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1.
Plast Reconstr Surg ; 151(2): 255e-266e, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36696321

RESUMO

BACKGROUND: Patients with Dupuytren contracture can receive a variety of surgical and nonsurgical treatments. The extent to which patients participate in the shared decision-making process is unclear. METHODS: An explanatory-sequential mixed-methods study was conducted. Participants completed the Nine-Item Shared Decision-Making Questionnaire and the brief Michigan Hand Outcomes Questionnaire before completing semi-structured interviews in which they described their experience with selecting treatment. RESULTS: Thirty participants [25 men (83%) and five women (17%); mean age, 69 years (range, 51 to 84 years)] received treatment for Dupuytren contracture (11 collagenase injection, six needle aponeurotomy, and 13 limited fasciectomy). Adjusted mean scores for the Shared Decision-Making Questionnaire and brief Michigan Hand Outcomes Questionnaire were 71 (SD 20) and 77 (SD 16), respectively, indicating a high degree of shared decision-making and satisfaction. Patients who received limited fasciectomy accepted invasiveness and prolonged recovery time because they believed it provided a long-term solution. Patients chose needle aponeurotomy and collagenase injection because the treatments were perceived as safer and more convenient and permitted rapid return to daily activities, which was particularly valued by patients who were employed or had bilateral contractures. CONCLUSIONS: Physicians should help patients choose a treatment that aligns with the patient's preferences for long-term versus short-term results, recovery period and postoperative rehabilitation, and risk of complications, because patients used this information to assist in their treatment selection. Areas of improvement for shared decision-making include equal presentation of all treatments and ensuring realistic patient expectations regarding the chronic and recurrent nature of Dupuytren contracture regardless of treatment received.


Assuntos
Contratura de Dupuytren , Procedimentos Ortopédicos , Masculino , Humanos , Feminino , Idoso , Contratura de Dupuytren/cirurgia , Colagenases , Procedimentos Ortopédicos/métodos , Fasciotomia/métodos , Injeções Intralesionais , Resultado do Tratamento
3.
Instr Course Lect ; 72: 567-576, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36534880

RESUMO

Dupuytren disease is associated with benign fibroproliferative changes to the palmar fascia of the hand sometimes resulting in progressive contractures of the fingers. The earliest descriptions of these contractures date back to the 18th century. Much has been learned about the condition since the clawing condition was first described; however, optimal treatment still poses significant challenges to modern-day surgeons. It is important to examine the treatment options for Dupuytren disease and highlight the current evidence, techniques, and cost considerations of open fasciectomy, needle aponeurotomy, and recently described minimally invasive treatment.


Assuntos
Contratura de Dupuytren , Procedimentos Ortopédicos , Humanos , Contratura de Dupuytren/cirurgia , Procedimentos Ortopédicos/métodos , Mãos/cirurgia , Fasciotomia/métodos , Resultado do Tratamento
4.
Cir. mayor ambul ; 27(1): 18-21, oct.- dic. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-212650

RESUMO

El bloqueo de tobillo ecoguiado resulta una técnica anestésica segura y eficaz en la cirugía de pie bajo régimen ambulatorio. Su principal ventaja respecto a otras técnicas regionales, como el bloqueo del nervio ciático, es la ausencia de bloqueo motor proximal al tobillo, permitiendo una deambulación precoz tras la cirugía. Se presenta el caso clínico de un paciente con síndrome de Ledderhose, en el cual se realiza fasciectomía plantar subtotal mediante bloqueo ecoguiado del pie en régimen ambulatorio (AU)


The ultrasound-guided ankle block is a safe and effective anesthetic technique for outpatient foot surgery. Its main advantage over other regional techniques such as sciatic nerve block is the absence of motor block proximal to the ankle, allowing early ambulation after surgery. We report a case of a patient with Ledderhose Syndrome, in which we perform subtotal plantar fasciectomy on an outpatient basis (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Ambulatórios , Fibromatose Plantar/cirurgia , Fasciotomia/métodos , Tornozelo/inervação , Tornozelo/cirurgia
5.
BMC Musculoskelet Disord ; 23(1): 939, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36307837

