Standing cough test stratification of moderate male stress urinary incontinence.

PURPOSE: Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. MATERIALS AND METHODS: We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. RESULTS: Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). CONCLUSIONS: Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.

Refining the extended circumflex scapular flap for neck burn reconstruction: A 30-year experience.

INTRODUCTION: Neck burn sequelae remain a major challenge for the reconstructive surgeon. To achieve satisfactory functional and aesthetic results, the anterior neck aesthetic unit must be covered as a single unit. In cases where free flaps are required, harvesting a flap of sufficient size can cause major donor site morbidity. In 1994, we published our favorable 6-year experience of reconstructing neck burn sequelae with an extended circumflex scapular flap (ECSF). Since then, we have made several modifications to the technique, resulting in improved long-term functional and aesthetic results. Herein, we present our 30-year, 150-patient experience with the ECSF flap for the treatment of anterior neck burn sequelae. METHODS: We retrospectively reviewed the records of 150 consecutive patients who underwent ECSF procedure for neck resurfacing performed or supervised by the senior author from 1986 to 2015. All cases were assessed for function, aesthetics, satisfaction, and complications. RESULTS: A total of 160 ECSFs were used in 150 patients. Ninety-nine patients were available for updated follow-up [1-30 years (mean, 15.3)]. At the last follow-up, 92 patients regained full range of motion, and 90 patients had acceptable cervicomental angle (<110°). The mean patient satisfaction score was 4.8/5. Nine flaps (5.6%) failed completely and were successfully replaced. Twenty-two patients (15%) had distal necrosis of the flap. Fifteen of these 22 patients underwent complementary flaps to replace the necrotic area, and all 15 patients regained full range of motion. CONCLUSIONS: For neck burn sequelae, the ECSF provides safe and effective long-term functional and aesthetic results with minimal donor site morbidity.

TDAP: Island versus propeller.

BACKGROUND AND AIM: Thoracodorsal artery perforator (TDAP) island flap is a safe and reliable method for breast reconstruction. TDAP propeller flap has been described as a modification of the conventional island technique that saves time and does not require microsurgical skills. However, a substantial portion of the propeller flap remains under the axilla and is not used for breast augmentation. The aim of this study is to identify the differences in the reaching distances between the propeller and island TDAP flaps. METHODS: In five cadaveric specimens and 10 breast reconstruction patients, an initial propeller flap was harvested and rotated to the anterior thorax; the distance from the tip of the flap to the anterior midline was recorded as the "midline-reaching deficit;" the flap was then converted into a conventional island flap, and the new midline-reaching deficit was recorded. Differences between groups were compared with paired two-tailed t-tests (α = 0.05). RESULTS: In the cadaveric specimens, the mean midline-reaching deficit was 4.8 ± 2.4 cm with the propeller TDAP and -0.6 ± 2.0 cm with the conventional island TDAP (P < 0.001). In the clinical cases, the mean midline-reaching deficit was 8.1 ± 1.0 cm with the propeller TDAP and -0.3 ± 1.1 cm with the island TDAP (P < 0.000000001). DISCUSSION: We observed that the midline-reaching deficit could be reduced by 7-9 cm with the conventional island TDAP in comparison to the propeller TDAP. This should be considered when reconstructing the medial inner part of the breast.

Reconstruction of thoracic burn sequelae by scar release and flap resurfacing.

