1/112. Reversed dynamic slings. A new concept in the treatment of post-traumatic elbow flexion contractures.Following the successful treatment of knee-flexion contractures in haemophiliacs using an external corrective system with reversed dynamic slings, these have been adapted to treat post-traumatic elbow contractures. A case is described in which 90 degrees of fixed flexion was corrected in 1 week without discomfort. Clearly there is no need to resort to an internally applied hinge-distractor apparatus or capsulectomy if a simple external sling system is successful without complications.- - - - - - - - - - ranking = 1keywords = discomfort (Clic here for more details about this article) |
2/112. Reliability of inferior pedicle reduction mammaplasty in burned oversized breasts.Heavy pendulous breasts cause physical and psychological trauma. Postburn deformity of breasts results in significant asymmetry, displacement of nipple-areola complex, due to burn scar contracture, and significant scarring; these factors add more psychological discomfort and subsequent behavioral changes. The use of the inferior pedicle procedure in burned breasts can solve many problems. The technique reduces the size of the large breast, eliminates the scar tissue by excising both medial and lateral flaps, and brings the mal-located nipple and areola to a normal position. This study stresses the possibility of harvesting the inferior dermal pedicle flap from within the postburn scar tissue without necrosis of the nipple and areola, because of the excellent flap circulation. Acceptable aesthetic appearance and retainment of nipple viability and sensitivity can be achieved with the inferior pedicle technique even with postburn deformity of the breast. The study was conducted on 11 women, all of whom had sustained deep thermal burns to the breasts and anterior torso and whose breasts were hypertrophied and pendulous.- - - - - - - - - - ranking = 1keywords = discomfort (Clic here for more details about this article) |
3/112. Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome.The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations.- - - - - - - - - - ranking = 0.31134541193678keywords = pain (Clic here for more details about this article) |
4/112. Reversed neurofasciocutaneous flaps based on the superficial branches of the radial nerve.Soft-tissue reconstruction of the hand needs to cover the vital structures with flaps. It is usually difficult to maintain function and form with minimal morbidity. Local tissue is preferable but it is also very valuable. Especially in the distal part of the upper extremity, flap coverage is a challenging problem because of limited reconstructive alternatives. On the dorsum of the hand, flaps can be designed based on the paraneural vascular network of the cutaneous sensory nerves. These paraneural vascular networks send branches to the surrounding tissues. The branches to the skin are known as neurocutaneous perforators. The authors used eight reversed neurofasciocutaneous flaps based on the superficial branches of the radial nerve. Six flaps were based on the branch to the index finger and two flaps were based on the branch to the thumb. All flaps survived completely, and successful flap coverage was achieved in all patients with minimal morbidity.- - - - - - - - - - ranking = 0.050239888507222keywords = upper (Clic here for more details about this article) |
5/112. Latissimus dorsi myocutaneous flap reconstruction of neck and axillary burn contractures.neck and axillary burn contractures are both a devastating functional and cosmetic deformity for patients and a challenging problem for reconstructive surgeons. Severe contractures are more commonly seen in the developing world, a result of both the widespread use of open fires and the inadequacy of primary and secondary burn care in these vicinities. When deep burns are allowed to heal spontaneously, patients develop hypertrophic scarring of the neck and axillary areas. The back is typically spared, however, remaining a suitable donor site. We have used nine latissimus dorsi myocutaneous flaps in a total of six patients, finding the flaps effective in resurfacing both the neck and the axillary regions after wide release of burn contractures. Before flap mobilization, surgical neck release is often necessary to ensure safe, effective control of the airway in patients with significant neck contractures. Flap bulkiness in the anterior neck region can eventually be reduced by dividing the thoracodorsal nerve. Anchoring the skin paddle to its recipient site through the placement of tacking sutures will also help achieve a more normal anterior neck contour.- - - - - - - - - - ranking = 0.013469050176136keywords = back (Clic here for more details about this article) |
6/112. Mosaic tetrasomy 8q: inverted duplication of 8q23.3qter in an analphoid marker.We observed an analphoid marker chromosome stable through cell division in a 16-year-old girl with developmental delay, short stature, limb contractures, and ovaries containing multiple cysts. She also developed myasthenia gravis at 15 years. The marker chromosome, present in 75% of metaphases (and in 90% of transformed lymphoblastoid cells), was C-band negative, and had no pan alpha-satellite sequences detectable by fluorescence in situ hybridization (FISH). The 8q origin of the marker was determined by use of subtelomeric probes and was confirmed by chromosome 8 painting probes. The marker was shown to be an inversion duplication of 8q when subtelomeric, telomeric, and c-myc FISH probes hybridized to both ends of the marker. The karyotype was 47,XX, inv dup(8)(qter--> q23.3::q23.3-->[neocen]-->qter), resulting in tetrasomy for 8q23.3qter. The parents had normal karyotypes. Centromeric proteins CENP-C and CENP-E were present, but alpha associated centromere protein CENP-B was absent at a position defining a neocentromere.- - - - - - - - - - ranking = 0.034593934659643keywords = pain (Clic here for more details about this article) |
