DELTOID FLAP for MANAGEMENT of MASSIVE IRREPARABLE ROTATOR CUFF TEARS: Case Series.

BACKGROUND: Muscle transfer has been reported as a good surgical option to reconstruct the deficient rotator cuff. The purpose of this study is to report the outcome of deltoid muscle flap transfer to restore shoulder function in patients with massive irreparable rotator cuff tear. MATERIAL AND METHODS: This is a retrospective descriptive case series. Included patients had a lesion of two or more tendons of the rotator cuff or lesion of one tendon of more than 5 cm in width and no lesion to the subscapularis. Evaluation was done using the Constant score, visual analog scale for satisfaction and quality of life. RESULTS: Twenty patients met the inclusion criteria. Three patients were lost to follow-up. The remaining (9 males and 8 females) had a mean follow-up period of 40.5 months. The mean age at surgery was 61.3 years. Thirty-five percent of patients were involved in heavy labor while the lesions affected the dominant side in 70% of the cases. Mean preoperative Constant score was 40.8 and increased to 78.8 (p < 0.05) with a difference of +38 points on the raw Constant score and an improvement rate of 64%. The greatest improvement involved essentially pain and quality of life (improvement rate of 82%) (p < 0.05). Eighty-nine percent of patients have good and excellent self-reported results. CONCLUSION: More than just a salvage procedure, deltoid muscle flap seems to be an adequate option in terms of appropriate pain relief, function recovery as well as patient satisfaction. Keywords: massive rotator cuff tears, deltoid muscle flap

Cholangitis in three critically ill patients after a severe CoVID-19 infection.

Coronavirus disease 2019 (CoVID-19) is a viral disease. Although the predominant presentation is respiratory disease, other manifestations such as gastrointestinal manifestations are commonly reported. Nevertheless, it has not been associated with chronic cholangitis or hepatic injury. In this study, we report three cases of severe CoVID-19 infection that required ICU admission, intubation, and sedation with ketamine. All three patients had abnormal liver function despite recovery and were diagnosed with cholangitis in the context of CoVID-19.