RESUMO

AIMS: Dupuytren's contracture (DC) is a chronic debilitating fibroproliferative disorder. Common treatment options include collagenase clostridium histolyticum injections (CI), percutaneous needle fasciotomy (NF) and limited fasciectomy (LF). Superiority of one specific treatment remains controversial. This study aims to assess the short-term efficacy and safety of CI, NF, and LF for the treatment of DC. METHODS: We included randomized controlled trials of CI compared with placebo, NF and LF for patients with DC. PubMed, Embase and the Cochrane Library were searched from inception to August 2021. Contracture reduction rates in treated joints (within 0-5° of full extension within 30 days), relative reduction in total passive extension deficit (TPED), occurrence of one or more adverse events and number of treatment-related adverse events per patient were the outcomes of interest. The Cochrane risk-of-bias tool was employed for quality assessment of the studies. A network meta-analysis was performed using MetaXL. RESULTS: Nine studies met our inclusion criteria (n = 903). Overall, risk bias was mixed and mostly low. Short term TPED reduction achieved with LF was superior compared to CI and NF. Although CI achieved greater TPED reduction compared to NF, it was associated with the highest risk of overall adverse effects. The analyzed data was limited to a maximum three-year follow-up period and therefore insufficient for long-term outcome evaluation. CONCLUSIONS: In DC, LF may be able to provide patients with severe disease, superior flexion contracture release postoperatively. CI is a valid treatment alternative to NF, however the higher risk of overall adverse effects must be considered. The quality-of-evidence is limited due to short-term follow-up periods and a lack of standardized definitions of complications and adverse events.


Assuntos
Contratura de Dupuytren , Luxações Articulares , Humanos , Colagenase Microbiana/efeitos adversos , Contratura de Dupuytren/tratamento farmacológico , Contratura de Dupuytren/cirurgia , Fasciotomia/efeitos adversos , Metanálise em Rede , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Injeções Intralesionais , Luxações Articulares/etiologia , Clostridium histolyticum
6.
Emerg Med Australas ; 34(6): 871-876, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36192364

RESUMO

Acute limb compartment syndrome (ALCS) is a surgical emergency that can have serious consequences unless promptly diagnosed and treated, which is particularly challenging when there is an unusual cause. This is a comprehensive review of reported causes of ALCS. From 1068 included articles, we found 299 discrete causes of ALCS including toxins, infections, endocrine pathology, haematological emergencies, malignancy and iatrogenic ALCS. Familiarity with this wide range of ALCS causes may assist in early diagnosis of this limb-threatening condition.


Assuntos
Síndromes Compartimentais , Fasciotomia , Humanos , Fasciotomia/efeitos adversos , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Doença Aguda
7.
Regen Med ; 17(12): 931-940, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36222008

RESUMO

Aim: The purpose of this study was to evaluate the clinical response to augmenting an ultrasound-guided percutaneous plantar fasciotomy (UGPF) with an amniotic membrane (AM) allograft injection. Design: Retrospective, single-center, matched, case-controlled study. Methods: Patients underwent either an UGPF (n = 15) or a combined UGPF and AM injection (n = 16). Results: The UGPF plus AM group demonstrated a significant reduction in pain (p = 0.02) from baseline at the short-term follow-up, but there was no significant difference in pain or patient satisfaction between groups at the 52-week follow-up. Conclusion: Both groups demonstrated a significant reduction in pain and high level of patient satisfaction, but the combination of UGPF with an AM injection may provide a greater reduction in pain earlier in the post-operative period.


