Autogenous Onlay Graft with Compression Plate for Treatment of Persistent Humeral Shaft Aseptic Non-union with Failed Previous Surgery

BACKGROUND: The humeral shaft fractures have a good rate of union, despite this fact, still there is a significant rate of nonunion after nonoperative treatment and more often after operative treatment. AIM: The aim of the study is to evaluate the autogenous onlay graft with compression plate for treatment of persistent humeral shaft non-union with failed previous surgery both radiological and functional outcome. MATERIALS AND METHODS: A prospective study on twenty patients having persistent aseptic non-union age between 20 and 60 years old, after failed surgical treatment of fractures humeral shaft in Al-Zahra teaching and Al-Kindy teaching hospitals, while infected nonunion, diabetes mellitus, secondary metastasis, smoking, alcoholism, and patients on long medication with corticosteroid were excluded from the study. All our patients were treated with corticocancellous onlay bone grafting harvesting from the ipsilateral upper tibia and compression plating (graft parallel to plate) and follow-up for at least 18 months post-operative to evaluate both radiology and functional using Mayo elbow performance index. RESULTS: All the patients ended with a solid union without hardware failure, and no one patient needs further surgery, even with significant resorption of the graft, there is a good chance of graft re-calcification and solid union with good to excellent functional outcome. CONCLUSION: Very successful solid union results achieve in those patients with established aseptic nonunion and pseudoarthrosis of the humerus.

Lichen sclerosis–induced long segment anterior urethral stricture: The early outcome of one-stage repair using dorsolateral onlay buccal mucosa graft

Background: Substitution urethroplasty using buccal mucosal grafts can be performed by several approaches including ventral onlay graft, dorsal onlay graft, or ventral urethrotomy with dorsal inlay graft. Our study aims to evaluate the surgical outcome of dorsolateral buccal mucosal graft for long segment anterior urethral stricture >6 cm in patients with Lichen sclerosus (LS). Methods: A retrospective study included patients who underwent repair for long segment anterior urethral stricture >6 cm due to LS between January 2013 and April 2019. All patients were followed-up at 3, 6, 9, and 12 months postoperatively and then yearly by clinical symptoms, uroflowmetry, and calculation of post-void residual urine volume. Retrograde urethrogram was requested for patients with voiding symptoms or decreased maximum flow rate. Stricture recurrence that required subsequent urethrotomy or urethroplasty was considered failure. The success rate and surgical complications were collected and analyzed. Results: Thirty patients were identified. The median age (range) was 39 (25–61) years and a median (range) stricture length was 8 (6–14) cm. Most of postoperative complications were of minor degree. The success rate at median follow-up of 15 (12–24) months was 86.5%. The median maximum flow rate increased significantly from 6 (2–11) ml/s preoperatively to 18 (range: 6–23) ml/s at the 6th month ( p value < 0.001). Conclusion: Dorsolateral buccal mucosal grafts urethroplasty for long anterior urethral stricture caused by LS has a high success rate and low risk of complications including stricture recurrence.

Repair of a Chronic Triceps Tendon Rupture in a Dog Using an Autogenous Thoracolumbar Fascia Onlay Graft

A 5-year-old 38 kg entire male German Shepherd dog was referred for persistent non-weight bearing left thoracic limb lameness 5 weeks following failed triceps tendon repair. Physical exam revealed complete incompetence of the triceps mechanism with a large palpable defect proximal to the olecranon and when the shoulder was fixed in extension, the elbow could be fully flexed. A purulent draining tract was present on the caudolateral aspect of the distal brachium. Staged tendon repair was delayed until resolution of infection to allow for improved healing. Culture following surgical exploration of the traumatized area with resection of sinus tract and interposed fibro-granulomatous tissue yielded no growth. Definitive triceps brachii tendon repair was augmented with an autogenous thoracolumbar fascia onlay graft. Postoperatively, the repair was protected with a spica splint and the left thoracic limb immobilized with the elbow maintained in an extended position for 6 weeks. Re-evaluation 7 months later revealed the patient to be free of lameness. Disruption of the triceps brachii tendon is a rarely reported tendon injury with chronic disruption of triceps tendon associated with a guarded prognosis. To the authors knowledge, successful surgical repair of tendinous injury incorporating the use of an autogenous thoracolumbar fascia onlay graft has not previously been described.