Palmar contracture release with arterialized venous instep flap: An anatomical and clinical study.

BACKGROUND: Plantar skin has similar histologic features to the palmar area and appears to be the ideal tissue for reconstruction of the palmar region. In this study, an anatomic examination was performed to determine the superficial venous architecture of the instep area, and the use of arterialized venous instep flaps for palmar contracture release was assessed. METHODS: The anatomical study was performed on 12 fresh cadaver feet. The arterialized venous instep flap, including the skin, subcutaneous tissue and superficial venous plexus, was harvested. To determine the venous structure, dissection (n = 6) and injection-corrosion (n = 6) techniques were used. In the clinical study, nine arterialized venous instep flaps were used for palmar contracture release. All flaps were harvested above the deep fascia and included skin, subcutaneous fat, and the superficial venous plexus. At the plantar site of the flap, two or three veins, one of which was used, were dissected for a sufficient length for the arterial anastomosis. The saphenous vein was used for the venous anastomosis. RESULTS: Dissection and injection-corrosion techniques revealed that the flap had 7-12 and 4-6 veins at its plantar and superior edges, respectively, with numerous anastomoses and interconnections between the veins. The flap dimensions were between 3 × 5 cm and 4 × 6 cm. All flaps survived, with two partial flap necrosis that healed with spontaneous epithelization. No debulking procedures were undertaken and all flaps adapted well to the recipient site. CONCLUSIONS: The arterialized venous instep flap is a good alternative to reconstruct palmar contractures by adding similar tissue that is thin and pliable with minimal donor site morbidity.

Nineteen reasons why physiatrists should do musculoskeletal ultrasound: EURO-MUSCULUS/USPRM recommendations.

This article is an eventual consensus of experts from the European Musculoskeletal Ultrasound Study Group (EURO-MUSCULUS) and the Ultrasound Study Group in Physical and Rehabilitation Medicine (USPRM) pertaining to the use of musculoskeletal ultrasound in physical and rehabilitation medicine. Nineteen important reasons (as regards general advantages, specific conditions in physical and rehabilitation medicine, as well as comparisons with other imaging tools) have been highlighted to consolidate the scenario of how/why the probe of ultrasound needs to become the stethoscope, the extended hand, and the pen of physiatrists.

A 22-year-old man with severe osteoporosis due to prolactinoma.

Prolactin-secreting adenomas represent nearly 40% to 60% of all pituitary adenomas. Prolactin inhibits the secretion of gonadotropin-releasing hormone that is responsible for the synthesis and secretion of gonadotropins. Sex steroids have an important effect on the regulation of bone metabolism in men. Decreased libido and impotence are the most common presenting symptoms of hyperprolactinemia in males. These symptoms are easily neglected by both patients and some physicians. We present a 22-year-old man with multiple osteoporotic fractures associated with prolactinoma despite the use of teriparatide for 18 months. We emphasize and highlight the importance of hyperprolactinemia and fractures caused by high prolactin levels.

The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome.

OBJECTIVE: Chronic fatigue syndrome (CFS) is a chronic disease with social components that ensue secondary to the incapacity of the person to fulfill work, social and family responsibilities. Currently, there is no consensus regarding its treatment. The aim of this study was to determine the efficacy of hyperbaric oxygen (HBO2) therapy in CFS. DESIGN: Sixteen patients included in the study were diagnosed with CFS according to the Fukuda criteria. Patients received 15 treatment sessions of HBO2 therapy over a period of three consecutive weeks (five days per week). The outcome measures (visual analog fatigue scale (VAFS). Fatigue Severity Scale (FSS) and Fatigue Quality of Life Score (FQLS) were assessed before the treatment and after completion of the 15 sessions. RESULTS: HBO2 therapy was well tolerated, with no complications. After treatment, patients' scores were found to have improved with respect to VAFS, FSS and FQLS (all p<0.005). CONCLUSIONS: We ,may infer that HBO2 therapy decreases the severity of symptoms and increases the life quality of CFS patients. It may be a new treatment modality for the management of CFS. However, further studies with larger sample sizes and control groups are definitely awaited.

Quality of life and functionality of patients with heel reconstruction after landmine explosions.

