Near-Complete Transection of the Sciatic Nerve After Closed Reduction Attempt of a Dislocated Total Hip Arthroplasty.

Sciatic nerve injuries are rare and devastating complications that can occur following total hip dislocations. These injuries are even more uncommon when resulting from a closed reduction attempt. In the literature, only one other case of sciatic nerve palsy secondary to sciatic nerve laceration has been reported. Conducting a careful neurovascular examination following a closed reduction procedure is crucial in determining the presence of sciatic nerve injury. We present a case of sciatic nerve palsy following a closed reduction attempt of a dislocated total hip arthroplasty (THA). Surgical exploration revealed a near-complete sciatic nerve laceration. The patient subsequently underwent neurolysis and nerve repair. This case highlights the importance of thorough neuromuscular examination following closed reduction of THA, with consideration for surgical exploration when necessary.

Discovery of Novel UDP-N-Acetylglucosamine Acyltransferase (LpxA) Inhibitors with Activity against Pseudomonas aeruginosa.

This study describes a novel series of UDP-N-acetylglucosamine acyltransferase (LpxA) inhibitors that was identified through affinity-mediated selection from a DNA-encoded compound library. The original hit was a selective inhibitor of Pseudomonas aeruginosa LpxA with no activity against Escherichia coli LpxA. The biochemical potency of the series was optimized through an X-ray crystallography-supported medicinal chemistry program, resulting in compounds with nanomolar activity against P. aeruginosa LpxA (best half-maximal inhibitory concentration (IC50) <5 nM) and cellular activity against P. aeruginosa (best minimal inhibitory concentration (MIC) of 4 µg/mL). Lack of activity against E. coli was maintained (IC50 > 20 µM and MIC > 128 µg/mL). The mode of action of analogues was confirmed through genetic analyses. As expected, compounds were active against multidrug-resistant isolates. Further optimization of pharmacokinetics is needed before efficacy studies in mouse infection models can be attempted. To our knowledge, this is the first reported LpxA inhibitor series with selective activity against P. aeruginosa.

Total scrotal reconstruction following Fournier's gangrene with bilateral prelaminated superior medial thigh flaps.

The patient is a 45-year-old man diagnosed with Fournier's gangrene and underwent treatment for septic shock, broad-spectrum antibiotic therapy and extensive surgical debridement of perineum, including total scrotectomy, ischiorectal fossa, abdomen and left superior thigh and flank. The patient required multiple staged complex reconstruction of the scrotum utilising prelaminated superior medial thigh flaps with use of dermal matrix, split-thickness skin grafting and pedicled gracilis muscle flap for coverage of the ischiorectal wound. The patient had full recovery and followed up 1 year postoperatively. This report discusses our technique for total scrotal reconstruction and provides review of surgical reconstructive techniques for wounds due to Fournier's gangrene.

Use of Pericranial Flaps with Dermal Substitute for Scalp Reconstruction: A Case Series.

Skin cancer incidence has been rapidly increasing over the past 2 decades, and the resulting defects from excision have significant aesthetic and functional implications. In particular, wound coverage for large scalp and forehead defects with calvarial exposure can lead to hairline distortion, contour irregularities, and alopecia. We describe a 2-stage technique for scalp reconstruction, which preserves the normal hairline, covers exposed bone with vascularized tissue, and restores an aesthetic soft-tissue contour. METHODS: This is a retrospective case series of 13 adults with ages ranging from 50 to 89 years. All patients underwent Mohs surgery on the forehead or scalp between July 2014 and April 2017. Patients underwent a 2-staged reconstruction with an initial pericranial flap and dermal substitute placement followed by the placement of a split-thickness skin graft within 4-6 weeks. RESULTS: Over a 3-year period, 13 patients had successful reconstruction of the scalp defect without alteration of the hairline or contour irregularity. Two patients had minor complications after the first-stage procedure with successful aesthetic reconstruction. CONCLUSIONS: Full-thickness defects of the scalp and forehead with bone exposure provide a reconstructive challenge for plastic surgeons. Reconstructive algorithms continue to evolve and should be tailored to best suit patients' needs and medial comorbidities. Two-staged reconstruction with local pericranial flap provides a safe and efficacious reconstruction that minimizes hairline distortion, contour irregularity, and donor site morbidity.

