Doença falciforme: cuidado com pessoas com úlcera da perna nos serviços de atenção à saúde / Sickle cell disease: caring for people with leg ulcers in heal-thcare services / Enfermedad falciforme: cuidado de personas con úlcera de pierna en los servicios de atención a la salud

Objetivo: identificar o local e os cuidados diretos recebidos por pessoas com úlceras da perna por doença falciforme nos serviços de atenção à saúde. Método: estudo transversal, realizado em 11 centros, no período de agosto de 2019 a abril de 2020. Fizeram parte do estudo 72 pessoas com úlcera da perna ativa. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultado: apresentavam anemia falciforme 91,7% dos participantes, com mediana de três anos de existência da úlcera; 77,8% eram redicivantes; 40,3% compravam os insumos; 66,7% trocavam o próprio curativo no domicílio; 52,8% realizavam uma ou mais trocas diárias; 45,8% dos tratamentos foram prescritos pelo médico; 37,5% eram pomada (colagenase ou antibiótico); 89% não utilizavam compressão para o manejo do edema. Conclusão: a maioria dos participantes não estava inserida na Rede de Atenção à Saúde para o tratamento da úlcera, e não recebia assistência sistematizada e nem insumos apropriados.

Objective: to identify the location and direct care received by people with leg ulcers due to sickle cell disease in health care services. Method: a cross-sectional study carried out in 11 centers from August 2019 to April 2020. The study included 72 people with active leg ulcers. The study was approved by the Research Ethics Committee. Results: a total of 91.7% of the participants had sickle cell anemia, with a median of three years of ulcer existence; 77.8% were recurrent; 40.3% bought the supplies; 66.7% changed their own dressings at home; 52.8% did one or more changes a day; 45.8% of the treatments were prescribed by physician; 37.5% were ointments (collagenase or antibiotics); and 89% did not use compression to manage edema. Conclusion: most of the participants were not included in the Health Care Network for ulcer treatment and did not receive systematized care or appropriate supplies.

Objetivo: identificar el lugar y los cuidados directos recibidos por personas con úlceras de pierna por enfermedad falciforme en los servicios de atención a la salud. Método: estudio transversal, realizado en 11 centros, en el período de agosto de 2019 a abril de 2020. Participaron 72 personas con úlcera de pierna activa. El estudio fue aprobado por el Comité de Ética en Investigación. Resultado: presentaban anemia falciforme 91,7% de los participantes, con una mediana de tres años de existencia de la úlcera; 77,8% eran recidivantes; 40,3% compraban los insumos; 66,7% cambiaban su propio vendaje en el domicilio; 52,8% realizaban uno o más cambios diarios; 45,8% de los tratamientos fueron prescritos por el médico; 37,5% eran pomada (colagenasa o antibiótico); y 89% no utilizaban compresión para el manejo del edema. Conclusión: la mayoría de los participantes no estaba integrada en la Red de Atención a la Salud para el tratamiento de la úlcera, y no recibía asistencia sistematizada ni insumos apropiados.

Generative Models for Periodicity Detection in Noisy Signals.

We present the Gaussian Mixture Periodicity Detection Algorithm (GMPDA), a novel method for detecting periodicity in the binary time series of event onsets. The GMPDA addresses the periodicity detection problem by inferring parameters of a generative model. We introduce two models, the Clock Model and the Random Walk Model, which describe distinct periodic phenomena and provide a comprehensive generative framework. The GMPDA demonstrates robust performance in test cases involving single and multiple periodicities, as well as varying noise levels. Additionally, we evaluate the GMPDA on real-world data from recorded leg movements during sleep, where it successfully identifies expected periodicities despite high noise levels. The primary contributions of this paper include the development of two new models for generating periodic event behavior and the GMPDA, which exhibits high accuracy in detecting multiple periodicities even in noisy environments.

