Evaluation of the Sagittal Saw Blade as an Intraoperative Fomite During Diabetic Foot Surgery.

Unlabelled: Surgical site infection is a major potential complication of all operative interventions, and the diabetic foot is particularly at risk for bacterial recontamination and infectious sequelae. The objective of this study was to identify whether the sagittal saw blade used during partial foot amputations and diabetic foot debridements carries the potential to serve as a bacterial fomite. We physically cultured the sagittal saw blade during 20 foot debridements involving the resection of bone in patients diagnosed with a diabetic foot infection.

Intra-canal dissolution of Sargenti paste.

Although the efficacy and safety of the Sargenti technique have remained controversial for more than a decade, the technique still is widely used by many dentists throughout the world. The following report describes a retrospective analysis of 367 cases that looked at the contribution of instrumentation technique and fill adequacy to paste dissolution.

Arrest and conviction of injured intoxicated drivers in eastern Pennsylvania.

The legal hazards of driving under the influence (DUI) are frequently not appreciated by alcohol users. Physicians who treat such patients following collisions are often unaware of the judicial disposition following hospital discharge. We examined the courthouse records of 511 intoxicated drivers involved in collisions and admitted to one Level I Trauma Center to determine if DUI arrests and convictions were obtained.

Relative donor-site morbidity of muscle and fascial flaps.

Accusations of excessive donor-site morbidity as an unavoidable sequela of fasciocutaneous flaps has negatively prejudiced this option for coverage of adjacent defects such that a muscle flap, if available, would instead be preferable even at the risk of loss of marginally expendable function. Our entire experience with 147 juxtaposed muscle-type and 122 fascia-type flaps was analyzed to confirm instead that actual donor-site morbidity was extremely uncommon for either type. Overall, there were 20 (14 percent) complications of the donor site of muscle flaps and 17 (14 percent) for fascial flaps, with only 4 (3 percent) major complications in each group.

Salvage by tattooing of areolar complications following breast reduction.

Even partial areolar loss following breast reduction must be considered an aesthetic disaster for which there are few surgical options for correction. Tattooing, as directly borrowed from postmastectomy techniques for nipple-areola creation, permits reconstitution of a reasonable facsimile of the areola. Discoloration or loss of nipple contour as may also occur in composite nipple-areola grafts may be enhanced and/or an illusion of nipple projection achieved by appropriate regional micropigmentation.

A Monte Carlo investigation of the robustness of the Wald, likelihood Ratio, and Median tests with specified symmetric and asymmetric marginal distributions.

The effect of nonnormality on the Type I (tau) error when comparing two independent binomial proportions (P) or the nonparametric alternatives, the Median (Me), Wald (W), and Likelihood Ratio (LR), has not been investigated. If these selected tests are overly conservative the implied loss of power would moderate their practical use. The purpose of the present study was to investigate the impact of nonnormality on small to moderate sample sizes on the estimated tau for alpha = 0.

Upper extremity salvage with free ulnar forearm flap from the amputated part: case report.

Preservation of a functional level of amputation in cases of nonreplantable upper extremity amputation injury can be accomplished utilizing spare-parts technology. A case is presented in which a nonreplantable arm amputated at the mid-humeral level was used for a free ulnar forearm flap to preserve bone level and secure stable coverage.

Futility of muscle flaps for self-inflicted wounds.

Unacceptable forms of self-mutilation usually are resistant to surgical intervention and have a basis in psychopathology. Establishing this diagnosis may be as difficult as is the treatment, frequently involving a prolonged process of exclusion of other known disease entities. Management of these chronic self-inflicted wounds demands flexibility by the surgeon who must be aware of this possibility and willing to deviate from the normal approach to wound healing.

Magnetic resonance imaging in the evaluation of persistent carpal tunnel syndrome.

Magnetic resonance imaging was used to assess nine median nerves in the wrists of seven patients who had signs and symptoms of persistent compressive median neuropathy despite previous carpal tunnel release. Intraoperative findings were then correlated in eight surgically treated cases with both MRI findings and postoperative results. Magnetic resonance imaging suggested a potential abnormality in each of eight operative cases.

Cylindrical nipple reconstruction using an H flap.

Just as a successful breast reconstruction cannot be achieved using a solitary method for every patient, no single surgical technique is a panacea for the final stage of nipple creation. For breast mounds with a thin subcutaneous layer, as commonly associated with the implanted breast, local flaps using a central subcutaneous core have strong advocates. The H-shaped local flap introduced here is a variant of the latter where large, well-vascularized side tabs provide adequate projection with minimal risk for flap slough.

Bipedicled fasciocutaneous flaps in the lower extremity.

It is well known that a bipedicled skin flap permits survival of longer flaps due to the secondary recruitment of vascularity. Inclusion of the deep fascia with such a flap, obeying the principles of the single-pedicled fasciocutaneous flap, provides even greater security for the immediate transposition of yet larger or riskier flaps without the need for delay maneuvers. This variation is especially valuable for the management of difficult wounds encountered in the lower extremity when no other local options may be available.

A chemomechanical system for caries removal and glass ionomer cement to restore fixed partial denture abutments.

