Evaluation of the Suprafascial Thin ALT Flap in Foot and Ankle Reconstruction

Background Distal lower extremity reconstruction can be challenging in terms of flap design. Bulky flaps result in limited mobility accompanied with the need of customized footwear. Raising the ALT-flap in a superficial fascial plane (thin ALT-flap) can be beneficial. This study evaluates thin ALT-flaps for lower distal extremity reconstruction. Methods In a retrospective study, patients that underwent microvascular extremity reconstruction at the level of the ankle and dorsal foot at the University of Freiburg from 2008–2018 were reviewed. Results 95 patients could be included in the study (35 perforator flaps, 8 fascia flaps and 54 muscle flaps).Among the perforator flaps, 21 ALT-flaps were elevated conventionally and 14 in the superficial fascial plane (thin ALT-flap). Among the conventional ALT-flaps, there was one flap loss (5%) and one successful revision (5%). 5(24%) flaps received secondary thinning. 57%(n = 12) were able to wear conventional footwear. There were 2(15%) successful revisions of thin ALT-flaps. 100% of thin ALT-flaps survived and 85%(n = 11) of the patients wore ordinary footwear after defect coverage.Among fascial flaps, 50%(n = 4) had to be revised with 2(25%) complete and 1 (13%) partial flap loss. All patients achieved mobility in ordinary shoes (n = 8).In muscle flaps, there were 7(13%) revisions and 5(9%) flap losses. 5(9%) flaps received secondary thinning. Only 33%(n = 18) were mobile in ordinary footwear. Conclusion The thin ALT-flap is a save one-stage evolution for lower distal extremity reconstruction with a favorable flap survival rate. Compared with conventional ALT-flaps it might be beneficial in reducing the need for expensive custom fitted shoes and secondary thinning procedures.

Gross anatomical studies on the femur, tibio-tarsus and fibula of emu (Dromaius novaehollandiae)

The study was conducted on three adult emu birds of 2-3 years of age. The femur was a relatively short, but thickbone, measuring about 23±0.43 cm in length.The fovea capitiswas absent.The large trochanter major was at the same level as the head.A large pneumatic foramen was present on the caudal surface of the femur, medioventrally to the trochanter major. Distal extremity of femur showed a trochlea anteriorly and two condyles posteriorly.The tibio-tarsus waslongest and formed by the fusion of the tibia and proximal row of tarsalbones.The average length was 43±0.68 cm, was almost twice as long as the femur.The cranial part of the proximal end was greatly expanded which formed a large ridge, the proximal end of which was divided to form lateraland medial cranial ridges.The distal end showed lateral and medial condyles cranially and a trochlea with symmetrical ridges caudally. The fibula was shorter than the tibia, measuring about 29±0.23 cm in length with a prominent head.

AYURVEDIC MANAGEMENT OF SYSTEMIC SCLEROSIS - A SINGLE CASE STUDY

Systemic sclerosis (SSc) is a multisystem autoimmune disorder caused by unknown factors. Which results in fibrosis of the skin, blood vessels, and visceral organs, including the gastrointestinal tract, lungs, heart, and kidneys. One among subset is referred to as diffuse cutaneous scleroderma and characterized by the rapid development of symmetric skin thickening of proximal and distal extremity, face, and trunk. When it affects on musculoskeletal system, the synovium in patients with arthritis is similar to that seen in early rheumatoid arthritis and shows edema with infiltration of lymphocytes and plasma cells. A 35-year-old house wife with this diagnosis came to OPD, which is managed by the principle of Amavata (diseases of connective tissue in Ayurveda) line of treatment. Vaitarana basti and Valuka sweda has done for 7 days with oral medication Vaishwanara churna ½ teaspoon with first morsal of food for 3 times. The QOL (quality of life) has been improved with in 7 days of treatment.

Pediatric Complex Regional Pain Syndrome: Stellate Ganglion and Lumbar Sympathetic Blocks

Complex regional pain syndrome (CRPS) is a chronic, localized pain condition following an injury, typically affecting a distal extremity. Although the pathophysiology of CRPS is unclear, multiple mechanisms are implicated, including peripheral and central sensitization as well as sympathetically mediated pain. Peripheral nerve blockade can treat the somatic component of CRPS pain, while sympathetic blockade may alleviate pain that is sympathetically mediated. Signs and symptoms manifest as abnormal sensory, motor, vasomotor, and sudomotor changes that are disproportionate to the inciting event. Early recognition of the signs and symptoms, followed by rapid implementation of a multidisciplinary treatment approach—including physical therapy, psychotherapy, pharmacotherapy, and sympathetic nerve blocks, is a major factor in improving outcome and preventing treatment-resistant CRPS.

