RESUMEN

Introduction The medial gastrocnemius flap is an established workhorse flap to cover proximal leg defects due to its reliability and simplicity to raise. However, it has the disadvantage of being bulky, requiring a skin graft for coverage, and is associated with loss of muscle power. The pedicled medial sural artery perforator (MSAP) flap has gained popularity as a reconstructive alternative for defects of the lower extremities. We present a case series of pedicled MSAP flaps for reconstructing defects around the knee as an alternative to the medial gastrocnemius flap. Materials and Methods A consecutive series of patients with proximal leg defects following trauma, osteomyelitis, burns, and chronic wounds were included. A hand-held Doppler was used to map out the MSAPs. Defects were reconstructed using pedicled MSAP flaps, preserving the nerve supply to the gastrocnemius muscle. Patient outcomes were recorded, including their Enneking scores postreconstruction. Results A total of 10 pedicled flaps was performed to reconstruct defects around the knee joint between October 2017 and November 2018. All the patients were discharged 1 week postoperatively, and rehabilitation consisted of graduated flexion in a knee brace by means of controlled passive mobilization. Three out of the ten patients developed complications: one patient developed flap congestion, one developed epidermolysis of the tip of the flap, and the other patient had partial necrosis of the skin paddle. The average Enneking score was 29 out of 35. Conclusion The pedicled MSAP flap is a good reconstructive option for proximal leg defects as it is associated with lower donor site morbidity and provides an aesthetically pleasing reconstruction.

RESUMEN

INTRODUCTION: The use of throat packs during oropharyngeal surgery has long been a topic of debate among cleft surgeons. The advantage of inserting an absorbent tulle within the pharynx must be weighed against the risk of unintended retention postoperatively. Despite safety check mechanisms in place, retention may occur with potentially life-threatening consequences. We present a comprehensive review of throat pack use in all cleft units within the United Kingdom and Ireland. METHODS: All 20 cleft surgery units in the United Kingdom and Ireland were surveyed on their use of throat packs in children aged 6 months to 2 years undergoing elective cleft palate surgery. RESULTS: The response rate to the survey was 100%. Seventy-five percent of units currently use throat packs; in 40%, they are used in addition to cuffed endotracheal tubes (ETTs). Inclusion of the throat pack in the surgical swab count was perceived as the safest mechanism employed to avoid retention. 26.1% of respondents were aware of at least 1 incident of pack retention in their unit. DISCUSSION/CONCLUSION: The reported UK and Irish experience demonstrates that three-quarters of units routinely use packs. Notably, a quarter of respondents to the survey have experience of an incident of throat pack retention. Nevertheless, the majority of respondents considered the perceived risk of retaining a pack to be low. The growing use of microcuffed ETTs in UK cleft units paired with a low incidence of perioperative complications when a throat pack is not introduced might prompt cleft surgeons to review routine pharyngeal packing.

Asunto(s)

RESUMEN

Nontuberculous mycobacteria (NTM) refer to all mycobacteria species not associated with the Mycobacterium tuberculosis complex. NTM have been shown to cause superficial and deep tissue infections of the hand, the vast majority of which are attributed to Mycobacterium marinum . There have been only eight cases of Mycobacterium szulgai -associated infections of the hand described in the English literature, none requiring surgical reconstruction. We describe a severe case of M. szulgai -associated carpal tunnel infection reported in an immunocompetent patient requiring extensive soft tissue debridement and reconstruction. This case illustrates the importance of a multidisciplinary team approach with microbiology specialists when managing severe soft tissue infections of the hand.

Asunto(s)

RESUMEN

Objective: Subdermal contraceptive implants are a well-established method of contraception. Aside from common side effects such as irregular menstrual periods, headaches, and weight gain, rarer complications related to their insertion and removal have been reported. These include traumatic peripheral neuropathy after procedures to remove nonpalpable implants. Only 2 cases of ulnar neuropathy after insertion of a contraceptive implant have been described in the literature, one which resolved spontaneously and another in which postoperative recovery was not described. We report a case of acute ulnar nerve neuropathy in a patient postinsertion of a contraceptive implant who achieved symptom resolution after prompt referral and treatment at a specialist plastic surgery center. Methods: A 22-year-old, right-hand-dominant woman presented 1 day postinsertion of a contraceptive implant (Implanon) in her left arm with paresthesia along the ulnar distribution of her hand and forearm, as well as shooting pain on palpating the course of the ulnar nerve. Ultrasonography found the implant to be lying in the subfascial plane of the inner arm. Results: The implant was found lying in the perineurium of the ulnar nerve, causing ulnar nerve neuropathy. A review 3 months after removal of the implant showed near-complete resolution of her symptoms. Conclusions: Complications related to implantable contraceptives may lead to significant morbidity. Appropriate training for health care professionals administering the devices is essential, as well as early referral to a specialist center to prevent permanent damage.