Follicular unit grafting in chronic ulcers: a valuable technique for integrated management

Abstract Chronic ulcers significantly affect the quality of life of patients and impose a high cost on the healthcare system. The therapeutic management should be comprehensive, taking into consideration the etiological diagnosis of the wound and the characteristics of the wound bed when deciding on a therapeutic proposal appropriate to the healing phase, correcting factors that delay healing. During the epithelialization phase, repair techniques with grafts are recommended to shorten re-epithelialization time, improve the quality of scar tissue, and achieve adequate pain management. Currently, due to the reported benefits of skin appendages, the technique of follicular unit auto-grafting obtained with a scalp punch is among the chosen strategies for wound repair. This is a minimally invasive, outpatient practice, whose technique has advantages over the donor site, patients recovery and well-being.

Production of highly soluble and immuno-reactive recombinant flagellin protein of Clostridium chauvoei.

OBJECTIVE: Flagellin protein, an integral component of flagella, provides motility to several bacterial species and also acts as a candidate antigen in diagnostics and subunit vaccines. The bulk production of flagellin with retention of all conformational epitopes using recombinant protein technology is of paramount importance in the development of pathogen-specific immuno-assays and vaccines. We describe the production of highly soluble and immuno-reactive rFliA(C) protein of Clostridium chauvoei, a causative agent of blackleg or black quarter (BQ) affecting cattle and small ruminants worldwide. The bacterium is known to possess peritrichous flagella that provide motility and also act as a virulence factor with high protective antigenicity. METHODS: Upon sequence and structural analysis, a partial fliA(C) gene from Clostridium chauvoei was cloned and the recombinant mature protein with N- and C- terminal truncation was over-expressed as a His-tagged fusion protein (∼25 kDa) in Escherichia coli. Subsequently, rFliA(C) protein was purified by single-step affinity chromatography and characterized for its immuno-reactivity in laboratory animals, Western blot, and indirect-ELISA format. RESULTS: rFliA(C) was highly soluble and was purified in high quantity and quality. rFliA(C) elicited antigen-specific conformational polyclonal antibodies in rabbit and guinea pig models, as well as anti-Clostridium chauvoei-specific antibodies being specifically detected in BQ-vaccinated and convalescent sera of bovines in Western blot and in indirect-ELISA format. Further, no cross reactivity was noted with antibodies against major bovine diseases (e.g., foot-and-mouth disease, IBR, LSDV, hemorrhagic septicaemia, brucellosis, and leptospirosis). CONCLUSION: The study indicated the production of conformational recombinant flagellin-rFliA(C)-antigen and its potential utility in development of diagnostics for detection of Clostridium chauvoei-specific antibodies in BQ-recovered and/or vaccinated animals.

Prevalence and Predictors of Leg Cramps in the Third Trimester of Pregnancy: A Cross-Sectional Study.

Objective: This study aimed to estimate the prevalence and determine predictors of leg cramps among pregnant women in their third trimester. Methods: A sample of pregnant women in their third trimester who routinely visited local clinics in Jordan was recruited. Participants completed a socio-demographic and clinical characteristics questionnaire, the numeric pain rating scale (NPRS) for leg cramp pain intensity, the Arabic version of the Pregnant Physical Activity Questionnaire (PPAQ), the Nordic Musculoskeletal Questionnaire (NMQ), Short Form Health Survey (SF-12), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). In addition, magnesium (Mg) and calcium (Ca) serum levels were examined. Logistic regression analyses were used to identify predictors of leg cramps occurrence. A linear regression model was used to investigate predictors of leg cramps pain intensity among pregnant women who reported leg cramps. Results: Two hundred and five (n=205) pregnant women completed the study. The estimated prevalence of leg cramps was 58%. Logistic regression results showed that not receiving assistance with housework (OR 0.46, p=0.025), progress in the number of gestational weeks (OR 1.10, p=0.021), the number of previous pregnancies (OR 1.21, p=0.049), having leg swelling (OR 2.28, p=0.019), and having gastrointestinal (GIT) problems (OR 2.12, P=0.046) were associated with a higher odds of leg cramps occurrence. In the subsample with pregnant women with leg cramps, linear regression results showed that pregnant women with high school education versus elementary school (ß=0.70, p=0.012), number of working hours (ß=0.11, p=0.010), using vitamins supplements (ß=-1.70, p=0.043), having diabetes after pregnancy (ß=1.05, p=0.036), having sciatica (ß=0.58, p=0.028), having hip pain (ß =-.33, p=0.029), and higher PSQI total score (ß=0.09, p=0.020) were the significant predictors of leg cramp pain intensity. Conclusion: Many health-related conditions, as well as work and home-related work characteristics, may be considered risk factors for the occurrence of leg cramps and increased leg cramps pain intensity in pregnancy.