Assuntos
Fasciíte Plantar , Humanos , Fasciíte Plantar/cirurgia , Fasciotomia , Estudos Retrospectivos , Âmnio , Dor , Aloenxertos , Ultrassonografia de Intervenção , Resultado do Tratamento
8.
Am J Emerg Med ; 62: 147.e5-147.e7, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36163064

RESUMO

Gluteal compartments can be difficult to assess for acute compartment syndrome (ACS) compared to other fascial compartments due to their anatomy and rarity of presentation. Point-of-care ultrasound (POCUS) needle guidance may assist in obtaining accurate compartment pressure measurements within the gluteal compartments. We present a case in which a 69-year-old woman presented following a fall resulting in a superior prosthetic hip dislocation. One-hour post hip-reduction, the patient began to experience severe pain of the right leg, swelling to the gluteal region, and numbness to her foot. With consideration of a developing gluteal compartment syndrome in mind, POCUS was used to guide the needle of a compartmental pressure monitor system into the gluteal maximus and medius-minimus compartments which demonstrated elevated compartment pressures consistent with ACS. The patient was subsequently taken for emergent fasciotomy and hematoma evacuation. There has been limited investigation into compartment pressure measurement under US guidance versus a palpation/landmark-guided technique. This case shows the feasibility of US needle guidance when assessing compartment pressures for this uncommon diagnosis.


Assuntos
Síndromes Compartimentais , Traumatismos da Perna , Humanos , Feminino , Idoso , Sistemas Automatizados de Assistência Junto ao Leito , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/cirurgia , Fasciotomia , Nádegas/diagnóstico por imagem
9.
PLoS One ; 17(9): e0274132, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36083984

RESUMO

BACKGROUND: Acute compartment syndrome (ACS) is a devastating complication which develops following a traumatic extremity injury that results in increased pressure within osteofascial compartments, thereby leading to ischemia, muscle and nerve necrosis, and creates a life-threatening condition if left untreated. Fasciotomy is the only available standard surgical intervention for ACS. Following fasciotomy the affected extremity is plagued by prolonged impairments in function. As such, an unmet clinical need exists for adjunct, non-surgical therapies which can facilitate accelerated functional recovery following ACS. Thus, the purpose of this systematic review was to examine the state of the literature for non-surgical interventions that aim to improve muscle contractile functional recovery of the affected limb following ACS. METHODS: English language manuscripts which evaluated non-surgical interventions for ACS, namely those which evaluated the function of the affected extremity, were identified as per PRISMA protocols via searches within three databases from inception to February 2022. Qualitative narrative data synthesis was performed including: study characteristics, type of interventions, quality, and outcomes. Risk of bias (RoB) was assessed using the Systematic Review Centre for Laboratory Animal Experimentation's (SYRCLE) RoB tool and reported level of evidence for each article. RESULTS: Upon review of all initially identified reports, 29 studies were found to be eligible and included. 23 distinct non-surgical interventions were found to facilitate improved muscle contractile function following ACS. Out of 29 studies, 15 studies which evaluated chemical and biological interventions, showed large effect sizes for muscle function improvement. CONCLUSIONS: This systematic review demonstrated that the majority of identified non-surgical interventions facilitated an improvement in muscle contractile function following pathological conditions of ACS.


Assuntos
Síndromes Compartimentais , Lesões dos Tecidos Moles , Síndromes Compartimentais/cirurgia , Extremidades , Fasciotomia/efeitos adversos , Fasciotomia/métodos , Humanos , Recuperação de Função Fisiológica
10.
Anesthesiol Clin ; 40(3): 491-509, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36049877

RESUMO

Acute compartment syndrome (ACS) is a potential orthopedic emergency that leads, without prompt diagnosis and immediate treatment with surgical fasciotomy, to permanent disability. The role of regional anesthesia (RA) for analgesia in patients at risk for ACS remains unjustifiably controversial. This critical review aims to improve the perception of the published literature to answer the question, whether RA techniques actually delay or may even help to hasten the diagnosis of ACS. According to literature, peripheral RA alone does not delay ACS diagnosis and surgical treatment. Only in 4 clinical cases, epidural analgesia was associated with delayed ACS diagnosis.


