Effect of electromyographic biofeedback training on functional status in zone I-III flexor tendon injuries: a randomized controlled trial.

BACKGROUND: Despite advances in hand therapy and surgery, functional deficits persist after flexor tendon repair especially in zone I-III. This suggests that methods applied may be insufficient. Electromyographic (EMG) biofeedback may provide an effective tendon gliding through visual and auditory feedback. PURPOSE: The purpose of this study was to investigate the effect of EMG biofeedback training applied in addition to early passive motion protocol on functional status in zone I-III flexor tendon injuries. METHODS: Patients were randomly assigned into two groups, each consisted of 11 patients. In addition to early passive motion method, EMG biofeedback training was applied in the first group. The second group was followed only with early passive motion protocol. Joint range of motion (ROM), Michigan Hand Outcomes Questionnaire (MHQ) and grip strength were evaluated. RESULTS: There were no significant differences between the groups in terms of the ROM, MHQ scores and grip strength (p ≥ .087). However, there were clinically important differences in the results of the 12th week ROM (effect size = 0.70), 24th week activity of daily living (ADL) score in MHQ (effect size = 0.68), 12th week gross, tip pinch and lateral grip strength (effect sizes = 0.59, 0.52, 0.81, respectively) and 24th week gross, tip pinch and lateral grip strength (effect sizes = 0.69, 0.73, 0.69, respectively) between the two groups. CONCLUSIONS: EMG biofeedback training was clinically but not statistically superior to early passive motion method in terms of the effect on functional status.

Effect of reduction mammoplasty on the pulmonary function tests.

INTRODUCTION: Bilateral breast reduction surgery is the surgical treatment of bilateral breast hypertrophy. This is one of the most common breast surgery requested by women, and performed by plastic surgeons. The reasons that patients want this surgery are to re-size sagging breasts aesthetically, and to get rid of somatic symptoms such as shoulder, chest, back, and neck pain. We believe that the objective positive effects of breast reduction surgery exist beside aesthetic. In our study, our aim is to elicit positive effects of surgery on lungs, if there are, by making pulmonary function test and carbon monoxide diffusion test before surgery and after 6 months of surgery. MATERIALS AND METHODS: Thirty patients agreed to participate in the study. Study is completed with 19 patients. Pulmonary function test and carbon monoxide diffusion test were made to all patients in preoperative and 6 months of postoperative period. Lung roentgenogram of all patients was performed and height, weight, body mass index were measured. Saturation level was measured. RESULT: There was a meaningful increase in FEV1 and FVC values in the postoperative period in comparison with pulmonary function test performed in preoperative period. DLCO in postoperative period decreased meaningfully as compared to the preoperative period. CONCLUSIONS: Breast reduction surgery seems to have positive effects on pulmonary function test values and relaxes patients clinically. Patients with big breasts should be evaluated from this perspective if they apply chest diseases clinic with shortness of breath.

Facial Actinomycosis Mimicking a Cutaneous Tumor.

Actinomycosis is a chronic granulomatous infection that commonly occurs in the cervicofacial region. Although Actinomcyes is an element of the normal oral flora, infections of the facial skin are very rare because of the entirely endogenous habitation of the organism. The authors report a case of facial actinomycosis, which mimicked a cutaneous tumor both clinically and surgically in a 44-year-old woman with chronic renal failure and Hepatitis C viral infection. The majority of cases can be treated with long-term antibiotics. However, a treatment-resistant abscess, a fistula, or postsurgical excision of the mass formation that are infected can be treated with antibiotics as soon as possible, and recurrence of infection is prevented. The treatment should consist of conservative surgery to obtain a firm histological diagnosis and to drain any collections.

Effect of Concentrated Growth Factor on Survival of Diced Cartilage Graft.

BACKGROUND: Diced cartilage grafts are important in rhinoplasty for raising the dorsum and eliminating dorsal irregularities. The most common problems with the use of diced cartilage are wrapping and cartilage resorption. OBJECTIVES: To histopathologically investigate and compare the viability of diced cartilage grafts wrapped with concentrated growth factor, fascia and fenestrated fascia, or blood glue. METHODS: Cartilage grafts were harvested from the ears of 10 New Zealand White rabbits and diced into 0.5 to 1 mm3 pieces. The grafts were divided into five groups for comparison: (1) bare diced cartilage; (2) diced cartilage wrapped with fascia; (3) diced cartilage wrapped with fenestrated fascia; (4) diced cartilage wrapped with concentrated growth factor (CGF); and (5) diced cartilage wrapped with blood glue. Each of the five grafts was autologously implanted into a subcutaneous pocket in the back of each rabbit. Three months later, the rabbits were sacrificed and the implants were harvested and examined histopathologically. RESULTS: Nucleus loss, calcification, inflammation, and giant cell formation differed significantly between the CGF group and both fascia groups. Chondrocyte proliferation was the highest in the CGF group. Nucleus loss rates were similar between the fascia and fenestrated fascia groups. CONCLUSIONS: Our findings suggest that CGF improves the viability of diced cartilage grafts, while fascia hampers it. Punching holes in the fascia does not improve diced cartilage graft viability and neither does blood glue wrapping.

Survival of Minced Cartilage Grafts with Comparison Surgicel(®) Original and Fibrillar.

