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1.
Skeletal Radiol ; 53(6): 1033-1043, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38044373

RESUMEN

Osseointegrated implants have been developed to allow direct skeletal fixation of a prosthesis as an alternative to traditional socket-fitted prostheses for patients who have suffered from a major limb amputation. The implants contribute to improvements in functional outcome and quality of life and radiological evaluation plays a crucial role in pre- and post-operative assessment. This article acts as a guide for radiologists who may be tasked with providing the radiological information required by surgeons and prosthetists. We also look at the radiological appearances of complications that may arise in patients treated with an osseointegrated implant. Plain X-rays are used to screen patients who wish to undergo treatment. Limb-length X-rays are then used to measure the length of any residual bone, and comparisons can be made with the normal side (if present). From this, decisions about the likely size of the implant and the need for further amputation can be made. CT scans enable accurate assessment of the medullary cavity and cortical thickness. Post-operatively, plain X-rays form the mainstay of the routine monitoring of the bone-implant interface. Potential complications include infection, aseptic loosening, mechanical fracture of the implant and periprosthetic fracture. Infection and aseptic loosening can be seen as a lucency at the bone-implant interface which (if left untreated) can lead to loss of the implant. Implant and periprosthetic fractures are radiographically obvious. Radiologists involved in the care of patients undergoing treatment with an osseointegrated implant should become familiar with the imaging requirements so they can contribute to optimal patient outcomes.


Asunto(s)
Miembros Artificiales , Calidad de Vida , Humanos , Amputación Quirúrgica , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Radiólogos , Resultado del Tratamiento , Diseño de Prótesis
2.
Clin Exp Rheumatol ; 40(9): 1620-1628, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34665696

RESUMEN

OBJECTIVES: To investigate the ex vivo effect of the JAK1/2 inhibitor baricitinib on expression of pro-inflammatory mediators in rheumatoid arthritis (RA) fibroblast like synoviocytes (FLS) stimulated with TNFα, IL-1ß and oncostatin M (OSM), and in RA synovial membrane cells (SMCs). METHODS: RA and osteoarthritis (OA) SMCs, were isolated from arthroplasty specimens of RA (n=8) and OA (n=8) patients, respectively, using enzymatic digestion followed by cell propagation to obtain RA (n=5) and OA (n=3) FLS. Normal FLS and normal human foreskin fibroblasts (HSF) were purchased from commercial sources. Fibroblasts were stimulated with cytokines with or without baricitinib. RA SMCs were cultured in the presence of baricitinib without stimulation. JAK/STAT activation and levels of mRNA and proteins of the various inflammatory cytokines (IL-6, IL-8, MCP-1, RANTES and IP-10) were determined by qPCR, ELISA and MSD. RESULTS: Baricitinib inhibited OSM-induced JAK signalling in RA synovial fibroblasts and effectively suppressed subsequent expression of the proinflammatory mediators IL-6, MCP-1 and IP-10. However, baricitinib was not effective in altering levels of spontaneously released TNFα, IL-6 and IL-8 in RA SMC. Although both TNFα and IL-1ß signal independently of the JAK/STAT pathway, in HSF, but not in RA FLS, baricitinib significantly inhibited TNFα- and IL-1ß-induced MCP-1 and IP-10 protein levels in a dose dependent manner. Furthermore, baricitinib did not inhibit TNFα- and IL-1ß-induced expression of IL-6, IL-8 and MCP-1 in RA FLS. CONCLUSIONS: These findings are consistent with known signalling pathways employed by OSM, TNFα and IL-1ß, but our data suggest that in HSF, baricitinib may have anti-inflammatory effects via downstream modulation of cytokines and chemokines produced in response to TNFα or IL-1ß.


