Mccartypower0592
Function and cosmesis are crucial in upper extremity reconstruction. Yet, there persists a lack of outcome evaluations, particularly regarding differences between free flap types.
In a single-center retrospective analysis, outcomes were compared between patients with cutaneous or muscle free flaps for distal upper extremity reconstruction between 2008 and 2018. The Disabilities of Arm, Shoulder and Hand -Score, Michigan-Hand (MHQ), and Short Form 36 Health Survey (SF-36) Questionnaires were assessed, motor function was quantified, and self-reported measures of cosmesis were compared, including the Vancouver Scar-Scale (VSS), MHQ aesthetics-subscale (MAS), and Moscona's cosmetic validation-score (CVS).
One-hundred forty-one cases were identified, with a shift toward cutaneous flaps over the study period. Muscle flaps were used for larger defects (251 vs. 142 cm
,
= 0.008). Losses, thromboses, and donor-site complications were equally distributed. Partial necroses were more frequent in muscle flaps (11 vs. 1%,
= 0.015). Seventy patients with 53 cutaneous versus 17 muscle flaps were reexamined. There was no difference in the timing of flap coverage (after 16 vs. 15 days,
= 0.79), number of preceding (2 vs. 1.7,
= 0.95), or subsequent operations (19/53 vs. 5/17,
= 0.77). Patients with cutaneous flaps showed higher grip strength (25 vs. 17 kg,
= 0.046) and reported better hand function (MHQ 58 vs. 47,
= 0.044) and general health (SF-36 70 vs. 61,
= 0.040), as well as more favorable appearance (MAS 71 vs. 57,
= 0.044, CVS 77 vs. Cyclopamine 72,
= 0.048), and scar burden (VSS 0 vs. 3,
< 0.001).
Cutaneous flaps yielded better motor function, self-perceived cosmesis, patient satisfaction, and quality of life in our cohort of distal upper extremity reconstructions.
Cutaneous flaps yielded better motor function, self-perceived cosmesis, patient satisfaction, and quality of life in our cohort of distal upper extremity reconstructions.
Early detection of thrombotic events is of paramount importance for microsurgical procedures. Here, we present findings that underscore the value of rotational thromboelastometry (ROTEM) to aid in decision-making for pre- and postoperative anticoagulation, as well for patients with suspected hypercoagulability.
We prospectively collected pre- and postoperative ROTEM values on all free flap cases at the University of California, San Francisco, from 2015 to 2016. Patient age, body mass index, comorbidities, operative reports, risk factors, thrombotic complications, and outcomes were collected from electronic medical records. Two-sample
-tests were used to compare ROTEM values between cohorts. Modeling for sensitivity, specificity, and accuracy was done for threshold fibrinogen-to-platelet ratio (FPR).
Of 52 patients who underwent free-tissue transfer, 15 had a thrombotic event either intraoperatively or postoperatively that required revision of the vascular anastomosis. Eight patients were clinicallymproves catchment of thrombotic events and flap failure with acceptable sensitivity. Our results support the routine use of ROTEM for detecting hypercoagulability in patients who would potentially benefit from intervention to prevent thrombotic complications.
Replantation is the ideal treatment in traumatic scalp defects to provide immediate coverage with restoration of hair-bearing skin. However, data are limited to case reports and small case series. Comprehensive analysis of techniques and outcomes is not available. Our aim was to systematically analyze the available literature to better understand management and postoperative outcomes of patients undergoing scalp replantation.
A systematic review of the PubMed, Cochrane, and EBSCO databases was performed in October 2019. Search terms included "replantation," "replant," "revascularized," "revascularization," "avulsion," and "scalp." Only papers reporting microvascular replantation of completely avulsed scalps, including case reports, were included. Review articles, non-English language articles, articles discussing nonreplant coverage, incomplete scalp avulsions, and articles discussing delayed scalp replantation were excluded. Data extracted included demographics, percent of scalp affected, mechanism, opigh rates of success. And as a focal point of a patient's appearance, this is invaluable in restoration of a sense of normalcy.
Scalp replantations, while technically challenging, are the ideal treatment for scalp avulsions. Fortunately, these have high rates of success. And as a focal point of a patient's appearance, this is invaluable in restoration of a sense of normalcy.
Hop tests play an important role in the rehabilitation process after injuries. A comparison of the jumping distances of both extremities allows for an evaluation of the injured limb. In the conventional cross-over hop test for distance, the jump width (medial vs. lateral) that the athlete has to cross during the jump is not standardised and therefore highly variable. This affects the absolute jump length in each jump series.
Modifying the test may reduce the jump length variance between test series of an athlete as well as the test-dependent variations in the cross-over hop for distance.
N = 47 athletes from the German and French national Judo youth teams were included in the study (age 15.3 years ± 13-17). A modified version of the cross-over hop for distance was developed with a cross-over width of 50 cm and a fixed landing zone of 10 cm. The jump lengths of the conventional test and the modified test were documented. The change in jump length variations of the two sexes were compared.
The mean value of the coefficient of variation decreased significantly from 4.09 % to 2.83 % (p < 0.01) due to the test modification. This resulted in an absolute improvement in accuracy of 1.26 % and a relative improvement of 30.8 %. A comparison of the limb symmetry index between the conventional and the modified cross-over hop for distance revealed no significant differences.
The modified cross-over hop for distance showed a significantly lower variation in jump lengths compared with the conventional cross-over hop for distance. As a result, more accurate statements can be made regarding the patient's return-to-competition progress.
The modified cross-over hop for distance showed a significantly lower variation in jump lengths compared with the conventional cross-over hop for distance. As a result, more accurate statements can be made regarding the patient's return-to-competition progress.