Assuntos
Anestesia por Condução , Síndromes Compartimentais , Anestesia Local , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/cirurgia , Extremidades , Fasciotomia/métodos , Humanos
11.
Sanid. mil ; 78(3): 172-177, septiembre 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-214637

RESUMO

Introducción: El síndrome compartimental agudo (SCA) es una complicación frecuente y potencialmente devastadora en las heridas de guerra que afectan a las extremidades, debido principalmente a las lesiones vasculares, óseas y de tejidos blandos frecuentemente asociadas, y a la dificultad para reevaluar a la baja durante su evacuación. El objetivo de esta revisión es analizar la evidencia científica disponible y actualizada sobre el manejo diagnóstico-terapéutico del SCA en la baja de combate.Material y métodos:Para la elaboración de este trabajo se ha realizado una búsqueda bibliográfica exhaustiva en las bases de datos: PubMed, Google Scholar, Scopus, ScienceDirect, Scielo y Latindex. Para la selección de artículos, se han establecido como criterios de inclusión que fueran realizados en entornos militares o sobre poblaciones de bajas de combate, escritos en castellano o inglés, y publicados durante los últimos quince años.Resultados y conclusiones:En el entorno operativo, el diagnóstico del SCA será fundamentalmente clínico y el tratamiento consistirá en una fasciotomía precoz y completa de todos los compartimentos del miembro afectado, ya que la fasciotomía tardía o incompleta se ha asociado con peores resultados y a un aumento de la morbimortalidad. La formación continuada en cirugía de guerra ha disminuido las tasas de fasciotomías de revisión. (AU)


Introduction: Acute compartment syndrome (ACS) is a frequent and potentially devastating complication of extremity war wounds, mainly due to the frequently associated vascular, bone and soft tissue injuries, and the limit close monitoring during casualty evacuation. The objective of this review is to analyze the available and updated scientific evidence on the diagnostic-therapeutic management of ACS in combat casualty.Material and Methods:For the preparation of this work, an exhaustive bibliographic search was carried out in the databases: PubMed, Google Scholar, Scopus, ScienceDirect, Scielo and Latindex. For the selection of articles, inclusion criteria have been established: carried out in military environments or on combat casualties populations, written in Spanish or English, and published during the last fifteen years.Results and Conclusions:In the combat zone, the diagnosis is even more heavily weighted toward clinical evaluation and the treatment will consist of a prompt and complete fasciotomy of all compartments of the affected limb, inasmuch as delayed or incomplete fasciotomy has been associated with worse outcomes and increased morbidity and mortality. Pre-deployment training of surgeons has decreased the rate of revision fasciotomies. (AU)


Assuntos
Humanos , Fasciotomia , Cirurgia Geral , Ortopedia , Procedimentos Cirúrgicos Operatórios
12.
Plast Reconstr Surg ; 150(5): 1033e-1036e, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-35998126

