The posterior interosseus artery flap (piaf) in reconstructive surgery of the hand: strategies of use and medico-legal implications.

Background and aim: The fascio-cutaneous posterior interosseus artery flap (PIAF) is used in hand reconstruction, especially to repair skin or tissue defects such as burn injuries, open fractures, gunshot wounds or traumatic amputations. The aim of this study is to examine the anatomical features of this flap, to describe the surgical harvesting technique and the difficulties associated with the dissection. Methods: From January 2016 to January 2022, we performed PIAF in 10 patients (3 women and 7 men) with a mean age of 28 years (range 22-44). This flap is taken from the back of the forearm, between the extensor carpi ulnaris (ECU) muscle and the extensor digitorum common (EDC) muscle. Results: We analyzed retrospectively our patients indicating the failures of this reconstructive surgery, the complications that have arisen and the results using DASH score with the related clinical and medico-legal implications. Conclusions: Due to its location and structure, PIAF is one of the most versatile fascio-cutaneous flaps in upper limb reconstructive surgery and can be used to reconstruct parts of the hand, wrist, or elbow, allowing to restore limb function and improve the quality of life of patients even if there could be some medico-legal implications.

Bilateral femur fracture as the first manifestation of multiple myeloma: a case report.

Abstract: The authors aimed to elaborate on an interesting clinical case of a subject that came to our attention following a low-energy traumatic event, producing a bilateral femur fracture. During the instrumental investigations, findings pointing to multiple myeloma were described, in fact later confirmed by the histological and biochemical investigations. In this specific case, unlike manifestations in most patients with MM, the classic correlated pathognomonic symptoms, such as lower back pain, weight loss, recurrent infections, asthenia, were not present. Furthermore, the inflammatory indices, the values of serum calcium, renal function and hemoglobin were completely normal, although numerous bone localizations of disease already coexisted, and these were all unknown to the patient.

Orthoplastic surgery: the modern vision of reconstructive surgery in orthopedics.

Abstract: Orthopedic care often calls for the treatment of different trauma-affected tissues, such as nerve, skin, skeletal and soft tissues. Orthoplasty is designed to meet such a need, hence not only does it constitutes a therapeutic method but a real "therapeutic attitude" as well, for the ultimate purpose of dealing with highly complex and multifaceted injuries; by virtue of such features, orthoplasty needs to rely on a truly multidisciplinary and concerted effort, in order to effectively treat highly complex traumatic lesions while prioritizing both anatomical and functional restoration, while avoiding as much as possible demolition surgery, e.g. amputation. Ultimately, the authors point out the extent to which such a technique is valuable in terms of optimizing healthcare resources allocation as well, given that no specific costs to apply orthoplastic surgical interventions, and in light of shorter hospitalization times and operating room occupation.

Trapeziometacarpal arthrodesis.

Arthrodesis of the trapeziometacarpal (TMC) joint is one of the first surgical procedures used to treat thumb basal joint arthritis. From 1970 to 1990, we performed 254 TMC arthrodeses with crossed K-wires. From 2015 to 2016, we performed 12 TMC arthrodesis procedures with shape-memory staples. The results were evaluated with De La Caffinière's classification and took into account patient satisfaction and any complications. The results were satisfactory overall, without any significant difference between the two fixation methods but with a rather high complication rate. The indication for arthrodesis in surgical treatment of thumb basal joint arthritis is based on the patient's age and occupation. The best indication is a young active patient.

Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study.