Asunto(s)
Artritis Reumatoide , Inhibidores de las Cinasas Janus , Sinoviocitos , Antiinflamatorios/farmacología , Artritis Reumatoide/metabolismo , Azetidinas , Células Cultivadas , Quimiocina CCL5/metabolismo , Quimiocina CCL5/farmacología , Quimiocina CXCL10/metabolismo , Fibroblastos/metabolismo , Humanos , Mediadores de Inflamación/metabolismo , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Inhibidores de las Cinasas Janus/farmacología , Quinasas Janus/metabolismo , Oncostatina M/metabolismo , Oncostatina M/farmacología , Purinas , Pirazoles , ARN Mensajero/metabolismo , Factores de Transcripción STAT/metabolismo , Factores de Transcripción STAT/farmacología , Transducción de Señal , Sulfonamidas , Membrana Sinovial , Sinoviocitos/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo
3.
J Craniofac Surg ; 29(1): 202-203, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29065050

RESUMEN

Methylmethacrylate bone cement (MM-BC) is one of the reconstructive methods: during cranioplasty to correct cranial defects following trauma or cranial surgery. Perfect intraoperative immobilization of the MM-BC is crucial to ensure correct subsequent shaping to best improve contour defects. Current immobilization techniques reported are time-consuming and involve complex metalwork. The authors hereby present a technique that may simplify the immobilization process by using histoacryl glue to secure the MM-BC. This provides a quick, inexpensive, and readily available option providing fixation strong enough to withstand final shaping of the MM-BC.


Asunto(s)
Cementos para Huesos , Enbucrilato , Metilmetacrilato , Procedimientos de Cirugía Plástica/métodos , Cráneo/cirugía , Adhesivos Tisulares , Cementos Dentales , Humanos
4.
Aesthet Surg J ; 38(7): 742-748, 2018 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-29329370

RESUMEN

BACKGROUND: The nipple-areola complex (NAC) is important aesthetically and functionally for both sexes. Methods for positioning the NAC in males are less well established in the literature compared to females but are just as important. OBJECTIVES: This study aims to determine the normal parameters for the male NAC, to review literature, and to present a reliable method for preoperative placement. METHODS: Normal male patients, with no prior chest wall conditions, were prospectively recruited to participate. General demographics and chest wall dimensions were recorded-sternal notch to nipple (SNND), internipple (IND), anterior axillary folds distances (AFD), NAC, and chest circumference were measured. Comparisons were made using t test and ANOVA. RESULTS: One hundred and fifty-eight patients were recruited (age range, 18-90 years); mostly (86.7%) with normal or overweight BMI. The IND averaged 249.4 mm, the SNND averaged 204.2 mm, and the AFD averaged 383.8 mm. Areola diameter averaged 26.6 mm and for the nipple, 6.9 mm. The IND:AFD ratio was 0.65. There was no statistical difference in the IND:AFD ratio, SNND, or NAC parameters comparing different ethnic groups. The SNND increased with greater BMI (P ≤ 0.001). Using these data, we suggest ideal NAC dimensions and devised a simple method for positioning of the NAC on the male chest wall. CONCLUSIONS: This is the largest study, with the widest range in age and BMI, to date on this topic. Although fewer men than women undergo surgery to the breast, there is a growing awareness for enhancing the appearance of the male chest wall.


Asunto(s)
Antropometría , Pezones/anatomía & histología , Pared Torácica/anatomía & histología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estética , Humanos , Masculino , Mamoplastia/métodos , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven
5.
Aesthet Surg J ; 36(3): NP100-16, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26673575