RESUMO

SUMMARY: Severe forms of Dupuytren disease are difficult to treat. Surgical fasciectomy is often the first choice, despite its high complication rate. At times, amputation is recommended. The authors evaluated the efficacy of minimally invasive needle fasciotomy (needle aponeurotomy) as the first and only treatment for severe (stage IV) Dupuytren contracture using a retrospective chart review of a single surgeon's consecutive experience over 8 years. A total of 204 rays from 165 patients with severe Dupuytren disease with total passive extension digit contracture of 135 degrees or greater were included in the study. Mean follow-up was 22.3 months. Standard goniometric measurements of finger joint contractures were taken before needle aponeurotomy and at follow-up visits. Total passive extension digit and flexion contracture improved significantly at each finger joint. Before the procedure, median flexion contractures were as follows: at the metacarpophalangeal joint, -70 degrees (interquartile range, -80 to -55); at the proximal interphalangeal joint, -75 degrees (interquartile range, -85 to -65); and at the distal interphalangeal joint, -5 degrees (interquartile range, -20 to 0); median total passive extension of digit was -145 degrees (interquartile range, -160 to -135). Flexion contractures after the procedure improved with 74 percent gain at the metacarpophalangeal joint, 32 percent gain at the proximal interphalangeal joint, and 46 percent gain at the distal interphalangeal joint, with 55 percent gain of total passive digit extension overall ( p < 0.001). The study shows that needle aponeurotomy led to significant improvements in joint contractures at all finger joints with minimal adverse effects. Needle aponeurotomy is an effective and safe first-line treatment for severe Dupuytren disease as the sole treatment or as a preliminary step for more invasive procedures if needed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Contratura de Dupuytren , Humanos , Contratura de Dupuytren/cirurgia , Estudos Retrospectivos , Anestesia Local , Resultado do Tratamento , Fasciotomia/métodos
13.
Dtsch Arztebl Int ; 119(17): 304, 2022 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-35912533
14.
J Am Acad Orthop Surg ; 30(18): 879-887, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36001887

RESUMO

Acute compartment syndrome is a surgical emergency in the extremities resulting from increased compartmental pressure, requiring immediate fasciotomy to resolve muscular compromise. As the mainstay treatment, fasciotomies involve substantial skin incisions and are thus prone to complications such as skin necrosis, wound infection, and permanent disability. Multidisciplinary care instituted at the time of fasciotomy can facilitate timely closure and minimize the complication profile. Several approaches are available to enhance outcomes of fasciotomy wounds, and a comprehensive knowledge of these options affords the treating surgeon greater flexibility and confidence in optimal management. Common techniques include early primary closure, gradual approximation, skin grafting, and negative pressure therapy. There is currently no consensus on the best method of closure. The purpose of this study was to review fasciotomy wound management from the time of initial release to final closure. Highlights include preparation for closing these wounds; the various techniques for fasciotomy closure, including adjunct options; evaluation of timing and staging; and injury-specific features, such as fracture management, limited subcutaneous tissues, and hand fasciotomies. Combining the perspectives of orthopaedic and plastic surgery, this review evaluates the benefits of multiple closure methods and highlights the importance of planning closure at the time of release.


Assuntos
Síndromes Compartimentais , Fasciotomia , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Extremidades/cirurgia , Fasciotomia/efeitos adversos , Humanos , Transplante de Pele/efeitos adversos , Transplante de Pele/métodos , Técnicas de Sutura
15.
Medicine (Baltimore) ; 101(33): e30107, 2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-35984117

RESUMO

In the surgical management of Dupuytren contracture (DC), Y-V plasty (YV) and Z-plasty (ZP) are techniques often used for skin extension. However, achieving sufficient skin extension with these procedures alone is often difficult. Therefore, we addressed this issue with an adjunctive digito-lateral flap (DLF) and report the clinical results of the surgery using a DLF in addition to YV and ZP. Fifteen patients with DC (15 affected fingers) underwent partial fasciectomy using a DLF in addition to YV or ZP, and early active finger extension training was performed immediately after the operation. The flap survival rate, preoperative and postoperative extension angle, Tonkin contracture improvement (TCI) rate, and Tubiana staging grades were evaluated. The contracture sites were at 4 proximal interphalangeal (PIP) and 3 metacarpophalangeal (MP) joints of the little finger and 4 PIP and MP joints each of the ring and little fingers. All the flaps survived, and the extension angle improved at the final observation from a preoperative mean of -45° to -3° and -55° to 5° for the PIP and MP joints, respectively. One patient with PIP joint contracture treated in the early stage of the study experienced a persistent 5° limitation of extension, even though the TCI rate was satisfactory (91.9%) and the outcome was "good." Full extension of the joints was achieved in 15 patients, in whom the TCI rate was 100% and the outcome was "very good." This technique was able to solve 3 important steps to achieve full extension: intraoperatively, wound closure, and rehabilitation. We attained and maintained long-term full extension intraoperatively and immediately after surgery and obtained very good treatment results, as shown in this study. In conclusion, highly favorable clinical outcomes were achieved through the combination of a DLF with YV and ZP. Skin extension with a DLF is a useful surgical technique for DC.


