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O autor realizou um estudo anatômico da região lateral e proximal da perna por meio de dissecção anatômica em cadáver, de exame arteriográfico e de mapeamento com Doppler em pacientes, visando a descrição da artéria denominada fibular superior, que se origina no tronco tíbio-fibular em 70% dos casos, da artéria fibular, em 20% e da artéria tibial anterior, em 10% e participa na irrigação do músculo sóleo e gastrocnêmio. Este vaso possui características adequadas para a realização de micro-anastomose. Após a conclusão da parte anatômica-descritiva, o autor aplicou o retalho derivado da artéria fibular superior, denominado retalho súpero-lateral da perna, na reconstrução de defeitos cutâneos e defeitos complexos tridimensionais, localizados no pé e tornozelo, em 10 pacientes, obtendo bons resultados The author performed an anatomical study of the proximal and lateral aspect of the leg, consisting of cadaver dissection, arteriogram and Doppler mapping, in order to disclose the features of a new vessel, denominated superior peroneal artery. It originates from the tibiofibular trunk in 70 % of times, from the peroneal artery, 20%, and from the anterior tibial artery, 10%. It contributes to nourish the soleous and the lateral gastrocnemius muscle. The superior peroneal vessels are also suitable for microanastomosis. Therefore, the flap derived from the superior peroneal artery, called superolateral leg flap (SLL), was used for lower leg reconstructions in 10 patients, in two of them as chimeric flap for complex tridimensional defects, with good results

OBJETIVO: Avaliar os resultados da transposição do tríceps para a flexão do cotovelo em pacientes portadores de lesão crônica e completa do tronco superior do plexo braquial. MÉTODOS: Estudo retrospectivo, com inclusão apenas de pacientes que apresentassem bíceps grau 0 e tríceps grau 5, submetidos à transferência anterior do músculo tríceps, operados entre 1998 e 2005. Foram pesquisados o lado acometido, o sexo, o tipo de acidente, a força de flexão do cotovelo, as complicações e a satisfação do pacientes, em 11 casos. RESULTADOS: 10 pacientes eram do sexo masculino; a idade variou de 24 a 49 anos, com média de 33,7 anos. O tempo mínimo entre a lesão e o procedimento cirúrgico foi de 21 meses (variando de 21 a 74 meses). O lado esquerdo foi acometido em oito casos, enquanto o direito apenas em três. Obtiveram-se bons resultados em 10 pacientes, que adquiriram força de flexão do cotovelo grau 3 (dois casos) e grau 4 (oito casos), enquanto um evoluiu desfavoravelmente, com força grau 2. Dois casos evoluíram com complicações (síndrome compartimental inicial e tensionamento insuficiente). Todos os pacientes definiram-se como satisfeitos com o procedimento. CONCLUSÃO: A transposição anterior do músculo tríceps proporcionou satisfação dos pacientes em todos os casos, exceto um, obtendo-se forças grau 4 em oito casos, grau 3 em dois casos e grau 2 em um caso. OBJETIVE: To evaluate the transposition of the triceps for elbow flexion in patients with chronic and complete injury to the upper trunk of the brachial plexus. METHODS: Retrospective study, including only patients who had biceps grade 0 and triceps grade 5, who underwent anterior transfer of the triceps muscle, operated between 1998 and 2005. The affected side, sex, type of accident, strength of elbow flexion, complications and satisfaction of patients, were studied in 11 cases. RESULTS: 10 patients were male, aged 24 to 49 years, with a mean of 33.7 years. The minimum time between injury and surgery was 21 months (range 21-74 months). The left side was affected in eight cases, the right only in three. Good results were obtained in 10 patients, who acquired grade 3 (two cases) and grade 4 (eight cases) strength in elbow flexion, while one evolved unfavorably with grade 2 strength. Two cases had complications (initial compartment syndrome and insufficient tensing). All patients reported satisfaction with the procedure. CONCLUSION: The anterior transposition of the triceps muscle provided patient satisfaction in all cases except one, attaining strength grade 4 in eight patients, grade 3 in two cases and grade 2 in one case.