Influence of Lead Knee Extension on Ball Velocity and Elbow Varus Torque in Professional and High School Baseball Pitchers.

Background: When the lead leg of a pitcher contacts the ground, the knee braces and then rapidly extends, initiating energy transfer to begin pelvis and trunk rotation. Purpose: To investigate the relationship of lead knee extension during the pitching delivery with peak lead knee extension velocity, ball velocity, and elbow varus torque in high school and professional pitchers. Study Design: Descriptive laboratory study. Methods: Data from 50 professional (PRO) and 50 high school (HS) pitcher groups were retrospectively analyzed. Pitchers threw 8 to 12 fastballs under 3-dimensional motion analysis (480 Hz). The groups were divided according to high or low lead knee extension: PRO-high (n = 18), PRO-low (n = 16), HS-high (n = 16), and HS-low (n = 17). Lead knee flexion, lead knee extension velocity, ball velocity, and elbow varus torque were analyzed between groups. Regression analyses were performed to quantify associations between lead knee extension and ball velocity and elbow varus torque for all pitchers. Results: At foot contact, all pitchers landed with similar knee flexion. PRO-high and HS-high pitchers had significantly greater lead knee extension through remaining pitching time points compared with the PRO-low and HS-low pitchers. PRO-high pitchers had faster ball velocity than PRO-low pitchers (39.8 ± 1.1 vs 39.3 ± 1.3 m/s, respectively), and HS-high pitchers had faster ball velocity than HS-low pitchers (34.1 ± 2.6 vs 31.2 ± 1.8 m/s, respectively) (P < .05). PRO-high pitchers had decreased elbow varus torque compared with PRO-low pitchers (85.3 ± 10.7 vs 95.4 ± 13.3 N·m, respectively); conversely, HS-high pitchers had greater elbow varus torque than HS-low pitchers (64.2 ± 14.7 vs 56.3 ± 12.2 N·m, respectively). For every 1° increase in lead knee extension, ball velocity increased by 0.47 m/s (P < .001) and elbow varus torque increased by 0.27 N·m (P = .025). Conclusion: Proper lead knee extension allowed efficient energy transfer through the kinetic chain to produce optimal ball velocity and minimize elbow varus torque in professional pitchers. Conversely, while proper lead knee extension improved ball velocity among high school pitchers, this did not minimize elbow varus torque. Clinical Relevance: Professional pitchers can extend their lead knee with minimal impact at the elbow. In high school pitchers, cognizance of proper full-body pitching mechanics remains a priority over increased velocity.

A technical tip for assessing leg length discrepancy in radiographs with windswept hips.

Restoration of equal leg lengths is essential when performing total hip arthroplasty. Pre-operatively, surgeons should assess leg length discrepancy (LLD) on plain radiographs to help adequately plan their operation. Often the hips are in a minor windswept position on radiographs and this can make assessing LLD unreliable. We have devised a simple method for assessing LLD on plain radiographs in patients with windswept hips.

Benefits of home-based foot neuromuscular electrical stimulation on self-reported function, leg pain and other leg symptoms among community-dwelling older adults: a sham-controlled randomised clinical trial.

