Metacarpal-Like and Metacarpal Hand.

The metacarpal-like and metacarpal hand injuries are devastating conditions that render the hand nonfunctional. Although the metacarpal hand is well-studied, the metacarpal-like hand is never addressed. The authors, using the same principles as in the classification and treatment of metacarpal hand, propose an easy to follow treatment algorithm for metacarpal-like hand injury to guide the reconstructive surgeon.

Trismus Secondary Release Surgery and Microsurgical Free Flap Reconstruction After Surgical Treatment of Head and Neck Cancer.

This article addresses trismus following head and neck cancer ablation and free flap reconstruction whether or not radiotherapy has been utilized. The focus is to achieve durable and favorable outcomes and avoid untoward results. To aid surgeons in fulfilling these goals, key factors, including adequate release surgery, optimal free flap selection and reconstruction, long-lasting results, and the untoward outcomes specific to trismus release and reconstruction surgery and how to avoid them have been investigated and discussed based on the authors' experience in this surgery.

Fistulae After Successful Free Tissue Transfer to Head and Neck: Its Prevention and Treatment.

Fistulas, either between oral cavity and external face or between oral and nasal cavity, are major complications after microsurgical head and neck reconstruction. Any flaw in surgical planning, design, and execution may lead to this untoward outcome. Once fistula develops, it may interface with oncologic treatment, endanger the reconstruction, and increase overall patient suffering.

Free Tissue Transfer to Head and Neck: Lessons Learned from Unfavorable Results-Experience per Subsite.

This article provides a lesson-learned approach per site and anatomic structure to head and neck reconstruction. It addresses the most common unfavorable results following successful free flap transfer shedding light on why they happen and how to prevent them. It draws from hundreds of advanced and complicated microsurgical head and neck reconstruction cases, aiming to achieve excellence in the reconstructive endeavor and to enhance the patient's quality of life.

The Triangle of Unfavorable Outcomes After Microsurgical Head and Neck Reconstruction: Planning, Design, and Execution.

Analysis of unfavorable results in microsurgical head and neck reconstruction beyond free flap survival is the goal of this article. Unfavorable outcome is the result of poor or inadequate planning, design, and execution. A triangular relationship between the 3 corners of a microsurgical reconstruction-plan, design, and execution-is suggested to govern the unfavorable outcome after a surviving free flap.

Effective Steroid Treatment in Traumatic Cervical Spinal Epidural Hematoma Presenting with Delayed Tetraparesis: Two Case Reports and Literature Review.

Background: Traumatic spinal epidural hematoma (TSEH) is a rare neurosurgical condition that according to conventional treatment requires prompt surgical decompression. Recent reports, however, suggest that conservative management within the acute phase after trauma also can lead to similar long-term functional outcomes without the need for immediate neurosurgical intervention.

Case Description: In the present paper, we describe 2 cases of TSEH located in the ventral upper cervical spine, which presented with delayed neurologic deficits.

Combined Anti-CD154/CTLA4Ig Costimulation Blockade-Based Therapy Induces Donor-Specific Tolerance to Vascularized Osteomyocutaneous Allografts.

Tolerance induction by means of costimulation blockade has been successfully applied in solid organ transplantation; however, its efficacy in vascularized composite allotransplantation, containing a vascularized bone marrow component and thus a constant source of donor-derived stem cells, remains poorly explored. In this study, osteomyocutaneous allografts (alloOMCs) from Balb/c (H2(d) ) mice were transplanted into C57BL/6 (H2(b) ) recipients. Immunosuppression consisted of 1 mg anti-CD154 on day 0, 0.

Computer-Assisted Surgery for Segmental Mandibular Reconstruction with the Osteoseptocutaneous Fibula Flap: Can We Instigate Ideological and Technological Reforms?

Virtual surgical planning and computer-aided design and computer-aided modeling are promising technologies with a growing trend in contemporary head and neck reconstruction. Segmental mandibular reconstruction with the osteoseptocutaneous fibula flap is one of the fields in which these technologies are increasingly used. Perceived benefits are increased surgical precision, improved operative efficiency, and overall good outcomes.

Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries.

Background: In cases of mutilating hand injuries, the primary goal is recovery of prehensile function. This is particularly true in the case of joints, which are extremely difficult to replace or reconstruct adequately when damaged. Heterotopic vascularized joint transfer is indicated when salvageable joints are available for transfer to a more functionally optimal position on the hand.

Revisiting spontaneous rupture of the extensor pollicis longus tendon: eight cases without identifiable predisposing factor.

Introduction: Rupture of the extensor pollicis longus (EPL) tendon has been reported in the setting of distal radius fracture, chronic inflammatory arthritis, following steroid injection, and with excessive or repetitive activities. Truly, spontaneous EPL rupture, without an identifiable predisposing factor, has rarely been reported.

Methods: We present a retrospective case series of eight patients with spontaneous EPL rupture who were treated in our institution.

A Single Bolus of Docosahexaenoic Acid Promotes Neuroplastic Changes in the Innervation of Spinal Cord Interneurons and Motor Neurons and Improves Functional Recovery after Spinal Cord Injury.

Unlabelled: Docosahexaenoic acid (DHA) is an ω-3 polyunsaturated fatty acid that is essential in brain development and has structural and signaling roles. Acute DHA administration is neuroprotective and promotes functional recovery in animal models of adult spinal cord injury (SCI). However, the mechanisms underlying this recovery have not been fully characterized.

