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BACKGROUND: This study aims to compare perfusion dynamics using indocyanine green videoangiography before and after the creation of a second venous anastomosis between the superficial inferior epigastric vein and the retrograde internal mammary vein (IMV) in deep inferior epigastric perforator (DIEP) flap breast reconstructions. METHODS: Indocyanine green videoangiography performed during DIEP flap reconstructions was analyzed prospectively. The areas of interest were above the perforators with the highest intensity (complete perfusion), the most distal lateral edge of the flap (partial perfusion), and the next lowest intensity (ischemic). We compared the zone intensities before and after the second venous anastomosis, assessing venous drainage patency and functionality. Patient characteristics, operative details, and complications were collected. RESULTS: Seven patients (10 breasts) underwent DIEP reconstruction. Mean age was 54.5 ± 12.4 years. Mean operative duration was 575.5 ± 172.6 minutes. Donors included DIEV (n = 10, 100.0%), superficial inferior epigastric vein (n = 9, 90.0%), and superficial circumflex epigastric vein (n = 1, 10.0%). All DIEVs were anastomosed to the antegrade IMV (n = 10, 100.0%). Superficial inferior epigastric veins were anastomosed to the retrograde IMV (n = 10, 100.0%). Mean peak intensities of the complete perfusion zone before and after the second venous anastomosis were 160.7 ± 42.1 and 188 ± 42.1, respectively ( P = 0.163). Mean peak intensities of the partial perfusion zone were 100.8 ± 21.5 and 152 ± 31.5, respectively ( P < 0.001). Mean peak intensities of the ischemic zone were 90.4 ± 37.4 and 143.4 ± 45.3, respectively ( P = 0.012). CONCLUSION: These findings highlight the potential benefits of the super drainage technique in enhancing perfusion and reducing complications, emphasizing the need for further investigation and consideration of this technique in clinical practice.
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Verde de Indocianina , Mamoplastia , Retalho Perfurante , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Feminino , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Adulto , Estudos Prospectivos , Angiografia/métodos , Idoso , Artérias Epigástricas/transplante , Anastomose Cirúrgica/métodos , Corantes , Veias/cirurgia , Veias/diagnóstico por imagem , Neoplasias da Mama/cirurgiaRESUMO
INTRODUCTION: We report on cases of isolated fourth extensor compartment tenosynovitis without evidence of systemic inflammation that occurred in the context of alteration in the work environment due to the COVID-19 epidemic. Early identification of the deleterious effects of virtual/technologically-dependent work from home can aid in treatment and prevention of these conditions. We describe the phenomenon and suggest a treatment approach.
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COVID-19 , Tenossinovite , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Tenossinovite/etiologia , Masculino , Local de Trabalho , Adulto , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Feminino , Pessoa de Meia-Idade , TeletrabalhoRESUMO
OBJECTIVE: To identify risk factors associated with accidental fetal skin lacerations (AFL) during cesarean section (CS). METHODS: This retrospective cohort study was obtained from the registry of two large medical centers between 2014 and 2019. The study group comprised all newborns identified with AFL. The rates of various potential risk factors were compared between the study group and a group of CS at which no AFL had occurred (the control group). RESULTS: Of the 14 666 CS deliveries, 48 cases of AFL (0.33%) were documented, 52% of these following urgent CS. Compared with the control group (n = 14 618), the only risk factors associated with AFL were premature rupture of membranes (PROM) (odds ratio [OR] 5.38, 95% convidence interval [CI] 2.97-9.74) and meconium-stained amniotic fluid (OR 6.50, 95% CI 2.55-16.54). In subgroup analysis by CS urgency, no significance for these factors was noted in elective CS group; but higher rates of both PROM and meconium-stained amniotic fluid were noted in the AFL during urgent CS (OR 14.23, 95% CI 6.30-32.16 and OR 15.36, (95% CI 5.65-41.75, respectively). CONCLUSIONS: During urgent CS, the surgeon should bear in mind that the presence of PROM or meconium-stained amniotic fluid should prompt extra care and application of preventive measures to decrease the rates of AFL.