RESUMEN

Osgood-Schlatter disease is a common cause of anterior knee pain in adolescents. In a good proportion of cases the pain is relieved through stopping sport alone, or by doing so in conjunction with undertaking physiotherapy. However, resolution of symptoms may take several years. A proportion of teenagers are prevented from participating in sport for a prolonged period as a result of the condition, and some have persisting knee pain into adulthood. We report the use of a new surgical treatment for this disease. We describe the case of a 12-year-old boy who was unable to play rugby for a year due to this pain. Following percutaneous fixation of the tibial tuberosity his symptoms entirely resolved and he returned to competitive sport 6 weeks after surgery. A year later the screw was removed. As soon as he resumed sport his symptoms immediately returned and he requested that the screw be replaced. Following replacement his symptoms once more resolved.

Asunto(s)

RESUMEN

Chronic wounds on the dorsum of the hand are often challenging to treat. Vacuum-assisted closure has enjoyed widespread use in recent years for many difficult chronic wounds as an alternative to surgery. Unfortunately, owing to the unique anatomy of the hand, it is usually very difficult to get a seal without significantly immobilising the hand. We report a case of a chronic wound on the dorsum of the hand as a result of osteomyelitis in a 37-year-old man, which was treated with Single Use Negative Pressure Wound Therapy, 'PICO' (Smith and Nephew Co, UK). We combined the PICO dressing with a rubber glove to get a good seal enabling appropriate suction without immobilising the hand. Once the wound bed was ready, the defect was covered with a reverse forearm flap.

Asunto(s)

RESUMEN

Gluteal compartment syndrome is a rare entity but a recognised complication of prolonged immobilisation. It can present as renal failure as a result of severe rhabdomyolysis and can lead to sepsis and death. We report a case of gluteal compartment syndrome in a 25-year-old man who was found unconscious following intoxication with alcohol and cocaine of an unknown duration. He presented with tense tight left buttock swelling, right thigh swelling, cold immobile extremeties and acute renal failure. Immediate left gluteal, thigh and calf fasciotomy resulting in an improvement of lower limb and renal function.

Asunto(s)

RESUMEN

INTRODUCTION: The aims of this study were to assess and compare vocal cord functions before and after thyroid surgery after intra-operative identification of recurrent laryngeal nerve. PATIENTS AND METHODS: Recurrent laryngeal nerve (RLN) is seen intra-operatively in all cases undergoing thyroid surgeries. Vocal cord functions including any voice change were evaluated by indirect laryngoscopy (I/L) and direct laryngoscopy (D/L) before and after surgery. RESULTS: Prospective study on 100 patients over 18 months with a total of 146 nerves at risk (NAR). Majority were women (n = 86) with mean age of 37.48 years (range, 13-60 years). RLN was seen in all patients and 19 patients complained of some change in quality of their voice after surgery. Evaluation by I/L and D/L at 6 weeks showed recurrent laryngeal nerve palsy (RLNP) in nine (47.36%) and five (26%) of these 19 patients respectively. Analysed according to total NAR, the incidence of voice change and temporary RLN palsy (I/L and D/L) at 6 weeks was still less at 13.01%, 6.16% and 3.42%, respectively. Voice change improved in all cases at 3 months with no RLNP palsy by I/L or D/L. All these 19 patients had undergone difficult or extensive surgery for malignancy, large gland, extratyhroidal spread or fibrosis. CONCLUSIONS: Despite identification and preservation of RLN, patients can develop postoperative voice change and RLNP although all voice change cannot be attributed to damaged RLN. Proper assessment of vocal cord functions by I/L and D/L laryngoscopy is required to rule out injuries to these nerves. Risk of damage is higher in patients undergoing more difficult surgery.

Asunto(s)