RESUMEN

BACKGROUND: The earFold™ implantable clip system is a new treatment for prominent ears using an implant made from nickel-titanium alloy, forged into a predetermined shape. The implant is fixed to the cartilage then released, causing the cartilage to fold back. OBJECTIVES: The study aimed to test the safety and behaviour of the implant in vivo. METHODS: This was a Phase 1, prospective, nonrandomised study. Thirty-nine patients were recruited, from 7 to 57 years of age (22 adults and 17 children). Thirty-seven patients were followed up for a minimum of 18 months. A total of 131 implants was used to treat 75 ears. All treatments were performed under local anaesthetic. RESULTS: Eighteen patients asked for their implants to be left in place permanently. Twenty-one patients agreed to have their implants removed at 6, 12, or 18 months after insertion. Complications affected 8 patients and included extrusion, infection, hypertrophic scarring, and Spock-ear formation. No new complications have arisen in any of the patients since the conclusion of the study, up to a maximum of 47 months. Patients were overwhelmingly satisfied with the outcome of treatment. CONCLUSIONS: earFold can be used as a permanent implant to correct prominence of the human ear. It is best suited for treating prominent ears with a poorly formed or absent antihelical fold. The procedure is quick and predictable with a complication rate comparable to suture-based otoplasty techniques.


Asunto(s)
Cartílago Auricular/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Prótesis e Implantes , Adolescente , Adulto , Niño , Cartílago Auricular/anomalías , Femenino , Humanos , Londres , Masculino , Persona de Mediana Edad , Níquel , Satisfacción del Paciente , Proyectos Piloto , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Diseño de Prótesis , Procedimientos de Cirugía Plástica/efectos adversos , Encuestas y Cuestionarios , Factores de Tiempo , Titanio , Resultado del Tratamiento , Adulto Joven
6.
J Plast Reconstr Aesthet Surg ; 76: 303-305, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36333186

RESUMEN

INTRODUCTION: A dartos interposition flap is often used as a waterproofing layer in hypospadias repairs. Recently, acellular dermal matrices (ADMs) have been described as an alternative. In this case-control study we compare the outcomes of using dCELL (an ADM) with dartos flap. METHODS: A retrospective, case-control study was conducted, comparing the use of dCELL in primary and revision cases to controls. Patients were matched according to age and surgical technique. Data were analysed using an independent t-test. RESULTS: 13 patients undergoing primary distal hypospadias repair using dCELL as an interposition layer were matched with 13 controls. There was no significant difference in the number of complications between the groups (p = 0.296). 5 patients undergoing revision surgery using dCELL were also matched in the same way. Although a statistically significant lower complication rate was shown in the dCELL group compared to controls (p = 0.029), this may represent a type II error due to the small sample size and heterogeneity. CONCLUSION: Using dCELL as an interposition layer was not associated with any reduction in complication rates for primary distal hypospadias repair and possibly useful in soft tissue-deficient reoperative cases. However, larger randomised controlled trials may be needed to confirm the presence (or absence) of any benefit from using dCELL in hypospadias surgery.


Asunto(s)
Dermis Acelular , Hipospadias , Fístula Urinaria , Masculino , Humanos , Lactante , Hipospadias/cirugía , Estudios de Casos y Controles , Estudios Retrospectivos , Fístula Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Uretra/cirugía , Resultado del Tratamiento
7.
J Hand Microsurg ; 15(3): 188-195, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37388556

RESUMEN

Objective Enchondromas are benign tumours of hyaline cartilage most frequently arising in the bones of the hand and the optimum surgical management strategy for these is debated. We present an audit of the surgical management of 57 enchondromas referred to our tertiary hand surgery department over a period of 12 years (2008-2020) and describe our surgical technique for this procedure as well as a comparison with other studies in the literature. Materials and Methods Retrospective audit of our practice. Data were extracted from our institutional operative database to identify all patients undergoing surgical management of enchondromas during the time period. The individual electronic patient records were then evaluated to extract demographics and outcome data. Results Our results demonstrate excellent clearance of enchondroma (74% Tordai group 1 radiological resolution) with very low complication rates and no recurrence. Our results also emphasize the importance of surgical management of enchondromas to allow diagnosis of rare chondrosarcoma (3.5% in this study). Conclusion A larger randomized controlled trial is still required to adequately determine the differences between the surgical options available and determine the best possible surgical approach to these cases. Level of evidence is III.

