Microsurgery
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Decompression of peripheral nerves at different anatomic sites leads to long-lasting improvement of nerve function. For the pudendal nerve such compression sites have also been described, however, indication for surgical decompression at the dorsal nerve canal, and outcome measures have not been presented. In the following work, we review the detailed anatomy of the pudendal nerve at its passage through the urogenital diaphragm into the base of the penis and present the results of our first five patients. ⋯ The distal pudendal nerve is susceptible to compression at the passage from Alcocks canal to the dorsum of the penis. Diabetic patients with peripheral neuropathy can suffer from additional compression neuropathy with decreased penile sensibility and dysaesthesia. One-point pressure threshold testing proved to be a sensitive parameter in the diagnosis and finally, patients would benefit from decompression of the pudendal nerve.
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Despite several publications strongly advocating prophylactic antibiotics during leech therapy, and recent primary articles shedding new light on the microbiota of leeches, many units either do not use antibiotic prophylaxis, or are continuing to use ineffective agents. ⋯ Despite infection due to leech therapy being a well known and relatively common complication, many units are not using appropriate antibiotic prophylaxis.
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Traumatic dislocation of the hip results in osteonecrosis of the femoral head (ONFH) or avascular necrosis (AVN) in approximately 40% of patients. This high-energy event causes an ischemic insult to the femoral head that may lead to ONFH. Here, we investigate use of Free-Vascularized Fibular Grafting (FVFG) in patients with ONFH after traumatic hip dislocation. ⋯ The average preoperative Harris Hip score was 64.9 which improved by over 10 points to 76.1 at 1-year follow-up. Seven of 35 patients required conversion to THA at an average of 45 (13-86) months postoperation. After a maximum follow up of 21 years, the remainder of the patients retained their native hips and Harris Hip scores tended to show improved hip function.