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BACKGROUND: Glide deficit of the distal flexors' tendons following primary repair in zone 1-3 are very common. Adhesions of tendons have multi factorial origins and are closely related to the healing of the affected tissues. The surgical practice used to resolve these complications is tenolysis. PURPOSE: The purpose of this study was to identify and compare the Visual Analog Scale (VAS) relate to pain and Total Active Motion (TAM) of adult patients of both sexes undergoing tenolysis surgery. The results will then be compared to existing research to confirm their significance. STUDY DESIGN: Case-series. METHODS: Retrospective data for TAM and pain VAS were extracted from the medical records for 63 patients (73 fingers) who underwent flexor tenolysis between 2017 and 2019. Data were compared pre-operatively and 3 months after surgery. All patients underwent pre- and post-surgery therapy by hand therapists. RESULTS: The sample presented very encouraging improvements, except in the VAS and active range of motion (AROM) of thumb where some patients maintained the same assessment. The fingers reported statistically significant results, whereas the thumb group did not meet significant criteria. Overall, TAM improved from 134.6° to 196.7 and VAS decreased from 2.7 to 1.2. DISCUSSION: According to the results and the data change between pre- and post-treatment, the sample demonstrated improvements in all areas examined, reporting statistically significant results for the fingers with an improvement of TAM of 62.1° with a percentage value (%TAM) of 75.6%. CONCLUSIONS: A specific treatment for this type of surgery is required for the patients so they can return to their daily and working activities. This article can be used as a starting point for further studies.
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BACKGROUND: Open bone fractures represent a demanding clinical condition that can be life- or limb-threatening. For small- to medium-size soft tissue defects of the lower extremity, propeller perforator flaps are a viable option for reconstruction. We report our experience in Gustilo IIIB open fractures treatment with immediate coverage through propeller-based perforator flaps performed in acute setting. METHODS: Between 2019 and 2022, 94 Gustilo III fractures were admitted to our trauma center, and 28 were Gustilo IIIB fractures. Five patients were eligible for an immediate perforator-based propeller flaps reconstruction. The mean age of the patients was 33.8 years. All of them were male. One of them was a heavy smoker (15 cigarettes per day). No other comorbidities were present. RESULTS: The mean operating time, including fracture reduction and fixation time, was 106 minutes. The length of the defect varied between 5 and 7 cm and the width between 3 and 4 cm. We reported no major complications, and none of the patients required a surgical revision of the flap. A patient with smoking habit reported a superficial flap necrosis. The mean follow-up was 5.5 months. No cases of nonunion or osteomyelitis have developed so far. CONCLUSIONS: The use of perforator-based propeller flaps, in acute trauma setting, has not been reported in literature so far. In our experience, propeller perforator flaps are a viable reconstructive option in immediate reconstruction during the acute management of open fractures.
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Fracturas Abiertas , Traumatismos de la Pierna , Colgajo Perforante , Procedimientos de Cirugía Plástica , Traumatismos de los Tejidos Blandos , Humanos , Masculino , Adulto , Femenino , Colgajo Perforante/cirugía , Fracturas Abiertas/cirugía , Extremidad Inferior/cirugía , Traumatismos de la Pierna/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: Neuroma-induced neuropathic pain is associated with loss of function and reduced quality of life. No consistently effective standard-of-care treatment has been defined. Neurocap, a bioresorbable nerve capping device, has been designed to isolate the nerve stump from surrounding tissues to reduce development of symptomatic end-neuromas. METHODS: Patients with peripheral symptomatic end-neuromas were included in a prospective, multicenter, single-arm design. Data were collected presurgery up till 24 months postsurgery. Eligible patients with neuromas were identified based on blocks using anesthetic. Intervention included surgical excision and capping of the transected proximal nerve end with the Neurocap. Main outcome measures were pain, function, recurrence of symptomatic neuroma, use of analgesics, and adverse events. RESULTS: In total, 73 patients with 50 upper-extremity and 23 lower-extremity end-neuromas were enrolled. End-neuromas were predominately located in the digits and lower leg. Statistical power of the study outcomes was preserved by 46 of 73 patients completing 24-month follow-up. The mean VAS-Pain score at baseline was 70.2 ± 17.8 (scale 0-100) and decreased significantly to 31 ± 32.5 (P < 0.001). Function significantly improved over time. The recurrence rate of confirmed symptomatic neuroma was low (2 of 98 capped nerves). Adverse event rate was low and included pain and infection; there were no unexpected device-related adverse events. Most patients reported lower use of nonsteroidal anti-inflammatory drugs, opioids, and antineuropathic medications at last follow-up compared with baseline. CONCLUSIONS: End-neuroma treatment with excision and capping resulted in long-term significant reduction in reported pain, disability, and analgesic medication use. Adverse event rate was low.