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Lacerações , Complicações na Gravidez , Recém-Nascido , Gravidez , Humanos , Feminino , Cesárea/efeitos adversos , Lacerações/epidemiologia , Lacerações/etiologia , Estudos Retrospectivos , Líquido Amniótico , Fatores de Risco , MecônioRESUMO
BACKGROUND: Cubital tunnel syndrome and the resulting loss of hand dexterity and strength may necessitate surgical management. Studies have demonstrated no difference in outcome between surgical techniques. In an attempt to leave more ulnar nerves in situ while providing for stability within the cubital tunnel, we suggest a surgical treatment approach. METHODS: The approach addresses individual anatomy methodically, eliminating muscular obstruction first and providing further decompression and stability as required. A retrospective review of 27 adult patients with ulnar neu- ropathy treated according to this method was performed. RESULTS: The mean duration of symptoms prior to surgery was 2.75 years (SD = 2.4). The mean follow-up was 17.1 months (SD = 16.9). All patients improved following surgery. Two revision surgeries were performed 4 years following the original surgery. CONCLUSIONS: We believe the nerve recovers best when left in situ, provided it is stable and not compressed within the cubital tunnel. A further comparison study is necessary to substantiate the advantage of this "personalized" approach over other surgical techniques for cubital tunnel release.
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Síndrome do Túnel Ulnar , Adulto , Síndrome do Túnel Ulnar/diagnóstico , Síndrome do Túnel Ulnar/cirurgia , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Cotovelo/cirurgia , Humanos , Reoperação , Nervo Ulnar/cirurgiaRESUMO
Non-melanoma skin cancers, including basal and squamous cell carcinomas (BCC and SCC), are the most common malignancies worldwide. BCC/SCC cancers are generally highly localized and can be surgically excised; however, invasive tumors may be fatal. Current diagnosis of skin cancer and prognosis of potential invasiveness are based mainly on clinical-pathological factors of the biopsied lesions. SCC invasiveness is also predicted by histomorphological factors, such as the degree of differentiation or the mitotic index, while BCCs are typically considered non-invasive. The above subjective measures do not provide direct, objective prognosis of cellular invasiveness in each specific sample. Hence, we have developed a mechanobiology-based approach to rapidly determine sample invasiveness. Here, cells from 15 fresh tissue samples of suspected non-melanoma skin cancer were seeded on physiological-stiffness (2.4 kPa) synthetic gels, and within 1-h invasive cell subsets were observed to push/indent the gel surface; clinicopathological results were separately obtained using standard protocols. The percentage of indenting cells from invasive (26.2 ± 2.4%) and non-invasive (4.8 ± 0.5%) SCC samples differed significantly (p < 0.0001), with well-separated invasiveness cutoffs of, respectively, > 12% and < 5%. The mechanical invasiveness directly agrees with the SCC cell-differentiation state, where over 3.3-fold more (p < 0.0001) cells from moderately differentiated samples indent the gels as compared to well-differentiated cell samples. In BCCs, < 20% of cells typically indented, and a highly migratory, desmoplastic sample was identified with 46%. By providing rapid, quantitative, early prognosis of invasiveness and potential metastatic risk, our rapid technology may facilitate informed (bed-side) decision making and choice of disease-management protocols on the time-scale of the initial diagnosis and surgical excision.
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Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Invasividade Neoplásica , Metástase Neoplásica , Neoplasias Cutâneas/patologia , Resinas Acrílicas/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Biofísica , Diferenciação Celular , Movimento Celular , Tomada de Decisões , Feminino , Géis , Humanos , Hidrogéis , Masculino , Pessoa de Meia-Idade , Índice Mitótico , Prognóstico , Estresse MecânicoRESUMO
INTRODUCTION: The use of sutures is a common practice in plastic surgical procedures. The potential risk of developing an allergic reaction to suture materials exists. To the best of the authors' knowledge, this is the first case reported in the literature of such a reaction in aesthetic breast surgery. The aim of this review is to raise the awareness of possible allergic and infective or inflammatory reactions to the suture material and to expand the knowledge of the management and interventions which are critical for patient safety and satisfaction. More research is needed to study this challenging topic.
