Fascial Free Flap for Reconstruction of the Dorsolateral Hand and Digits: The Advantage of a Thin Contour.

BACKGROUND: Fascial free flaps have been widely used for reconstruction of the hand because they are thin. However, studies reporting objective data regarding the advantages of this approach are lacking. Thus, we report our experience with such flaps. METHODS: Forty-five cases of fascial free flaps between November 2006 and March 2014 were reviewed. Nine cases involving reconstructed dorsal or lateral defects were included. Four anterolateral thigh fascial free flaps and 5 lateral arm fascial free flaps were examined. Maximal flap contour was assessed by measuring reconstructed tissue thickness at the central area from the surface of the skin to below the bone in a vertical manner using ultrasonography and X-ray data. Contralateral regions were examined in the same manner and a comparative analysis was performed. A questionnaire survey regarding aesthetic satisfaction was also administered. RESULTS: All reconstructed parts had a thicker contour than the contralateral side. The average relative percentage of reconstructed tissue thickness was found to be 152% using ultrasonography and 143% using X-ray imaging. According to the aesthetic satisfaction survey, the average rate of satisfaction for patients was 62%, and satisfaction with the flap contour was 72%. CONCLUSIONS: Using a fascial free flap, the reconstructed tissue was approximately 1.5× as thick as the contour of the normal side, which led to positive responses regarding aesthetic satisfaction.

Joint-specific prevalence and radiographic pattern of hand osteoarthritis in Korean.

We investigated the prevalence and involvement patterns of radiographic osteoarthritis (OA) with hand symptoms among Korean people and compared the difference in prevalence of hand OA between racial groups. Hand radiographs in 299 Korean subjects (266 female, 33 male) ≥40 years of age were examined, who had hand arthralgia. The study population was comprised of 206 patients who had radiographic OA at least at one hand joint. Radiographic OA (Kellgren-Lawrence scale ≥2 grades) was evaluated for 16 joints of each hand. The most prevalent OA was in the interphalangeal joints (IP) of thumb, followed by the distal interphalangeal joints (DIP) of index finger, DIP of middle and fifth finger in the frequency of order. The involvement of metacarpophalangeal joints (MP) was relatively common in 1st-3rd MP. Hand OA in Korean was higher in the thumb IP and lower in the thumb carpometacarpal joints compared with Caucasian previously reported. Moreover, the higher OA frequency of 1st-3rd MP was not in accordance with other studies in Caucasian and other Asian populations. The patterns of radiographic hand OA were symmetric (OR 15.68), clustered by ray (OR 8.69) and row (OR 6.66). In conclusion, our study showed that thumb IP and 2nd/3rd/5th DIP should be included in the assessment of radiologic hand OA in Koreans.

Involvement of the proximal tibiofibular joint in ankylosing spondylitis.

BACKGROUND: Ankylosing spondylitis (AS) may affect peripheral joints, with the shoulder, hip, and knee being well known involved sites. However, involvement of the proximal tibiofibular (PTF) joint has not yet been investigated. PURPOSE: To evaluate PTF joint abnormalities in patients with AS. MATERIAL AND METHODS: From July 1997 to June 2005, 16 patients (15 male, one female; mean age 25 years), who were clinically diagnosed with AS, underwent magnetic resonance imaging (MRI) to evaluate knee pain. All patients also underwent plain radiographs of the knee, lumbar spine, and pelvis. Twenty knee MRIs (bilateral in four patients) and 16 sets of knee, lumbar spine, and pelvic radiographs were retrospectively reviewed in order to evaluate possible AS involvement. The presence of abnormalities suggesting AS involvement were recorded separately in the sacroiliac joints, lumbar spine, hip, and femorotibial and PTF joints. If the PTF joint showed any pathologic findings, the radiologic findings were recorded. RESULTS: Three of 16 patients (18.7%) had pathologic features of the PTF joint observed by plain radiographs or MRI. One of these three patients showed bilateral involvement of the PTF joints on plain radiographs, while the other two patients showed unilateral involvement on MRI. Subchondral sclerosis, cartilage abnormality, erosion, and abnormal bone marrow signal intensity were identified on MRI. Plain radiographs of two patients revealed subchondral sclerosis and spur formation in the PTF joint. The frequencies of involvement of other joints in the 16 patients were as follows: lumbar spine, n=5 (31%), hip joint, n=1 (6%) (identified by plain radiographs), and femorotibial joints, n=10 (62.5%) (identified by knee MRI). CONCLUSION: MR imaging of the PTF joint can depict synovial changes and their effect on joint structures in patients with AS. The MRI findings of AS involving the PTF joints are subchondral sclerosis, cartilage abnormality, erosion, and abnormal bone marrow signal intensity.

Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation.

OBJECTIVE: The purpose of this study was to evaluate the relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch. MATERIALS AND METHODS: We retrospectively reviewed the 105 patients with knee magnetic resonance imaging (MRI) with or without knee arthroscopy [group 1: patients with arthroscopic notchplasty (N = 47), group 2: knee arthroscopy demonstrating intact ACL (N = 33), and group 3: patients with normal knee MRI but no arthroscopy (N = 25)]. Groups 2 and 3 served as an arthroscopic and MR control group, respectively. Two musculoskeletal radiologists reviewed all MR examinations. The intercondylar notch width, notch index (width of intercondylar notch/width of femoral condyle), transverse notch angle (TNA), sagittal notch angle (SNA), and notch area were recorded on axial and sagittal MR images at the midpoint of Blumensaat's line which was identified on sagittal images. The diameter of the ACL was recorded on coronal MR images at the posterior end of Blumensaat's line. RESULTS: The mean values of the intercondylar notch width, notch index, TNA, SNA, notch area, and ACL diameter for the three groups were 16.0 mm/0.2/50.3 degrees /36.5 degrees /249.0 mm(2)/7.7 mm (group 1); 19.3 mm/0.3/52.9 degrees /40.2 degrees /323.4 mm(2)/4.8 mm (group 2); and 20.3 mm/0.3/51.4 degrees /39.1 degrees /350.8 mm(2)/4.5 mm (group 3). The intercondylar notch width, notch index, SNA, and notch area were smaller, and ACL diameter was thicker in group 1 compared with the other groups (p < 0.05). CONCLUSION: Patients with mucoid ACL hypertrophy show a narrower notch, a steeper notch angle, and a smaller notch area than control groups.

Liquid-crystal display monitors and cathode-ray tube monitors: a comparison of observer performance in the detection of small solitary pulmonary nodules.

OBJECTIVE: To compare observer performance using liquid-crystal display (LCD) and cathode-ray tube (CRT) monitors in the interpretation of soft-copy chest radiographs for the detection of small solitary pulmonary nodules. MATERIALS AND METHODS: By reviewing our Medical Center's radiologic information system, the eight radiologists participating in this study (three board-certified and five resident) retrospectively collected 40 chest radiographs showing a solitary noncalcified pulmonary nodule approximately 1 cm in diameter, and 40 normal chest radiographs. All were obtained using a storage-phosphor system, and CT scans of the same patients served as the gold standard for the presence of a pulmonary nodule. Digital images were displayed on both high-resolution LCD and CRT monitors. The readers were requested to rank each image using a fivepoint scale (1 = definitely negative, 3 = equivocal or indeterminate, 5 = definitely positive), and the data were interpreted using receiver operating characteristic (ROC) analysis. RESULTS: The mean area under the ROC curve was 0.8901+/- 0.0259 for the LCD session, and 0.8716+/- 0.0266 for the CRT session (p > 0.05). The reading time for the LCD session was not significantly different from that for the CRT session (37.12 and 41.46 minutes, respectively; p = 0.889). CONCLUSION: For detecting small solitary pulmonary nodules, an LCD monitor and a CRT monitor are comparable.

Lateral decubitus HRCT: a simple technique to replace expiratory CT in children with air trapping.

OBJECTIVE: To evaluate the effectiveness of lateral decubitus high-resolution CT (HRCT) in detecting air trapping in children. MATERIALS AND METHODS: HRCT scans of 21 children with heterogeneous lung attenuation caused by air trapping (n = 10) or with infiltrative lung disease (n = 11) were reviewed retrospectively. The air-trapping disease included bronchiolitis obliterans (n = 7), bronchial obstruction due to mediastinal lymphoma (n = 1), endobronchial haemangioma (n = 1) and foreign body aspiration (n = 1). HRCT was performed in both lateral decubitus positions as well as the supine position. The attenuation (Hounsfield units; HU) was measured in both the hypo- and adjacent hyper-attenuating areas of the heterogeneous lung portion, and the difference of attenuation between these two areas was calculated in the supine and both lateral decubitus scans, respectively. The attenuation differences of the three scans were compared in each group. RESULTS: The attenuation difference was larger in the ipsilateral decubitus (207.95 +/- 105.24 HU) scans than in the contralateral (121.25 +/- 90.05 HU) or supine (162 +/- 94.01 HU) scans in the air-trapping group (P < 0.05). There were no significant differences among the three scans in the infiltrative lung disease group (P > 0.05). CONCLUSIONS: Lateral decubitus HRCT is an effective adjunct to standard HRCT in the evaluation of air trapping as a cause of mosaic lung attenuation in uncooperative paediatric patients.