scholarly journals Inferior Gluteus Maximus Island Flap for Reconstruction of Ischial Pressure Sores

2017 ◽  
Vol 23 (1) ◽  
Author(s):  
Yawar Sajjad ◽  
Beenish Rahat ◽  
Salman Hameed
Keyword(s):  
Case Series ◽  
Gluteus Maximus ◽  
Wound Dehiscence ◽  
Island Flap ◽  
Wound Management ◽  
Medical Institute ◽  
High Recurrence Rate ◽  
Pressure Sores ◽  
Retrospective Case ◽  
Grade 3

<p>Surgical management of ischial pressure sores has always been a challenge due to high recurrence rate. Ischial pressure sores develop due to unrelieved pressure over the Ischium. Inferior gluteus maximus island flap has been used effectively for coverage of ischial pressure sores.</p><p><strong>Objective:</strong><strong>  </strong>To describe the efficacy of inferior gluteus maximus flap for reconstruction of ischial pressure sores.</p><p><strong>Methods:</strong><strong>  </strong>A retrospective case series, consisted of sample of 17 cases. The study was conducted in the Department of Plastic and Reconstructive Surgery, Post Graduate Medical Institute, Lahore General Hospital Lahore, over a period of 8 years from March 2008 to March 2016. The case series included17 patients with grade 3 and grade 4 ischial pressure sores, comprising 12 male and 5 female, with age range of 28 to 64 (mean = 46 years).Follow-up ranged from 1 to 4 years with a mean of 2.5 years. Inferior gluteus maximus island flap was used for reconstruction of Ischial pressure sores.</p><p><strong>Results:  </strong>In thirteen (76%) of the seventeen patients, wound healed uneventfully without any complication. Partial wound dehiscence was observed in 2 patients (12%). Both of these healed with conservative wound management. Recurrence was seen in 2 patients (12%) after 8 months. These two patients underwent <em>reoperation</em> and gluteus maximus flap was readvanced that resulted in satisfactory wound coverage.</p><p><strong>Conclusion:</strong>  Inferior gluteus maximus island flap can be considered as a reliable option for reconstruction of ischial pressure sores.</p>

Nivolumab for patients with recurrent glioblastoma progressing on bevacizumab: A retrospective case series.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13538-e13538
Author(s):  
Marc C. Chamberlain ◽  
Bryan T. Kim
Keyword(s):  
Unmet Need ◽  
Case Series ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Retrospective Case ◽  
Free Survival ◽  
Entire Cohort ◽  
First Recurrence ◽  
Grade 3 ◽  
Recurrent Gbm

e13538 Objective: A single institution retrospective evaluation of nivolumab following disease progression on bevacizumab in adults with recurrent glioblastoma (GBM) with an objective of determining progression free survival (PFS). Background: There is no accepted therapy for recurrent GBM after failure of bevacizumab. Methods: 16 adults, ages 52-72 years (median 62), with recurrent GBM were treated. All patients had previously been treated with surgery, concurrent radiotherapy and temozolomide, and post-radiotherapy temozolomide. Bevacizumab (with or without lomustine) was administered to all patients at first recurrence. Patients were treated with nivolumab only (3mg/kg) once every 2 weeks at second recurrence. One cycle of nivolumab was defined as 2 treatments. Neurological evaluation was performed bi-weekly and neuroradiographic assessment every 4 weeks. Results: A total of 37 treatment cycles (median 2) were administered of nivolumab in which there were 14 Grade 2 adverse events (AEs) and Grade 3 AEs in 2 patients. No Grade 4 or 5 AEs were seen. Following 1 month of nivolumab, 7 patients’ demonstrated progressive disease and discontinued therapy. No patient demonstrated a response though 9 patients demonstrated neuroradiographic stable response. Survival in the entire cohort ranged from 2 - 6 months with a median of 3.5 months (CI: 2.8, 4.2). Median and 6-month PFS at 6 months was 2.0 months (range 1-5 months; CI: 1.3, 2.7) and 0% respectively. Conclusions: Nivolumab salvage therapy demonstrated no survival advantage in patients with recurrent bevacizumab refractory GBM emphasizing a continued unmet need in neuro-oncology.

Primary acquired melanosis/melanoma: utility of conjunctival map biopsy

2020 ◽  
pp. bjophthalmol-2020-317772
Author(s):  
Hansell Soto ◽  
Randy C Bowen ◽  
Vishal Raval ◽  
Gabrielle Yeaney ◽  
Arun Singh
Keyword(s):  
Case Series ◽  
Treated Group ◽  
Low Grade ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Primary Acquired Melanosis ◽  
Diagnostic Biopsy ◽  
Severe Atypia ◽  
Grade 3

