A case of sub-acute compartment syndrome of bilateral pectoralis major, deltoid and triceps muscles

A 19-year-old healthy bodybuilder presented to the emergency department with gradually worsening pain in both his upper arms and shoulders and inability to fully flex his elbows. The haematological investigations revealed a markedly raised Creatinine Kinase (74,400 U/L) and myoglobinuria. The patient required an emergency surgical decompression of the pectoral and the anterior and posterior compartments of arms of both upper limbs with secondary closure after 48 h. The patient had an uneventful post-op and recovery of his functions with some initial restriction of full flexion of his left elbow and some weakness in his triceps, all of which gradually improved.

Surgical management of Encapsulating Peritoneal Sclerosis (EPS) in children: international case series and literature review

Background Encapsulating Peritoneal Sclerosis (EPS) is a rare phenomenon in paediatric patients with kidney failure treated with peritoneal dialysis (PD). This study highlights clinical challenges in the management of EPS, with particular emphasis on peri-operative considerations and surgical technique. Methods Retrospective analysis of all paediatric patients with EPS treated at the Manchester Centre for Transplantation. Results Four patients were included with a median duration of 78 months on PD. All patients had recurrent peritonitis (> 3 episodes), and all had symptoms within three months of a change of dialysis modality from PD to haemodialysis or transplant. In Manchester, care was delivered by a multi-disciplinary team, including surgeons delivering the adult EPS surgical service with a particular focus on nutritional optimisation, sepsis control, and wound management. The surgery involved laparotomy, lavage, and enterolysis of the small bowel + / − stoma formation, depending on intra-abdominal contamination. Two patients had a formal stoma, which were reversed at three and six months, respectively. Two patients underwent primary closure of the abdomen, whereas two patients had re-look procedures at 48 h with secondary closure. One patient had a post-operative wound infection, which was managed medically. One patient’s stoma became detached, leading to an intra-abdominal collection requiring re-laparotomy. The median length of stay was 25 days, and patients were discharged once enteral feeding was established. All patients remained free of recurrence with normal gut function and currently two out of four have functioning transplants. Conclusions This series demonstrates 100% survival and parenteral feed independence following EPS surgery. Post-operative morbidity was common; however, with individualised experience-based decision-making and relevant additional interventions, patients made full recoveries. Health and development post-surgery continued, allowing the potential for transplantation. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

A NOVEL TECHNIQUE FOR POST IMPLANT DIFFICULT SKIN CLOSURE

The management of grossly displaced fractures sometimes needs immediate reduction to relieve pressure on neurovascular structures and simultaneous stabilization with plates & screws. Surgeons frequently encounter difculty in the nal stage of surgery which is skin closure due to signicant swelling. Delayed secondary closure increases the risk of exposing the fracture site & implant to infection. Also counselling relatives postop for second surgery and for additional expenditure is difcult. Here we present our experience of managing difcult closures using multiple tension relieving small skin incisions to relieve compartmental pressure and catostrophic wound complications. Here we have shown an example of difcult closure on a complex displaced distal radius fracture post xation.

Potential Abuse of Negative Pressure Wound Therapy (NPWT)

NPWT is a promising adjunct in the treatment of surgical and non-surgical wounds. These include wounds due to trauma, pressure ulcers, chronic venous or arterial ulcers, radiation-induced wounds, burns, neuropathic wounds, necrotic wounds, high output lymph or serous fluid producing wounds. NPWT can easily become a method of treatment in the absence of other effective modalities which may be costly and only postpone an inevitable debridement or secondary closure. It may become a “lazy” way of treating wounds.

Limberg Flap is a Safe and Effective Procedure for the Surgical Treatment of Pilonidal Sinus in Sacrococcygeal Region

Pilonidal sinus in the sacrococcygeal region is an acquired condition and usually seen in young male adults. Diagnosis is indicated by to see the site and appearance of chronic discharging opening, and identification of midline pit in the natal cleft. The management of the sacrococcygeal pilonidal sinus varies from clipping of hairs with good hygiene of the area, wide excision of the area with primary or secondary closure and newer flap procedures, but none is widely accepted. The main concern for the treatment to the patient is the recurrence. This prospective study has been performed to determine the effectiveness and safety of the Limberg flap procedure for sacrococcygeal pilonidal sinus for new and recurrent cases. Primary end point was rate of recurrence and secondary end points were its complianceand complications such as wound infection, postoperative pain and return to work. A total of 17 patients were operated from March 2012 to June 2016.Both primary and recurrent diseases were included. All patients successfully underwent surgery. Patients complained very minimal postoperative pain. LO were average 2 days. All patients were discharged with negative suction drain in situ. Drains were removed on 7th POD and stitches were removed on 9th to 12th postoperative day. All patients returned to work after 2nd weeks. In our study no recurrence or major complications were found. Limberg flap for sacrococcygeal pilonidal sinus was found very useful and effective in terms of recurrence rate and patients morbidity. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 6-8

Surgical treatment of Fournier’s Gangrene: debridement and coverage. Series of 7 cases

Introduction: Fournier’s disease is a type of necrotizing fasciitis, which is quickly progressive and involves mainly the testicular, perineal and perianal areas. Its etiology is polymicrobial, being associated to multiple risk factors.Due to its complexity, its treatment comprises antibiotic therapy, as well as two surgical steps, including the first one various surgical interventions, which consist in aggressive debridement of the nonviable tissue, and a second step, in which the coverage of the resulting defect is undertaken, for which multiple surgical techniques are available, although it has not been clarified which one should be indicated. Objectives: To find out which surgical techniques are used for coverage in Fournier’s disease and the length of the hospital stay that each one associates, as well as the characteristics of the patients with this disease. Material and methods. We selected all the patients whose diagnosis was Gangrene Fournier when discharged form hospital, who also underwent surgical coverage of the resulting defect in the Department of Plastic and Reconstructive Surgery in Hospital Reina Sofía of Córdoba, Spain. From these patients, we recollected data about the coverage surgical technique undertaken, length of the hospital stay, demographic characteristics of the patients, associated risk factors, possible precipitating factors, as well as anatomical affected areas. Subsequently, absolute and relative frequencies were calculated. Results. Most patients were middle-advanced aged males. The perineal area was the most common affected one. The most usual risk factors were hypertension and smoking. The split-thickness skin graft was the coverage technique most frequently used. Conclusions. Fournier’s disease is potentially severe illness which requires a multidisciplinary approach, involving multiple surgical operations, as well as a long hospital stay. The coverage surgery presents high heterogeneity, being primary closure, secondary closure, split-thickness skin graft and fascio/musculocutaneous flap considered among the surgical techniques available.