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Procedimentos de Cirurgia Plástica , Cirurgia Plástica , Suturas , Humanos , Mastectomia , Técnicas de SuturaRESUMO
Background: Anatomical structure affects function. The morphology of articulations dictates the way forces will travel through the joint. A better understanding of the structure and function of the wrist will enhance our ability to diagnose and treat wrist conditions. Two wrist types have been described based on the morphology of the midcarpal joint. Biomechanically it is important to see if these 2-dimensional (2D) observations reflect articular contact areas. Our purpose was to assess the correlation between measurements performed on wrist radiographs (2D) to measurements performed on 3-dimensional (3D) computed tomography (CT). Methods: Retrospective review of a database of normal wrist radiographs and corresponding normal CT scans. Only imaging pairs with normal carpal alignment and technically optimal imaging were included. Evaluations included lunate, capitate and wrist type, capitate circumference, percent capitate circumference and volume that articulates with the lunate, scapholunate ligament, scaphoid, hamate, trapezoid, base of the index and middle and ring metacarpal bones. Results: Midcarpal joint radiographic measurements were positively correlated with measurements on CT scans. Correlations were 0.51 for capitate type and 0.71 for lunate type with both p < 0.001. Percent contact of the lunate with the hamate: r was 0.74 p < 0.001. Using logistic regression analysis, percent lunate-hamate contact on CT was a significant predictor of radiographic lunate type 2 p < 0.001. Percent contact area between lunate and hamate > 7.8% on CT scan achieved a sensitivity of 100% and specificity 79.4% for a type 2 lunate. Conclusions: 1) Good correlations found between CT and plain radiographs in lunate type, capitate type, and midcarpal joint contact support the use of plain radiographs to describe contact between the carpal bones in the clinical setting. 2) The retrospective nature of this study limited the technical quality of the measurements. Volumetric analysis may aid in a more exact evaluation of surface contact area.
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Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Articulação do Punho/diagnóstico por imagem , Adulto , Ossos do Carpo/diagnóstico por imagem , Humanos , Radiografia , Estudos RetrospectivosRESUMO
Background Wrist structure is complicated by distinct anatomical patterns. Previous studies defined radiographic wrist types based on lunate and capitate shape within the midcarpal joint. We hypothesized that these disparate structural patterns will transfer forces differently through the wrist. Objective This study aims to correlate force transferred to the distal radius and ulna with morphological measurements in cadaver arms. Methods Radiographs from 46 wrists, previously tested for force transfer between the radius and ulna, were examined. The percentage of compressive force through the distal ulna was determined by mounting load cells to the radius and ulna, while 22.2 Newton (N) tensile forces were individually applied to multiple tendons. Each wrist was tested in a neutral flexion-extension and radial-ulnar deviation position. Results Wrist type and lunate type were associated with percentage of force transfer through the ulna ( p = 0.002, p = 0.0003, respectively). Percentage of force transfer was correlated with capitate circumference ( p = 0.02, r = 0.34). Conclusions This study supports distinct force transfer between morphological wrist types. Clinical Relevance Understanding the mechanical significance of different structural variations in the wrist bones will improve our ability to understand wrist function and the distinctive development of wrist pathology. Level of Evidence This is a Level II study.
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Dor no Peito/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia/métodos , Mamoplastia/métodos , Dor Pós-Operatória/diagnóstico , Centros Médicos Acadêmicos , Adulto , Neoplasias da Mama/cirurgia , Dor no Peito/epidemiologia , Estudos de Coortes , Comorbidade , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Israel , Mastectomia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Dispositivos para Expansão de TecidosRESUMO
BACKGROUND: Interpreting the structure in the wrist is complicated by the existence of multiple joints as well as variability in bone shapes and anatomical patterns. Previous studies have evaluated lunate and capitate shape in an attempt to understand functional anatomical patterns. OBJECTIVE: The purpose of this study was to describe anatomical shapes and wrist patterns in normal wrist radiographs. We hypothesized that there is a significant relationship in the midcarpal joint with at least one consistent pattern of wrist anatomy. METHODS: Seventy plain posteroanterior (PA) and lateral wrist radiographs were evaluated. These radiographs were part of a previously established normal database, had all been read by a radiologist as normal, and had undergone further examination by 2 hand surgeons for quality. Evaluation included: lunate and capitate shape (type 1 and 2 lunate shape according to the classification system by Viegas et al.), ulnar variance, radial inclination and height, and volar tilt. RESULTS: A significant association was found between lunate and capitate shape using a dichotomal classification system for both lunate and capitate shapes (p=0.003). Type 1 wrists were defined as lunate type1and a spherical distal capitate. Type 2 wrists had a lunate type 2 and a flat distal capitate. No statistically significant associations were detected between these wrist types and measurements of the radiocarpal joint. CONCLUSION: There was a significant relationship between the bone shapes within the midcarpal joint. These were not related to radiocarpal anatomical shape. Further study is necessary to better describe the two types of wrist patterns that were defined and to understand their influence on wrist biomechanics and pathology.
