period was 15.7 years (range 20.4–10.1). The patients’ age at the last follow-up ranged from 11 to 21 years old.

The final evaluation based on the criteria of Magone, et. al., gave us the following results: Excellent: 17 feet (28%); Good: 17 feet (28%); Fair: 11 feet (18%); Poor: 16 feet (26%).

Posteromedial release with the Steindler procedure added gives us more than 50% excellent and good results when applied early and with proper pre- and post-operative conservative treatment.