Assuntos
Contratura , Contratura de Dupuytren , Contratura de Dupuytren/cirurgia , Fasciotomia/métodos , Articulações dos Dedos/cirurgia , Dedos/cirurgia , Humanos , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento
16.
Surgery ; 172(5): 1569-1575, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35970609

RESUMO

BACKGROUND: Initially used in trauma management, delayed abdominal closure endeavors to decrease operative time during the index operation while still being lifesaving. Its use in emergency general surgery is increasing, but the data evaluating its outcome are sparse. We aimed to study the association between delayed abdominal closure, mortality, morbidity, and length of stay in an emergency surgery cohort. METHODS: The 2013 to 2017 American College of Surgeons National Surgical Quality Improvement Program database was examined for patients undergoing emergency laparotomy. The patients were classified by the timing of abdominal wall closure: delayed fascial closure versus immediate fascial closure. Propensity score matching was performed based on preoperative covariates, wound classification, and performance of bowel resection. The outcomes were then compared by univariable analysis. RESULTS: After matching, both the delayed fascial closure and immediate fascial closure groups consisted of 3,354 patients each. Median age was 65 years, and 52.6% were female. The delayed fascial closure group had a higher in-hospital mortality (35.3% vs 25.0%, P < .001), a higher 30-day mortality (38.6% vs 29.0%, P < .001), a higher proportion of acute kidney injury (9.5% vs 6.6%, P < .001), a lower proportion of postoperative sepsis (11.8% vs 15.6%, P < .001), and a lower proportion of surgical site infection (3.4% vs 7.0%, P < .001). CONCLUSION: Compared with immediate fascial closure, delayed fascial closure is associated with an increased mortality in the patients matched based on comorbidities and surgical site contamination. In emergency general surgery, delaying abdominal closure may not have the presumed overarching benefits, and its indications must be further defined in this population.


Assuntos
Traumatismos Abdominais , Técnicas de Fechamento de Ferimentos Abdominais , Traumatismos Abdominais/cirurgia , Idoso , Emergências , Fáscia , Fasciotomia , Feminino , Humanos , Laparotomia/efeitos adversos , Masculino , Estudos Retrospectivos
17.
Medicina UPB ; 41(2): 161-165, julio-diciembre 2022. ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1392158

RESUMO

Se describen las características sobre el phoneutrismo a propósito de un caso. El phoneutrismo es el término con el que se conoce al accidente ocasionado por la mordedura de la araña phoneutria spp, la cual tiene una relevancia clínica dada por las características tóxicas de su veneno. Se presenta un caso de mordedura de la araña phoneutria spp de un paciente atendido en un hospital de alta complejidad de la ciudad de Medellín, Colombia, con manifestaciones cardiovasculares y hallazgos compatibles con un síndrome compartimental, lo cual es inusual en este tipo de arañas, por lo que se necesitó vigilancia en unidad de alta dependencia y fasciotomía cutánea. En Colombia este tipo de accidentes no son de reporte obligatorio, por tanto existe un alto riesgo de subregistro. Lo llamativo de este caso está en las manifestaciones cardiovasculares y la presencia de síndrome compartimental que no se ha descrito en la literatura con este subespecie de arañas.


The characteristics of phoneutrism are described in relation to a case. Phoneutrism is the term with which the accident caused by the bite of the phoneutria spp spider is known, which has clinical relevance given by the toxic characteristics of its venom. We present a case of a bite by the phoneutria spp spider in a patient treated at a high-complexity hospital in the city of Medellín, Colombia, with cardiovascular manifestations and findings compatible with compartment syndrome, which is unusual in this type of spiders, and required surveillance in a high dependency unit and cutaneous fasciotomy. In Colombia reporting this type of accident is not mandatory; therefore, there is a high risk of underreporting. What is striking about this case is the cardiovascular manifestations and the presence of compartment syndrome that has not been described in the literatura with this genre of spiders.