8.
bioRxiv ; 2023 Dec 14.
Artículo en Inglés | MEDLINE | ID: mdl-38168448

RESUMEN

Neuroscientists have long debated the adult brain's capacity to reorganize itself in response to injury. A driving model for studying plasticity has been limb amputation. For decades, it was believed that amputation triggers large-scale reorganization of cortical body resources. However, these studies have relied on cross-sectional observations post-amputation, without directly tracking neural changes. Here, we longitudinally followed adult patients with planned arm amputations and measured hand and face representations, before and after amputation. By interrogating the representational structure elicited from movements of the hand (pre-amputation) and phantom hand (post-amputation), we demonstrate that hand representation is unaltered. Further, we observed no evidence for lower face (lip) reorganization into the deprived hand region. Collectively, our findings provide direct and decisive evidence that amputation does not trigger large-scale cortical reorganization.

9.
Cureus ; 14(4): e24353, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35611036

RESUMEN

We present the case of an unusual base of the first metacarpal fracture. The presentation and radiological images are provided to demonstrate a first metacarpal base fracture but with a concurrent appearance at first glance of a trapeziectomy mimic on plain radiographs. The CT scan however demonstrates the true nature of the injury - a comminuted fracture with carpometacarpal subluxation. The radiological and clinical findings presented a diagnostic and therapeutic dilemma. We elected to not intervene surgically with a good resulting clinical outcome, reminding us of the need to treat the patient and not their radiographic images.

10.
J Plast Reconstr Aesthet Surg ; 75(3): 960-969, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34840118

RESUMEN

BACKGROUND: Studies have suggested that targeted muscle reinnervation (TMR) can improve symptoms of neuroma pain (NP) and phantom limb pain (PLP) in patients. OBJECTIVES: Our primary objective was to measure changes in NP and PLP levels following TMR surgery at 4-time points (baseline, 3, 6- and 12-months postoperatively). Secondary aims included identification of the character and rate of any surgical complications and patients' satisfaction with TMR. METHODS: A retrospective review of outcomes of 36 patients who underwent TMR surgery to treat intractable NP and/or PLP after major amputation of an upper (UL) or lower limb (LL) at a single centre in London, UK over 7 years. The surgical techniques, complications, and satisfaction with TMR are described. RESULTS: Forty TMR procedures were performed on 36 patients. Thirty patients had complete data for NP and PLP levels at all pre-defined time points. Significant improvements (p<0.01) in both types of pain were observed for both upper and LL amputees. However, there were varying patterns of recovery. For example, UL amputees experienced worsening of PLP in the first few months post-operatively whereas surgical complications were more common in LL cases. Patients were overwhelmingly satisfied with the improvements in their symptoms (90%). CONCLUSIONS: TMR surgery appeared to relieve both NP and PLP although the retrospective nature of this study limits the strength of this conclusion. However, complication rates were high, and it is crucial for surgeons and patients to fully understand the course and outcomes of this novel surgery prior to undertaking treatment.


Asunto(s)
Amputados , Transferencia de Nervios , Neuroma , Miembro Fantasma , Amputación Quirúrgica/métodos , Humanos , Músculo Esquelético/cirugía , Transferencia de Nervios/métodos , Neuroma/diagnóstico , Neuroma/cirugía , Miembro Fantasma/etiología , Miembro Fantasma/cirugía , Estudios Retrospectivos , Reino Unido
12.
J Hand Surg Am ; 36(4): 677-85, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21463729

