Goals of lower extremity microvascular reconstruction (LEMR) include the restoration of function, prevention of infection, and optimal cosmesis. Indications for LEMR include large defects that are ...not amenable to pedicled options, a large zone of injury, and large complex defects. The novice microsurgeon should first master a handful of free flaps to develop an armamentarium of options for addressing such defects. The scope of this review is to provide free flap options for LEMR in any of the thirds of the lower leg. After reading this article, the reader will understand variations, advantages, disadvantages, indications, and tips for raising each of these flaps.
Six most commonly used free flaps for LEMR are described in this paper, including the anterolateral thigh flap (ALT) and its variations, the radial forearm flap (RFFF), the lateral arm flap (LAF), the gracilis muscle flap, the rectus abdominis flap (RAF) and the latissimus dorsi flap and its variations. Indications, advantages, disadvantages and technique tips are discussed for each flap. Moreover, selection of the recipient vessels, preoperative management along with an algorithm are also provided.
The ALT flap is a workhorse in covering defects of the leg, foot, and ankle. It's the flap of choice at our institution, especially given the number of traumatic wounds seen as a result of motor vehicles, all-terrain vehicles (ATV), lawnmowers, and gunshot wounds (GSW). At times, the lower extremity zone of injury requires a distant donor site. The RAF can also provide coverage for large soft tissue defects but donor-site morbidity remains its main drawback. The LAF and RFFF provide two pliable options, one that provides pliable soft tissue with minimal donor site morbidity and another that provides a long pedicle. The free gracilis flap is an excellent choice for crossing the ankle joint. Lastly, the free latissimus dorsi is indicated for large defects of the lower extremity independently of the location.
Brown tumors represent a rare clinical manifestation reported in approximately 3% of patients with primary hyperparathyroidism and correspond to radiologically osteolytic lesions with well-defined ...borders in different parts of the skeleton.
We report the case of a 53-year-old white man who presented to our hospital with osteolytic lesions of his distal ulna and radius, causing pain and swelling of 2-month duration. A subsequent biopsy revealed histological features consistent with giant cell tumor and a complete resection of his distal ulna was followed, along with curettage and cementoplasty of the distal radial metaphysis. Two weeks later, he was re-admitted with diffuse musculoskeletal soreness, anorexia, constipation, nausea, and localized abdominal pain and multiple osteolytic lesions on plain radiographs. A histopathological examination of the ulna and radius specimens showed similar findings and, given the multifocality, brown tumors related to primary or secondary hyperparathyroidism was included in the differential diagnosis. A laboratory examination showed high total serum calcium (14.5 mg/dl) and low serum phosphorus and 25-hydroxyvitamin D levels. Primary hyperparathyroidism was suspected and confirmed by the elevated parathyroid hormone levels of 1453 pg/mL. At radiological work-up, using computed tomography, ultrasonography, and parathyroid subtraction technetium-99m sestamibi scintigraphy, a 4.5 × 2.5 × 3.2 cm mass emanating from the right lobe of his thyroid gland was detected, displaying extensive uptake in the right lower parathyroid gland. After appropriate medical support including hyperhydration and high doses of diuretics and diphosphonates, his laboratory profile normalized and he underwent total thyroidectomy with removal of the parathyroid glands. Our patient is now recovering 12 months after surgery, with normal values of serum parathyroid hormone and calcium levels. The lytic bone lesions have almost disappeared and no other additional orthopedic intervention was necessary.
The present case report emphasizes the need of inclusion of brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to avoid harmful surgical interventions. Laboratory testing of serum phosphate, calcium levels, and parathyroid hormone levels should always be included in the routine survey of patients with multifocal osteolytic lesions.
Purpose
The optimal (SBJI) surgical treatment for acute acromioclavicular (AC) joint disruption remains controversial. What is being presented is the long-term functional outcomes of a double ...cross-looped coracoclavicular (CC) suture technique with the intention of restoring both anteroposterior and superior displacement of the clavicle.