OBJETIVO: comparar a rigidez de três diferentes montagens de placa em ponte com a da haste intramedular bloqueada, em tíbias de cadáveres com fratura tipo C. MATERIAIS E MÉTODOS: vinte tíbias humanas captadas de cadáveres, submetidas à fratura do tipo C; quinze fixadas com placas em ponte, divididas em 03 grupos, de acordo com o tamanho das placas (10, 14 e 18 furos) e 05 fixadas com hastes intramedulares bloqueadas. Todas as tíbias foram expostas a cargas progressivas e semelhantes. Foram medidos os deslocamentos de ambos fragmentos (proximal e distal), nos planos sagital, coronal e axial do espaço, conforme incremento gradual de carga. RESULTADOS: tíbias fixadas com placas em ponte de 18 furos apresentam um comportamento biomecânico semelhante às fixadas com haste intramedular bloqueada. CONCLUSÕES: Em fraturas do tipo C em tíbias há maior mobilidade do segmento ósseo distal no plano coronal, quando a fratura é fixada com placas em ponte de 14 e 18 furos que quando fixada com haste intramedular bloqueada sem fresagem. Apesar dessa maior mobilidade, os movimentos relativos entre os fragmentos fraturários nos GHB e GP18 tendem a ser semelhantes entre si. OBJECTIVE: To compare the stiffness of three different assemblies of bridging plates with intramedullary locking nails in cadaveric models of tibial fractures type C. MATERIALS AND METHODS: Twenty cadaveric tibias subjected to type C fractures; fifteen were fixed with the bridging plate technique and divided into three groups, according to the plate size (10, 14 and 18 holes), and five were fixed with intramedullary nail. All the tibias were exposed to similar and progressive loads. Dislocation of both fragments (proximal and distal) was measured on three planes (sagittal, coronal and axial), as the load was increased. RESULTS: tibias fixed with the 18 hole bridging plate have the same biomechanical behavior of tibias fixed with intramedullary locking nails. CONCLUSIONS: In type C tibial fractures, there is more mobility at the distal segment on the coronal plane when the fracture is fixed with 14 and 18 holes bridging plates as compared to fractures fixed with non-reamed intramedullary locking nails. Even with this mobility, the relative movements between the fragments at GHB and GP18 seem to be similar.

We sought to evaluate the indirect impact of ertapenem use for the treatment of extended-spectrum β-lactamase-producing Enterobacteriaceae infections in our hospital on the susceptibility of Pseudomonas aeruginosa to imipenem. The use of ertapenem was mandated for treatment of extended-spectrum β-lactamase-producing Enterobacteriaceae infections in the absence of nonfermenting gram-negative bacilli for 1 year. The use of imipenem was restricted. Imipenem consumption decreased 64.5%. Ertapenem consumption was 42.57 defined daily doses per 1,000 patient-days. None of the 18 P. aeruginosa isolates recovered after ertapenem introduction were imipenem-resistant, compared with 4 of the 20 P. aeruginosa isolates recovered in the previous year.

