RESUMEN
BACKGROUND: Treating chronic osteomyelitis of the lower extremities is challenging. The treatment of acute lower limb trauma by orthoplastic teams has shown good results over the past few decades. This study aimed to characterize surgical outcomes of leg and heel chronic osteomyelitis by an orthoplastic team. METHODS: The cases of 113 consecutive leg and heel chronic osteomyelitis patients undergoing soft-tissue reconstruction with an orthopedic procedure were reviewed in this retrospective single-center observational study. The main objective was to assess surgical outcomes of skin healing and gait recovery at the 1-year follow-up. The secondary objective was to evaluate the global success rate at the last follow-up. RESULTS: The median follow-up was 19.7 months. A free flap was performed for 33 patients (29.2 percent) and a locoregional flap was used in 79 patients (69.9 percent). Seventy-two patients (63.7 percent) had chronic osteomyelitis on continuous bone. The others had a septic pseudarthrosis with a mean bone defect length of 42.9 mm. Forty-four patients (38.9 percent) underwent curettage only, eight (7.1 percent) underwent curettage and cement, 20 (17.7 percent) underwent curettage and bone fixation, and 39 (34.5 percent) underwent the Masquelet technique. At the 1-year follow-up, 72 patients (63.7 percent) had achieved skin healing and had recovered their gait. The success rate at all follow-up time points was 82.3 percent. The median time to achieve skin healing was 6.5 months and that to bone union in cases of septic pseudarthrosis was 7.9 months. CONCLUSION: Orthoplastic management of leg and heel chronic osteomyelitis patients with combined soft-tissue reconstruction using an orthopedic procedure was a viable strategy that offered good results even though the time to complete healing was long. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Asunto(s)
Legrado/métodos , Osteomielitis/cirugía , Procedimientos de Cirugía Plástica/métodos , Seudoartrosis/cirugía , Piel/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cementos para Huesos/uso terapéutico , Niño , Preescolar , Enfermedad Crónica/terapia , Legrado/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Huesos del Pie/microbiología , Huesos del Pie/patología , Huesos del Pie/cirugía , Marcha/fisiología , Talón/patología , Talón/cirugía , Hospitales Universitarios/estadística & datos numéricos , Humanos , Pierna/patología , Pierna/cirugía , Huesos de la Pierna/microbiología , Huesos de la Pierna/patología , Huesos de la Pierna/cirugía , Masculino , Persona de Mediana Edad , Osteomielitis/complicaciones , Osteomielitis/microbiología , Osteomielitis/patología , Seudoartrosis/microbiología , Seudoartrosis/fisiopatología , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Recuperación de la Función , Estudios Retrospectivos , Piel/microbiología , Piel/patología , Resultado del Tratamiento , Cicatrización de Heridas , Adulto JovenRESUMEN
INTRODUCTION: Scrotal rejuvenation is a real male aesthetic demand. Scrotal injection of botulinum toxin makes the testicles smoother, less dangling and subjectively larger. METHODS: Intrascrotal botulinum toxin injections were performed to a 44-year-old patient for aesthetic purposes. We used the intracremasteric injection protocol. Cremaster muscle injections and dartos muscle injections were performed. RESULTS: The patient was satisfied. No adverse reaction to the intrascrotal botulinum toxin injection was observed. The patient wanted to repeat the procedure in the future. CONCLUSION: At the moment, there is no recommendation about the aesthetic use of intrascrotal injections of botulinum toxin A and the risks are unknown. The purpose of this article is to show the feasibility, context and technical modalities of intrascrotal injection. The risk of infertility is real, but marginal for men who no longer have progeny's desire. LEVEL OF EVIDENCE: Level 3.
