ABSTRACT
Given the appearance of a good number of cover flaps in recent decades, the Mac Gregor flap in its free form is used less and less but still finds its place today in certain complex cases with extensive loss of substance. This report describes an unusual case of wide tissue coverage by «all around¼ flap by Mac Gregor technique in a victim of an extensive burn of the left upper limb which occurred on 08/08/1997 and was responsible for a progressive flessum of the wrist and a hyperextension of the fingers with a complete loss of their mobility. The intervention is done in one step with a wide release of the scarred areas of the wrist and hand and the realization of the free inguinal flap in «all around¼. Here we discuss the type of flap, the surgical approach, the different advantages and disadvantages compared to other known flaps and the possible complications of the Mac Gregor free inguinal flap.
Suite à l'apparition de nombreux lambeaux de couverture au cours des dernières décennies, le lambeau de Mac Gregor sous sa forme libre est de moins en moins utilisé mais trouve encore sa place aujourd'hui dans certains cas complexes avec des pertes de substance étendues. Ce rapport décrit un cas inhabituel de large couverture tissulaire par un lambeau libre de type Mac Gregor en «all around flap¼ chez une victime d'une brûlure étendue du membre supérieur gauche survenue le 08/08/1997 et responsable d'un flessum progressif du poignet et d'une hyperextension des doigts avec une perte complète de leur mobilité. L'intervention se fait en un temps avec une large libération des zones cicatricielles du poignet et de la main et la réalisation du lambeau inguinal libre en «all around flap¼. Nous discutons ici du type de lambeau, de l'approche chirurgicale, des différents avantages et inconvénients par rapport à d'autres lambeaux connus et des possibles complications du lambeau inguinal libre de Mac Gregor.
Subject(s)
Burns , Free Tissue Flaps , Humans , Fingers , Cicatrix , Postoperative Complications/etiology , Treatment OutcomeABSTRACT
The adductor canal block has become a common analgesic technique in patients undergoing knee arthroplasty. Dispersion of local anesthetic outside the adductor canal through interfascial layers and blockade of smaller nerves that confer innervation to the knee could contribute to the analgesic efficacy of the adductor canal block. We studied the diffusion of local anesthetic mixed with dye after injection into the adductor canal in fresh human cadavers. In all 8 legs, injectate was found in the popliteal fossa in contact with the sciatic nerve and/or popliteal blood vessels. Interfascial spread patterns were identified.
Subject(s)
Anesthetics, Local/administration & dosage , Knee/innervation , Nerve Block/methods , Sciatic Nerve/anatomy & histology , Anatomic Landmarks , Cadaver , Coloring Agents/administration & dosage , Diffusion , Humans , Injections , Knee/surgery , Methylene Blue/administration & dosageABSTRACT
We have assessed turnaround time (TAT) for urgent laboratory analysis. Twelve hospital laboratories participated to this study. All laboratories have organized a classification of a management system of urgent analyses. The TAT reporting were relatively homogeneous for 12 laboratories. We have defined TAT as time of specimen receipt in the laboratory to time of results reporting. This TAT divides into 4 groups: close to 50 minutes for analyses as TP, D-dimeres, CRP (C Protein Reactive), HCG, troponin, alcoholhemia, K, lipase; 35 minutes for the cytology of cerebrospinal fluid; 25 minutes for complete blood cell count and 15 minutes for blood gases. All laboratories have accepted to TAT as a quality indicator. Quality indicator data should be collected in time to identify and correct problems to implemente effective interventions and to standardize processes among clinical laboratories.
Subject(s)
Clinical Laboratory Techniques , Laboratories, Hospital/statistics & numerical data , France , Humans , Laboratories, Hospital/standards , Quality Assurance, Health Care , Time FactorsABSTRACT
Infantile digital fibromatosis (IDF) is a rare benign fibroproliferative tumor of early childhood. IDF preferentially affects the fingers and the toes. Malignant transformation or metastases have never been reported. Surgical treatment has been advocated previously but local recurrences were observed frequently. Recent literature supports clinical surveillance without any medical or surgical intervention as spontaneous regression usually occurs after two to three years. A six-month-old Caucasian girl with IDF on the left fourth digit is presented here. The tumor progressively increased in size after birth. Topical imiquimod cream and diflucortolone valerate cream, both displaying antifibrotic properties, had no effect on tumor growth. Currently the lesion size remains stable without any treatment. Early recognition of IDF is important in order to avoid unnecessary surgical intervention that may prove to be potentially aggravating, unless serious functional or cosmetic concerns intervene. Parents should be reassured concerning the benign nature of IDF and be informed that spontaneous involution of IDF might be expected.
ABSTRACT
Vascular injection techniques for anatomic studies are often complementary. Use of colored gelatinous mixtures with methylene blue provides precious data about descriptive anatomy by the contrast that it produces in the tissues. The introduction of radiopaque medium, such as lead oxide, into the gelatinous mixture can be used as a complement by means of x-ray examination, in order to facilitate and to reduce the time of investigation. Addition of rhodamine B to the radiopaque mixture keeps the advantages of the contrast medium, but also permits further dissection to demonstrate some details shown by prior x-ray examination. This article compares these different injection techniques in the study of the nasal vascular network. Moreover, it depicts a new injection approach that allows the investigation of vascular territories depending on thin caliber arteries by selective reinjection, defining microangiosomes. Each above-cited technique was used in ten facial territories of fresh cadavers. The patterns of the vessels shown by these techniques were identical, with a constant visualization of infra-millimetric arteries. However, selective reinjection was the only method that permitted characterization of the proper vascular territory of the lateral nasal artery.