OBJECTIVE: To compare the locked, unreamed intramedullary nail with Ender pins in the treatment of open Gustilo grade I or II or closed tibial diaphyseal fractures of type A, B, or C2 of the AO classification. MATERIALS AND METHODS: Forty-four patients with unilateral tibial diaphyseal fractures were treated with intramedullary nails or Ender pins. Twenty patients were treated with an unreamed intramedullary nail with access via the patellar tendon with static locking. Twenty-four patients were treated with Ender pins introduced medially and laterally with respect to the tuberosity of the tibia. The main parameters analyzed were type of reduction, complications, union rate, deformities, joint mobility, pain, gait, effort capacity, presence of neurovascular disorders, and complaints related to the synthesis material. RESULTS: During 1 year of follow-up, the fractures of 90.0% of the patients with intramedullary nails and 95.7% of patients with Ender pins healed within an average of 21.5 weeks and 20.9 weeks, respectively. The significant findings were as follows: patients treated with Ender pins had less mobility of the subtalar joint; patients treated with intramedullary nails were more likely to have pain in the knee; both groups showed shortening of the tibia at the end of 1 year of treatment. CONCLUSIONS: The two methods are similar in the treatment of type A, B, and C2 tibial diaphyseal fractures. OBJETIVO: Comparar a haste intramedular bloqueada não-fresada com os pinos de Ender no tratamento das fraturas da diáfise da tíbia tipos A, B ou C2 da classificação AO, fechadas ou expostas graus I ou II de Gustilo. MATERIAIS E MÉTODOS: 44 pacientes com fratura unilateral da diáfise da tíbia, tratados com HIB ou com pinos de Ender. Vinte pacientes foram tratados com uma haste intramedular bloqueada não fresada por acesso através do tendão patelar e com bloqueio estático; vinte e quatro pacientes com pinos de Ender introduzidos medial e lateralmente à tuberosidade da tíbia. Principais parâmetros analisados: tipo de redução, complicações, consolidação, deformidades, mobilidade articular, dor, marcha, capacidade para esforços, distúrbios neuro-vasculares e desconforto pelo material de síntese. RESULTADOS: No seguimento de um ano, 90,0% das hastes intramedulares e 95,7% dos pinos Ender dos pacientes apresentaram consolidação da fratura com tempo médio de 21,5 e 20,9 semanas, respectivamente. Os achados significantes foram: mobilidade da articulação subtalar menor nos pacientes tratados com pinos de Ender; dor no joelho mais freqüente nos pacientes tratados com HIB; encurtamento da tíbia nos dois grupos ao final de um ano de tratamento. CONCLUSÕES: Os dois métodos são semelhantes no tratamento das fraturas da diáfise da tíbia tipos A, B e C2.

Among the complications of 2-part fractures of the upper end of the humerus, little attention has been paid to the treatment of the varus malunion. However, this deformity frequently causes pain and disability of the shoulder. To improve this condition, we treated this malunion with a valgus wedge osteotomy. From August 1995 to January 1999, 5 patients with this deformity, all complaining about pain or unsatisfactory function of the shoulder (University of California, Los Angeles score13), underwent osteotomy and internal fixation with a plate and screws. The mean age was 53 years (range, 25-73 years), there were 4 male patients, and the left side was involved in 4 cases. The mean follow-up was 34 months (range, 22-63 months). Union occurred in all cases by 6 weeks. Three of the results were excellent, and two were good (University of California, Los Angeles score30). All patients were satisfied with the treatment.

This article describes a modification of the double-osteotomy radial technique that has been described previously and summarizes our clinical experience with this method in 4 female patients. All patients had improvement in functional motion and were satisfied with the improved appearance of their wrist after surgery.

O enxerto ósseo vascularizado tem sido utilizado com mais frequência nas últimas duas décadas, principalmente no tratamento de perdas ósseas extensas difíceis de serem tratadas com métodos convencionais. A viabilidade e a consequente hipertrofia do enxerto ósseo vascularizado depende da presença de microanastomoses pérvias. A monitoração das microanastomoses é extremamente importante no período pós-operatório para se identificar eventuais tromboses e dessa forma poder planejar a exploração cirúrgica precoce. Dentre os métodos disponíveis para esta avaliação a cintilografia óssea, a angiografia e a ultrassonografia convencional com aparelho tipo Doppler apresentam limitações pois fazem controles pontuais. A monitoração contínua , por outro lado, pode ser realizada com instrumentos através da medida do fluxo arterial com implantação de eletrodos acoplados ao ultrassom tipo Doppler , com eletrodos que medem temperatura e pela geração eletroquímica de hidrogênio local ou ainda clinicamente com o retalho cutâneo baseado em perfurantes da artéria fibular. Apesar de estarmos usando o retalho fibular como monitor das microanastomoses desde a sua descrição por Yoshimura, em 1983, existem controvérsias a respeito de sua eficácia. Por essa razão, desenvolvemos o presente trabalho com o objetivo de analisar a sensibilidade e a especificidade desse método para monitoração das microanastomoses em transplantes vascularizados da fíbula.

