Microsurgery
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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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Case Reports
Repairs of complex groin wounds with contralateral rectus abdominis myocutaneous flaps.
Management of complex groin wounds posterior to complications of vascular prosthetic surgery, malignant tumor excision, and irradiation therapy for recurrent cancers continued to pose a difficult task in reconstructive surgery. Pedicled and microsurgical myocutaneous flaps are valuable tools for wound repairs, but applications of these flaps are limited when the healthy vascular vessels are not available around the wound. ⋯ All the flaps were completely survived and the wounds healed uneventfully. The results suggest that the contralateral myocutaneous flap can be used for the repair of the groin wound with presence of significant comorbidities in the area, in which the ipsilateral local flaps and microsurgical flaps are not available.
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Combined compression of both the common peroneal nerve and the proximal tibial nerve at the level of the popliteal fossa is rare. Recently, an anatomic site of compression of the proximal tibial nerve at the soleal sling (originating arch for the soleus muscle) has been described in cadavers. ⋯ Neurolysis of both nerves resulted in restoration of motor and sensory function in each of these three patients. This is the first clinical report illustrating combined neurolysis of the common peroneal at the knee and the proximal tibial nerve in the soleal sling.
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The purpose of this study is to describe the harvesting technique, anatomic variations, and clinical applications of a compound flap from the great toe and vascularized joint from the second toe used for thumb reconstruction. Five fresh cadaver dissections were studied, focusing attention on the dorsal or plantar vascular dominance, position of the communicating branch between the dorsal and plantar system, the Gilbert classification, and the size of the first dorsal metatarsal artery (FDMA) and first plantar metatarsal artery (FPMA) to the great toe and second toe. Five compound flaps were performed on five patients with traumatic thumb amputation at the level of proximal metacarpal bone. ⋯ It can be used for amputation of the thumb at carpometacarpal joint level. Finally, the compound flap maintains growth potential in children through transfer of vascularized epiphyses. The disadvantages of this compound flap include a technically challenging harvest and a longer operative time.
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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.