RESUMO
Proximal interphalangeal joint (PIPJ) fractures are a treatment challenge for hand surgeons. Poor treatment options may lead to stiffness, non-union and markedly reduced range of movement (ROM). We describe our experience using the Hoffman-2 micro static external fixation device (Stryker) in a case series of ten patients with closed comminuted intra-articular PIPJ fractures. The use of this device in the management of these fractures has not previously been described. The mean total active motion (TAM) of the injured joint had recovered to 80% of normal at the six-month follow up.
Assuntos
Traumatismos dos Dedos/cirurgia , Articulações dos Dedos , Fixação de Fratura/métodos , Fraturas Cominutivas/cirurgia , Fraturas Intra-Articulares/cirurgia , Adulto , Feminino , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Fraturas Cominutivas/diagnóstico por imagem , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Adulto JovemAssuntos
Acidentes de Trabalho , Traumatismos dos Dedos/etiologia , Traumatismos dos Tendões/etiologia , Ferimentos não Penetrantes/etiologia , Traumatismos dos Dedos/diagnóstico , Traumatismos dos Dedos/reabilitação , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Ruptura , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/reabilitação , Ultrassonografia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/reabilitaçãoRESUMO
BACKGROUND: Cutaneous sebaceous carcinoma (SC) is a rare malignancy derived from adnexal epithelium of sebaceous glands. Periorbital SC is approximately three times more common than extraorbital SC. To date, there are few data from an Australian source to document the prevalence or clinical outcome of this tumour. METHODS: A retrospective review was undertaken of the cases from the Institute of Clinical Pathology and Medical Research using their histopathology database for patients with a diagnosis of SC. Patients were identified over a period of 34 years from 1971-2005 and their management and follow up are reported. RESULTS: There were 25 patients in all. Seventeen were men and eight were women. Of the 25 cases, 12 were extraorbital and 13 were periorbital. Three metastases and one tumour showed extensive local invasion. There were nine cases of incomplete excisions and 13 patients were reoperated on for either incomplete excisions, to obtain a wider margin or for local recurrences. Adjuvant radiotherapy was used on five patients, three of whom had lymph node deposits. CONCLUSION: Sebaceous carcinoma is a rare tumour. Extraorbital SC is an aggressive and invasive malignancy. Excision margins may need to be wider than previously thought. Exposure to ultraviolet radiation (sunlight) may play a role in the aetiology. Wide excision and selective use of radiotherapy remain the treatment of choice.
Assuntos
Adenocarcinoma Sebáceo/patologia , Adenocarcinoma Sebáceo/terapia , Recidiva Local de Neoplasia/patologia , Neoplasias das Glândulas Sebáceas/patologia , Neoplasias das Glândulas Sebáceas/terapia , Adenocarcinoma Sebáceo/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Radioterapia Adjuvante , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Neoplasias das Glândulas Sebáceas/epidemiologia , Distribuição por Sexo , Procedimentos Cirúrgicos Operatórios/métodos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
An "off the shelf" vascular conduit for free flap surgery that remained patent until the flap is vascularized from the recipient bed would be useful to avoid autograft donor-site morbidity and reduce operation time. To date, no successful studies of microvascular prostheses in low-flow states exist. This study investigated the effects of L-arginine on neointimal hyperplasia and the overall patency of cold-stored femoral arterial allografts implanted into a low-flow arterial defect model in rabbits. A cutaneous island flap based on the inferior epigastric artery was raised, and the femoral artery was ligated distally. Immediately proximal to the inferior epigastric artery, the femoral artery was divided and a 1-cm long cold-stored femoral arterial allograft was inserted into the defect. Half of the animals received L-arginine as a subcutaneous injection. When harvested at 4 weeks, 9 out of 11 allografts of the L-arginine-treated group and 8 out of 14 grafts of the control group were patent. Intimal thickening and graft stenosis were significantly reduced in the L-arginine group. Our findings reveal the potential of a combined approach of an arterial allograft and the use of L-arginine as a short-term vein graft substitute.