As características do fonutrismo são descritas em um relatório de um caso. Fonutrismo é o termo usado para descrever o acidente causado pela mordida da aranha Phoneutria spp, que é clinicamente relevante devido às características tóxicas de seu veneno. Apresentamos um caso de mordida de aranha por uma aranha Phoneutria em um paciente tratado em um hospital de alta complexidade na cidade de Medellín, Colômbia, com manifestações cardiovasculares e achados compatíveis com a síndrome compartimental, o que é incomum neste tipo de aranha, exigindo vigilância em uma unidade de alta de-pendência e fasciotomia cutânea. Na Colômbia, este tipo de acidente não é obrigatório, portanto, há um alto risco de subnotificação. O que é impressionante neste caso são as manifestações cardiovasculares e a presença da síndrome compartimental, que não foi descrita na literatura com esta subespécie de aranha.


Assuntos
Humanos , Animais , Aranhas , Venenos , Peçonhas , Mordeduras e Picadas , Fasciotomia
18.
J Hand Surg Am ; 47(9): 834-842, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35868901

RESUMO

PURPOSE: To compare collagenase injection with surgical fasciectomy in Dupuytren disease (DD) for the prevalence of contracture in treated fingers 5 years after treatment. METHODS: This was a single-center, comparative cohort study comprising 2 cohorts of patients treated for DD in 1 or more of 3 ulnar fingers with collagenase injection (159 patients) or surgical fasciectomy (59 patients). At 5 years after treatment, 13 collagenase-treated and 8 fasciectomy-treated patients had undergone subsequent treatment on the treated fingers and were considered to have current contracture. Of the remaining patients, 112 collagenase-treated patients (128 hands, 180 fingers) and 46 fasciectomy-treated patients (49 hands, 63 fingers) attended follow-up evaluation performed by 2 independent examiners (participation rate 84% and 93%, respectively). We defined current contracture in a treated finger as an active extension deficit of ≥20° in the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint or a total (MCP + PIP) active extension deficit (TAED) of ≥30°. We used linear mixed models to analyze differences between the cohorts over time. RESULTS: In the collagenase cohort, current contracture was present in 45 (25%) MCP and 60 (33%) PIP joints, and in the fasciectomy cohort, current contracture was present in 12 MCP (19%) and 30 PIP (48%) joints; a TAED of ≥30° was present in 79 (44%) of the collagenase-treated and 30 (48%) of the fasciectomy-treated fingers. In MCP and PIP joints with ≥20° pretreatment contracture, complete correction was observed in 82 (56%) MCP and 30 (30%) PIP joints in the collagenase cohort and 23 (70%) MCP and 5 (16%) PIP joints in the fasciectomy cohort. There was no statistically significant difference between the 2 cohorts in the TAED change over time. CONCLUSIONS: In patients with DD, collagenase injection and surgical fasciectomy improved finger joint contracture over the pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Contratura de Dupuytren , Luxações Articulares , Estudos de Coortes , Colagenases/uso terapêutico , Contratura de Dupuytren/tratamento farmacológico , Contratura de Dupuytren/cirurgia , Fasciotomia , Articulações dos Dedos/cirurgia , Humanos , Colagenase Microbiana/uso terapêutico , Resultado do Tratamento
19.
Injury ; 53(10): 3481-3485, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35906118