When a fixed partial denture fails due to recurrent caries under the casting of the abutments, a remake process usually requires a great deal of cooperation, multiple lengthy appointments, and financial resources. Many patients with special needs may not have the cooperation, tolerance, and resources to support such treatment. This paper describes an alternative method that utilizes a chemomechanical system for caries removal followed by a conventional restorative material to treat those patients.

Intrathoracic application of the transverse rectus abdominis musculocutaneous flap.

The use of extrathoracic muscles for intrathoracic transposition of healthy tissues for correction of intrathoracic pathology has many precedents. The lower transverse rectus abdominis musculocutaneous flap as elevated in a manner identical to that more commonly used for breast reconstruction may also serve that role especially for basilar thoracic defects if more traditional muscle flap options are unavailable. A unique case of intrathoracic transfer of a lower transverse rectus abdominis musculocutaneous flap for obliteration of a chronic empyema cavity is presented.

Laser deepithelialization of the transverse rectus abdominis musculocutaneous flap.

Total or partial skin deepithelialization of the transverse rectus abdominis musculocutaneous (TRAM) flap is an integral component of this technique for achieving a successful breast reconstruction. In a manner similar to dermabrasion, the carbon dioxide laser in a defocused mode permits precise removal by vaporization of the epidermis and outer dermis. The extended application of this method for deepithelializing the TRAM flap is simple, rapid, and safe.

The role of local fasciocutaneous flaps in total burn wound management.

The majority of acute burn wounds or delayed reconstructions are best managed simply with a skin graft. However, if vascularized tissue is mandatory, the local fasciocutaneous flap may have an important role in providing a single-stage technique for obtaining tissue nearly identical in color, texture, and consistency to that of the defect being restored. This review of 182 consecutive burn patients needing surgery found that they underwent 233 separate episodes for skin grafting.

Dorsal thoracic fasciocutaneous flap salvage of the failed transverse rectus abdominis musculocutaneous flap.

The pedicled lower transverse rectus abdominis musculocutaneous flap, now considered the standard for breast reconstruction using autologous tissues, still may be plagued occasionally by significant flap necrosis in spite of the best intentions. Rather than discarding the residual flap, it may suffice as an autologous implant if an additional source of tissue can be used for surface coverage. The dorsal thoracic fasciocutaneous free flap provides such a large, yet reasonably thin, skin territory that can uniformly cover the new breast, ultimately salvaging an acceptable result after a partially failed transverse rectus abdominis musculocutaneous flap.

Assessment of TRAM flap perfusion using laser Doppler flowmetry: an adjunct to microvascular augmentation.

Any necrosis after reconstruction of the modified radical mastectomy defect using a superior epigastric based unipedicled lower transverse rectus abdominis myocutaneous flap should be unusual. Identification of the marginal flap at risk for this complication is important as this would permit immediate microvascular augmentation to enhance total survival. The dilemma, then, is how to define which flaps would benefit.

Transient single-digit ectopic implantation.

Although immediate replantation of an amputated digit is always preferable, mitigating circumstances (such as a severe concomitant injury involving the appropriate recipient neurovascular structures) might preclude such an attempt altogether. However, if these local structures have the potential, following adequate debridement and/or other tissue transfer, to accept this digit later, than an alternative for transient storage for delayed replantation should be considered. The deep inferior epigastric vessels are a recognized convenient site that could provide temporary ectopic revascularization of such a solitary finger.

Temporary tarsorrhaphy "zipper".

Reconstructive eyelid procedures on occasion justify the concomitant use of a temporary, reversible tarsorrhaphy to provide corneal protection. A dilemma ensues in the trauma patient when frequent neurological evaluations simultaneously requires examination of the pupils. To circumvent the inconvenience of repeated suturing of the eyelids as in an occlusive suture, a technique with the facility of the opening and closing of a zipper is reviewed that allows rapid removal and reestablishment of the desired temporary tarsorrhaphy.

Rectovaginal fistula: complication of low anterior resection.

Three hundred of 990 active members (30 percent) of The American Society of Colon and Rectal Surgeons responded to a survey regarding the incidence of rectovaginal fistulas following low anterior resection. A total of 57 patients were reported to have had postoperative rectovaginal fistulas; of these, 53 had circular-stapled anastomoses. Patient characteristics, surgeon's experience, technical methods, pathology, and methods of treatment were surveyed.

Closure of the ulnar forearm free flap donor site using a local radial forearm flap.

Thin, pliable cutaneous flaps with large calibre vessels ideal for microsurgical transfers are major attributes of the reliable forearm fasciocutaneous flaps. A major detriment, however, that must always be considered is the management of the residual donor site deformity. Just as this potential morbidity for small radial forearm free flap donor sites may be minimised by the V-Y advancement of a local ulnar forearm flap, the converse, using a local radial forearm flap for closure of the ulnar forearm free flap donor site, may be efficacious.

Delayed debulking of free muscle flaps for aesthetic contouring debulking of free muscle flaps.

Although denervated muscle and myocutaneous free flaps atrophy over a period of time, when used for surface coverage they may remain bulky, resulting in a less than optimal aesthetic result. With the availability of a number of donor sites, soft tissue defects can often be reconstructed with like tissue in a single stage. Even though the goal of all plastic surgeons is to achieve a good cosmetic result, special circumstances might dictate that need take precedence over form.