7/112. Progressive pseudorheumatoid arthropathy of childhood.Progressive pseudorheumatoid arthropathy of childhood (PPAC) described by Spranger et al is a rare autosomal recessive disorder. An 11 year-old girl was diagnosed as having PPAC at Ege University, faculty of medicine, Department of Paediatrics. Her complaints of painful joints, difficulty in walking and joint contractures began at the age of 3 years and she was treated for juvenile rheumatoid arthritis for 8 years. Her symptoms did not respond to nonsteroid anti-inflammatory treatment. During her last hospitalisation period, she was reinvestigated. Radiological examination showed spondyloepiphyseal dysplasia, severe acetabular irregularity and osteoporosis. All the laboratory test results for rheumatoid arthritis were negative. The clinical and radiological findings of the patient are illustrated.- - - - - - - - - - ranking = 0.034593934659643keywords = pain (Clic here for more details about this article) |
8/112. Isolated finger flexion: a novel form of focal neuromyotonia.Two almost identical elderly women are described who presented with gradually progressive painless involuntary flexion of the ring and middle fingers over 12 months, leading eventually to contractures. The flexion deformity persisted during sleep and was the sole neurological abnormality. Both patients had advanced chronic obstructive pulmonary disease and were on long term salbutamol and oxygen. Neurophysiological studies indicated that this was due to neuromyotonia mainly involving flexor digitorum superficialis muscles without evidence of underlying peripheral neuropathy, proximal conduction block, or generalised neuromyotonia. Voltage gated potassium channel antibodies were negative. The clinical and neurophysiological picture remained static over a 2 year follow up period. It is suggested that this is a novel form of acquired focal neuromyotonia and speculate both on its cause and distribution.- - - - - - - - - - ranking = 0.034593934659643keywords = pain (Clic here for more details about this article) |
9/112. Free transfer of the radial forearm flap with preservation of the radial artery.One of the main disadvantages of the radial forearm flap is the sacrifice of a major artery. To overcome this drawback the authors describe a technique of free transfer of the flap with preservation of the radial artery. The flap is elevated as a distal row perforator-based fasciocutaneous flap with a very short segment of the radial artery included in the inverted-T-shaped arterial pedicle. The venous outflow of the flap is provided by the cephalic vein, with accompanying veins of the radial artery left behind. Although the donor radial artery is repaired primarily, the flap is transferred to reconstruct a soft-tissue defect resulting from the release of a neck contracture after radiotherapy in a 42-year-old patient who had previous excision of a mandibular osteosarcoma. The arterial anastomosis was performed end to end between the superior thyroid artery and one limb of the arterial pedicle, with the other limb ligated. The venous anastomosis was performed end to end between the cephalic vein and the external jugular vein. The flap survived completely and a satisfactory result was obtained. The radial artery is demonstrated to be patent long after surgery, both with Allen's test and with a Doppler examination. Considering the possible sequelae of the sacrifice of the radial artery, this technique is obviously advantageous to such patients, even with a nonsatisfactory preoperative Allen's test. This perforator-based radial forearm flap is very easy to raise and to transfer, with anastomoses of large-diameter vessels.- - - - - - - - - - ranking = 0.013469050176136keywords = back (Clic here for more details about this article) |
10/112. Free transfer of expanded parascapular, latissimus dorsi, and expander "capsule" flap for coverage of large lower-extremity soft-tissue defect.The coverage of large soft-tissue defects usually requires a large flap transfer, especially in a combination and expanded form. However, some large soft-tissue defects still cannot be covered by such flaps. In this article, we present a case of a civil war injury in a patient from afghanistan who had severe trauma to the right knee, lower thigh, and upper leg and a marked soft-tissue defect. This large soft-tissue defect was covered with a large combined free flap of the expanded parascapular and latissimus dorsi muscle, including a large retrograde hinge flap of the tissue expander capsule and a complementary skin graft. The defect was covered completely, and the final result was excellent.- - - - - - - - - - ranking = 0.050239888507222keywords = upper (Clic here for more details about this article) |
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