Carpal tunnel release: transverse or longitudinal limited-incisions?

AIMS: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the upper extremity. Surgical decompression through a limited open palmar incision is still the most widely used treatment. The aim of this study was to compare two different incision surgical techniques for carpal tunnel surgery. PATIENTS AND METHODS: In this retrospective study, 41 patient hands (transverse surgery) were compared with 55 controls (longitudinal surgery) using, as validated outcome instruments, the "Boston Carpal Tunnel Questionnaire" for postoperative effectiveness to measure symptoms, disability and health-related quality of life. The patients were monitored just before the CTS surgery and then 4 weeks and 3 months after surgery. RESULTS: Complications resulted few and comparable for both techniques. Results showed similar outcomes in both procedures regarding symptoms release and function, except for one month results where function was better for the transverse incision (p<0.01) which required reduced time, anyway. CONCLUSIONS: The transverse incision technique proved a suitable optimal solution for carpal tunnel release. This technique, therefore, induces to a better tolerated scar at short term follow up, compared to a standard palmar longitudinal incision.

Continuous negative pressure wound therapy in the treatment of a gigantic trophic leg ulcer.

AIM: to present a therapeutic algorithm for chronic venous insufficiency complicated with ulceration, using etiologic treatment combined with local treatment by negative pressure wound therapy (NPWT) before and after skin grafting. MATERIAL AND METHOD: we are discussing a 59 years-old patient with a lower leg gigantic, circumferential trophic lesion. The aetiology was combined, post-traumatic and chronic venous insufficiency, with 30 years of evolution. RESULTS: the treatment was applied in two surgical steps. Initially the pathological refluxes were interrupted; secondarily a skin graft was applied, preceded and followed by NPWT until graft intake. The wound healed completely; patient developed secondary foot lymphoedema. CONCLUSIONS: 1. Case treatment particularity consists in using a combination of etiologic and local treatment, combined with adjuvant NPWT. 2. Secondary lymphoedema developed due to circumferential location of the lesion. 3. Continuous NPWT has proven its efficiency in chronic ulcer before and after skin grafting, reducing costs and duration of treatment.

Retrospective study regarding objectives and results of upper limb transplant.

INTRODUCTION: Upper limb amputation causes a severe permanent disability. Upper limb transplantation is subject to treatment to prevent rejection and influenced by organizational, socioeconomic, psychological, ethical factors. Analysis of the results creates the potential for continuing this work in specific conditions in our country. MATERIAL AND METHODS: We retrospectively analyzed data from the literature. Upon completion of documentation (May 2011) there were 74 transplants in 53 patients worldwide. We have studied the available information on the surgical interventions and their results. RESULTS: Upper limb allograft has a complex structure comprising tissue with variable antigenicity. Surgery is performed by a large multidisciplinary team, whose increased experience leads to a shorter length of the operation. The postoperative follow-up and rehabilitation program are standardized, and patients' compliance is essential. The greatest advances have occurred in immunosuppression protocols. CONCLUSION: The upper limb transplantation was performed in 20 centers of 12 countries so far. The specification of the indications and contraindications, the proper selection of patients, the increasing experience and new immunosuppression protocols provide a higher success rate and quality of functional outcome. By applying these conceptual acquisitions we will be able to create conditions for the integration of our country in this globally convergent scientific effort.

Breast reconstruction with autologous tissue--our clinical experience.

INTRODUCTION: Breast reconstruction after mastectomy gained new grounds since the introduction of autologous tissue and oncoplastic surgery techniques. Nowadays large postoperative breast defects can be treated with high quality tissues obtained by autogenous flap surgery, to achieve the best functional and physical results. OBJECTIVES: The purpose of this study is to analyze our results in breast reconstruction using autologous tissue and to emphasize the importance of a multidisciplinary team. MATERIAL AND METHODS: During a five year period (2005-2009) we performed 28 breast reconstructions after cancer surgery, 15 in delayed and 13 in primary reconstruction, using three types of flaps: latissiumus dorsi flap, transverse rectus abdominis myocutaneous flap and deep inferior epigastric artery perforator flap. RESULTS: Functional and cosmetic results were very good, only minor complications such as seroma and hematoma of the donor site and partial/marginal flap necrosis occurred after the surgical procedure. There were no major complications like total flap loss. CONCLUSIONS: Breast reconstruction with autologous tissue is a safe, well proved, although not easy procedure that confers best functional and cosmetic results and is at the same time oncologically safe.