Mcfaddensahl1820
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. 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. Rapamycin manufacturer 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.
Before a forensic addiction treatment can be ordered by the court according to sec. 64 of the German Criminal Code (StGB), a prognosis of success must be made and affirmed. In recent years, several studies have been devoted to the search for appropriate predictors of a "sufficiently concrete" prospect of success. Legal probation after release is the legally stipulated criterion for success in forensic addiction treatment.
As the second part of a two-part review on the determinants of success in forensic addiction treatment, this paper aims to provide an overview of the current evidence on predictors of legal probation after forensic addiction treatment and relates this to the evidence to the predictors of the discharge mode.
Based on systematic literature research, the results of eight empirical studies published between 2002-2019 were processed in depth and presented in an overview table.
Despite heterogeneous findings in detail, the presence of motivational, practical life and social resources, on tther the information base for experts could be improved, for example, through a probationary phase.
The limitations of the current state of research suggest a two-step approach for the preparation of a treatment prognosis first, the predictors of the discharge mode could be used to examine the question of the likelihood of success of a regular course of treatment; then, the predictors of legal probation could be used to examine whether any conclusions can be drawn on the relapse-preventive effect of forensic addiction treatment. Both parts of the review can thus support forensic psychiatric experts in making a reliable prognosis of treatment prospects. In addition, consideration should be given to whether the information base for experts could be improved, for example, through a probationary phase.
Soft tissue reconstructions of the hand require a thin and resistant flap palmarly as well as sliding abilities between the extensor tendons and the flap on the dorsum of the hand. Elasticity is required to maintain the normal wrist range of motion. One option in these cases is the free serratus fascia flap that sometimes shows limitations regarding resistance as well as reliability. Here, we describe an easy modification including a thin muscle cuff in the serratus fascia flap - the serratus carpaccio flap - that improves the ease of flap harvest and morbidity rates.
The indications for the serratus carpaccio flap, the technique of flap harvest and contouring as well as flap inset are described in detail. Clinical examples are given.
The main advantage of the serratus carpaccio flap is the ability of the surgeon to adapt the flap thickness to the recipient site requirements. This allows excellent results regarding contour and function. Split thickness skin grafting fromthe instep region of the foot additionally allows optimal results for palmar as well as plantar defect reconstruction. Eighteen flaps for soft tissue defects of the hand (n = 5), foot (n = 10), and lower leg (n = 3) were performed. Complications included one flap loss, one venous re-anastomosis, two partial wound dehiscences and one postoperative hematoma at the donor site. Seventeen flaps survived completely. Secondary thinning procedures were not required.
The serratus carpaccio flap is an excellent option for the reconstruction of medium-sized skin and soft tissue defects of the dorsum of the hand or foot, the palm, and the distal forearm.
The serratus carpaccio flap is an excellent option for the reconstruction of medium-sized skin and soft tissue defects of the dorsum of the hand or foot, the palm, and the distal forearm.It is unknown if birthing people in same-sex relationships have different perinatal outcomes than people in different-sex relationships, despite differences in risk factors such as use assisted reproductive technologies, obesity, smoking, and poor mental health. Marriage equality has established birth certificates as a promising new source of population-based data on births to same-sex married parents. We used birth certificate data from Massachusetts for 201,873 singleton births to married parents from 2012 to 2016. We estimated the association between several birth outcomes and having a birth parent in a same-sex marriage, using a propensity-score matched and unmatched sample. We also tested whether these associations were modified by use of assisted reproductive technologies. Birthing people in same-sex marriages had similar perinatal outcomes related to decreased fetal growth and preterm birth compared to their peers in different-sex marriages. Use of assisted reproductive technology was associated with decreased fetal growth and increased risk of preterm birth for infants with different-sex parents, but not for infants with same-sex parents.