INTRODUCTION: In the USA, 450,000 thermal burns receive medical treatment annually. Burn scars are commonly excised and covered with skin grafts. Long-term, these treatments commonly leave patients with discomfort, reduced total lung capacity and forced vital capacity, and restriction of thoracic expansion and shoulder joint mobility. In this article, we present our experience with using scar release and immediate flap reconstruction to treat thoracic restriction due to burn sequelae. METHODS: From 1998 to 2014, we enrolled 16 patients with anterior thoracic burn sequelae that had previously been treated conservatively or with skin grafts that eventually recidivated. Preoperatively, we measured thoracic circumference in expiration and inspiration, %FVC, %FEV1, and shoulder mobility. All patients underwent anterior thoracic scar release and immediate flap resurfacing. RESULTS: At 2 weeks to 3 months postoperatively (mean, 2.6 months), mean thoracic circumference upon inspiration increased from 83.6 cm±5.7 to 86.5 cm±5.8 (p<0.0000000001). Mean %FVC improved from 76.0%±2.64% to 88.2%±4.69% (p<0.0000001). Mean %FEV1 improved from 79.2%±3.85 to 87.8%±2.98 (p<0.000001). All 14 patients who had restricted shoulder mobility preoperatively no longer had restricted shoulder mobility postoperatively. The mean patient-reported satisfaction was 4.6/5 (range, 3-5). At a mean follow up of 2.5 years, none of the contractures recidivated. Complications included 2 cases of tissue necrosis of the distal end of the flap. In one case, the flap was restored; in the other case, the patient eventually had to receive a new flap. Additional complications included two local infections that were successfully treated with oral and local antibiotics and two hematomas that were drained and eventually healed without tissue loss. CONCLUSIONS: Scar releases and flaps provide a safe and effective method for the correction of restricted thoracic expansion, respiratory restriction, decreased range of shoulder motion, and discomfort from thoracic burn sequelae.

Humanização hospitalar infantil: intervenções musicoterapêuticas no Centro Clínico Electra Bonini / Children's hospital humanization: music therapy at Electra Bonini Clinical Center

Objetivo: promover a musicoterapia como recurso aplicável a crianças internadas em uma unidade de pediatria hospitalar, dentro de um programa de humanização hospitalar infantil da equipe multidisciplinar...

Objective: to promote music therapy as a resource of the pediatric multidisciplinary team that can be introduced to children admitted at a pediatrics unit as a part of hospital humanization program...

Asistencia artroscópica en fijación de fracturas del radio distal / Assistance arthroscopic fixation of distal radius fractures

Describimos la técnica, filosofía, indicaciones, ventajas usando asistencia artroscópica en la reducción de la superficie articular al realizar fijación de fracturas del radio distal. 27 pacientes fueron sometidos a este procedimiento entre Marzo 1999 y Agosto 2001. Según clasificación AO hubo 9 C1, 12 C2, 2 C3, 3 B1 y 1 B2. La edad promedio fue 41 años. El seguimiento promedio fue de 26 meses. La evaluación final incluyó AMA, dolor, fuerza de agarre, estudios radiográficos y el sistema de puntaje DASH. Las últimas radiografías evidenciaron un promedio de 21° de inclinación radial, 2° de inclinación volar, 0.7 mm de variación ulnar sin escalones articulares residuales. Los arcos de movimiento fueron satisfactorios. No tuvimos complicaciones. El uso de la artroscopia ha probado ser útil en la reducción de la superfi cie articular; la artroscopia, también permite la identificación y tratamiento de lesiones ligamentosas ocultas. Sugerimos este tratamiento en la población adulta joven con alta demanda física.

Osteoartritis de la articulación carpometacarpiana del pulgar. Una clasificación artroscópica original y algoritmo de tratamiento / Osteoarthritis of the carpometacarpal joint of the thumb. Arthroscopic classification and treatment algorithm Original

La osteoartritis de la base del pulgar es una condición bastante común y limitante que afecta principalmente mujeres de edades intermedias. La evaluación artroscópica de la primera articulación carpometacarpiana (CMC) permite una fácil identificación y clasificación de patología articular con mínima morbilidad. En este estudiopresentamos nuestra experiencia correlacionando los hallazgos radiográficos y artroscópicos. También proponemos una clasificación artroscópica y establecemos un algoritmo de tratamiento de esta entidad. Se practicó evaluación artroscópica de la primera articulación CMC a pacientes con enfermedad degenerativa de la base del pulgar que no respondieron a tratamiento conservador entre Enero de 1995 y Julio del 2003. Obtuvimos hallazgos artroscópicos constantes que no se correlacionaron necesariamente con los estados radiográficos. Los resultados del presente estudio demuestran que es posible establecer un criterio más apropiado de todos los estados de esta patología cuando existe la disponibilidad de la artroscopia diagnóstica y terapéutica en el armamentario del cirujano.