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Neuralgia , Neuroma , Humanos , Estudios Prospectivos , Calidad de Vida , Implantes Absorbibles , Neuroma/cirugía , Neuralgia/etiología , Neuralgia/cirugíaRESUMEN
Upper extremity involvement in patients with arthrogryposis multiplex congentia is quite frequent. Treatment initially consists of stretching and splinting as significant gains can be seen in the first years of life. The goal of any surgical procedure is to improve upper extremity function and performance of daily living activities, yet it is important to treat each patient individually and understand that areas do not always need to be addressed surgically. Despite overall lower functioning scores in this patient population, quality of life scores are comparable to the general aged adjusted population. This article will discuss the clinical presentation, treatment procedures and outcomes when addressing the upper extremities of patients presenting with arthrogryposis.
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Artrogriposis/fisiopatología , Artrogriposis/terapia , Extremidad Superior/fisiopatología , Actividades Cotidianas , Humanos , Calidad de Vida , Resultado del TratamientoRESUMEN
We describe here a platform for autonomous hand rehabilitation and telemonitoring of young patients. A toy embedding the electronics required to sense fingers pressure in different grasping modalities is the core element of this platform. The system has been realized following the user-centered design methodology taking into account stakeholder needs from start: clinicians require reliable measurements and the ability to get a picture remotely on rehabilitation progression; children have asked to interact with a pleasant and comfortable object that is easy to use, safe, and rewarding. These requirements are not antithetic, and considering both since the design phase has allowed the realization of a platform reliable to clinicians and keen to be used by young children.
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Fuerza de la Mano/fisiología , Mano/fisiología , Juego e Implementos de Juego , Técnicas Biosensibles , Humanos , Presión , Tecnología InalámbricaRESUMEN
Patients with arthrogryposis often require anesthesia for surgical procedures. Intubation can be challenging due to lack of visualization. Anesthetic maintenance is fairly routine. Pheripheral blocks are an important adjunct to postoperative pain management.
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Anestesia/métodos , Artrogriposis/cirugía , Dolor Postoperatorio/terapia , Anestesia Local , Niño , Humanos , Intubación/métodos , Bloqueo NerviosoRESUMEN
Patients with arthrogryposis multiplex congenita have a characteristic upper extremity resting posture consisting of internal rotation of the shoulders, elbow extension, flexed wrists, thumb-in palm deformities, and variable degrees of finger contractures. Treatment of these patients is aimed at improving independence and performance of activities of daily living. Although each area needs to be assessed independently for the most appropriate surgical procedure, often multiple areas can be addressed at the same operative setting. This limits the number of anesthetic exposures and cast immobilization time. The following is a synopsis of treatment strategies presented at the second international symposium on Arthrogryposis which took place in St Petersburg in September 2014.
