Recent Smoking History Is Not Associated with Adverse 30-Day Standardized Postoperative Outcomes following Microsurgical Reconstructive Procedures of the Upper Extremity.

Background: Upper extremity (UE) microsurgical reconstruction relies upon proper wound healing for optimal outcomes. Cigarette smoking is associated with wound healing complications, yet conclusions vary regarding impact on microsurgical outcomes (replantation, revascularization, and free tissue transfer). We investigated how smoking impacted 30-day standardized postoperative outcomes following UE microsurgical reconstruction. Methods: Utilizing the National Surgical Quality Improvement Program, all patients who underwent (1) UE free flap transfer (n = 70) and (2) replantation/revascularization (n = 270) were identified. For each procedure, patients were stratified by recent smoking history (current smoker ≤1-year preoperatively). Baseline demographics and standardized 30-day complications, reoperations, and readmissions were compared between smokers and nonsmokers. Results: Replantation/revascularization patients had no differences in sex, race, or body mass index between smokers (n = 77) and nonsmokers. Smokers had a higher prevalence of congestive heart failure (5.2% vs 1.0%, P = .036) and nonsmokers were more often on hemodialysis (15.6% vs 10.4%, P = .030). Free flap transfer patients had no differences in age, sex, or race between smokers (n = 14) and nonsmokers. Smokers had a longer length of stay (6.6 vs 4.2 days, P = .001) and a greater prevalence of chronic obstructive pulmonary disorder (COPD; 7.1% vs 0%, P = .044). Recent smoking was not associated with increased odds of any 30-day minor and major standardized surgical complications, readmissions, or reoperations following UE microsurgical reconstruction via free flap transfer or replantation/revascularization. Baseline diagnosis of COPD was also not a predictor of adverse 30-day outcomes following free flap transfer. Conclusion: Recent smoking history was not associated with any 30-day adverse outcomes following UE microsurgical reconstruction via replantation/revascularization or free flap transfer. In light of these findings, further investigation is warranted, with particular focus on adverse events specific to free flaps and replantation/revascularization.

Contexte: La reconstruction microchirurgicale du membre supérieur repose sur la bonne guérison de la plaie pour des résultats optimaux. Le tabagisme est associé à des complications pour la guérison des plaies; toutefois, les conclusions concernant ses répercussions sur les résultats microchirurgicaux (réimplantation, revascularisation et transfert de tissu libre) sont variables. Nous avons cherché à savoir quelles étaient les répercussions du tabagisme sur les résultats postopératoires standardisés à 30 jours après reconstruction microchirurgicale du membre supérieur. Méthodes: Utilisant le Programme national d'amélioration de la qualité de la chirurgie, tous les patients ayant subi (1) un transfert de lambeau libre du membre supérieur (n = 70) et (2) une réimplantation/revascularisation (n = 270) ont été identifiés. Pour chaque procédure, les patients ont été classés en fonction de leurs antécédents de tabagisme récent (fumeur actuel ≤ 1 an préopératoire). Les données démographiques initiales et les complications standardisées à 30 jours, les réinterventions et les réhospitalisations ont été comparées entre fumeurs et non-fumeurs. Résultats: Concernant les réimplantations/revascularisations, il n'y a pas eu de différences en termes de sexe, race ou IMC entre les fumeurs (n = 77) et les non-fumeurs. Les fumeurs avaient une plus grande prévalence d'insuffisance cardiaque congestive (5,2 % contre 1,0 %, P = 0,036) et les non-fumeurs étaient plus souvent sous hémodialyse (15,6 % contre 10,4 %, P = 0,030). Concernant les patients ayant eu un transfert de lambeau libre, il n'y a pas eu de différences en termes d'âge, de sexe ou de race entre les fumeurs (n = 14) et les non-fumeurs. La durée d'hospitalisation des fumeurs a été plus longue (6,6 jours contre 4,2 jours, P =0,001) avec une prévalence plus élevée de MPOC (7,1 % contre 0 %, P = 0,044). Le tabagisme récent n'a pas été associé à une augmentation de la probabilité de complications chirurgicales standardisées, majeures ou mineures, à 30 jours, de réhospitalisation ou reprises chirurgicales après reconstruction microchirurgicale du membre supérieur par transfert de lambeau libre ou réimplantation/revascularisation. Le diagnostic de MPOC à l'inclusion dans l'étude n'était pas non plus un facteur prédictif d'événements indésirables à 30 Jours après transfert de lambeau libre. Conclusion: Un antécédent de tabagisme récent n'a pas été associé à des résultats indésirables à 30 jours après reconstruction microchirurgicale du membre supérieur via réimplantation/revascularisation ou transfert de lambeau libre. À la lumière de ces constatations, des études supplémentaires portant particulièrement sur les événements indésirables propres aux procédures de lambeaux libres et de réimplantation/revascularisation sont justifiées.

Heterotopic Ossification After Revision Carpal Tunnel Release Causing Mixed Ulnar and Median Compression Neuropathy.