PURPOSE: Unicompartmental knee arthroplasty (UKA) has shown a higher rate of revision compared with total knee arthroplasty. The success of UKA depends on prosthesis component alignment, fixation and soft tissue integrity. The tibial cut is the crucial surgical step. The hypothesis of the present study is that tibial component malalignment is correlated with its risk of loosening in UKA. METHODS: This study was performed in twenty-three patients undergoing primary cemented unicompartmental knee arthroplasties. Translations and rotations of the tibial component and the maximum total point motion (MTPM) were measured using radiostereometric analysis at 3, 6, 12 and 24 months. Standard radiological evaluations were also performed immediately before and after surgery. Varus/valgus and posterior slope of the tibial component and tibial-femoral axes were correlated with radiostereometric micro-motion. A survival analysis was also performed at an average of 5.9 years by contacting patients by phone. RESULTS: Varus alignment of the tibial component was significantly correlated with MTPM, anterior tibial sinking, varus rotation and anterior and medial translations from radiostereometry. The posterior slope of the tibial component was correlated with external rotation. The survival rate at an average of 5.9 years was 89%. The two patients who underwent revision presented a tibial component varus angle of 10° for both. CONCLUSIONS: There is correlation between varus orientation of the tibial component and MTPM from radiostereometry in unicompartmental knee arthroplasties. Particularly, a misalignment in varus larger than 5° could lead to risk of loosening the tibial component. LEVEL OF EVIDENCE: Prognostic studies-retrospective study, Level II.

Lipoplastics of legs: our experience with a new cannula compared with classical technique.

The Authors compare the results obtained between two groups of patients suffering from leg lipodystrophy, who were subjected to a reducing lipoplasty. In the first group, surgeons made use of a new sort of cannula, deprived of the classical grip, whereas in the second group, they employed the traditional probe. The best results, achieved with the first group, prove this new operating system is really effective, particularly on legs, for the following reasons: (1) Higher precision and better control of the instrument (2) Swan-neck cannula abolition (3) Opportunity to operate with both hands (4) Halved operating time (5) No tiredness after the operation.

Radial forearm fasciocutaneous free flap as a solution in case of Noma.

The authors describe a case of Noma or Cancrum Oris, an oral gangrenous disease, features more frequently found in children from developing countries. The clinical features, its ethiopathogenesis, and its particular link with different geographic and economic areas of the world, its clinical evolution as well as surgical treatment are all discussed. Underlined is the functional and organic aspect of this disease, in particular the distortion of the face, which commonly involves the full thickness of the cheek skin and bone, mandibular ankylosis and craniofacial dismorphisms, and the modern approach in reconstructive microsurgery. The authors report a case of a patient affected by Noma, with a very evident left face dismorphism, where we found a brilliant solution using a left radial forearm fasciocutaneous free flap, appropriately shaped.

Liposculpture with ultrasound: biomedical considerations.

The authors, after a careful review of the scientific literature and on the basis of biophysical concepts with their own experience, conclude that high-intensity ultrasounds (US) are responsible for some biological lesions, which are partly unknown. US can cause burns and skin necrosis; thus, our employment of this technique must be correct, justified, and practiced very carefully and shrewdly and its advantages versus traditional liposuction must be reviewed.

Idiopathic tumoral calcinosis associated with congenital malformation of the hand. Case report.

The authors describe a case of tumoral calcinosis of the hand in a three-year-old child, involving the digits and carpus, and associated with ectrodactyly. The clinical features, diagnostic imaging procedures, particularly radiography and MRI, and therapeutic approach, in most cases radical excision, of this rare soft tissue tumour are discussed.

[Our experience in the treatment of intrathoracic and intraspinal hourglass neurogenic neoplasms]. / Nostra esperienza nel trattamento delle neoplasie neurogene a clessidra, intratoraciche ed intraspinali.

The authors describe their experience in the treatment of dumbbell neurogenic tumours, intrathoracic and intraspinal, with particular reference to clinical presentation, diagnostic for imaging, anatomo-pathological classification and surgical treatment, comparing their clinical cases (9) with the international literature, accurately reviewed. The authors think that the best surgical treatment is the combined approach, in only one stage, of thoracic surgeon and neurosurgeon by hemilaminectomy and extended costotrasversectomy, reserving hemilaminectomy and thoracotomy only for the tumours with big dimension of intrathoracic portion.