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Artrogriposis/cirugía , Artroplastia/métodos , Contractura/cirugía , Músculo Esquelético/cirugía , Anomalías Múltiples/cirugía , Actividades Cotidianas , Preescolar , Articulación del Codo/cirugía , Articulaciones de los Dedos/cirugía , Humanos , Lactante , Masculino , Rango del Movimiento Articular , Articulación del Hombro/anomalías , Articulación del Hombro/cirugía , Pulgar/anomalías , Pulgar/cirugía , Articulación de la Muñeca/cirugíaRESUMEN
Chronic wounds are an expression of underlying complex pathologies and have a high incidence. Skin substitutes may represent an alternative approach to treat chronic ulcers. The aim of this retrospective observational study was to evaluate the wound reduction using skin substitutes based on allogenic fibroblasts or keratinocytes in 30 patients not responding to conventional therapy. Wound bed was prepared, then keratinocytes on Laserskin(®) to treat superficial wounds or fibroblasts on Hyalograft 3D(R) to treat deep leg ulcers were applied, and finally wounds were treated with a secondary dressing composed of nanocrystalline silver. Once a week constructs were removed and new bioengineered products were applied, as well as nanocrystalline silver medication. In none of the cases under examination did any complications arise relating to the treatment. We also achieved a reduction in wound dimension and exudates, and an increase in wound bed score. Postoperative assessment shows a degree of healing that is statistically higher in the group treated with keratinocytes as compared with the fibroblast group. This retrospective study improves our understanding and defines the clinical indications for the various uses of the two types of skin substitutes.
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Fibroblastos/trasplante , Queratinocitos/trasplante , Úlcera de la Pierna/terapia , Piel Artificial , Adulto , Anciano , Anciano de 80 o más Años , Vendajes , Desbridamiento , Femenino , Humanos , Masculino , Nanopartículas del Metal/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos , Compuestos de Plata/uso terapéutico , Andamios del Tejido , Trasplante Homólogo , Cicatrización de HeridasRESUMEN
Tumor cells able to recapitulate tumor heterogeneity have been tracked, isolated and characterized in different tumor types, and are commonly named Cancer Stem Cells or Cancer Initiating Cells (CSC/CIC). CSC/CIC are disseminated in the tumor mass and are resistant to anti-cancer therapies and adverse conditions. They are able to divide into another stem cell and a "proliferating" cancer cell. They appear to be responsible for disease recurrence and metastatic dissemination even after apparent eradication of the primary tumor. The modulation of CSC/CIC activities by the tumor microenvironment (TUMIC) is still poorly known. CSC/CIC may mutually interact with the TUMIC in a special and unique manner depending on the TUMIC cells or proteins encountered. The TUMIC consists of extracellular matrix components as well as cellular players among which endothelial, stromal and immune cells, providing and responding to signals to/from the CSC/CIC. This interplay can contribute to the mechanisms through which CSC/CIC may reside in a dormant state in a tissue for years, later giving rise to tumor recurrence or metastasis in patients. Different TUMIC components, including the connective tissue, can differentially activate CIC/CSC in different areas of a tumor and contribute to the generation of cancer heterogeneity. Here, we review possible networking activities between the different components of the tumor microenvironment and CSC/CIC, with a focus on its role in tumor heterogeneity and progression. We also summarize novel therapeutic options that could target both CSC/CIC and the microenvironment to elude resistance mechanisms activated by CSC/CIC, responsible for disease recurrence and metastases.
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Diferenciación Celular/fisiología , Matriz Extracelular/metabolismo , Neoplasias/patología , Células Madre Neoplásicas/citología , Microambiente Tumoral/fisiología , Animales , Humanos , Metástasis de la Neoplasia/patologíaRESUMEN
The suture button (SB) suspension technique has become popular in the treatment of thumb basal joint arthritis, as it works as an internal mean for metacarpal stabilization, demonstrating good results with improvement in function and strength. The aim of our study is to describe a new transosseous suture suspensionplasty technique using a simple Ethibond #2 suture as a substitute for the suture button and to report the postoperative clinical outcomes. In this study, we included a total of 14 patients with 2 years follow-up. We evaluated patients with the use of the Disabilities of the Arm, Shoulder and Hand questionnaire, the Visual Analog Scale, the Kapandji test, and the key pinch strength. Patients treated with transosseous suture suspensionplasty demonstrated clinical improvement at an average follow-up of 24 months. No complications were noted immediately after the procedure or during the 2-year follow-up period.