Between 1994 and 1998, the authors treated 70 patients presenting with post-traumatic tibial osteomyelitis. Eighty-five percent were males, with a mean patient age of 32 years. The mean duration of the disease was 2 years. Fifty-one percent were of type IV in the Cierny-Mader classification. The mean follow-up period was 36 months. Case management was through thorough debridement, antibiotic therapy, and soft-tissue reconstruction using free flaps: latissimus dorsi (39.4 percent), scapular (28.2 percent), lateral arm (19.7 percent), and anterior serratus (12.7 percent). To evaluate the results, the control of infection and the quality of the soft tissue repaired were considered. The success rate was 90 percent. The authors conclude that their described method constitutes an effective treatment for post-traumatic tibial osteomyelitis.

OBJETIVO: Avaliar prospectivamente o emprego do retalho do músculo gastrocnêmio no tratamento de lesões infectadas do joelho. MÉDOTOS: foram operados 12 pacientes, onze do sexo masculino, com idade variando de 19 a 78 anos, média de 55 anos. A cobertura com músculo gastrocnêmio medial foi realizada em 11 pacientes, e lateral em um. A média de desbridamentos pré-operatórios foi de 3,2 procedimentos, variando de um a nove. RESULTADOS: todos os retalhos sobreviveram. O agente etiológico mais comum foi o S. aureus, em 54,5%. Após seguimento médio de 20,08 meses (13 a 31), todos os pacientes apresentam cobertura estável sem sinais ou sintomas de reinfecção. CONCLUSÃO: a utilização do músculo gastrocnêmio no tratamento de lesões infectadas do joelho proporcionou bons resultados com baixa morbidade. OBJECTIVE: to prospectively evaluate the use of gastrocnemius muscle flap in the treatment of knee infected injuries. METHODS: twelve patients were operated on: eleven males with ages ranging from 19 to 78 years, mean: 55 years. Coverage of injuries with medial gastrocnemius muscle was accomplished in 11 patients and a lateral in 1. The mean number of preoperative surgical debridement procedures was 3.2, ranging from 1 to 9. RESULTS: all flaps survived. The most common etiological agent was S. aureus, in 54.5%. After a mean follow-up of 20.08 months (13 to 31), all patients show stable coverage without recurrence of infection signs or symptoms. CONCLUSION: gastrocnemius muscle use in knee infected injuries treatment presented good results and low morbity rates.

O complexo da fibrocartilagem triangular tem importante papel na biomecânica do punho. O diagnóstico preciso das lesões é fundamental para se obter sucesso no tratamento. Há controvérsias acerca da especificidade e sensibilidade dos métodos de imagem empregados atualmente. A artroscopia de punho é um método pouco empregado para o diagnóstico das lesões do CFCT em nosso meio, embora apresente grandes vantagens, como possibilidade de visão direta das lesões e tratamento no mesmo tempo cirúrgico. O objetivo deste estudo foi o de avaliar o papel da artroscopia de punho na inspeção do CFCT, bem como na detecção de possíveis lesões, comparando os dados com a dissecção macroscópica. Foram avaliados 15 punhos de cadáveres sexo masculino, média de idade de 56,1 anos. A artroscopia demonstrou presença de lesões em 33,3% dos punhos avaliados. Estes achados foram coincidentes após estudo anatômico com ampla dissecção. Concluímos que houve absoluta correlação entre o exame artroscópico e a dissecção macroscópica na detecção de lesões do CFCT. The triangular fibrocartilage complex plays a key role on wrist biomechanics. An accurate injuries diagnosis is paramount for a successful treatment. There are controversies regarding specificity and sensitiveness of imaging methods employed today. Wrist arthroscopy is a method uncommonly used for diagnosing TFCC injuries in our environment, although it presents good advantages, such as the potential of direct viewing injuries, and treatment at the same surgical time. The objective of this study was to evaluate the role of wrist arthroscopy for inspecting TFCC, as well as for detecting potential injuries, comparing those data to gross dissection. Fifteen wrists of male cadavers (mean age: 56.1 years old) were assessed. Arthroscopy showed the presence of injuries in 33.3% of the assessed wrists. Those findings showed consistency after an anatomical study with broad dissection. We concluded that an absolute correlation existed between arthroscopic test and gross dissection in detecting TFCC injuries.