INTRODUCTION: Lower leg pain and symptoms, and poor leg circulation are common in older adults. These can significantly affect their function and quality of life. Neuromuscular electrical stimulation (NMES) applied via the feet as 'foot NMES' activates the leg musculovenous pump. This study investigated the effects of foot NMES administered at home using Revitive® among community-dwelling older adults with lower leg pain and/or other lower leg symptoms such as cramps, or sensations of tired, aching, and heavy feeling legs. METHODS: A randomised placebo-controlled study with three groups (2 NMES, 1 Sham) and three assessments (baseline, week 8, week 12 follow-up) was carried out. Self-reported function using Canadian occupational performance measure (COPM), leg pain, overall leg symptoms score (heaviness, tiredness, aching, or cramps), and ankle blood flow were assessed. Analysis of covariance (ANCOVA) and logistic regression were used to compare the groups. Statistical significance was set at p < 0.05 (two-sided 5%). RESULTS: Out of 129 participants enrolled, 114 completed the study. The improvement in all outcomes were statistically significant for the NMES interventions compared to Sham at both week 8 (p < 0.01) and week 12 (p < 0.05). The improvement in COPM met the minimal clinically important difference (MCID) for the NMES interventions compared to Sham at both week 8 (p < 0.005) and week 12 (p < 0.05). Improvement in leg pain met MCID at week 8 compared to Sham (p < 0.05). Ankle blood flow increased approximately 3-fold during treatment compared to Sham. Compliance with the interventions was high and no device-related adverse events were reported. CONCLUSIONS: The home-based foot NMES is safe, and significantly improved self-reported function, leg pain and overall leg symptoms, and increased ankle blood flow compared to a Sham among older adults. TRIAL REGISTRATION: The trial was prospectively registered in ISRCTN on 17/06/2019 with registration number ISRCTN10576209. It can be accessed at https://www.isrctn.com/ISRCTN10576209 .

Total Hip Replacement and Femoral Nail Lengthening for Hip Dysplasia and Limb Length Discrepancy: A Literature Review.

Developmental dysplasia of the hip (DDH) is a serious condition resulting in inadequate acetabular development, distorted bone configuration, and substantially altered hip biomechanics. An extensive leg length discrepancy (LLD) is commonly encountered in such cases, making a total hip arthroplasty (THA) procedure extremely challenging. Although good results in terms of patients' satisfaction, implant survival rates and overall improved quality of life have been reported, complication rates are considerably higher than primary THA procedures performed for idiopathic osteoarthritis. Reconstructing a dysplastic hip arthrosis and equalizing a preexisting LLD is a technically demanding procedure that is associated with significant bone and soft tissue complications. Intramedullary lengthening through motorized nails has become increasingly popular to address difficult cases with extensive LLD following THA in recent years. However, limited data on femoral lengthening procedures implemented following THA are available considering complications, radiological results, and patient-reported outcomes following staged THA and subsequent femoral lengthening using a femoral magnetically-driven intramedullary lengthening nail. We performed a literature review of the past 10 years in PubMed using the terms neglected hip dislocation, DDH, THA, and intramedullary lengthening nail as keywords. A total amount of eight cases addressing LLD through a telescoping intramedullary nail following THA in DDH have been reported in recent literature. All eight patients underwent primary THA for DDH followed by the implantation of the intramedullary lengthening nail. The mean THA was lengthened by 28.9 mm (from 13.0 to 45.0). The mean time for nail implantation after THA was 11.1 months (from 3.5 to 21). The mean time for lengthening per day through the nail was 0.94 mm (from 0.65 to 1.0) from 26 days to 70 days, and the mean lengthening through the nail was 37.6 mm (from 24.0 to 70.0). Good union and consolidation rates were reported by the authors, while there were no complications. The intramedullary distraction osteogenesis method with a telescopic rod can be an effective method to manage leg length discrepancies while avoiding soft tissue complications in challenging cases of DDH.

Bird Leg Skin Lesions and Urbanization in a Neotropical Savanna City.

