Radial tunnel syndrome (RTS) is caused by compression of the posterior interosseous nerve and consists of a constellation of symptoms that have previously been characterized as aspects of other disease processes, as opposed to a distinct diagnosis. First described in the mid-20th century as “radial pronator syndrome,” knowledge regarding the anatomy and presentation of RTS has advanced markedly over the past several decades. However, there remains notable controversy and ongoing research regarding diagnostic imaging, nonsurgical treatment options, and indications for surgical intervention. In this review, we will discuss the anatomic considerations of RTS, relevant physical examination findings, potential diagnostic modalities, and outcomes of several treatment options.
PurposeTissue-expander breast reconstruction (TEBR) is a common method of reconstruction after mastectomy but may result in complications that may necessitate removal. Although complications in TEBR have been well studied, there is a paucity of data regarding outcomes after tissue-expander loss. In this study, we examine the eventual reconstructive pathways and associated factors of patients who required tissue-expander removal after infection.MethodsThis retrospective study examines patients undergoing breast reconstruction at a single institution. Patients included underwent mastectomy, immediate TEBR, and subsequent tissue-expander loss. Patients who underwent autologous reconstruction after mastectomy or had successful TEBR were excluded. Patients were followed for an average of 7 years, with a minimum of 2 years and a maximum of 13 years.ResultsA total of 674 TEBR patients were initially screened, of which 60 patients (8.9%) required tissue-expander removal because of infection or skin necrosis. Thirty-one of these patients (group 1) did not complete reconstruction after initial tissue-expander loss, whereas the remaining 29 patients (group 2) underwent either TEBR or autologous reconstruction after tissue-expander loss. Group 1 had a significantly higher mean body mass index than group 2 (32.61 ± 8.88 vs 28.69 ± 5.84; P = 0.049) and also lived further away from our institution than group 2 (P = 0.052), which trended toward significance. There were otherwise no significant differences in demographics between the 2 groups.Among the 29 patients in group 2, 18 patients underwent a second TEBR (group 2a), and 11 patients underwent autologous reconstruction (group 2b). Patients in group 2b had a significantly greater mean number of complication related admissions (1.11 ± 0.323 vs 1.55 ± 0.688; P = 0.029) and also had higher occurrence of postmastectomy radiation therapy (16.7% vs 45.5%; P = 0.092), although this was not significant. There were otherwise no differences between the 2 groups.ConclusionOur data demonstrate the trends in breast reconstruction decision making after initial tissue-expander loss. This study elucidates the factors associated with patients who undergo different reconstructive options. Further work is needed to delineate the specific reasons between the decision to pursue different reconstructive pathways among a larger cohort of patients.
Craniofrontonasal dysplasia (CFND) is a rare congenital malformation, which has a wide array of symptoms that can vary drastically between patients. These include coronal synostosis with associated brachycephaly, hypertelorism, cleft lip and palate, and limb malformations, among others. The pleomorphic nature of the disease and numerous clinical decisions required for its management present a unique challenge to craniofacial surgeons when considering indications and timing for surgical intervention. In this report, we present the case of a patient with CFND, their surgical management, and discuss updates in principles of management of CFND.
Staphylococcal toxic shock syndrome (TSS) is a severe systemic disease characterized by fever, hypotension, desquamating rash, and multiorgan dysfunction. Attributed to bacterial exotoxins, TSS has been a known, though rare, complication in the field of pediatric burns for decades. The adoption of new antimicrobial burn dressings has allowed for the management of small to medium sized burns with minimal discomfort or inconvenience to the patient. In this report, we discuss a 3-year-old male with burns wounds dressed using a silver-impregnated foam who went on to develop TSS.
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