Objective: This is a clinical study of our experience using pedicle perforator flaps to cover skin defects in the middle and distal segment of the leg. Design: Prospective study. Setting: University hospital. Patients/Intervention: Twenty-four patients underwent treatment of a skin defect in the middle or distal segment of the leg by means of pedicled flaps based on perforating arteries. The perforating arteries were located before the operation by means of echo-Doppler examination. The flaps were planned in propeller fashion (21 cases) and as advancement (three cases). Main Outcome Measurements: The results were evaluated according the origin of perforator flap, size of the flap, and donor area and viability of the flap. The success rate of the echo-Doppler to identify the location of perforator vessel was also evaluated. Results: In nine cases, the perforating vessels originated from the fibular artery, in 10 the posterior tibial artery, and in five the anterior tibial artery. The mean size of the flaps was 5 cm in width by 12 cm in length. The success rate using an echo-Doppler was 87%. The flaps were fully viable in 20 cases and partially viable in four cases. Conclusion: On the basis of these results, it is concluded that perforating flaps are a good choice of treatment for skin losses, especially in the distal segment of the leg, and could be an alternative option for the use of free microsurgical flaps.

Heterodigital pedicle flaps have 2 possible patters of vascularization: anterograde flow (Littler) or reverse flow (Adani). The Adani's flap uses the Y-V pedicle lengthening principle. The flap is raised from the adjacent uninjured finger based on the digital artery. The common digital artery is ligated and a long pedicle is formed from the 2 converging digital arteries to supply a reverse flow flap. Four patients with severe fingertips injuries were submitted to surgical treatment with the Adani's flap. All flaps integrated and provided skin coverage. The Adani's flap has a long vascular pedicle that allows a wide arch of transposition. An easier vascular dissection in a site distant from the trauma which evolves a higher diameter digital artery and proximal interphalangeal arterial system promotes a high survival rate and good functional results. Adani's flap is a reliable technique for severe fingertip injuries.

Conventional methods for the treatment of congenital pseudarthrosis of the tibia (CPT) often lead to unsatisfactory results and so microsurgical fibula transfer (MFT) has appeared as an option to treat this challenging problem. In this series of 27 patients with CPT, we obtained satisfactory results in 23 as assessed by the timing of bone union and bone hypertrophy of the fibular transplant. The overall functional results were also good; in 18 patients, the residual shortening was less than 2 cm (with no limb shortening in 4) and in 7, shortening ranged between 2 and 4 cm. All 25 patients resumed normal walking without the help of braces after an average of 12 months. This report suggests that microvascular fibula transfers provide superior results in the treatment of CPT, especially when considering that many of such cases represented previous surgical failures. © 1994 Wiley-Liss, Inc.

Immediate survival and functional results were studied in 60 finger replants performed from 1980 to 1990. The follow-up ranged from 1 to 5 years with the mean of 2 years and 8 months. The survival rate achieved was 70% and was not related to the patient's age, the mechanism of injury, the level of amputation, the total ischemia time, the number of arteries and veins repaired or the type of vascular reconstruction. Sensory return was related to the mechanism of amputation and the total active motion was strongly correlated with the level of amputation. Of the 16 digits that had only one artery anastomosed, there were 10 survivals (62.5%), and in 15 digits with anastomosis of two arteries, the success rate was 86.66% (P = 0.1244). The success rate in those cases in which vascular grafts were employed was 62.96% (P = 0.4161). In replantations with one, two or three veins anastomosed, the survival rate was 50%, 79.16% and 100%, respectively (P = 0.1324).