RESUMO

BACKGROUND: The objective of this study was to identify demographic, injury-related, and treatment-related characteristics of patients who underwent decompressive fasciotomies for acute thigh compartment syndrome. METHODS: A cohort of 38 adult patients with acute thigh compartment syndrome treated with fasciotomy at two tertiary care referral centers over a 10-year time period from January 1, 2006 to June 30, 2015 were retrospectively identified. We searched the electronic medical record for patient-related variables (e.g., age, sex, race, smoking status, diabetes mellitus), injury-related variables (e.g., mechanism of injury, associated fractures, other traumatic injuries), treatment-related variables (e.g., delay to treatment, compartments released, number of debridements, use of split-thickness grafts), and outcomes (e.g., amputation, death, sensory/motor impairments at final follow-up). RESULTS: The mean age of our cohort was 47 years, and 35 patients (92%) were male. There were various mechanisms of injury, but the most common mechanisms were spontaneous hematoma (21%), followed by motor vehicle accidents (16%). Associated leg fractures were present in 15 (39%) patients. Delay between time of injury and fasciotomy was greater than 24 hours in 27 patients (71%), 12 to 24 hours in 6 patients (16%), and less than 6 hours in 3 patients (8%). The most frequently released compartment was the anterior compartment only (68%), followed by both the anterior and posterior compartments (16%) and the posterior compartment only (11%). Six patients (16%) had motor impairment, and 2 patients (5%) had sensory impairment at final follow-up. There were 2 deaths (5%) recorded in the hospital course for this cohort, none of which were directly related to compartment syndrome of the thigh. CONCLUSION: Delays to fasciotomy are frequent in the treatment of acute thigh compartment syndrome. The demographics of acute thigh compartment syndrome demonstrate a strong male predominance. Treating providers should recognize spontaneous hematoma and motor vehicle accidents as the most common causes of acute thigh compartment syndrome.


Assuntos
Síndromes Compartimentais , Coxa da Perna , Adulto , Síndromes Compartimentais/epidemiologia , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Demografia , Fasciotomia/efeitos adversos , Feminino , Hematoma , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coxa da Perna/lesões , Coxa da Perna/cirurgia
20.
Trials ; 23(1): 567, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35841003

RESUMO

BACKGROUND: An incision for total hip arthroplasty (THA) via the direct anterior approach (DAA) is generally made outside of the space between the sartorius and tensor fasciae latae muscles to prevent lateral femoral cutaneous nerve (LFCN) injury. Anatomical studies have revealed that the LFCN courses between the sartorius and tensor fasciae latae muscles. When the LFCN branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle, it is called the fan type. Studies suggest that damage to the fan type LFCN is unavoidable during conventional fasciotomy. We previously demonstrated that injury to non-fan variation LFCN occurred in 28.6% of patients who underwent THA by fasciotomy performed 2 cm away from the intermuscular space. This suggests that the conventional approach also poses a risk of LFCN injury to non-fan variation LFCN. LFCN injury is rarely reported in the anterolateral approach, which involves incision of fascia further away than the DAA. The purpose of this study is to investigate how the position of fasciotomy in DAA affects the risk of LFCN injury. METHODS: We will conduct a prospective, randomized, controlled study. All patients will be divided into a fan variation and a non-fan variation group using ultrasonography before surgery. Patients with non-fan variation LFCN will receive conventional fasciotomy and lateral fasciotomy in the order specified in the allocation table created in advance by our clinical trial center. The primary endpoint will be the presence of LFCN injury during an outpatient visit using a patient-based questionnaire. The secondary endpoints will be assessed based on patient-reported outcomes at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip-disease Evaluation Questionnaire, and the Forgotten-Joint Score-12. DISCUSSION: We hypothesize that the incidence of LFCN injury due to DAA-THA is reduced by making the incision further away from where it is typically made in conventional fasciotomy. If our hypothesis is confirmed, it will reduce the disadvantages of DAA and improve patient satisfaction. TRIAL REGISTRATION: UMIN Clinical Trials Registry, UMIN000035945 . Registered on 20 February, 2019.


Assuntos
Artroplastia de Quadril , Antivirais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Fasciotomia , Nervo Femoral/diagnóstico por imagem , Nervo Femoral/lesões , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Coxa da Perna/inervação
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