RESUMEN

PURPOSE: The cause of ulnar drift in patients with rheumatoid arthritis (RA) is unknown. It may occur because of external forces applied to the fingers during normal use. Alternatively, it may arise after changes in the internal forces on the anatomy of the digits owing to alterations in the supporting structures of the joints or their control mechanisms, or both. Intrinsic muscle tightness, which is commonly seen in RA hands, may be the result of adaptive shortening or a direct consequence of RA. Previous studies carried out by our group have shown that joints, tendons, and associated synovium in RA hands are consistently hypoxic. Therefore, we formed the hypothesis that there is a difference in hand/forearm muscle oxygen tension in RA versus non-RA. METHODS: We measured tissue oxygen levels in the intrinsic muscles of the hands and forearm muscles of 29 patients with a diagnosis of RA, who were undergoing elective surgery. We measured oxygen levels using a microelectrode technique. A total of 31 patients without RA undergoing elective surgery served as matched controls. RESULTS: Our results show that the intrinsic muscles of RA patients are significantly more hypoxic than in non-RA controls. Moreover, there is a trend in the RA group for increasing hypoxia in a radial-to-ulnar direction when comparing the different intrinsic muscle groups. We also demonstrate that forearm and thenar and hypothenar muscles are significantly more hypoxic in RA versus non-RA patients. CONCLUSIONS: The intrinsic muscle weakness, intrinsic tightness, and muscle wasting observed in RA may not be due to disuse atrophy resulting from joint disease. From our data, we speculate that these changes may be the result of direct muscular involvement in RA leading to muscle hypoxia.


Asunto(s)
Artritis Reumatoide/complicaciones , Deformidades Adquiridas de la Mano/diagnóstico , Hipoxia/fisiopatología , Músculo Esquelético/fisiopatología , Oxígeno/metabolismo , Adulto , Anciano , Análisis de Varianza , Antirreumáticos , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Estudios de Casos y Controles , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Deformidades Adquiridas de la Mano/etiología , Deformidades Adquiridas de la Mano/cirugía , Humanos , Hipoxia/etiología , Masculino , Persona de Mediana Edad , Músculo Esquelético/irrigación sanguínea , Consumo de Oxígeno/fisiología , Radiografía , Valores de Referencia , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Cúbito/diagnóstico por imagen , Cúbito/fisiopatología
13.
JPRAS Open ; 27: 63-65, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33335966

RESUMEN

The Estlander flap is an axial-pattern, lip-switch technique used to reconstruct lip defects that include the oral commissure. We describe a neurotised modification that may confer functional advantages by preserving sensation and helping to maintain oral competence. This is achieved by preservation of the mental nerve branches to the lip and facial nerve branches to the orbicularis oris muscle in the flap.

14.
J Plast Reconstr Aesthet Surg ; 74(10): 2776-2820, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33947649

RESUMEN

BACKGROUND: Prominent ear deformity is common amongst the human population and is partly due to underdevelopment of the antihelical fold, a prominent conchal bowl, or both. Recently, the senior author described a minimally invasive technique for changing the shape of the antihelical fold using the Earfold™ implant (Allergan plc, Dublin, Ireland). However, there is still a paucity of data regarding outcomes from combing this approach with surgical techniques to correct conchal bowl hypertrophy. OBJECTIVES AND METHODS: Questionnaire-based study evaluating outcomes in consecutive patients undergoing treatment with Earfold™ and conchal bowl reduction. Patient reported outcome measures were assessed with a validated questionnaire. Data on complications were obtained from the patient's case notes and free-text sections of the questionnaire. RESULTS: Completed questionnaires were received from 8 patients out of a total of 18 who underwent the combination treatment (44% response rate). Statistically significant differences were noted in nearly all questions (18/19) relating to changes in ear appearance as a result of the surgery, with all patients being satisfied following the combined procedure. Improvements in subjective outcomes were compared to previous studies evaluating treatment with Earfold™. CONCLUSIONS: The Earfold™ implant can be combined safely with other otoplasty techniques to achieve a good outcome in a carefully selected patient population.