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Articulaciones Carpometacarpianas , Osteoartritis , Humanos , Pulgar/cirugía , Osteoartritis/cirugía , Cánula , Mano , Articulaciones Carpometacarpianas/cirugía , SuturasRESUMEN
AIM: Dynavisc® is a novel surgical product made of carboxymethylcellulose (CMC) and Polyethylene Oxide (PEO) designed to reduce post-surgical adhesions in tendons surgery. A multicenter retrospective cohort study was performed to investigate the clinical safety and efficacy of the Dynavisc® gel in reducing post-surgical adhesions after flexor tenolysis in zone 2. MATERIAL OF STUDY: Thirty-one patients suffering from stiff finger after flexor tendon repairs in zone 2 treated with standard release with (18 Dynavisc®-treated group) or without (13 controls) anti-adhesion gel application into the flexor tendon sheath and around the site of the tenolysis, were collected in five different hand surgery units. Safety profile and functional outcomes (based on TAM test and the The Quick-DASH questionnaire) were examined from patients' charts and analyzed. RESULTS: The application of Dynavisc® posed no safety concerns and it was not related to any additional complication. The Dynavisc®-treated group showed greater progressive improvement of TAM value in all visits with superior TAM value at T(90) and T(180) compared to the control group. DISCUSSION: Tendon adhesions are the main cause of flexor tendon surgery failure. Multiple strategies (i.e. robust tendon repair, early rehabilitation and lubricant or barrier agents) have been proposed to minimize their formation. Among different products described in the literature Dynavisc® showed a significant role in limiting adhesions formation in a recent experimental study. CONCLUSIONS: This clinical study confirm the safety of Dynavisc® gel application in hand surgery demonstrating its potential long-term benefits after flexor tendon tenolysis. KEY WORDS: Flexor Tendon Repair, Tendon Adhesions, Tenolysis.
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Antifibróticos , Carboximetilcelulosa de Sodio , Cicatriz , Polietilenglicoles , Tendones , Adherencias Tisulares , Humanos , Cicatriz/etiología , Cicatriz/prevención & control , Estudios Retrospectivos , Traumatismos de los Tendones/cirugía , Traumatismos de los Tendones/complicaciones , Tendones/cirugía , Adherencias Tisulares/etiología , Adherencias Tisulares/prevención & control , Carboximetilcelulosa de Sodio/administración & dosificación , Carboximetilcelulosa de Sodio/uso terapéutico , Polietilenglicoles/administración & dosificación , Polietilenglicoles/uso terapéutico , Antifibróticos/administración & dosificación , Antifibróticos/uso terapéutico , Combinación de Medicamentos , GelesRESUMEN
Finger amputations are one of the most common traumas of daily life. Regularization of the digital stump is the most widely used option in the literature today. The aim of this study was to evaluate a valid functional and aesthetic alternative to amputation. Methods: We retrospectively investigated our prospective database' selecting the patients who underwent trimmed great toe flap reconstruction for the amputation of a digit from September 2019 to November 2021. All the operations were performed by the first author (L.T.) in the Reconstructive Microsurgery Service of the University Department of Hand Surgery and Rehabilitation of MultiMedica Group. Results: No flap required anastomosis revision or had major complications. The length of the amputated finger was maintained, with a high functional and aesthetic result achieved. Conclusions: The trimmed great toe flap has proven to be a viable alternative to finger amputation in the reconstruction of thumb and long finger defects, leading to high aesthetic results. The morbidity of the donor site is reduced compared with the classic great toe flap, allowing a direct closure in most cases.
