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SURGICAL TREATMENT OF SACROCOCCYGEAL PILONIDAL SINUS WITH THE LIMBERG FLAP: REVIEW OF 81 CASES
Written by Doreid Oueidat et Al.   
domenica, 27 marzo 2016

 Pilonidal sinus disease is a complex condition that causes both discomfort and embar-rassment to sufferers. Direct cost through absence from work is high. Controversy still exists regarding the best surgical technique for its treatment in terms of minimizing disease recurrence and patient discomfort. Thus, we conducted this study to evaluate the results of rhomboid excision and Limberg flap reconstruction in the surgical treat-ment of pilonidal sinus disease. This prospective study included 81 patients who had pilonidal sinus and were treated by the rhomboid excision and Limberg flap. The mean follow–up was 18 months and all patients were satisfied with the procedure. There were lower complication rates, minimal discomfort, patients discharged in 2-3 days and only two recurrences. The authors recommend the Limberg Flap procedure for pilonidal sinus disease. It is effective, with short hospitalization, low recurrence rate and shorter time off work.

 
CLINICAL AND RADIOLOGICAL OUTCOMES OF DISTAL RADIUS FRACTURES TREATED WITH ORIF WITH VOLAR PLATES
Written by Michele Bisaccia et Al.   
domenica, 27 marzo 2016

 Distal radius fractures are the most common fractures of the upper limbs and repre-sent 17% of all fractures treated in emergency medicine. The purpose of the present study is to evaluate the correlation between the clinical and radiographic outcomes obtained with surgical osteosynthesis using volar plates for the treatment of articular fractures of the wrist. We evaluated a series of 50 consecutive patients from January 2010 to December 2013 who had undergone surgery, aged 24 to 75, for distal meta-epiphyseal fractures of the radius, with or without distal ulnar involvement. All pa-tients were evaluated clinically and radiographically, pre-operatively and post-operatively. For the clinical evaluation, the DASH score and Mayo Wrist clinical rating scale were used. After one year, the range of movement of the wrist was very satis-factory, and the mean grip strength was 77.5% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 18 and the Mayo Modified Wrist Score was 82.5. Complex articular distal radius fractures, like those of other sites, needed an appropriate surgical treatment and the fixation with the volar LCP system demonstrated its validity for the stabilization of these fractures, the articular surface reconstruction and prompt mobilization. All the clinical results were related to the pa-tients’ age, the functional needs, the physiotherapy and the individual recovery

 
ANTITHROMBOTIC PROPHYLAXIS IN MICROSURGERY
Written by Sara Di Lorenzo et Al.   
domenica, 27 marzo 2016

 Background. The most common complication of microsurgical reconstruction is graft failure secondary to thrombosis. It is clear that thromboprophylaxis is helpful for a successful microsurgery. However, it’s also obvious that thrombosis can’t be avoided in cases of poor microsurgical technique. There is no consensus regarding the use of anticoagulation therapy during and after microsurgery. The authors compared two dif-ferent antithrombotic prophylaxis protocols used in the past ten years, and analyzed the effectiveness and risks of different pharmacological protocols.

Materials and methods. The authors performed a retrospective review of microsur-gical patients operated between 2005-2014 by the same surgical team. 37 patients (Group A) operated between 2005-2010 and 45 patients (Group B) operated between 2011-2014 were selected. The majority of patients had generic and specific risk fac-tors. Different thromboprophylaxis therapies were used in the two groups. While re-viewing medical records, the authors compared Hb values before and after surgery, the free flap success rate, the need for blood transfusions intra and post-op in order to assess the efficacy (failure rate), and safety of the administered antithrombotic thera-pies (bleeding complications).

Results. The pharmacological protocol used for the patients from Group B was more effective and less risky compared to results obtained from Group A. The therapy used in Group B did not increase the risk of bleeding and postoperative blood loss, and the flap success rate in Group B was significantly higher than that of Group A (p<0.000).

Discussion and Conclusion. This study suggests that even in a perfect microanasto-mosis, prothrombotic mechanisms are activated, which lead to flap failure. A reasoned and balanced drug therapy can counteract the natural tendency of pedicle thrombosis, without exposing the patient to bleeding complications. Vasoactive drugs, although still experimental in microsurgery, may be used in the near future in order to further improve the success rates of free flaps.

Last Updated ( domenica, 27 marzo 2016 )
 
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