Asunto(s)
Pabellón Auricular , Deformidades Adquiridas del Oído/cirugía , Medición de Resultados Informados por el Paciente , Procedimientos de Cirugía Plástica , Prótesis e Implantes , Encuestas y Cuestionarios , Adulto , Pabellón Auricular/anomalías , Pabellón Auricular/cirugía , Cartílago Auricular/cirugía , Estética , Femenino , Humanos , Masculino , Satisfacción del Paciente , Selección de Paciente , Apariencia Física , Prótesis e Implantes/psicología , Prótesis e Implantes/normas , Mejoramiento de la Calidad , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/psicología , Cirugía Plástica/psicología , Cirugía Plástica/normas
15.
JPRAS Open ; 29: 113-122, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34195332

RESUMEN

Three per cent hydrogen peroxide (H2O2) is widely used to irrigate acute and chronic wounds in the surgical setting and clinical experience tells us that it is more effective at removing dried-on blood than normal saline alone. We hypothesise that this is due to the effect of H2O2 on fibrin clot architecture via fibrinolysis. We investigate the mechanisms and discuss the clinical implications using an in vitro model. Coagulation assays with normal saline (NaCl), 1% and 3% concentrations of H2O2 were performed to determine the effect on fibrin clot formation. These effects were confirmed by spectrophotometry. The effects of 1%, 3% and 10% H2O2 on the macroscopic and microscopic features of fibrin clots were assessed at set time intervals and compared to a NaCl control. Quantitative analysis of fibrin networks was undertaken to determine the fibre length, diameter, branch point density and pore size. Fibrin clots immersed in 1%, 3% and 10% H2O2 demonstrated volume losses of 0.09-0.25mm3/min, whereas those immersed in the normal saline gained in volume by 0.02±0.13 mm3/min. Quantitative analysis showed that H2O2 affects the structure of the fibrin clot in a concentration-dependent manner, with the increase in fibre length, diameter and consequently pore sizes. Our results support our hypothesis that the efficacy of H2O2 in cleaning blood from wounds is enhanced by its effects on fibrin clot architecture in a concentration- and time-dependent manner. The observed changes in fibre size and branch point density suggest that H2O2 is acting on the quaternary structure of the fibrin clot, most likely via its effect on cross-linking of the fibrin monomers and may therefore be of benefit for the removal of other fibrin-dependent structures such as wound slough.

16.
J Hand Surg Am ; 35(7): 1130-4, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20541327

RESUMEN

Exoprosthetic replacement with an artificial limb is the main option for reconstruction after traumatic amputation of an upper limb. Direct skeletal attachment using an osseointegrated implant improves the ease of fixation of the exoprosthesis to the amputation stump. We now report the use of an intraosseous transcutaneous amputation prosthesis that is designed to achieve osseocutaneous integration. Osseocutaneous integration differs from osseointegration because the aim is to create a stable interface among the implant, the bone, and the soft tissues. This reduces the risk of soft tissue infection and troublesome discharge, which are problems encountered with current osseointegrated implants that focus largely on the bone-implant interface. We describe our experience with an intraosseous transcutaneous amputation prosthesis in a case of transhumeral amputation with 2 years of follow-up.


Asunto(s)
Muñones de Amputación/cirugía , Amputación Traumática/cirugía , Miembros Artificiales , Húmero/cirugía , Oseointegración/fisiología , Amputados/rehabilitación , Brazo , Traumatismos por Explosión/cirugía , Procedimientos Quirúrgicos Dermatologicos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Traumatismo Múltiple/cirugía , Diseño de Prótesis , Ajuste de Prótesis , Implantación de Prótesis , Resultado del Tratamiento , Cicatrización de Heridas/fisiología
17.
Plast Reconstr Surg Glob Open ; 8(10): e3152, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33173673