Methods
Between 2007 and 2016, 81 patients underwent surgical reconstruction for acute acromioclavicular joint (AC) disruption in two orthopaedic centers. Two patients died for reasons unrelated to the treatment, and seven missed the final follow-up appointment, leaving 72 patients (67 males; 5 females; age 37 ± 12.4; range 15–64 years) for clinical and radiological assessments. All cases were classified according to the Rockwood classification as type III (
n
= 34), IV (
n
= 14) or V (
n
= 24). The dislocation was repaired with double cross-looped CC fixation using four Ethibond sutures passing underneath the coracoid and through a 4.5 mm drill hole in the clavicle in opposing directions to control both anteroposterior and vertical displacement. Radiological investigation preoperatively and at the last follow-up included anteroposterior and/or Zanca views, axillary or Alexander views, and comparative stress radiography of both AC joints. Patients were evaluated clinically with the Constant-Murley score (CMS) and Acromio Clavicular Joint Instability Score (ACJIS). Loss of reduction, subluxation, CC ligament ossification, post-traumatic arthritis, and peri-implant fractures were also recorded.
Results
Seventy-two patients were available for the last clinical and radiological evaluations. At a median follow-up period of 6.3 ± 2.1 years (range 3–12 years), the CMS and ACJIS were 92.1 ± 7.2 (range 60–100 points) and 90.4 ± 8.6 (range 45–100 points), respectively. Complications included 9 (12.5%) patients with slight loss of reduction, 2 (1.7%) with dislocation recurrence, 1 (1.3%) with superficial infection, 1 (1.3%) with a fracture of the lateral end of the clavicle, and 2 (1.7%) with persistent tenderness in the AC joint. The incidence of periarticular ossification was 22.4% and did not affect the final outcome.
Conclusions
This technique represents an effective and low-cost treatment for acute AC joint separations.
Level of evidence
IV.
Introduction
Complex fractures of the proximal humerus with splitting-head component and metaphyseal propagation are very rare injuries that are difficult to treat. Preservation of the humeral head ...is always considered except in cases with severe comminution and compromised vascularity where shoulder hemiarthroplasty is an alternative option.
Case Report
We present two male patients, 57- and 62-years-old who sustained such a complex proximal humeral fracture after a high-energy injury. They both managed with long-stemmed shoulder hemiarthroplasty and cerclage wiring of the metaphyseal area. They both demonstrated good clinical and radiological outcome at 32- and 24-months postoperatively.
Conclusion
We report the functional and radiological outcomes of two cases of a rare proximal humeral fracture's pattern - combination of splitting-head and metaphyseal comminution – that were managed with long-stemmed hemiarthroplasty and cerclage wire and demonstrated good midterm clinical outcome.
Fifty-two children (54 upper extremities) with obstetric brachial plexus palsy who underwent primary reconstruction for elbow flexion restoration were studied. The outcomes were analysed in relation ...to the type of brachial plexus lesion, timing of surgery, and the type of reconstruction. Overall, 42 of 54 extremities (78%) achieved good and excellent results (≥M3+). The average postoperative muscle grading for the biceps was 3.7 (SD 0.8), and the average postoperative active elbow flexion was 108° (SD 33°). The average elbow flexion contracture was 18° (SD 21°). The timing of surgery and the type of the brachial plexus injury significantly influenced the final outcome. The best results were seen in early cases (≤3 months), where the lateral cord was reconstructed from intraplexus donors. In this group, minimal flexion contracture deformity was observed. Late reconstruction (≥7 months) of the musculocutaneous nerve resulted in inferior results.
Diet, Lung Function and Swimmers' Performance Kokkalis, C. Z.; Athanassaki, Maria; Gourgoulianis, K. I. ...