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Acquired soft-tissue defects of the hand can be a result of different types of trauma, infection, tumor resection, or burns. The evolution of the design and types of flaps have optimized the reconstruction and, nowadays, it is important to achieve not only a functional result but also an aesthetic result. The aim of the present study is to propose a model for treating a wide variety of skin defects in the hands based on our flap experience. Methods: We conducted a retrospective study from February 2019 to January 2022, which included all patients who underwent a skin flap for hand reconstruction. Patients' medical records were reviewed and data collected included demographics, smoking status, presence of risk factors, type of trauma, flap reconstruction, dimensions, reoperations, and long-term complications. Results: A total of 99 patients underwent skin flap-based reconstruction for hand trauma between February 2019 until January 2022. The mean age was 43.9 (range 38.3-49.5), 87.9% of patients were male, and follow-up was between 2 and 30 months; 90.9% of the flaps were free flaps, and the rest were pedicle flaps (3% of them being propeller flaps). Conclusions: When planning a hand reconstruction, it is vital to ensure that the outcomes are not only functional but also aesthetic, with minimum donor site morbidity; in this study, we showed a variety of flaps that can be applied to achieve this goal. We believe that the final decision should be made after comprehending the defect and the patient's preferences.
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High-quality evidence is currently poor regarding the benefits of end-to-end (ETE) or end-to-side (ETS) anastomosis in arterial and venous anastomoses, despite being postulated as a potential influence on outcomes. A sufficient microvascular anastomosis is indispensable for the success of any free tissue transfer. ETS microvascular anastomoses have been becoming increasingly important as they allow reconstruction even in patients with impaired vascular status. To the authors' knowledge, no studies have examined the choice of ETE or ETS anastomoses specifically for digital arteries. Methods: We conducted a retrospective study of ETE and ETS anastomosis cases; the only inclusion criteria was that digital arteries (proper, common) were the recipient vessels. Results: Fifty-seven cases met the inclusion criteria. All the venous anastomoses were ETE. Of these cases, four total intraoperative complications (immediate thrombosis) and only one case of complete failure were registered. The ETE group consisted of 49 patients and the ETS group of eight patients. A comparison of the mean ischemia time in the two groups showed no statistically significant difference (P = 0.121). Conclusions: We observed no difference in the reconstructive outcomes of hand free-flaps and reconstruction between ETE or ETS digital arteries anastomoses. The successful microsurgical reconstruction was independent of anastomotic technique. In particular, the results of our study demonstrated no statistically significant increase of the ischemia time; thus, no prolongation of operative time can be attributed to the higher technical challenge of the anastomosis.
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The aim of post-traumatic digital reconstruction is to restore form and function, allowing early rehabilitation. In the absence of feasible local options, free tissue transfer can be a versatile and reliable alternative. The aim of this study was to describe our experience with the use of the free proximal ulnar artery perforator flap (PUPF). METHODS: Our prospectively maintained free flap database was inquired for patients that had undergone digital reconstructions with free PUPFs. RESULTS: Six patients that underwent digital reconstruction were eligible. The ipsilateral forearm was donor site of choice, with all flaps based on a perforator of the ulnar artery, without the need to compromise the main vessel. A superficial vein was routinely included with the flap. No flap failures were encountered. Mean hospital stay was 5.5 days, and all patients achieved a satisfactory functional result. CONCLUSIONS: The proximal ulnar perforator free flap offers an alternative for finger reconstruction, having the advantage of including thin and hairless skin from the proximal ulnar forearm. The vascular anatomy of the ulnar perforators seems to be constant. Furthermore, donor site morbidity is low, as the ulnar artery is not harvested with the flap, the donor site defect can generally be closed directly, and the scar is well concealed.
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Soft tissue reconstruction in elderly patients must be rapid and reliable. The keystone island flap (KF) offers an effective solution, with low complication rates and quick recovery. This multi-centric study aims to show authors' experience with KFs in treating soft tissue defects of trunk and limbs. Patients with soft tissue defects suitable for KF reconstruction were recruited from March 2019 to December 2019. Active inflammation and previous surgeries in the same region were considered exclusion criteria. Complications that occurred during follow-up were recorded, and their incidence pattern was assessed with the Fisher test. Seventy-two patients with mean age of 76.2 years old were selected. They presented lesions in torso (46; 63.9%) or in upper (4; 5.6%) or lower (22; 30.6%) limb regions. Fifteen (20.8%) wounds were non-oncologic lesions, and the others were oncologic lesions, mostly non-melanoma skin cancers. KF type I was carried out in 42 (58.3%) cases, KF type II-A in 13 (18%) cases, double opposed type III KF in 16 (22.2%) patients, and 1 (1.4%) case required partial flap's undermining (IV KF). Mean post-operative recovery period was 4.3 days (range, 1-9 days). Post-surgical complications occurred in 15 (20.8%) cases, 7 (9.7%) of them were considered major complications. No statistically significant difference in complications' incidence, nor among different surgical sites nor among KF types, was registered. Reconstructive surgeons have to adapt their work to elderly patients. The KF allows rapid operative times, low morbidity rates, and short post-operative recovery time, thus appearing as a feasible solution.