We report a case of heterotopic ossification formation 6 years after a revision carpal tunnel release in a 46-year-old woman, causing new-onset mixed ulnar and median nerve compression symptoms. The patient underwent excision of the heterotopic ossification mass along with decompression of the median and ulnar nerves, and postoperative radiation. Four years after treatment, the patient was completely asymptomatic with full range of motion in her hand and wrist.

Management of lower extremity orthopaedic injuries in epileptic patients: A systematic review.

Lower-extremity injuries may occur during seizures. There is a lack of standardized guidelines when diagnosing and planning perioperative care. Databases were systematically screened using predefined search terms. Of the 13 patients included, seven (53.8%) involved bilateral femoral neck fractures. Associated fractures were observed in all cases with surgical intervention performed in eight (61.5%) patients. Eleven patients reported functional outcomes, with over a quarter (three of 11, [27.3%]) endorsing mild range of motion deficits or issues with ambulation. Post-seizure patients may require standardized diagnostic protocols to ensure prompt management with a specialized treatment approach that accommodates the nuances of their condition.

Management of gunshot wound-related hip injuries: A systematic review of the current literature.

PURPOSE: To propose a gunshot wound-related hip injury algorithm and improve patient outcomes. METHODS: Multiple online databases were queried to identify studies reporting on management of gunshot-wound hip injury. RESULTS: Of 47 papers included, 5 and 14 studies recommended surgical intervention for the treatment of low- and high-velocity gunshot wounds, respectively, and 1 paper advocated the use of prophylactic antibiotics in the treatment of high-velocity injuries. All remaining papers had mixed and conflicting results. CONCLUSION: Various therapeutic strategies have been used for the management of gunshot wound-related hip injuries but further prospective studies are necessary to determine the optimal therapeutic modality.

Unilateral Laminotomy with Bilateral Decompression: A Case Series Studying One- and Two-Year Outcomes with Predictors of Minimal Clinical Improvement.

OBJECTIVE: To assess factors that may predict failure to improve at 12 and 24 months after unilateral laminotomy with bilateral decompression (ULBD) for the management of lumbar spinal stenosis. METHODS: A database of 255 patients who underwent microdecompression surgery by a single orthopedic spine surgeon between 2014 and 2018 was queried. Patients who underwent primary single-level ULBD of the lumbar spine were included. Visual analog scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI) results were collected preoperatively and at 12 and 24 months postoperatively. Demographic, radiographic, and operative factors were assessed for associations with failure to improve. Clinically important improvement was defined as reaching or surpassing the previously established minimum clinically important difference for ODI (12.8) and not requiring revision. RESULTS: A total of 68 patients were included. Compared with preoperative values for back pain, leg pain, and ODI (7.32, 7.53, and 51.22, respectively), there were significant improvements on follow-up at 12 months (2.89, 2.23, and 22.40, respectively; P < 0.001) and 24 months (2.80, 2.11, 20.32, respectively; P < 0.001). Based on the defined criteria, 50 patients showed clinically important improvement after ULBD. Of the 18 patients who failed to improve, 12 required revision. Independent predictors of failure to improve included female sex (adjusted odds ratio, 5.06; 95% confidence interval, 1.49-21.12; P = 0.014) and current smoker status (adjusted odds ratio, 5.39; 95% confidence interval, 1.39-23.97; P = 0.018). CONCLUSIONS: ULBD for the management of lumbar spinal stenosis leads to clinically important improvement that is maintained over a 24-month follow-up period. Female sex and tobacco smoking are associated with poorer outcomes.

Microwave-assisted cleavage of Alloc and Allyl Ester protecting groups in solid phase peptide synthesis.

Orthogonal protection of amino acid side chains in solid phase peptide synthesis allows for selective deprotection of side chains and the formation of cyclic peptides on resin. Cyclizations are useful as they may improve the activity of the peptide or improve the metabolic stability of peptides in vivo. One cyclization method often used is the formation of a lactam bridge between an amine and a carboxylic acid. It is desirable to perform the cyclization on resin as opposed to in solution to avoid unwanted side reactions; therefore, a common strategy is to use -Alloc and -OAllyl protecting groups as they are compatible with Fmoc solid phase peptide synthesis conditions. Alloc and -OAllyl may be removed using Pd(PPh3 )4 and phenylsilane in DMF. This method can be problematic as the reaction is most often performed at room temperature under argon gas. It is not usually done at higher temperatures because of the fear of poisoning the palladium catalyst. As a result, the reaction is long and reagent-intensive. Herein, we report the development of a method in which the -Alloc/-OAllyl groups are removed using a microwave synthesizer under atmospheric conditions. The reaction is much faster, allowing for the removal of the protecting groups before the catalyst is oxidized, as well as being less reagent-intensive. This method of deprotection was tested using a variety of amino acid sequences and side chain protecting groups, and it was found that after two 5-min deprotections at 38°C, all -Alloc and -OAllyl groups were removed with >98% purity. Copyright © 2016 European Peptide Society and John Wiley & Sons, Ltd.