Reconstruction of traumatic lumbar hernias: A case report.

BACKROUND: Traumatic lumbar hernias are not common hernias that are encountered by general or plastic surgery teams, however it is important to understand the anatomy of the hernia in order to be able to correct the flank defect. In our patient, the oblique muscles were sheared off the iliac crest periosteum, however the attachments to the ribs and spine were maintained. We were able to successfully place a pre-peritoneal polypropylene mesh which was secured to the musculature, and re-approximate the oblique muscles to the iliac crest using Mitek QUICKANCHOR® sutures. Our case study has been reported in line with the SCARE criteria ([8] Agha et al., 2016). CASE REPORT: The subject in our case was a 47-year-old gentleman who was involved in a motor vehicle accident, and sustained a traumatic lumbar hernia due to the 3-point seatbelt he was wearing. He was transported via ambulance to our trauma center. CONCLUSION: Understanding the anatomy and mechanism of injury is the key to reconstructing traumatic lumber hernias. Although not required, mesh reinforcement has significantly reduced the recurrence of all hernias. This is the simplest and most effective way, in our opinion, to return the flank muscles to their native position while providing mesh reinforcement.

Malleolar Ulceration Induced by Hydroxyurea Therapy for Chronic Eosinophila.

A 59-year-old African American female presented to a plastic surgery office in consultation for a very painful non-healing wound of her right lateral malleolus. An incisional biopsy was performed and ultimately a diagnosis of hydroxyurea-induced ulcer was concluded. Descriptions of this entity are rare in the surgical and wound care professional literature. This diagnosis does appear in the hematology/oncology literature; however, these practitioners may not be the first to examine a patient with the development of such an ulcer. This article presents the pathophysiology and clinical presentation of hydroxyurea-induced ulceration as well as the characteristics of hydroxyurea-induced ulceration in addition to the case study.

Clinical Question: In women who have undergone breast cancer surgery, including lymph node removal, do blood pressure measurements taken in the ipsilateral arm increase the risk of lymphedema?

Throughout the healthcare industry fears of taking blood pressure in arm of patients who have undergone breast cancer surgery have been propagated for decades and continue to be recommended by multiple medical societies and healthcare organizations. However, these precautions are not well based on evidence-based medicine and may have a more historical and traditional basis. The purpose of this study was to review current evidence-based research as well as current guidelines regarding ipsilateral arm blood pressure measurements in women who have undergone breast surgery for cancer including lymph node removal.

Clinical Inquiry-In women who have undergone breast cancer surgery, including lymph node removal, do blood pressure measurements taken in the ipsilateral arm increase the risk of lymphedema?

Throughout the healthcare industry fears of taking blood pressure in the arms of patients who have undergone breast cancer surgery have been propagated for decades and continue to be recommended by multiple medical societies and healthcare organizations. However, these precautions are not well based on evidence-based medicine and may have a more historical and traditional basis. The purpose of this study was to review current evidence-based research as well as current guidelines regarding ipsilateral blood pressure measurements in women who have undergone breast surgery for cancer including lymph node removal.

Clinical Inquiry-In women who have undergone breast cancer surgery, including lymph node removal, do blood pressure measurements taken in the ipsilateral arm increase the risk of lymphedema?

Throughout the healthcare industry fears of taking blood pressure in the arm of patients who have undergone breast cancer surgery have been propagated for decades and continue to be recommended by multiple societies and healthcare organizations. However, these precautions are not well based on evidence-based medicine and may have a more historical and traditional basis. The purpose of this study was to review current evidence-based research as well as current guidelines regarding ipsilateral arm blood pressure measurements in women who have undergone breast surgery for cancer including lymph node removal.

Stereocontrolled synthesis of lepadiformine A.

In this paper we present results of a study into whether the tricyclic core of the lepadiformines A-C can be accessed via intramolecular hetero-Diels-Alder cycloaddition. We are able to demonstrate that such a process is possible and that the reaction proceeds in an endo-selective fashion, providing the correct relative stereochemistry for this family of natural products. By employing this approach we have been able to develop a short (7 step) synthesis of (+/-)-lepadiformine A, starting from commercially-available trans-2-nonenal.