AimTo assess the role of map biopsy in patients with conjunctival primary acquired melanosis (PAM)/melanoma.MethodsRetrospective case series of 400 conjunctival biopsy samples of 51 unique patients in a tertiary referral centre.ResultsEach patient underwent one diagnostic biopsy and several additional map biopsies (range 2–7) providing a total of 400 samples for the analysis (55 diagnostic biopsies, 345 map biopsies). The median age was 63 years old (range 20–88) with women representing 67% of the cases. Histopathological findings were graded as negative for melanosis/normal (grade 0), melanosis without atypia (grade 1), melanosis with mild atypia (grade 2), melanosis with severe atypia (grade 3) or invasive melanoma (grade 4). Clinicopathologic concordance was observed in the majority of the map biopsies (313, 91%) (positive: clinical+/path+ (57,17%), negative: clinical−/path− (256, 74%)). Three discordant samples (clinical−/path+) represented PAM sine pigmento. The histopathological spectrum of atypia was absent (40, 73%) or limited (11, 20%) in the majority of cases with tendency to cluster as low-grade or high-grade atypia. Map biopsy led to the identification of six patients (11%) with severe atypia, requiring topical mitomycin (MMC). Similarly, in 29 cases, periodic observation without topical MMC was recommended. One case of invasive melanoma transformation occurred in the MMC-treated group.ConclusionsMap biopsy enhances overall assessment of the anatomic and pathologic extent, impacting use of adjuvant topical chemotherapy. In absence of map biopsy, it would be impossible to diagnose PAM sine pigmento. Additional corroborative work is needed to validate our observations.

scholarly journals A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nan Zhang ◽  
Xin Yu ◽  
Kai Zhang ◽  
Tongjun Liu
Keyword(s):  
Necrotizing Fasciitis ◽  
Case Series ◽  
Fournier’S Gangrene ◽  
Wound Management ◽  
Risk Indicator ◽  
Fournier's Gangrene ◽  
Retrospective Case ◽  
Female Ratio ◽  
Male Predominance ◽  
Lrinec Score

Abstract Background To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Methods We retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented. Results There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits. Conclusions Fournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

scholarly journals Gluteus maximus island flap for the repair of sacral pressure sores

Spinal Cord ◽  
1996 ◽  
Vol 34 (6) ◽  
pp. 346-350 ◽  
Author(s):  
Aditya Aggarwal ◽  
S S Sangwan ◽  
R C Siwach ◽  
K M Batra
Keyword(s):  
Gluteus Maximus ◽  
Island Flap ◽  
Pressure Sores

Tangentially Split Gluteus Maximus Myocutaneous Island Flap Based on Perforator Arteries for the Reconstruction of Pressure Sores

1999 ◽  
Vol 103 (7) ◽  
pp. 2071-2076 ◽  
Author(s):  
Cihat Nazmi Baran ◽  
Selim Çelebioğlu ◽  
Birol Civelek ◽  
Ömer Şensöz
Keyword(s):  
Gluteus Maximus ◽  
Island Flap ◽  
Pressure Sores ◽  
Perforator Arteries

scholarly journals A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region

2020 ◽  
Author(s):  
Nan Zhang ◽  
Xin Yu ◽  
Kai Zhang ◽  
Tongjun Liu
Keyword(s):  
Necrotizing Fasciitis ◽  
Case Series ◽  
Fournier’S Gangrene ◽  
Wound Management ◽  
Risk Indicator ◽  
Fournier's Gangrene ◽  
Retrospective Case ◽  
Female Ratio ◽  
Male Predominance ◽  
Lrinec Score

Abstract Background To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Methods We retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented.Results There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits.Conclusions Fournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

scholarly journals Early Weight-Bearing Does Not Compromise Postoperative Healing in Jones Fracture ORIF

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Leonardo V. M. Moraes ◽  
Stéfani C. Kelly ◽  
James R. Jones ◽  
Haley McKissack ◽  
Aaradhana J. Jha ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Weight Bearing ◽  
Case Series ◽  
Wound Dehiscence ◽  
Fracture Treatment ◽  
Retrospective Case ◽  
Early Weight Bearing ◽  
Non Union ◽  
Jones Fracture ◽  
Radiographic Union

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Several controversies persist regarding fracture treatment of the fifth metatarsal base. Due to its low blood supply, Jones fracture has an inherent difficulty of consolidation, and may devolop complications such as delayed union, non- union and refracture. Usually the Jones fracture treatment is done with extended period of non-weightbearing with either nonoperative or operative treatment. The surgery is indicated particularly in athletes or in the setting of nonunion or fracture displacement. The purpose of the present retrospective case series is to assess postoperative outcomes among patients who weight bear earlier than standard practice. Methods: We performed a retrospective analysis of the medical and radiographic records from patients who had undergone operative IM fixation of an acute isolated Jones fracture from May 2013 and August 2018. Patients were permitted to weight- bear as tolerated. Demographic information, such as age, gender, body mass index, the use of tobacco, presence of medical comorbidities, and the time of radiographic union were evaluated. Standardized radiographs at 2 weeks, 6 weeks, 3 months and 6 months after surgeries were chosen for evaluation. Radiographic union was defined as bridging in 2 of 3 (medial, lateral, plantar) cortices. Results: Twenty one patients were included for analysis. Of these, 14 had at least one comorbidity present at time of operation. Average BMI was 37.6, and average age was 44.8. One patient (4.8%) was lost to follow up, and therefore did not have radiographic results available for review at any appointment. At 6 weeks, 16 of 21 patients showed signs of radiographic healing; 8 were completely healed, and 8 were incomplete. One patient (4.8%) had nonunion, which was documented at 6 week, 3 month, and 6 month readings. None of the 21 patients experienced any other postoperative complications, including infection, wound dehiscence, sepsis, DVT, implant failure, or need for revision surgery. Conclusion: Patients who were subjected to early weight-bearing after fifth metatarsal Jones fracture surgery had satisfactory fusion rates with no additional postoperative complications, even despite having high average BMI and multiple comorbidities. We believe that patients can be treated with early weightbearing as tolerated after operative fixation of an acute Jones fracture, and achieve satisfactory outcomes comparable those associated with traditional postoperative protocols.

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