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Articulação do Punho/anatomia & histologia , Adulto , Feminino , Humanos , Masculino , RadiografiaRESUMO
BACKGROUND: Because fragility fractures have an enormous impact on the practice of medicine and global health systems, effective screening is imperative. Currently, dual-energy X-ray absorptiometry (DXA), which has limited ability to predict fractures, is being used. We evaluated the current literature for a method that may constitute a better screening method to predict fragility fractures. A systematic review of the literature was conducted on computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound to evaluate screening methods to predict fragility fractures. We found that ultrasound had sufficient data on fracture prediction to perform meta-analysis; therefore, we analyzed prospective ultrasound cohort studies. Six study populations, consisting of 29,299 individuals (87,296 person-years of observation) and including 992 fractures, were analyzed. MRI was found to be sensitive and specific for osteoporosis, but its use for screening has not been sufficiently evaluated and more research is needed on cost, accessibility, technical challenges, and sensitivity and specificity. CT could predict fracture occurrence; however, it may be problematic for screening due to cost, exposure to radiation, and availability. Ultrasound was found to predict fracture occurrence with an increased risk of 1.45 (95% confidence interval 1.21-1.73) to fracture. Ultrasound has not replaced DXA as a screening tool for osteoporosis, perhaps due to operator-dependency and difficulty in standardization of testing.
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Absorciometria de Fóton/métodos , Programas de Rastreamento/métodos , Fraturas por Osteoporose/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodosRESUMO
Background In joints, structure dictates function and consequently pathology. Interpreting wrist structure is complicated by the existence of multiple joints and variability in bone shapes and anatomical patterns in the wrist. Previous studies evaluated lunate and capitate shape in the midcarpal joint, and two distinct patterns have been identified. Purpose Our purpose was to further characterize the two wrist patterns in normal wrist radiographs using measurements of joint contact and position. Our hypothesis was that we will find significant differences between the two distinct anatomical patterns. Patients and Methods A database of 172 normal adult wrist posteroanterior (PA) radiographs was evaluated for radial inclination, height, length, ulnar variance, volar tilt, radial-styloid-scaphoid distance, and lunate and capitate types. We measured and calculated percent of capitate facet that articulates with the lunate, scapholunate ligament, scaphoid, and trapezoid. These values were compared between the wrist types and whole population. Results Type-1 wrists (lunate type-1 and spherical proximal capitate) were positively associated with a longer facet between capitate and distal lunate ( p = 0.01), capitate and base of middle metacarpal ( p = 0.004), and shorter facet between the capitate and hamate ( p = 0.004). The odds ratio of having a type-1 wrist when the interface between the capitate and lunate measures >8.5 mm is 2.71 (confidence interval [CI] 1.07, 6.87) and when the line between the capitate and the base of middle metacarpal >9.5 mm is 3.5 (CI 1.38, 9.03). Conclusion We characterized the two-wrist patterns using intracarpal measurements. Translating these differences into three-dimensional contact areas may help in the understanding of biomechanical transfer of forces through the wrist. Level of Evidence This is a Level II, diagnostic study.
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Infantile Digital Fibromatosis (IDF) is a rare benign lesion that can affect the fingers, often appearing at birth or early on in life. Treatment is controversial due to a high recurrence rate following surgical excision, and the tendency of the lesions to regress or resolve completely after the age of one year. Functional loss has rarely been described. We describe a case of IDF with joint contracture and significant functional deficit that was treated with cryotherapy and post procedural occupational therapy with an excellent result. Indications for treatment and cryotherapy as a therapeutic modality for IDF are discussed.
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Fibroma/cirurgia , Dedos/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Contratura/etiologia , Contratura/cirurgia , Criocirurgia , Feminino , Fibroma/patologia , Humanos , Lactente , Neoplasias de Tecidos Moles/patologiaRESUMO
Surgical treatment of scaphoid nonunion is not always successful, often requiring stabilization and bone grafting to achieve healing. Even after intramedullary screw fixation, residual instability may still hinder union. The purpose of this study was to describe the addition of Kirschner wires (KWs) through the capitate and the lunate to supplement an intramedullary screw for temporary enhanced stability, possibly improving healing of unstable fractures. A case-control study reviewing 25 cases with addition of KWs and 19 controls was performed. Demographic and fracture information, time to diagnosis, and healing time were documented. We found no differences in population characteristics, fracture characteristics, or outcome measures between patients treated with this method and those treated with a screw alone. We had no complications related to the addition of KWs. Preoperative lunate type and scapholunate gapping was suggestive but not significantly associated with KW insertion. Addition of KWs is safe and may be considered in scaphoid nonunion in the presence of intraoperative suboptimal stability. Intraoperative stability may possibly be inferred by reviewing preoperative radiographs for signs of instability.