Fahr’s Syndrome: A Case Report

Context: Fahr’s syndrome is a clinical entity of primary or secondary causes characterized by neurological and/or psychiatric symptoms associated with abnormal calcifications in basal ganglia, cerebellum and cerebral cortex. Case report: G.M.A, female, 49 years-old, presented athetosis in the distal extremity of the right upper limb (RUL) in December 2020, without seeking for medical help. Known to be diabetic, hypertensive and with diastolic heart failure (HF), in February 2021 she presented decompensated HF associated with worsening of involuntary movements in the RUL. During investigation, abnormalities in serum levels of parathormone (PTH) and calcium were observed, in addition to bilateral calcifications in basal ganglia and thalamus in brain computed tomography (CT) without contrast. In March 2021, she was admitted to the University Hospital of the Federal University of Piauí, with maintenance of athetosis at the distal extremity of the RUL, in addition to oromandibular dyskinesia. Laboratory profile compatible with primary hypoparathyroidism and new brain CT without contrast with calcifications in basal ganglia and pulvinar of the thalamus, bilaterally, were confirmed. Intravenous calcium replacement and use of calcitriol were performed, with partial clinical improvement. Conclusions: Fahr’s syndrome is characterized by the presence of movement disorders (with highlights for parkinsonism and athetosis) and psychiatric symptoms (depression most commonly). Possible etiologies are primary (genetic) and secondary (mainly idiopathic or secondary hypoparathyroidism). Classic finding of symmetrical calcifications in base nuclei is seen on brain CT. Treatment is symptomatic and control of the underlying disease.

Hemodynamic Assay of Hind Limb in Multiple Animal Models

ABSTRACT Introduction Measuring hemodynamic characteristics of injured limbs is paramount to early identification of potentially damaging ischemic conditions, but can often prove difficult attributable to a multitude of factors. Here, we present an in vivo optical imaging technique to characterize pulsatile blood flow quality through the distal extremity in multiple animal models that replicate the signs of distal extremity ischemia. The purpose of this study is to examine the feasibility of the optical imaging technique and relevance to hemodynamic complications such as acute compartment syndrome (ACS) and nonobvious hemorrhage. Materials and Methods In one pig and six mice, three different methods were used to create ischemic conditions in the lower extremity, producing symptoms similar to what is observed in ACS. In each condition, perfusion to the distal extremity was measured with the hemodynamic detection device (HDD; Odin Technologies), an optical assessment tool for perfusion and blood flow quality. Results We observed a profound decrease in extremity perfusion immediately after onset of ischemia in all three models. In the porcine model, the HDD’s measurements demonstrated similar characteristic flow between the various measurement locations. After the tourniquet was applied, the HDD revealed a 95% decrease in normalized perfusion value (npv) while the intracompartmental pressure rose from 5 to 52 mmHg (a 47mmHg increase). After the tourniquet was removed during reperfusion, the normalized blood flow returned to baseline and the intracompartmental pressure dropped from 20 to 6 mmHg in less than 5 minutes. For each mouse, the HDD test leg demonstrated a measurement of 0.97 npv before femoral ligation and 0.05 npv after femoral ligation, an 89% decrease (P < .01) in flow. Pulsed-wave Doppler ultrasound (PWDU) measurements on the test leg had pre-ligation measurement of 0.84 npv and a post-ligation measurement of 0.001 npv, a 99% decrease. These PWDU measurements revealed almost complete stoppage of blood flow during ischemia, followed by a substantial increase after the femoral artery ligation was removed. Conclusions Here, we show that a novel, optics-based sensing system can be used to diagnose and assess ACS in animal models. This technology is comparable to other standards used to monitor ACS and nonobvious hemorrhage and may also be a plausible alternative to prolonged invasive monitoring of patients with sustained extremity trauma.

Correlation between functional and radiological outcome after surgical stabilization of volar Barton fracture with plating: a comparative study

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the functional and radiological outcomes after open reduction with internal fixation of volar Barton’s fracture of the wrist and compare their outcomes.</p><p class="abstract"><strong>Methods:</strong> Total of 30 cases of volar Barton fractures were operated by open reduction and internal fixation with plating. Mean follow up period was 6 months. Patients were assessed both radiological and functional outcome and compare between the two outcomes.<strong></strong></p><p class="abstract"><strong>Results:</strong> All fractures were healed in a mean period of 7 weeks (range 6-9 weeks). The mean disabilities of the arm, shoulder and hand (DASH) score was 13.21 points (range: 10.3 to 30), thus confirming the patient’s good functional capacity. The higher the DASH score was (i.e. the worse the functional result), the smaller were the flexion (p=0.01), pronation (p=0.03), supination (p&lt;0.0001) and radial deviation (p=0.005) of the wrist that underwent the surgical procedure after the fracture of the distal extremity of the radius. The radiological results were evaluated by modified Lidstrom criteria.</p><p class="abstract"><strong>Conclusions:</strong> The radiographic results did not influence the DASH score. There was no statistical relationship between the DASH score and the radial height or the volar tilt or the radial tilt of the distal extremity of the operated radius.</p>