Reconstruction of the foot using microvascular flaps has been widely performed in the last 15 years but the choice of flap to repair some areas in the foot remains controversial. We present a series of 128 free flaps to the foot performed during the period of 1975–1990. One hundred and seventeen had a successful outcome (91%). The etiology of the problem was traumatic in 94, congenital in 10, tumor in 9, and chronic ulcerations due to vascular problems in 15. The indications for a specific flap depended on the site and extension of the foot problem, and were divided into four groups: 1 Dorsum of the foot. Cutaneous parascapular flap was the best choice. 2 The sole-weight-bearing area. We favored the use of the latissimus dorsi muscle flap covered with a split thickness skin graft, done immediately. A proper tailoring of the flap and postoperative care by the patient are very important to maintain the result without ulceration. Tactile sensation does not seem to be essential. 3 The area over the calcaneus tendon. We have used cutaneous flaps such as the parascapular and lateral arm flap or fascial flaps covered by split thickness skin grafts (STSG). The fascia used were the serratus or the parascapular. 4 Complex trauma problems with extensive skin loss or chronic ulcerations due to vascular diseases: the latissimus dorsi musculocutaneous or muscle plus STSG was mostly used. The overall number of donor areas were 5 groins, 48 parascapular, 2 gluteal fold flaps, 4 lateral arm, 61 latissimus dorsi, and 8 fascial flaps. © 1994 Wiley-Liss, Inc.

OBJETIVO: avaliar o efeito das neuregulinas 1-alfa e 1-beta na regeneração de nervos ciáticos de camundongos C57BL/6J, adultos, machos, através da técnica de tubulização. MÉTODOS: Utilizaram-se 18 animais, divididos em 3 grupos, implantando-se prótese de polietileno em falhas de 4,0 mm no nervo ciático esquerdo: grupo 1 contendo apenas colágeno purificado (Vitrogen®); grupo 2, colágeno associado a neuregulina 1-alfa; grupo 3 com colágeno e neuregulina 1-beta. O grupo controle foi formado por 6 segmentos de nervos ciáticos direitos. Após 4 semanas, os animais foram sacrificados; extraiu-se segmento do ponto médio do nervo regenerado no interior das próteses, padronizaram-se cortes histológicos e confecção das lâminas para análise histomorfométrica. Confrontaram-se os resultados estatisticamente. RESULTADOS: Os animais tratados com neuregulinas tiveram maior número de axônios mielinizados, com diferença estatisticamente significante quando comparados ao grupo colágeno. Não houve diferença estatística entre os grupos de neuregulinas 1-alfa e 1-beta. CONCLUSÃO: a adição de neuregulinas proporcionou aumento significativo do número de fibras mielinizadas. PURPOSE: To evaluate the effect of neuregulins 1-alpha and 1-beta on the regeneration the sciatic nerves of male adult C57BL/6J mice, using the tubulization technique. METHODS: Eighteen animals were used, divided into three groups. A polyethylene prosthesis was implanted in a 4.0 mm defect of the left sciatic nerve, as follows: group 1 containing only purified collagen (Vitrogen®); group 2, collagen with neuregulin 1-alpha; group 3, collagen with neuregulin 1-beta. The control group was formed by six segments of right sciatic nerves. Four weeks later, the animals were sacrificed. A segment from the midpoint of the nerve regenerated inside the prostheses was extracted, histological sections were standardized and slides were made up for histomorphometric analysis. The results were statistically compared using the Tukey multiple comparisons test and Students t test. RESULTS: The animals treated with neuregulins had greater numbers of myelinized axons, with a statistically significant difference in relation to the collagen-only group. There was no statistical difference between the neuregulin 1-alpha and 1- beta groups. CONCLUSION: It was concluded that the addition of neuregulins provided a significant increase in the number of myelinized fibers.

