Wide-awake Anesthesia No Tourniquet Trapeziometacarpal Joint Prosthesis Implantation.

Wide awake local anesthesia no tourniquet (WALANT) hand surgery is a rapidly growing in popularity. WALANT has been used by hand surgeons when operating on bones, tendons, ligaments, nerve entrapments. We offer a case report of the first case in the literature describing WALANT technique when performing trapeziometacarpal joint arthroplasty with prosthesis implantation. We offer technical points on how to perform this procedure and the advantages that are associated with using WALANT for prosthesis arthroplasty.

DIEP flap for breast reconstruction: Is abdominal fat thickness associated with post-operative complications?

INTRODUCTION: Some surgeons consider a high body mass index (BMI) or important abdominal fat excess as contraindications for breast reconstruction with free deep inferior epigastric perforator (DIEP) flap. This study aimed to identify factors associated with post-operative complications by using this type of flap, with an emphasis on BMI and abdominal subcutaneous fat thickness. METHODS: A retrospective chart review of 105 consecutive patients who underwent DIEP flap breast reconstruction at our institution was performed to assess post-operative complications. Among other risk factors, we specifically studied the influence of BMI and abdominal wall thickness on complication occurrence. Abdominal wall thickness was measured at 10 different points on the angio-computed tomography scan performed pre-operatively. RESULTS: Median age was 49.8 years (range, 27-69); average BMI was 25.57 kg/m2 (range, 18.07-41.91). Immediate breast reconstruction was performed for 35% of patients, and five patients (4.7%) underwent bilateral reconstruction. Twenty-six patients (24.8%) presented 29 post-operative complications; 12 concerned abdominal complications (delayed wound healing [n = 6] and seroma [n = 6]) and 17 were related to complications of the reconstructed breast (six minimal necrosis treated conservatively, eight minor necrosis requiring surgical debridement and three total flap loss). The complication rate was not correlated with increased BMI or abdominal wall thickness. The only factor that significantly predicts DIEP flap complications was pre-operative radiotherapy (odds ratio = 4.05; p = 0.03). CONCLUSIONS: No significant correlation was observed between BMI of 25-35 kg/m2 or abdominal wall thickness and post-operative complications of the donor site or DIEP flap. Therefore, these factors should not be considered as contraindication criteria.

Good correlation of goutallier rating of supraspinatus fatty changes on axial and reformatted parasagittal computed tomographic images.

UNLABELLED: Traumatic tendon tear of the rotator cuff occurs frequently and leads to fatty muscle infiltration. With regard to the outcome, fatty infiltration of the rotator cuff muscles constitutes a major negative predictive factor after rotator cuff surgery. In 1989, Goutallier et al established his classification system for assessment of fatty infiltration of the rotator cuff muscles. He used computed tomographic (CT) images in the axial plane. Today, the assessment of rotator cuff muscles on axial CT images has been widely replaced by assessment on parasagittal acquired magnetic resonance images. This change raised 2 important questions. First, there is a controversy whether the Goutallier classification can simply be adopted for magnetic resonance imaging. The second question is whether the muscle assessment in the axial plane is interchangeable with that in the parasagittal plane. We hypothesize that the assessment of fatty muscle infiltration is the same on reformatted parasagittal CT images as on axial CT images METHODS: Three independent readers, 2 radiologists and one shoulder surgeon, rated fatty changes of the supraspinatus muscle on CT scans of 91 shoulders. Goutallier grades were assessed on axial and reformatted parasagittal CT images in 2 separate reading sessions. The paired t test was used to find differences between grading results on axial and reformatted parasagittal images. The Pearson correlation coefficient and weighted kappa statistics were used to quantify linear correlation, intrareader, and interreader agreement. RESULTS: Mean (SD) Goutallier grading among all readers was 0.80 (1.16) (range, 0-4) on axial images and 0.89 (1.05) (range, 004) on parasagittal reconstructions. We detected a trend toward a slightly higher Goutallier grading on parasagittal reconstructions; however, this result was not significant (P = 0.07). The Pearson correlation coefficient was 0.702 (P < 0.001). Weighted kappa statistics indicated a moderately good to good intrareader (range of weighted kappa, 0.53-0.62) and interreader (weighted kappa, axial images, 0.55; reformatted parasagittal images, 0.65) agreement. CONCLUSION: Grading of fatty infiltration of the supraspinatus muscle on parasagittal CT images is comparable with the standard Goutallier grading on axial images and is characterized by a moderately good to good intrareader and interreader agreement. Assessment of parasagittal images is characterized by a slightly higher interreader agreement and may therefore be the preferable modality.