British journal of plastic surgery
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There are only a few reports on the use of thoracodorsal nerve (TDN) transfer to the musculocutaneous or axillary nerves in cases of directly irreparable brachial plexus injuries. In this study, we analysed outcome and time-course of recovery in correlation with recipient nerves and type of nerve transfer (isolated or in combination with other collateral branches) for 27 patients with transfer to the musculocutaneous or axillary nerves. ⋯ Although, we found no significant statistical difference between analysed patients according to the percentage of recoveries and mean values, we established a better quality and shorter time of recovery for the musculocutaneous nerve. According to obtained results, we consider that transfer may be a valuable method in reconstruction after directly irreparable C5 and C6 spinal nerve lesions.
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Toxic epidermal necrolysis (TEN) is an acute drug-induced life-threatening disorder characterised by extensive epidermal exfoliation and high rate of mortality. Between October 2000 and April 2003, five severe TEN patients were evaluated using a specific TEN severity-of-illness scale (SCORTEN) and treated for the first time, with a combined therapy using Intravenous Human Immunoglobulins (IVIG) and plasmapheresis. The standardised mortality ratio (SMR) analysis ([Sigma observed deaths/Sigma expected deaths]x100) was applied to establish how IVIG and plasmapheresis treatment could reduce TEN patient mortality. ⋯ The SMR analysis revealed a 70% reduction in mortality (SMR=0.30; 95% confidence interval, 0.0-0.96). Our series show a low mortality rate (20%) related to the severity of the patients (66% expected mortality). The use of IVIG in association with plasmapheresis has a rational basis and may be effective in severe TEN patients.
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Necrotising fascitis is a fulminant infective process which can result in significant morbidity and can indeed be life threatening. It needs to be recognised early and managed aggressively with extensive surgical debridement followed by appropriate antibiotics. On the other hand, Pyoderma gangrenosum is a disease process that needs to be managed non-surgically. We present one such case, the diagnosis of which had treaded along the thin line between the two.
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We present the case of a 22-year-old man who suffered an avulsion injury of the left upper extremity including the elbow region in an industrial accident. After debridement of the skin flap, the defect was primarily closed with Integra. On day 22 split thickness skin graft was performed. Functional and aesthetic outcome and skin quality are excellent.
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We report two patients exhibiting complete polymetatarsia between the fourth and fifth metatarsals of the right foot, without supernumerary digit. To our knowledge, only a few cases of polymetatarsia without supernumerary digit have been reported, and all of those cases have involved incomplete duplication. ⋯ Although case 2 was asymptomatic, the extra metatarsal of the left foot was resected during surgery for postaxial polydactyly of the right foot. Although differential diagnosis with os intermetatarseum was problematic, we concluded that the extra bones in the present cases were duplicated metatarsals, rather than accessory bones, based on three clinical findings: configuration of the extra metatarsal (articular cartilage and growth plate), in case 1; location of extra metatarsal (the most common site of polydactyly of the foot), in both cases; and polydactyly of the opposite foot, in case 2.