RESUMEN

BACKGROUND: In hypospadias repairs, there is some evidence to suggest that a "waterproofing" layer can be helpful in reducing the risk of urethrocutaneous fistula formation. The most likely role of this layer is to prevent the creation of overlapping suture lines. Many hypospadias surgeons use a dartos fascia interposition flap for this purpose. However, raising a dartos fascia flap adds time to the procedure, can result in devascularization of the overlying skin, and can create unsightly torsion of the penis, which may be hard to correct. To avoid these problems, the senior author has started to use dCELL (decellularized human dermis) as an alternative to dartos fascia to separate the suture lines. METHODS: Between March and July 2018, a pilot study was performed in 8 patients undergoing closure of a urethrocutaneous fistula or glans dehiscence combined with dCELL. Data on infections, wound breakdown, length of stay and catheterization, surgical time, and hospital stay were collected. RESULTS: All patients had a successful reconstruction. One patient developed a urinary tract infection, possibly related to prolonged catheterization following his repair. CONCLUSION: Our results suggest that dCELL may be useful in the repair of urethrocutaneous fistulas and glans dehiscence after hypospadias surgery.

18.
Bone Joint J ; 102-B(2): 162-169, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009427

RESUMEN

AIMS: Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees. METHODS: A retrospective review identified 518 osseointegration procedures which were undertaken in 458 patients between 2010 and 2018 for whom complete medical records were available. Potential risk factors including time since amputation, age at osseointegration, bone density, weight, uni/bilateral implantation and sex were evaluated with multiple logistic regression. The mechanism of injury, technique and implant that was used for fixation of the fracture, pre-osseointegration and post fracture mobility (assessed using the K-level) and the time that the prosthesis was worn for in hours/day were also assessed. RESULTS: There were 22 periprosthetic fractures; they occurred exclusively in the femur: two in the femoral neck, 14 intertrochanteric and six subtrochanteric, representing 4.2% of 518 osseointegration operations and 6.3% of 347 femoral implants. The vast majority (19/22, 86.4%) occurred within 2 cm of the proximal tip of the implant and after a fall. No fractures occurred spontaneously. Fixation most commonly involved dynamic hip screws (10) and reconstruction plates (9). No osseointegration implants required removal, the K-level was not reduced after fixation of the fracture in any patient, and all retained a K-level of ≥ 2. All fractures united, 21 out of 22 patients (95.5%) wear their osseointegration-mounted prosthetic limb longer daily than when using a socket, with 18 out of 22 (81.8%) reporting using it for ≥ 16 hours daily. Regression analysis identified a 3.89-fold increased risk of fracture for females (p = 0.007) and a 1.02-fold increased risk of fracture per kg above a mean of 80.4 kg (p = 0.046). No increased risk was identified for bilateral implants (p = 0.083), time from amputation to osseointegration (p = 0.974), age at osseointegration (p = 0.331), or bone density (g/cm2, p = 0.560; T-score, p = 0.247; Z-score, p = 0.312). CONCLUSION: The risks and sequelae of periprosthetic fracture after press-fit osseointegration for amputation should not deter patients or clinicians from considering this procedure. Females and heavier patients are likely to have an increased risk of fracture. Age, years since amputation, and bone density do not appear influential. Cite this article: Bone Joint J 2020;102-B(2):162-169.


Asunto(s)
Amputación Quirúrgica , Fracturas del Fémur/cirugía , Oseointegración , Fracturas Periprotésicas/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Implantación de Prótesis/efectos adversos , Amputación Quirúrgica/rehabilitación , Femenino , Fracturas del Fémur/etiología , Fémur/lesiones , Fémur/cirugía , Humanos , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas/etiología , Falla de Prótesis , Estudios Retrospectivos , Factores de Riesgo
20.
JPRAS Open ; 17: 1-4, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32158823

RESUMEN

A case report to describe the occurrence of Dupuytren's disease in the wrist leading to compression of the palmar cutaneous branch of the median nerve. A 60-year-old male presented with a lump on the volar aspect of the left wrist with reduced sensation in the thenar eminence. Intra-operatively this was found to be a nodule integrated within the palmaris longus tendon and positioned superficially to the palmar cutaneous branch of the median nerve. Histological findings were consistent with Dupuytren's disease and the patient's symptoms improved post excision of the nodule. Although Dupuytren's nodules occur rarely in the wrist, they should be considered as part of the differential diagnosis of wrist lumps and they have the potential to impact on nearby neural structures.

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