Foi realizado um estudo clínico prospectivo analisando os resultados obtidos no tratamento de 23 pacientes portadores de lesões do revestimento cutâneo de dimensões iguais ou menores a 20 cm de comprimento por 10 cm de largura com a utilização do retalho microcirúrgico lateral do braço ampliado distalmente ao epicôndilo lateral do cotovelo. Todos os pacientes foram tratados pelo Grupo de Mão e Microcirurgia do Instituto de Ortopedia da Faculdade de Medicina da Universidade de São Paulo, no período de dois anos, 2003 à 2005. Na presente casuística, tivemos 69.5% de pacientes do sexo masculino, 73.9% de origem traumática e a região receptora foi o membro inferior em 65.2% dos casos. A idade variou de 6 anos até 62 anos, com média de 32 anos. O seguimento mínimo foi de 5 meses. Houve sucesso na realização de 100% dos retalhos. As dimensões dos retalhos realizados neste trabalho variaram em comprimento, de 9 cm até 20 cm, com média de 14 cm e em largura, de 3 cm até 8 cm, com média de 5.5 cm. A maior distância entre o epicôndilo lateral e a extremidade distal do retalho utilizada neste estudo foi de 8 cm, variando de 2 cm até 8 cm, com média de 4.9 cm. O retalho microcirúrgico lateral do braço ampliado distalmente ao epicôndilo lateral do cotovelo mostrou-se seguro para a cobertura cutânea de lesões de dimensões iguais ou menores a 20 cm de comprimento por 10 cm de largura, com o prolongamento do retalho até 8 cm distal ao epicôndilo lateral This prospective clinical study investigates the results of treatment of 23 patients with cutaneous lesions of no more then 20 cm of length by 10 cm of width, by means of a microsurgical lateral arm flap, distally extended by the elbow lateral epicondilyle. All patients came from the Hand and Microsurgery Group of the \"Instituto de Ortopedia da Faculdade de Medicina\" of the \"Universidade de São Paulo\", in a two years period from 2003 till 2005. Our population comprises the following basic statistics: 69.5% males, 73.9% of traumatic origin, the receiving region was the lower members in 73.9% of the cases. Age ranged form 6 to 64 years old, average 32 years. The minimum follow up was of 5 (five) months. The procedure was successful in 100% of the cases. The flap length dimension ranged from 9 cm up to 20 cm, with average 14 cm. The flap width dimension ranged from 3 cm up to 8 cm, with average 5.5 cm. The greater distance from the lateral epicondyle up to the end of the skin flap in this study was of 8 cm, ranging from 2 cm up to 8 cm, with 4.9 cm average. The microsurgical lateral arm flap, distally to lateral epicondyle showed itself to be safe for cutaneous covering of lesions of 20 cm or less length and 10 cm of less width, with the distal extension of the skin flap up to 8 cm from the lateral epicondyle

O autor estudou comparativamente, em coelhos, enxertos autólogos retirados do crânio e da crista ilíaca. Os animais foram divididos em dois lotes, crânio e crista ilíaca e a seguir distribuídos em três grupos diferentes, de acordo com o tempo de incorporação do enxerto ósseo. Foram correlacionados as medidas das dimensões e peso do enxerto com os achados histológicos realizados após o sacrifício do animal. O autor observou que o enxerto autólogo de crista ilíaca apresentou maior reabsorção que o de crânio aos sessenta dias. O enxerto autólogo de crânio iniciou a formação óssea mais precocemente que o enxerto de crista ilíaca The author compared cranial and iliac crest autogenous bone grafts using an experimental model in rabbits. 57 animals were studied and divided in three different groups, according with the time of evaluation, of the bone graft, 18, 30 and 60 days after the first procedure. Before being positioned on the nasal bone and fixed with a screw, the bone grafts were measured and weighted. The same measures were done at the time of removal of the bone graft and all these datas were correlated with the information achieved with histomorphometric parameters of osteogenesis (bone volume, osteoid volume, osteoid surface, osteoblastic surface and osteoid thickness) and of bone resorption (osteoclastic surface and resorption surface). The author concluded: the relation final wight/inicial weight in the cranial bone grafts was greater than in the iliac crest bone grafts; the osteogenesis was smaller on the 18th day in the iliac crest bone grafts group than the control group; the osteogenesis was greater in the cranial bone grafts group than the iliac crest bone grafts group on the 18th and 30th day after bone grafting; the bone resorption was greater in the iliac crest bone grafts group than the cranial bone grafts group after 60 days; the presence of superficial osteogenesis was increased in the cranial bone grafts.