Journal of nutritional and environmental medicine,
2001, Letnik:
11, Številka:
2
Journal Article
Recenzirano
Purpose: The aim of this study was to correlate athletic performance with both lung function and diet. Design: Open, uncontrolled trial. Materials and Methods: Sixty-eight swimmers (28 females and 40 ...males), 9-15 years old, were registered for the study. The average age was 11.75 years, the average height was 151.65 cm and the average weight was 42.88 kg. Every swimmer completed a questionnaire which included details about eating habits and performances in the 100 m freestyle and backstroke. They were submitted to spirometry tests and diffusion capacity measurements (with a simple inspiration of carbon monoxide). All swimmers had three spirometry tests. The best one was recorded and compared to the expected values. Results: The average diffusing capacity was 29.07% higher than expected and the average forced expiratory volume in the first second was 4.21% higher than expected. Swimmers who consumed 5.7 meals per week based on meat and 4.43 meals per week based on vegetables performed better than swimmers who consumed 4 meals per week based on vegetables and 3.35 meals per week based on meat ( p < 0.001). Swimmers with better lung function performed significantly more impressively in both styles ( p < 0.001). Based on multiple logistic regression analysis we found equations that correlate swimming performance with age, height, lung function and diet. Conclusions: Swimmers' performance is related to lung function and diet. Diffusing capacity and dynamic volume measurement are adequate methods of evaluating lung function.
IntroductionComplex fractures of the proximal humerus with splitting-head component and metaphyseal propagation are very rare injuries that are difficult to treat. Preservation of the humeral head is ...always considered except in cases with severe comminution and compromised vascularity where shoulder hemiarthroplasty is an alternative option. Case ReportWe present two male patients, 57- and 62-years-old who sustained such a complex proximal humeral fracture after a high-energy injury. They both managed with long-stemmed shoulder hemiarthroplasty and cerclage wiring of the metaphyseal area. They both demonstrated good clinical and radiological outcome at 32- and 24-months postoperatively. ConclusionWe report the functional and radiological outcomes of two cases of a rare proximal humeral fracture's pattern - combination of splitting-head and metaphyseal comminution - that were managed with long-stemmed hemiarthroplasty and cerclage wire and demonstrated good midterm clinical outcome.
The authors reviewed 52 patients who underwent Bier’s block, as supplementary anesthesia for insufficient axillary block in upper extremity surgical procedures. Prior to proceeding to the Bier’s ...block, the mean value of pain using the visual optical analogue scale (VAS) was 7.0. In 48 of the patients supplementation with the Bier’s block was sufficient (mean VAS score of 1.0) and all patients were comfortable throughout the procedure. In the remaining four patients supplementation with narcotics and sedatives via the other IV line was required. Intraoperative Bier’s block provides a safe and effective alternative way of successfully compensating for an insufficient axillary block in upper extremity surgical procedures.
Les auteurs rapportent une série de 52 patients qui ont bénéficié d'un bloc endoveineux complémentaire d'un bloc axillaire jugé insuffisant pour des interventions chirurgicales du membre supérieur. Avant l'administration du bloc endoveineux, la douleur était de 7.0 en utilisant l'échelle visuelle analogue (VAS – Visual Analogue Scale). Dans 48 cas, le bloc endoveineux supplémentaire était suffisant (VAS moyen de 1.0), et tous les patients se sentaient bien durant l'intervention. Dans les quatre cas restants, l'administration de narcotiques et de sédatifs via l'autre ligne endoveineuse était nécessaire. Le bloc endoveineux complémentaire d'un bloc axillaire jugé insuffisant constitue une alternative sûre et efficace dans la chirurgie du membre supérieur.
The need to provide a safe environment for vulnerable road users in the road network is essential when considering the land-use system and the transportation system in an area. This need is more ...important in the case of students due to the fact that they are not always in the position to easily realize the danger of the road traffic and thus take the necessary precautionary measures. In the framework of this paper the results of a research concerning high school students' perception of the level of traffic safety provided in school areas are presented. Students in high schools (first to third grade) participated in a questionnaire-based survey in the Municipalities of Kalamaria and Larissa, Greece. The perception of the traffic safety level in the vicinity of schools, the reasons for which students feel unsafe, their knowledge of the Highway Code, their participation in traffic education events, their opinion about the traffic calming measures and the transport modes used for the trips to and from schools are examined and presented in this paper.
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