ciNPT might reduce the rate of minor local complications in post-bariatric patients undergoing body-contouring procedures, improving surgical outcomes and treatment costs.
A method of treatment of chronic flexion contractures of the PIP joint is presented, with the results obtained in 19 patients treated between 1989 and 1992 after a follow-up of from 6 to 53 months. The flexion contractures, with an extension deficit which ranged between 70 and 90 degrees, had been present for a period of between 2 months and 24 years. Our treatment program involves the surgical release of the unreducible PIP joint followed by the use of static and/or dynamic splints. Surgery is performed using a midlateral approach; the accessory collateral ligament and the flexor sheath are incised and, after the volar plate and check-rein ligaments have been excised, forced hyperextension is applied. The main collateral ligaments are carefully spared and freed from the condyle if there are any remaining adhesions. In our 19 patients, complete extension of the finger was achieved in 11 cases (57.9%); in the remaining 8 cases (42.1%) the residual extension deficit ranges from 10 to 15 degrees. In our experience this combined surgical and rehabilitative approach had led to consistently good results with minimal complications.
BackgroundAutologous fat grafting (AFG) has been used in the treatment of cutaneous and subcutaneous graft neoplastic demolitions, in limited cutaneous sclerotic conditions and in localized scleroderma. Several reports showed the possible therapeutic effects in the management of cutaneous perioral thickness and digital ulcers (DU) in patients affected by systemic sclerosis (SScl). Patients suffering from SScl in the course of the pathology, undergo progressive thickening of the skin, especially in perioral area, with functional limitation in the opening of the mouth, chewing, swallowing and phonation. On the other hand is well known that digitals ulcers (DU) localized on the hands developed in more than 50% of SScl patients. Usually DU are very painful, debilitating and difficult healing despite various therapies adopted, and often are complicated by infections that lead to gangrene and amputation.ObjectivesWe evaluated the response to AFG in treatment of DU and perioral thickness in Sclerodermic pts.MethodsWe treated 9 SScl pts (median age 47±14 years, affected by diffuse SScl, mean age of onset of disease 11±9) with perioral thickening ad DU. All patient were in treatment with iv iloprost and 7 also with bosentan to prevent new DU onset. All the 9 pts were subjected to perioral region treatment and 6 also to DU treatment; altogether there were 10 DU active. Under local anesthesia and mild sedation three cc of subcutaneous autologous fat were taken from the periumbilical or trochanteric area (only in two patients), and after centrifugation and purification, injected into the perioral region in 6 standardized points, or in presence of DU at the finger base in two contiguous sites. Before and after the graft and during the follow up, all pts were monitored by measuring of mouth opening, SHAQ and pts self reports based on visual scale regarding phonation, chewing and swallowing. Monitoring of digital ulcers involved the counting of those number, size, activity and/or superinfection, improving the bending of the fingers and hand grip strength, need of advanced medications and analgesic.ResultsAFG was well tolerated and no adverse events were reported, there were no infections; only 3 pts showed a small hematoma in the areas of periumbilical graft. In all the pts three and six months after treatment, mouth opening were conserved, and it was not necessary to repeat the treatment. In 6 pts treated for DU a healing of ulcers occurs in 6/10 DU after a month, a significant reduction of size in 4/10 DU, but at 3th month of follow up 1 small DU appears, and 2 DU at 6th month (already present, increased their size). All the patients were very satisfied of the perioral AFG (also for a good aesthetic result agreement 95%), instead of DU treatment the agreement decreased at 60%.ConclusionsAFG treatment can be an another therapeutic opportunity in treatment of perioral thickness and DU in SScl pts non responsive to conventional treatments.ReferencesDel Bene M et al. Handchir Mikrochir Plast Chir 2014; 46: 242-247.Del Papa N et al...
anchored to the ulnar surface of the proximal phalanx with a bone tag. Results: The average PIP joint hyperextension of 131 preoperatively was converted to an average of 131 postoperatively. The average MCP and DIP joint range of motion were improved by 51 by the procedure. The average PIP joint range of motion decreased by 51. No patient suffered a recurrence of the deformity or significant complication during an average follow-up of 18 months. Conclusion: Our technique is simple to use, eliminates some unappealing aspects of previously described techniques and gives reliable correction of the swan neck deformity.Background: Recent advances in wrist arthroscopic surgical techniques and instrumentation have enabled the surgeon to improve the treatment of wrist rheumatoid arthritis. Aim: To evaluate the results of arthroscopic synovectomy concerning function, relief of pain and progression of the disease. Study design: Clinical study in a prospective case series. Methods: From 2001 to 2004, 42 patients, mean age of 41 years, with chronic wrist pain unresponsive to initial conservative treatment for a mean period of 12 weeks, without advanced degenerative change, were included in this study. The arthroscopic synovectomy was performed with a 2 mm monopolar radiofrequency ablation probe with temperature-controlled system. Range of motion, grip strength, VAS, Mayo modified wrist score, were registered preoperatively and at 3, 6, 12, 18 months, and the latest evaluation was on average at 26 months after treatment. Progression of the disease has been checked in standard posterior-anterior radiographs which were taken pre-operatively and at 6,12 months and final follow-up and analysed using a modified Larsen scoring system. Results: No complications were noted. Wrist motion improved in almost all patients from an average value of extension plus flexion of 791 pre-operatively to 1151 at the last follow-up. The wrist-score improved significantly from an average of 40 points pre-operatively to 74 points postoperatively at the last follow-up. The mean pre-operative pain score was 8.5 which decreased to 3.1, 1 year after surgery and increased to 3.8 at final follow-up. The mean modified Larsen's score was 13.8 pre-operatively and 14.9 at final follow-up.
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