Terminal amputations with loss of the distal pulp are common injuries. This report analyses 64 consecutive cases of advanced or exchanged homodigital neurovascular island flaps operated on by one surgeon between 1981-1986. The surgical technique, indications, contra-indications and five year results are evaluated. Overall, these flaps provide reliable vascularity as well as normal sensibility at the distal end of the finger where high quality perception is required.

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Verrucous carcinoma of the foot often affects deep structures such as tendons, muscles, or bones. A 74-year-old man presented with a foot lesion that had been diagnosed as a skin infection 7 years earlier. He was treated with multiple excisions and superficial biopsies associated with antibiotic therapy without success. In our department he underwent an aggressive and accurate debridement with marginal excision harvesting multiple biopsies. Pathological evaluation of tissue at the time of operation confirmed the diagnosis of verrucous carcinoma of the foot. Therefore, the patient underwent an amputation below knee, and there were no postoperative complications; the patient was able to walk with the aid of a prosthesis with no signs of recurrence. The lesion follows a chronic course evolving from a discrete focal lesion to a large fungating deeply penetrating mass often compromised by local infection. The slow growth and confusing early-stage appearances can lead to delays in diagnosis of 8 to 15 years causing the extracutaneous involvement that requires a leg amputation. Many patients are initially treated with many topical medications without success, and most tumors have been treated as recalcitrant warts or corns for some time, whereas the basic approach is surgical.

BackgroundThe aim of this research was to study the epidemiology, microbiology, prophylaxis, and antibiotic therapy of surgical site infections (SSIs), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), and identify the risk factors for these infections. In Italy SSIs occur in about 5 % of all surgical procedures. They are predominantly caused by staphylococci, and 30 % of them are diagnosed after discharge. In every surgical specialty there are specific procedures more associated with SSIs.MethodsThe authors conducted a systematic review of the literature on SSIs, especially MRSA infections, and used the Delphi method to identify risk factors for these resistant infections.ResultsRisk factors associated with MRSA SSIs identified by the Delphi method were: patients from long-term care facilities, recent hospitalization (within the preceding 30 days), Charlson score > 5 points, chronic obstructive pulmonary disease and thoracic surgery, antibiotic therapy with beta-lactams (especially cephalosporins and carbapenem) and/or quinolones in the preceding 30 days, age 75 years or older, current duration of hospitalization >16 days, and surgery with prothesis implantation. Protective factors were adequate antibiotic prophylaxis, laparoscopic surgery and the presence of an active, in-hospital surveillance program for the control of infections. MRSA therapy, especially with agents that enable the patient’s rapid discharge from hospital is described.ConclusionThe prevention, identification and treatment of SSIs, especially those caused by MRSA, should be implemented in surgical units in order to improve clinical and economic outcomes.

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Terminal amputations with loss of the distal pulp are common injuries. This report analyses 64 consecutive cases of advanced or exchanged homodigital neurovascular island flaps operated on by one surgeon between 1981–1986. The surgical technique, indications, contra-indications and five year results are evaluated. Overall, these flaps provide reliable vascularity as well as normal sensibility at the distal end of the finger where high quality perception is required.

Background. Recent findings indicate that the connective tissue of tendons hosts cells that can self-renew and are multipotent. Even if these cells seemingly fail to accomplish tendon regeneration in pathological conditions, their identification and characterization represents a milestone in the research and development of new biological therapies for tendinopathies. Methods. We isolated the adult human tendon-derived stem cells (hTDSCs) from the fragments of patellar or calcaneal tendons and characterized these cells in vitro by immunochemistry and histochemistry. Subsequently, the MTT test and Trypan Blue were used for the evaluation of cytotoxicity of the supplements/drugs commonly used for the treatment of musculoskeletal disorders: Curcumin, Hyaluronic Acid, Palmitoylethanolamide, Diclofenac sodium, Triamcinolone acetonide and Thiocolchicoside. Results. Cells obtained by outgrowth expressed mesenchymal markers, were clonogenic and differentiated into chondroblasts, osteoblasts and adipocytes. High concentrations of the anti-inflammatory glucocorticoid Triamcinolone and the analgesic fatty-acid amide Palmitoylethanolamide significantly reduced cell viability. Only curcumin had a positive effect on cell survival, both in the normal and oxidative stress conditions. Conclusions. Adult human tendons posses stem cells. The influence of several drugs or supplements used for the treatment of musculoskeletal disorders should be taken into consideration in order to take the full advantage of the healing properties of stem cells within tendons.