The Krampus and the Old, Dark Christmas-Full-thickness Contact Alkali Burn With Soot, Milking Grease and Baby Oil.

A chemical alkali burn caused by ash and soot is quite rare, resulting from its high pH-value, and underestimated in its potential to cause injury. In folkloric medicine, ash was purportedly used to relieve pain. We present an unusual case of a 27-year-old man who used a self-mixed cream of soot of wooden pellets, milking grease and baby oil to blacken his face and hands for a traditional Krampus procession.

Assessment of skin permeability to topically applied drugs by skin impedance and admittance.

OBJECTIVE: Pharmacokinetic and pharmacodynamic studies of topically applied drugs are commonly performed by sampling of interstitial fluid with dermal open flow microperfusion and subsequent analysis of the samples. However, the reliability of results from the measured concentration-time profile of the penetrating drug suffers from highly variable skin permeability to topically applied drugs that is mainly caused by inter- and intra-subject variations of the stratum corneum. Thus, statistically significant results can only be achieved by performing high numbers of experiments. To reduce the expenditures needed for such high experiment numbers we aimed to assess the correlation between skin permeability and skin impedance/skin admittance. APPROACH: We performed an ex vivo drug penetration study with human skin, based on the hypothesis that inter-subject variations of the respective concentration-time profiles can be correlated with variations of the passive electrical properties of the skin. Therefore, skin impedance and skin admittance were related to the skin permeability to the model drug Clobetasol-17-proprionate. MAIN RESULTS: The measured low frequency skin impedance and the skin admittance correlated linearly with the drug concentration-time profiles from dermal sampling. SIGNIFICANCE: Skin permeability can be assessed by measuring the passive electrical properties of the skin, which enables correction of skin permeability variations. This allows reduction of experiment numbers in future pharmacokinetic and pharmacodynamic studies with human skin ex vivo and in vivo and leads to diminished study costs.

Analysis of functional outcome after posttraumatic thumb reconstruction in comparison to nonreconstructed amputated thumbs at the proximal phalanx of the thumb ray: a mid-term follow-up with special attention to the Manchester-modified M2 DASH questionnaire and effect size of Cohen's d.

BACKGROUND: Pollicization, toe to thumb transfer, and osteoplastic thumb reconstruction, along with free tissue transfer, are the most reported reconstructive procedures after traumatic amputation at the proximal and middle third of the thumb. We will present our clinical studies on functional outcomes with special attention to the M2 DASH questionnaire and effect size of Cohen's d. METHODS: Eleven patients (2 women and 9 men) with posttraumatic thumb reconstruction (three pollicizations of the index or index stump, four free lateral arm osteocutaneous neurosensory flaps, and four microvascular second toe to thumb transfers), performed during the period 2000 to 2007, were reexamined after 4.2 (SD ±2.1) years (range, 2-7 years postinjury). To ensure homogeneity among the patients' data, we selected only patients with isolated thumb amputations at the level of the proximal phalanx. RESULTS: The total M2-DASH score after thumb reconstruction was 18.55 (SD ±16.79). The M2-DASH score of patients with nonreconstructed thumbs was 32.77 (SD ±18.87). Pairwise comparisons between reconstructed and amputated thumbs showed statistically significant differences (Wilcoxon rank-sum test, p value = 0.03) and a highly effective improvement of hand function (Cohen's d = 1.10) after thumb reconstruction relative to amputated thumbs. CONCLUSION: Before selecting a candidate for thumb reconstruction, it is critical to decide on an individualized treatment plan. Factors such as the patient's occupation and the importance of the aesthetic appearance of the thumb must be carefully considered. The surgeon must investigate the patient's current use pattern and functional requirements before considering a reconstructive treatment.

Osteoporosis, weight gain and atypical fat accumulations - a typical feature not only for Cushing's, but also Madelung's disease: A case report.

Madelung's disease, or multiple symmetric lipomatosis, is an extremely rare disease and very likely to be under-diagnosed. It is characterized by multiple symmetrical non-encapsulated fat accumulations mainly located around the neck, shoulders, upper extremities and upper parts of the trunk. The disorder predominantly affects middle-aged men of Mediterranean origin with a history of ethanol intake. Reports of this uncommon disorder in women are very rare. The aim of this article is to report the endocrine and metabolic workup leading to the diagnosis of this uncommon disorder. A 55-year-old woman with osteoporosis was referred to our outpatient clinic with a suspected diagnosis of Cushing's disease. The patient complained of undesired weight gain with atypical fat accumulations predominantly in the upper trunk region during the previous 10 weeks. She presented with the characteristic physical features of Madelung's disease and underwent a thorough examination with endocrine and metabolic evaluation of this rare condition and was finally diagnosed with Madelung's disease. This report demonstrates how a diagnosis of this rare disorder can be reached efficiently. A history of osteoporosis in combination with weight gain and atypical fat accumulations ultimately led to the diagnosis of Madelung's diseases, a rather unknown disorder likely to be under-diagnosed. Although treatment options are limited, a diagnosis is still important for the affected individual.