BACKGROUND: Cartilage grafts are commonly used in nasal surgery for structural and/or esthetic purposes. The viability of cartilage grafts has been investigated in many forms since the use of cartilage grafts in surgical procedures. OBJECTIVES: The objective of this study was to investigate the viability of minced cartilage grafts and whether there is a difference between grafts wrapped in Surgicel(®) Original and Surgicel Fibrillar. METHODS: A total of ten New Zealand rabbits were used for the study. Cartilage grafts were harvested from one side ear. Four groups were formed. Group 1: minced cartilage graft wrapped in Surgicel Fibrillar; Group 2: minced cartilage graft wrapped in Surgicel Original; Group 3: bare minced cartilage graft; and Group 4: bare diced cartilage graft. Four small subcutaneous pockets were made in the backs of the rabbits, and the grafts were placed in these pockets. All of the rabbits were sacrificed at the end of 3 months, and the samples were collected. The sections were stained with hematoxylin and eosin (H&E), toluidin blue, safranin-O, masson trichrome, and glial fibrillary acidic protein immunohistochemical. All specimens were assessed histopathologically under a light microscope. RESULTS: There was no statistically significant difference between the Surgicel Fibrillar and Surgicel Original groups with respect to any of the parameters. Bone formation, calcification, inflammation, fibrosis, and basophilia were similar in all groups, with no significant difference among them. In the Surgicel Fibrillar and Surgicel Original groups, a heavy chondrocyte nucleus loss accompanied by a minimal peripheral proliferation was observed. CONCLUSIONS: The viability of bare minced cartilage grafts was found to be similar to that of bare diced cartilage in this study. Minced cartilage grafts can be used in the correction of minor dorsal defects and irregularities in persons with thin nasal skins, especially in primary and revision rhinoplasty. Although there is no statistically significant difference between the Surgicel Fibrillary and Surgicel Original groups, we think that, if it is necessary to use oxidized regenerated cellulose, it should be in the fibrillar form. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

The Use of the PlasmaBlade and Acellular Dermal Matrix in Rhinophyma Surgery: A Case Report.

BACKGROUND: Rhinophyma is a rare, disfiguring disease characterized by a slow progressive overgrowth of the soft tissue of the nose associated with end-stage severe acne rosacea. OBJECTIVE: We present a case of severe rhinophyma treated successfully using PlasmaBlade and acellular dermal matrix with split-thickness skin graft. METHODS: This procedure combines deep excision with PlasmaBlade followed by coverage with an acellular dermal matrix for dermal substitution and split-thickness skin graft. RESULTS: Functional and aesthetic results were satisfactory. CONCLUSION: We offer a new approach to surgical treatment of rhinophyma. Total excision of phymatous tissue and single session replacement of epidermal-dermal components is an effective treatment for patients with severe rhinophyma, resulting in satisfactory functional and aesthetic outcome. This combined treatment modality prevents the recurrence of rhinophyma. It should be considered an appropriate alternative in cases of severe rhinophyma.

[Investigation of the relationship between severity of injury, return to work, impairment, and activity participation in hand and forearm injuries]. / El ve önkol yaralanmalarinda yaralanma ciddiyeti ile ise geri dönüs, bozukluk, aktivite ve katilim arasindaki iliskinin incelenmesi.

BACKGROUND: Forearm and hand injuries are the main cause of work-related disability. This study was planned to investigate the relationship between severity of injury, time of return to work, impairment, and activity participation of patients with hand and forearm injuries. METHODS: One hundred and thirty patients who had patients who had had forearm or hand injuries with a mean age of 31±11.13 years participated in this study. Injury severity was evaluated using Modified Hand and Forearm Injury Severity Scoring (MHISS) after surgery. Patients were evaluated using the Jebsen Hand Function Test (JHFT) and Buck-Gramko scoring eight weeks after injury. Additionally, grip strength was evaluated with a dynamometer, and disability/symptom score was evaluated using the Turkish version of the Disabilities of the Arm, Shoulder, and Hand (DASH-T) questionnaire twelve weeks after injury. RESULTS: A significant relationship between MHISS, hand strength, time of return to work, DASH-T, and Buck-Gramko scores of patients with forearm and hand injuries was identified (p≤0.05). Higher impairment was significantly related to body structure and body functions (1.86±1.47), and the most limited activity was writing (2.06±1.50) regarding ICF framework. CONCLUSION: Higher MHISS scores were associated with delays in returning to work and lower activity participation. The DASH-T score was the most strongly associated with time of return to work. Furthermore, there is a positive relation between time of return to work and activity participation of patients.

Comparison of static and dynamic splinting regimens for extensor tendon repairs in zones V to VII.

The aim of this prospective, randomised, controlled trail was to compare two methods of rehabilitating extensor tendon repairs in zones V-VII. Patients who incurred simple and complete lacerations of their extensor tendons in zones V-VII enrolled into the study and underwent either static splinting (n = 25) or dynamic splinting (n = 27) after primary acute repair of tendons. Extension lag, flexion deficit, total active motion (TAM), grip strength, and functional status of upper extremities were measured. TAM was improved in the dynamic group when compared with the static group in the injured digits at 4 weeks (p = 0.001), at 12 weeks (p = 0.05), and at 6 months (p = 0.001). Grip strength outcomes demonstrated improved grip force for the dynamic group when compared with the static group at 12 weeks (p = 0.001). There were no ruptures in either group. Also, a better functional level was found in the dynamic splinting group at 6 months (p = 0.001). The findings of the current study suggest that dynamic splinting of complex lacerations of the extensor tendons in zones V-VII provides improved functional outcomes at 4 and 12 weeks and 6 months when compared with static splinting.