Compression of Ulnar Nerve by Ganglion Cyst in Guyon's Canal-a Case Report.

Background: Compression of the ulnar nerve at the level of Guyon's canal is a very rare compressive neuropathy. Due to the vast range of symptoms that can manifest depending on the degree of ulnar nerve compression, the clinical picture is not consistent. Objective: The aim of the study is to outline the diagnostic techniques and therapeutic options. Case report: We reported a case of ganglion cyst-induced compression of the ulnar nerve in Guyon's canal. A 45-year-old female patient underwent surgical ulnar nerve release in Guyon's canal at the Clinic for Plastic and Reconstructive Surgery. Discussion: After a thorough medical history and physical examination, the diagnosis of the syndrome is made, and ultrasound and magnetic resonance imaging (MRI) testing are used to determine the origin of the neuropathy. A ganglion cyst was identified pathohistological one month following the surgical excision of the soft tissue tumor. In order to hasten the patient's nerve recovery, physical therapy was recommended, and the patient was monitored for the following two years. After two years of treatment, the patient has made a very good recovery of the functionally damaged hand, as determined by a modified Bishop scoring method for evaluating functional ulnar nerve recovery. Conclusion: In virtually all cases, early surgical intervention can lead to an outstanding functional recovery. If the symptoms are more severe and continue or get worse for more than three months, early surgical intervention is the gold standard for treating Guyon's canal syndrome. If soft tissue formations are compressing the ulnar nerve in Guyon's canal, MRI is thought to be the gold standard for diagnosis.

Modalities of extensor tendon repair related to etiological factors and associated injuries.

Aim To evaluate modalities of extensor tendons repair of hand and forearm in specific anatomical zones with regard to etiological factors and presence of associated injuries of adjacent anatomical structures. Methods This cross-sectional study included 279 patients referred for extensor tendon repair of hand and forearm in specific anatomical zones. Available treatment modalities were evaluated concerning etiological factors, anatomical zones, and associated injuries. Statistical significance was analysed in the occurrence of early and late postoperative complications according to anatomical zones. Results Direct repair of extensor tendon lesions was found to be the most common modality of reconstruction, 230 (93.5%), of which blade injuries were predominant, 120 (48.7%). Direct tendon repair was mostly indicated in Zone VI and Zone III, in 55 (23.9%) and 42 (18.3%) patients, respectively. Statistically, a significant correlation was confirmed between treatment modalities, injuries in specific anatomical zones, and type of etiological factor (p<0.0001). Statistical correlation was confirmed between zones of injuries and the occurrence of early and late complications (p=0.002). Conclusion Successful postoperative recovery was correlated with the recognition of functional failure in specific zones, assessment of potential associated injuries, and selection of the most optimal modality of reconstruction.

Classic and modified Barr's technique of anterior transfer of the tibialis posterior tendon in irreparable peroneal palsies.

Peroneal palsy with loss of active dorsal flexion in foot can be surgically treated by anterior transfer of tibialis posterior tendon. Two techniques are available, classic and modified Barr's technique of the anterior transfer of tibialis posterior tendon, with different place of tendon's reinsertion. The aim of the study is evaluation of the degree of active dorsal flexion in foot, and appearance of varus position and hipercorrection of the foot, by comparing the results of the two operative techniques. The study included 40 patients with peroneal irreparable palsies, divided into two equally sized groups. The first group was treated by classic Barr's technique. The other group of patients was treated by modified Barr's technique. The group treated by modified Barr's technique exhibited better functional results. Active dorsal flexion achieved between 950 (in 35% cases) and 900 (in 50% cases), while varus position and hipercorrection of the foot were absent. In the second group of 20 patients, treated by classic Barr's technique, 800 (40%) and 900 (25%) of active dorsal flexion, indicated worse functional postoperative results. Active dorsal flexion of 700 achieved by this method in two cases (10%), represents unsatisfactory functional result. Varus position of the foot was recorded in 5 cases (25%) and hipercorrection in 4 cases (20%). Modified Barr's technique is surgical method with better functional and postoperative results in treatment of irreparable peroneal palsy.

Stress ulcers after heel reconstruction using free microvascular flap comparing with reverse supramaleolar fasciocutaneous flap.

INTRODUCTION: the lower extremity requires an understanding of the ways in which such reconstruction differs from that of the upper extremity. The weight-bearing requirements are the most obvious difference. The difference between the cutaneous coverage on the plantar surface on the foot and that on the dorsum has important implication for reconstruction of defects in these areas. There are few operative techniques for reconstruction of the posttraumatic heel defects, in our study we have been compared two techniques, free microvascular flap and reverse supramaleolar fasciocutaneous flap. AIM: the aim of the study is evaluation of the appearance of stress ulcers as late complications of the heel reconstruction, comparing these two methods. MATERIAL AND METHODS: in testing were included 50 patients with posttraumatic heel defects, of different etiology, divided in two groups. The first group of 25 patients with posttraumatic heel defects has been treated by microvascular free flap. The other group of 25 patients with posttraumatic heel defects has been treated by reverse supramaleolar fasciocutaneous flap. DISCUSSION: according to our results, there are significant differences between proportions of patients with and without of late complications of free microvascular flap comparing with reverse supramaleolar fasciocutaneous flap. CONCLUSION: stress ulcers, as result of continuous pressure on weight-bearing area, have been evaluated by using both operative methods. Reverse supramaleolar fasciocutaneous flap is good alternative method for heel reconstruction.