Solitary paralysis of the flexor pollicis longus muscle after minimally invasive elbow procedures: anatomical and clinical study of the anterior interosseous nerve.

BACKGROUND: The origin of the flexor pollicis longus muscle can vary, causing compression of the anterior interosseous nerve in the forearm. The topographic relationship of the flexor pollicis longus to the median and anterior interosseous nerves must be considered when these nerves are decompressed. The anterior interosseous nerve is a motor nerve supplying the flexor pollicis longus, the flexor digitorum profundus, and the pronator quadratus. Unusual etiologic conditions can occasionally cause isolated neuropathy of the flexor pollicis longus branch from the anterior interosseous nerve. METHODS: Six patients presented with isolated paralysis of the flexor pollicis longus, four following venipuncture in the cubital fossa and two following arthroscopy of the elbow joint. Cadaveric dissections were performed to examine any anatomy clinically relevant to the above techniques. The structure of the flexor pollicis longus nerve branch at different levels was examined with macroscopic and microscopic dissections and immunohistochemistry. RESULTS: In each case, clinical symptoms resolved completely with conservative treatment. Dissection of cadaver arms showed that the nerve branch to the flexor pollicis longus joins the anterior interosseous nerve in the proximal third of the forearm and shares a common epineurium, but has its own fascicle up to the proximal aspect of the elbow. The branch to the flexor pollicis longus has no proximal interneural cross-connections up to the main trunk of the median nerve. CONCLUSION: The variable relationship of the superficial cubital veins to the underlying muscles and minimally invasive approaches to the elbow joint may cause an isolated neuropathy in the motor branch to the flexor pollicis longus, with a resultant solitary paralysis of the muscle.

Clinical experience with a tensor fasciae latae perforator flap based on septocutaneous perforators.

BACKGROUND: Based on an anatomical study of the perforators of the tensor fasciae latae (TFL) perforator flap, a clinical study was undertaken to confirm our data in a clinical trial and to demonstrate the ability to harvest a TFL perforator flap on septocutaneous perforators. METHODS: A retrospective case series analysis was performed of patients, who had undergone reconstruction of soft-tissue defects of the extremities, the groin and the head in 17 cases with a TFL perforator flap based on septocutaneous perforators; in three cases, a combined flap was used. The size of the flaps, the number of perforators, their external diameter, the length of the pedicle and the location and the distance from the anterior superior iliac spine (ASIS) were recorded. RESULTS: The average number of septocutaneous perforators per flap was 1.3 (range, 1-3); the average distance from the ASIS was 11 cm (range, 8-14 cm). The pedicle length varied between 4 and 10 cm, with an average of 7 cm; the average diameter of the pedicle was 4 mm (range, 1-5 mm). The average length of the flaps was 14 cm (range, 4.5-25), and the average width was 7 cm (range, 4.5-19). Donor site closure was achieved by direct closure in 14 patients, and in three patients with a split-thickness skin graft. In one case, at least two-thirds of the flap became necrotic because the septocutaneous perforator was located too far laterally from the flap centre. In one case of a combined flap, one skin island became partly necrotic due to compression after the pedicle was placed beneath the tendon of the extensor tibialis anterior muscle. One flap was successfully revised after venous thrombosis. CONCLUSIONS: The reliability and consistency of the septocutaneous perforators of the TFL flap make planning of this flap easy and the dissection straightforward. Although the number of complications is high in this series, only one complication is related to the flap and the planning itself. With the proposed modifications, we recommend this flap as an interesting alternative to other fasciocutaneous flaps.

Treatment of spider leg veins with the KTP (532 nm) laser--a prospective study.

BACKGROUND AND OBJECTIVES: Spider leg veins are telangiectasias located intracutaneously. This condition poses a cosmetic problem. STUDY DESIGN/PATIENTS AND METHODS: The purpose of this study was to determine what influence the KTP (532 nm) laser has on spider leg veins dependent on the vascular diameter and to what extent the skin has been affected. Seventy female patients were treated in three laser sessions. Analysis was done 30 weeks after the last laser treatment session. RESULTS: Fifty-six patients completed the study. In group 1 (vascular diameter < or = 0.6 mm), spider leg veins were no longer visible in 33%; in 40%, a decrease in vascular diameter could be observed; in 27%, no change in size occurred. In group 2 (vascular diameter 0.7-1.0 mm), laser-treated spider leg veins were visible in all patients. Hyperpigmentation occurred in 13 patients. CONCLUSIONS: The KTP (532 nm) laser is an effective for treating spider leg veins having a vascular diameter under 0.7 mm.