Urban sprawl threatens biodiversity and is responsible for significant changes in the species that live in these environments. Given the high cost of comprehensive surveillance, monitoring disease indirectly, such as detecting skin lesions in birds, may help us better understand the prevalence of diseases affecting wild populations. We assessed the frequency of leg skin lesions, as a proxy of disease presence, in 1,565 individuals of 25 species, along the urban matrix of a large Neotropical city, Brasília, Federal District, Brazil. We tested the hypothesis that there is an increase in the frequency of skin lesions in birds due to urban intensification. We observed an increasing trend in some bird species between the frequency of occurrence of lesions and the intensity of urbanization. Species with a higher number of captures had an increase in the percentage of lesions, indicating that the occurrence of lesions may be linked to higher population density or that detection of the effect occurs only when sample sizes are high and controlled among urbanization categories. Our study highlights how the intensity of urbanization may increase the risk of disease transmission for these species. Unfortunately, studies on this topic are scarce in Neotropical regions, despite the region's high biodiversity and urban expansion.

Treatment of bacterially contaminated lower extremity ulcers with a fatty acid-containing wound matrix: a case series.

OBJECTIVE: The aim was to evaluate the effectiveness of a marine omega fatty acid-containing multimodal wound matrix (MWM) in reducing bacterial contamination and supporting wound area reduction (WAR) in patients with hard-to-heal wounds of varying aetiologies. METHOD: A prospective, single-site, pilot case series of patients with hard-to-heal wounds. All wounds were considered non-healing prior to inclusion as they had failed to achieve at least 50% WAR after at least four weeks of standard of care (SoC) treatments. Patients were seen once weekly for wound assessments, matrix application and dressing changes. Baseline and weekly fluorescence images, standard wound images and wound measurements were obtained. RESULTS: A total of three patients, two with venous leg ulcers (VLUs) and one with a diabetic foot ulcer (DFU) were enrolled in this pilot study. The mean baseline wound age prior to study enrolment was 24 weeks, with a mean baseline wound size of 8.61cm2. The two VLUs went on to complete closure. The DFU displayed a total WAR of 53% by six weeks, when the patient was lost to follow-up due to a geographical relocation. The mean percentage area reduction of all wounds combined was 82% upon study completion. CONCLUSION: The use of MWM proved to be effective and safe in this patient cohort. The wounds included in this case series failed to enter a healing trajectory with SoC wound therapies. The MWM supported wound closure and reduced bacterial loads in this patient cohort.

[Modified pendulum osteotomy to correct severe tibial varus deformity]. / Modifizierte Pendelosteotomie zur Korrektur einer hochgradigen tibialen Varusdeformität.

OBJECTIVE: Correction of a severe tibial varus deformity near the knee joint with only a slight influence on leg length and patella height. INDICATIONS: Medial osteoarthritis and/or cartilage damage with a severe varus deformity > 10° with a medial proximal tibial angle (MPTA) < 80°. CONTRAINDICATIONS: Femoral varus deformity with lateral distal femoral angle > 91°, severe lateral cartilage damage, lateral osteoarthritis, lateral meniscus loss. SURGICAL TECHNIQUE: Skin incision of approx. 8-10 cm between the tibial tuberosity and the head of the fibula. Exploration of the peroneal nerve. Detachment of the extensors. Insertion of an obliquely ascending guidewire ending approximately 10 mm below the medial articular surface. Insertion of a second guidewire. This aims at the middle of the first wire (hemi wedge). Check the wire position under fluoroscopy. Osteotomy with an oscillating saw under cooling. Removal of the wedge and closure of the osteotomy. Percutaneous needling of the medial collateral ligament with a cannula to carefully lengthen the ligament. Check the correction result with a metal rod. Osteosynthesis with lateral angle-stable plate. POSTOPERATIVE MANAGEMENT: Partial weight-bearing with 10 kg for 6 weeks postoperatively, free range of motion. RESULTS: Reports from the literature show that good clinical results can be achieved with this procedure for severe tibial varus deformities. Postoperative leg length discrepancies are less common with this procedure than with laterally closing osteotomy.

The effects of six weeks of combined balance and plyometric training on postural control performance in elite badminton players: A pilot randomized, controlled study.