Raised Proinflammatory Cytokine Production Within Cerebrospinal Fluid Precedes Fever Onset in Patients With Neurosurgery-Associated Bacterial Meningitis.

Objective: The objective of the present study was to determine whether selective inflammatory cytokine concentrations within cerebrospinal fluid are useful markers for the differential diagnosis of aseptic and bacterial meningitis within neurosurgical patients.

Design: Prospective, open-label, observational, cohort study.

Setting: Neurosurgical ICU, Chang Gung Memorial Hospital.

Functional and aesthetic outcomes of the fingertips after nail lengthening using the eponychial flap.

Introduction: Eponychial flap technique is able to lengthen the visible nail and allow the preservation of the nail complex following fingertip amputations with nail bed involvement. The study assessed the functional and aesthetic outcomes of the reconstructed fingertips using the eponychial flap.

Methods: Eponychial flaps were performed in 11 fingertip amputations.

An Algorithm for Forefoot Reconstruction With the Innervated Free Medial Plantar Flap.

Background: Because of shearing forces, the forefoot is more prone to trophic ulcers than the heel. Reconstruction of trophic ulcers and other forefoot defects is a vexing challenge. We favor the innervated free medial plantar flap to replace like-with-like and confer protective sensation.

Refinements in flap design and inset for pharyngoesophageal reconstruction with free thigh flaps.

Background: Complications arising from anastomotic failure may occur after pharyngoesophageal reconstruction. In this report we present results of pharyngoesophageal reconstruction with free thigh flaps using a refined design and inset strategy in a series of patients.

Methods: From May 2011 to December 2012, pharyngoesophageal oncologic defects were reconstructed in 12 men using thigh flaps.

The combined ALT-groin flap for the mutilated and degloved hand.

Background: Degloving and mutilation of the hand is a rare but formidable challenge. When replantation is not possible, we rely on distant pedicled flaps. We present a technique using pedicled anterolateral thigh (ALT) and groin flaps to sandwich and resurface the degloved hand.

Precision of three-dimensional stereo-photogrammetry (3dMD™) in anthropometry of the auricle and its application in microtia reconstruction.

Background: The advent of three-dimensional stereo-photogrammetry in recent years has vastly helped the craniomaxillofacial field improve in terms of preoperative and intraoperative decision making. With regard to the auricle though, there is paucity of research as to the application of this promising technology.

Methods: A total of 20 normal adult ears were included in this study.

Algorithmic approach to anterolateral thigh flaps lacking suitable perforators in lower extremity reconstruction.

Background: The anterolateral thigh flap is preferred at the authors' institution for lower extremity reconstruction. When variations in vascular anatomy preclude flap harvest, the authors follow an algorithm for contingency planning. The authors compared outcomes of contingency strategies to anterolateral thigh flaps that go as planned.

Rates of susceptibility of carbapenems, ceftobiprole, and colistin against clinically important bacteria collected from intensive care units in 2007: Results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART).

Background: Data on susceptibility to ceftobiprole and colistin, and the complete evolutionary trends of minimum inhibitory concentrations (MICs) of important carbapenem agents among important pathogens collected in intensive care units (ICUs) in Taiwan are lacking.

Methods: We surveyed the MIC distribution patterns of ceftobiprole and colistin and susceptibility profiles of some important pathogens collected from patients hospitalized in intensive care units (ICUs) of major teaching hospitals throughout Taiwan in 2007. We also investigated the rates of nonsusceptibility to powerful carbapenems (imipenem, meropenem) among four important species of Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Proteus mirabilis) collected during the same period.

The distally based, venous supercharged anterolateral thigh flap.

The distally-based anterolateral thigh flap is an attractive option for proximal leg and knee coverage but venous congestion is common. Restoration of antegrade venous drainage via great saphenous vein supercharge to the proximal flap vein is proposed. The purpose of this study was to evaluate and compare outcomes of 18 large, distally-based anterolateral thigh flaps with and without venous augmentation on the basis of flap size, venous congestion, and clinical course.

Carbapenem susceptibility among Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae isolates obtained from patients in intensive care units in Taiwan in 2005, 2007, and 2009.

To investigate the evolutionary trends in non-susceptibility of carbapenems against the isolates of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae from patients hospitalized in intensive care units (ICUs) of major teaching hospitals throughout Taiwan during 2005-2009, we applied the breakpoints of MICs recommended by Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing in 2013. Escalations in imipenem MIC levels for overall E. coli and E.

Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps.

Lower abdominal, perineal, and groin (LAPG) reconstruction may be performed in a single stage. Anterolateral thigh (ALT) flaps are preferred here and taken as fasciocutaneous (ALT-FC), myocutaneous (ALT-MC), or vastus lateralis myocutaneous (VL-MC) flaps. We aim to present the results of reconstruction from a series of patients and guide flap selection with an algorithmic approach to LAPG reconstruction that optimizes outcomes and minimizes morbidity.

Secondary reconstructive surgery following major upper extremity replantation.

Background: Little literature currently exists on reconstructive strategies following successful upper extremity replantation. The authors hypothesized that the type of secondary surgery would vary predictably depending on mechanism and amputation level.

Methods: The authors performed a retrospective review of upper extremity replantations performed at their institution between 2003 and 2012.