VAC therapy, together with debridement and appropriate antibiotic therapy, enables a higher rate of limb salvage, especially in Wagner Grade 3 and Grade 4 ulcers.

According to radiological and histological parameters, PTX appears to improve angiogenesis and healing of segmental cortical bone defects of the radius in a rat model.

4.

Background. This study was conducted to compare and evaluate the effect of adding lornoxicam or nitroglycerine as adjuncts to lidocaine in intravenous regional anesthesia (IVRA). Methods. 60 patients were randomly separated into three groups, lidocaine group (group L), lidocaine + lornoxicam group (group LL), and lidocaine + lornoxicam + transdermal nitroglycerine group (group LL-N). Hemodynamic parameters, sensory and motor blocks onset, and recovery times were recorded. Analgesic consumption for tourniquet pain and postoperative period were recorded. Results. Sensory block onset times and motor block onset times were shorter in the LL-N and LL groups compared with L group. Sensory block recovery time and motor block recovery time were prolonged in the LL and LL-N groups compared with group L. The amount of fentanyl required for tourniquet pain was less in group LL and group LL-N when compared with group L. VAS scores of tourniquet pain were higher in group L compared with the other study groups. Postoperative VAS scores were higher for the first 4 hours in group L compared with the other study groups. Conclusion. The adjuvant drugs (lornoxicam or TNG) when added to lidocaine in IVRA were effective in improving the overall quality of anesthesia, reducing tourniquet pain, increasing tourniquet tolerance, and improving the postoperative analgesia.

ÖZAmaç: Bu çalışmada hipotenar çekiç sendromu nedeniyle cerrahi tedavi yapılan hastalarla ilgili deneyimlerimiz sunuldu ve ilgili literatür gözden geçirildi. Hastalar ve yöntemler: Çalışmaya Eylül 2004 -Mart 2013 tarihleri arasında hipotenar çekiç sendromu nedeniyle cerrahi geçiren sekiz hastanın (5 erkek, 3 kadın; ort. yaş 48 yıl; dağılım 29-60 yıl) 11 eli dahil edildi. Ortalama takip süresi 50 aydı (dağılım 3-103 ay). Semptom başlama zamanı, mesleki öykü ve ayrıntılı fizik muayene bulguları kaydedildi. Cerrahi sedasyon ve aksiller anestezi altında gerçekleştirildi. Ön kolun distal kısmı, Guyon ve yüzeyel arktaki tüm tromboze kısımlar çıkartıldı. Ulnar arter ve yüzeyel ark rekonstrüksiyonları ön koldan alınan ven greftleri kullanılarak yapıldı. Bulgular: Hastaların tamamının dominant eli etkilenirken üç hastada iki el etkilenmişti. Tüm hastalar bir veya birkaç parmağında ağrı ve renk değişikliğinden yakındı. İki hastanın parmak ucu pulpasından minimal amputasyon ve debridman yapılırken diğer hastaların tamamı sorunsuz iyileşti. Takiplerinde, sekiz hastanın beşinde ulnar arter açıklığı sorunsuz iken üç hastaya yeni ven grefti için revizyon cerrahisi yapıldı. Hastaların yakınmalarının çoğu takip sürecinde ortadan kalktı. Sonuç: Hipotenar çekiç sendromu, parmak iskemisi ve el işleri ile sigara öyküsü olan hastalarda dikkate alınması gereken, üst ekstremitelerin bir hastalığıdır. Bu hastalık konservatif olarak tedavi edilebilse de konservatif tedaviye yanıt vermeyen ileri dönem hastalar ven greftleri ile cerrahi olarak tedavi edilebilir.Anahtar sözcükler: Arter rekonstrüksiyonu; parmak iskemisi; hipotenar çekiç sendromu; ulnar arter; ven grefti. ABSTRACTObjectives: This study aims to report our experience regarding patients who were surgically treated due to hypothenar hammer syndrome and review the related literature. Patients and methods: The study included 11 hands of eight patients (5 males, 3 females; mean age 48 years; range 29 to 60 years) who underwent surgery due to hypothenar hammer syndrome between September 2004 and March 2013. Mean follow-up period was 50 months (range 3-103 months). The time of symptom onset, occupational history, and detailed physical examination findings were recorded. Surgery was performed under sedation and axillary anesthesia. Distal segment of the forearm, all thrombosed segments of the Guyon and superficial arch were removed. Reconstruction of the ulnar artery and the superficial arch was performed using vein grafts obtained from the forearm.

Vascularized fibular grafts (VFG) are used for the treatment of femoral head avascular necrosis, osteomyelitis, nonunions, and excessive bone defects. Mostly the ascending branch of the lateral circumflex femoral artery (LCFA) or first or second perforating branch of the profound femoral artery is used for the customary recipient vessel. In this report, an alternative technique of using descending branch of LCFA in VFG surgery and its clinical results are reported. Sixteen patients (13 men and 3 women) underwent VFG surgery between the years 2005 and 2012. Predicted etiologies were: ANFH in 10 hips, traumatic femur neck pseudoarthrosis in 4 hips, tumor in 1 hip, and 1 femur shaft defect due to osteomyelitis. Patients' average age at the time of surgery was 29 years (range, 14-43 years). All patients were treated with VFG. All of the grafts survived and none of the patients needed any revision surgery. One had superficial wound infection, one developed peroneal nerve palsy, and one had trochanteric bursitis. The follow-up time was 36 months (range 20-72). It is believed that the descending branch of LCFA is a reliable alternative for anastomosis in VFG surgery.

In this study, 6-week intraperitoneal administration of 80 µg/kg of folic acid significantly improved peripheral nerve healing. Histological analysis of the group that received folic acid revealed increased axon myelination with little granular tissue or fibrosis. We propose that folic acid supplementation may be an effective component of peripheral nerve injury treatment.

Multiple factors (eg, interpedicular angle, S1 vertebra interfacet index, the distance between the iliac crest and L5 vertebra transverse process, L5 pedicle width, height of the iliac crest and L5 vertebra sagittal index) in lumbosacropelvic morphology affect the defect development in pars interarticularis. In individuals with spondylolysis, paravertebral muscle hypertrophy develops as a secondary adaptive change.