Background/Objectives: The athletic performance in badminton players largely depends on the capability of dynamic postural control to quickly restore balance when performing high-paced movements (e.g., frequent single-leg jumps). Our aim was to examine the effects of a novel intervention that combines balance training on an unstable surface and plyometric training on the performance of restoring balance after jumping, as well as related postural control in elite badminton players. Methods: Sixteen elite male badminton players were randomly allocated to either a combined balance and plyometric training group (CT, n = 8) or a plyometric training group (PT, n = 8). The CT group participated in a six-week training program, which included three training sessions per week. Each session comprised 40 min of plyometric exercises and 20 min of balance training. The PT group underwent plyometric training using the identical protocol as that of the CT group. All participants underwent identical technical training in badminton throughout the duration of the study. At baseline and immediately after the intervention, participants completed a single-leg jumping test. The capacity to restore balance was evaluated using the time to stabilization (TTS) after landing; and the related center of pressure (COP) fluctuations were also recorded. The effect of intervention was examined by two-way repeated-measures of ANOVA. Results: The primary two-way repeated-measures ANOVA models showed no significant interactions between group and time on either the time to stability in the dominant leg (D-TTS) or the time to stability in the non-dominant leg (N-TTS) (p > 0.70). Significant main effects of time, group, and their interactions on dominant legs of the anterior-posterior displacement difference (D-COPAP) (time: p = 0.001; group: p = 0.001; interaction: p = 0.014), non-dominant legs of the anterior-posterior displacement difference (N-COPAP) (time: p < 0.001; group: p = 0.003; interaction: p = 0.021) and non-dominant legs of the medial-lateral displacement difference (N-COPML) (time: p < 0.001; group: p < 0.001; interaction: p = 0.026), that is, compared to baseline of both groups and post PT, the COP metrics were significantly reduced after CT. Secondarily, within the CT and PT group, after the intervention, the N-TTS (CT: p = 0.001, post: 0.58 ± 0.87; PT: p = 0.03, post: 0.71 ± 0.11) was significantly decreased compared to baseline (CT pre: 0.76 ± 0.16; PT pre: 0.88 ± 0.13). Conclusion: This pilot study demonstrated that, compared to PT-only, the 6-week CT which combines balance training induced comparable improvements in the capacity to restoring balance after landing from a single-leg jump, and significantly improved the postural control performance as measured by COP metrics.

[Treatment of pediatric bone tumors around the knee]. / Behandlung kniegelenksnaher Knochentumoren im Wachstumsalter.

Primary bone tumors are rare but more frequently seen during childhood and with predilection for the distal femur and proximal tibia. Therapy of benign tumors-if indicated-includes surgical resection in most cases, whereas malignant bone tumors such as osteo- and Ewing's sarcomas are treated with chemotherapy, wide resection and/or radiation therapy (Ewing's sarcoma). The reconstruction of emerging bone defects is significantly influenced by surgeon-related preferences and tumor-associated factors, respectively. Double-barrel vascularized fibula grafts or extracorporeally irradiated autografts in combination with a free fibula transplant are preferred biological reconstruction techniques around the knee joint. In cases in which the knee joint cannot be preserved, reconstruction is performed using tumor endoprostheses, but potentially emerging leg length discrepancies after resection of a potent physis must be taken into account. In considerably young patients, rotationplasty might represent a viable option with promising functional results.

Temporal changes in postural control strategy through single-leg stance practice with active restriction of knee movement.

[Purpose] This study aimed to examine and verify temporal changes in lower limb joint action after 2 weeks of single-leg stance training under active restriction of knee movement. [Participants and Methods] The participants included 28 healthy adult females (mean age, 19.6 ± 1.0 years). A stabile meter was used to measure the center of pressure sway as an index of ankle joint action. In addition, a triaxial accelerometer was used to measure pelvic and knee sways as indices of hip and knee joint actions, respectively. We established two experimental groups: an active-restriction group and an unrestricted group. Measurements of lower limb joint actions were recorded thrice during single-leg stance exercises during the first session of practice, the third session 1 week later, and the sixth session 2 weeks later. [Results] Both groups exhibited shorter total trajectory lengths in sessions three and six than in the first session. The active restriction group showed less knee sway in later sessions, whereas the unrestricted group showed reduced pelvic sway in the third session. [Conclusion] Single-leg stance exercises with active restriction of knee movement may alter the strategy of lower limb joint action.