BACKGROUND: Landmine injuries cause extensive soft and bony tissue loss of the weight-bearing areas, particularly the heel. Reconstruction of these injuries is challenging, and there are no studies that report long-term functional results. OBJECTIVE: To determine the quality of life and long-term functionality of patients who had heel reconstruction with free muscle flap after landmine injuries. DESIGN: A case-control study. PARTICIPANTS: Nine male patients who had heel reconstruction with free muscle flap. Ten male volunteers without any gait disorder were included in the study as the control group. METHODS AND INTERVENTIONS: Functional ambulation scale, visual analog scale, energy expenditure index, 6-minute walking test, 10-m walking test, and Short Form 36 were performed to determine the quality of life and functionality of the participants. RESULTS: There were no statistically significant differences between the 2 groups in terms of functional ambulation scale, energy expenditure index, 6-minute walking test, and 10-m walking test. Regarding Short Form 36 scores, all subgroup values were lower in the reconstruction group, whereas only those of general health, vitality, and physical-emotional role limitation subgroups showed statistical significance. Mean visual analog scale scores were found to be statistically different between the groups (P < .05). Mean Freiburg Ankle scores showed moderate functionality. CONCLUSION: Despite the associated physical and emotional trauma, combat-injured veterans with heel reconstruction after landmine injuries had adequate and functional ambulation at long-term follow-up. Early rehabilitation and close cooperation between surgeons and rehabilitation physicians during the care of these patients will enhance patient outcomes.

Hepatitis B virus reactivation in a juvenile rheumatoid arthritis patient under treatment and its successful management: a complicated case.

Juvenile rheumatoid arthritis is a common chronic inflammatory disease in the childhood and it can differentiate rarely into spondiloarthropaties. It is one of the important causes of chronic pain and disability. Some of the drugs used for the treatment have immunosupressive activity. One of the serious side-effects of immunosupressive treatment is activation of opportunistic pathogens. Hepatitis B virus (HBV) is one of these pathogens, and the rate of carriers in the population is considerably high. It can cause liver damage and death if reactivated. Thus, the management of oppotunistic pathogens becomes a complex issue when treating rheumatic diseases with immunosupressive drugs. In this case report, we present a juvenile rheumatoid arthritis patient whose liver enzymes raised while he was under treatment and afterwards HBV reactivation was determined as the cause. When reactivation was detected, we started controlled antiviral therapy. We achieved successful clinical and laboratory results after adding biological agents to the treatment. Careful evaluation of the patients who have indication for immunosuppressive agents and regular follow-up in case of infection may be protective from severe morbidity and/or mortality.

Comparison of quality of life and functionality in patients with traumatic unilateral below knee amputation and salvage surgery.

The aim of this study was to compare the functionality during daily activities and quality of life of patients with transtibial amputation vs. salvage surgery after severe lower limb trauma. Ten patients with unilateral below knee amputation and nine patients with salvage surgery after severe lower limb trauma were enrolled. Functional Ambulation Scale (FAS), Visual Analogue Scale (VAS), Short Form 36 (SF-36) Energy Expenditure Index (EEI), 6-Minute Walking Test (6MWT) and 10-Meter Walking Test (10MWT) were used for the evaluation of subjects. Patients in the salvage group were also evaluated radiologically with Graves' radiological assessment method and Freiburg ankle scoring system. All patients were classified as grade 5 according to FAS. All SF-36 subgroup values were higher in the amputation group whereas only those of general health and vitality reached statistical significance (p < 0.05). The visual analogue scale (VAS) has been used to assess the efficacy of pain management. Mean VAS scores were found to be statistically higher in the salvage group (p < 0.005). Reoperation rates were one in 10 amputee and six in nine salvage patients. Mean Freiburg ankle scores of the patients in the salvage group were 55.33 +/- 15.51 which was consistent with moderate functionality. According to Graves' radiological assessment; four patients had grade 3 degeneration, four had grade 2 and one had grade 1 degeneration in the ankle joints. Mean EEI values, 6-MWT and 10-MWT results were not significantly different between the groups (p values > 0.05). Although amputation still remains as the last resort both for patients and the physicians, our results demonstrated that reoperation rates, quality of life (general health and vitality) and pain scores were better in amputee patients.