Subject(s)
Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/mortality , Fasciitis, Necrotizing/surgery , Upper Extremity/microbiology , Administration, Intravenous , Adult , Aged , Aged, 80 and over , Amputation, Surgical/methods , Amputation, Surgical/statistics & numerical data , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Debridement/methods , Debridement/statistics & numerical data , Ethnicity/statistics & numerical data , Fasciitis, Necrotizing/diagnosis , Humans , Middle Aged , Mortality/trends , New Zealand/epidemiology , Outcome Assessment, Health Care , Patient Satisfaction/statistics & numerical data , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/statistics & numerical data , Retrospective Studies , Streptococcus pyogenes/isolation & purification , Upper Extremity/pathologySubject(s)
Fingers , Myoepithelioma/diagnosis , Soft Tissue Neoplasms/diagnosis , Aged , Humans , MaleABSTRACT
Our aim was to compare two methods of treatment of ganglia on the volar aspect of the wrist (the open excision done through a longitudinal volar skin incision and the arthroscopic resection through two or three dorsal ports), to see if arthroscopy could reduce the risks of operating in this area and the time to healing. Twenty radiocarpal and five midcarpal volar ganglia were operated on by open approach and an equivalent group was treated by arthroscopy. Fifteen radiocarpal and five midcarpal ganglia were treated with good results in the open group and 18 radiocarpal and one midcarpal ganglia in the arthroscopic group (no visible or palpable ganglion, a full range of active wrist movement, grip strength equal to preoperatively, no pain, and a cosmetically acceptable scar). In the open group there were four injuries to a branch of the radial artery, two cases of partial stiffness of the wrist associated with a painful scar, one case of neuropraxia, and one recurrence (all of which were among the 20 radiocarpal ganglia). In the arthroscopic group there was one case of neuropraxia, one injury to a branch of the radial artery, and three recurrences (three of the complications were among the five midcarpal ganglia). The mean functional recovery time was equal to 15 (6) days in the open group and 6 (2) days in the arthroscopic group. The mean time lost from work was equal to 23 (11) days in the open group and 10 (5) days in the arthroscopic group. Our results suggest that arthroscopic resection is a reasonable alternative to open excision in treating radiocarpal volar ganglia because it has less postoperative morbidity and a better cosmetic result. Midcarpal volar ganglia, however, should still be treated by open operation.
Subject(s)
Arthroscopy , Synovial Cyst/surgery , Wrist Joint/surgery , Adolescent , Adult , Arthroscopy/methods , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: There are currently limited treatment options available to modify the appearance of scarring due to deliberate self-harm (DSH). The authors present two cases of Integra dermal matrix use for resurfacing scars due to past DSH. METHODS: By excising the scars and resurfacing with Integra, we present and describe a novel technique for treating the visible stigmata of previous DSH. RESULTS: No complications occurred, and patients noted improved appearance, skin quality and self-esteem following surgery. Both patients would recommend this treatment to others. CONCLUSIONS: Integra dermal matrix substitute may be used successfully to treat scarring from previous DSH.
Subject(s)
Chondroitin Sulfates/therapeutic use , Cicatrix/surgery , Collagen/therapeutic use , Self-Injurious Behavior/complications , Adult , Arm Injuries/complications , Cicatrix/etiology , Cicatrix/pathology , Female , Humans , Skin, Artificial , Treatment OutcomeABSTRACT
BACKGROUND: A 59-year-old man presented with a 4-day history of scrotal pain and swelling and the rapid development of moist, black, foul-smelling lesions on the scrotum and penis. As a liver-transplant recipient, he was immunosuppressed. He also had type 1 (insulin-dependent) diabetes and poor nutrition, which might have compromised immunity further. INVESTIGATIONS: Physical examination, blood and tissue cultures, full blood count, urea and electrolytes, liver function tests, coagulation profile, C-reactive protein, and examination under anesthesia. DIAGNOSIS: Fournier's gangrene originating from an infected cutaneous lesion in an immunocompromised patient. MANAGEMENT: Resuscitation and triple broad-spectrum antibiotics, urgent surgical debridement, serial examinations under anesthesia with further debridements, and split-skin grafting. Phallic reconstruction is planned.
Subject(s)
Fournier Gangrene , Fournier Gangrene/pathology , Fournier Gangrene/surgery , Humans , Male , Middle AgedABSTRACT
An application of the LeJour vertical mammaplasty skin pattern for skin-sparing mastectomy is presented. The approach provides adequate access for the mastectomy, axillary dissection, and immediate breast reconstruction. The technique is ideal for patients with large or ptotic breasts undergoing a simultaneous contralateral breast reduction or mastopexy. It is particularly suitable for autogenous tissue reconstruction. Its use in mastectomies for cancer and prophylactic subcutaneous mastectomies is described.