Versatility of the Peroneus Brevis Muscle Flap for Distal Leg, Ankle, and Foot Defects: A Comprehensive Review.

Soft tissue defects of the distal third of the leg are challenging and management with simple split thickness skin graft or conservative measures is often difficult. The peroneus brevis muscle flap is well described in the literature to cover such defects. The aim of our study was to review the different applications and potential complications of the peroneus brevis muscle flap. A comprehensive review of all existing evidence on the use of peroneus brevis muscle flaps for coverage of defects in the distal third of the leg in adult populations was performed. Two hundred forty-eight records were identified in the literature search, among which 15 met the PICOS (Patient, Intervention, Comparison, Outcome and Study design) criteria. All selected studies were retrospective. Overall, 222 patients who received peroneus brevis muscle flaps were analyzed. Indications for reconstruction were post-traumatic defects, infected wounds, and chronic wounds. The overall complication rate was 21% (46/222) with the most commonly reported complication being skin graft loss. We observed 2 cases of partial flap loss, 17 cases of skin graft loss, 2 cases of post-operative hematoma, 2 cases of recurrent infection, 12 cases of partial flap necrosis, 3 cases of skin graft necrosis, and 8 cases of delayed wound healing. Overall, 16 patients (7%) required revision surgery. No cases of donor site morbidity were described. The current review shows that the peroneus brevis muscle flap is a versatile and reliable option for the coverage of small to medium sized defects of the distal leg, ankle, and foot with low complication rates and donor site morbidity.

Multicenter survey about leg length discrepancy and total hip arthroplasty: postoperative management.

BACKGROUND: We created a Multicenter Survey for Italian orthopedics surgeons on how they approach leg length discrepancy when dealing with primary total hip arthroplasty. Aim of the study was to show how surgeons manage LLD and follow literature recommendations during clinical practice. METHODS: The Survey was composed of 25 questions divided in 4 sections: surgeon's profile, preoperative and intraoperative evaluation, postoperative management. In this paper, we report the absolute and relative frequencies of answers to section on "postoperative management." Then, regarding the treatment of residual LLD, we reported whether trauma surgeons and experts in replacement surgery had higher odds ratios for providing "literature-based" answers compared to orthopedics physicians. RESULTS: Only four questions received more than 70% agreement on one of the answers. The OR for giving the "literature-based" answer, taking OP as the reference group was 1.57 for TR and 1.72 for RS for 10 mm LLD at first follow-up (FU) and 1.23 TR and 1.32 RS when 20 mm. When 10 mm LLD at 3 months FU the OR was 0.88 TR and 1.15 RS. The OR for treatment of LLD after the first examination of a new patient was 2.16 TR and 1.85 RS. CONCLUSIONS: LLD is a debated topic with no definitive recommendations. Many decisions still depend on tradition. Treatment of LLD during clinical practice often differs from literature recommendations.

Treatment of lower limb telangiectasias with Nd: Yag 1064 nm laser with and without tumescent anesthesia - TTL technique.

INTRODUCTION: Transdermal laser is an option for varicous veins treatment, yet it may be painful. In this study, we will present a technique for performing tumescent anesthesia associated to transdermal laser (TTL) to reduce pain during treatment. OBJECTIVE: The study compares pain during treatment of telangiectasias in lower limb with and without tumescent anesthesia to offer a less painful procedure. METHODS: 50 CEAP C1 patients with bilateral telangiectasias on thighs underwent transdermal laser treatment, using tumescent anesthesia on one side and standard technique on the other. Pain was assessed via the Visual Analogue Scale. The outcomes were compared with Student's t-test. Significance was set at p < .05. RESULTS: Laser treatment without tumescent anesthesia resulted in a VAS pain score of 7.9, versus 0.0 with anesthesia, showing a significant statistical difference. CONCLUSION: Tumescent anesthesia and transdermal laser (TTL) is capable of reducing pain in laser treatment of telangiectasias and reticular veins.