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Procedimientos de Cirugía Plástica , Anciano , Extremidades , Humanos , Procedimientos de Cirugía Plástica/efectos adversos , Estudios Retrospectivos , Trasplante de Piel , Colgajos Quirúrgicos , Resultado del TratamientoRESUMEN
ABSTRACT: The study aims to investigate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among ophthalmology unit staff throughout the first and second waves of the outbreak, in order to verify the effectiveness of the measures adopted in containing the contagion.A retrospective observational study was conducted involving staff members, who received a naso/oropharyngeal swab when complaining of SARS-CoV-2 symptoms and once a month as a screening measure. They were tested for SARS-CoV-2 antibodies as a screening measure during the first and the second wave. Clinical activities performed during the outbreak were compared with those performed during the same period in 2019 and correlated with the number of coronavirus disease-2019 eye care workers.Analysis included 25 workers. Clinical infection was 0% and 12% whereas the prevalence of SARS-CoV-2 antibodies ranged from 4% to 8% in the first and second wave, respectively. The increase in the prevalence of SARS-CoV-2 infection between the first and the second wave was not significant (1/25 vs 3/25, Pâ=â.6092). Clinical activities significantly decreased during the first wave compared with the same period in 2019 (3256 vs 10,075, Pâ<â.0001, -68% to 2019), but increased during the second wave (8208 vs 3256, Pâ<â.0001, +152% to the first wave).Despite the increase in routine activities during the second wave, we did not observe a significant increase in SARS-CoV-2 prevalence. Strict protection measures seemed to contain the rate of contagion among the ophthalmology unit members even in a high-volume clinical setting in one of the most affected area by the coronavirus disease-2019 outbreak.
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COVID-19 , Oftalmólogos , Anticuerpos Antivirales/aislamiento & purificación , COVID-19/epidemiología , Humanos , Oftalmólogos/estadística & datos numéricos , Pandemias , Prevalencia , SARS-CoV-2RESUMEN
Background: Although hand and upper limb malformations are quite frequent, up to now very few reports have been published on epidemiology. The aim of this study is to evaluate the number of infants who presented with hand and upper limb malformations from 2010 to 2015 in Italy. Methods: A retrospective analysis of a pediatric population presenting with hand and upper extremity malformations was carried out, gathering reports achieved from eight Italian Centers of pediatric hand surgery. Other factors such as gender, date and region of birth, family distribution of malformations and associated syndromes, were analysed. Results: Out of 3,100,421 live births, 765 children presented with hand and upper limb malformations. The incidence was 2,5/10,000 live births with a predominance of males and the right side. Radial polydactyly was the anomaly with the highest percentage, closely followed by simple syndactyly, simbrachidactyly and complex syndactyly. Less common conditions were the triphalangic thumb, thumb in palm, proximal radioulnar synostosis and Sprengel deformity. Inheritance of and familial predisposition to those malformations was recorded in 25 cases, while 84 children presented with syndromes related to hand anomalies. Conclusions: In conclusion the incidence of hand and upper extremity malformations in Italy is lower than that registered in other countries. The retrospective nature of the study combined with the fact that some defects frequently evade pediatric hand surgeon consultations are some possible limitations of the study. However, our data confirmed that, in spite of the decrease in the birth rate in Italy, the trend of congenital hand disorders maintained a stable trend. We aim to integrate this study with a prospective analysis and to involve the institutional health authorities in other countries so as to register the correct incidence of hand and upper extremity defects.