Compression Wrap Research Articles

Effect of Lymphedema Treatment for Management of Acute Pilon Fractures.

Pilon fractures are high-energy injuries that often result in considerable edema and compromise of the soft tissue envelope of the ankle. These injuries are typically staged with an external fixator until the soft tissue is amenable for definitive fixation. This study was conducted to determine the effects of lymphedema treatment for the management of pilon fractures. Patients who underwent open reduction and internal fixation of pilon fractures between 2007 and 2014 at the authors' level II trauma center were identified by Current Procedural Terminology codes indicative of placement of an external fixator (20690) and open reduction and internal fixation of a pilon fracture (27826, 27827, or 27828). The primary efficacy endpoint to determine negative outcomes was 90 days after definitive fixation. Eighty-two patients with 84 pilon fractures met inclusion criteria. Forty-eight ankles (57%) received lymphedema treatment. There were no significant differences in population demographics between the control and treatment groups. Median times to internal fixation in the control and treatment groups were 20 days (inter-quartile range, 15.5-30 days) and 11 days (interquartile range, 6-18 days), respectively. This difference was statistically significant (P=.001). Additionally, there was no significant difference in the overall incidence of wound complications between the control and treatment groups (P=.246). Compression wrapping for posttraumatic edema was effective in reducing the time needed for soft tissues to be appropriate for definitive surgical fixation of pilon fractures without increasing the risk of wound complications. These promising results warrant future study. [Orthopedics. 2017; 40(4):e668-e674.].

Haddenham easywrap: the latest innovation in the management of lymphoedema.

The use of velcro compression wrapping devices in the management of lymphoedema and chronic oedema is not a new concept. Wraps have been available for many years and are being used widely in clinic and community settings where bandaging or traditional compression garments are not suitable. Furthermore, they are becoming more common when treating venous disease, patients with wounds and lipoedema. The aim of this article is to introduce the reader and clinician to the new Haddenham easywrap and to demonstrate why it is different to any other velcro wrapping device available. Case studies will be utilised from clinicians currently using easywrap in clinical practice, with both therapist and patient feedback given to demonstrate the efficacy of this new velcro compression wrapping device.

Medical Treatment for Postthrombotic Syndrome.

Deep vein thrombosis (DVT) is a prevalent disease. About 20 to 30% of patients with DVT will develop postthrombotic syndrome (PTS) within months after the initial diagnosis of DVT. There is no gold standard for diagnosis of PTS, but clinical signs include pitting edema, hyperpigmentation, phlebectatic crown, venous eczema, and varicose veins. Several scoring systems have been developed for diagnostic evaluation. Conservative treatment includes compression therapy, medications, lifestyle modification, and exercise. Compression therapy, the mainstay and most proven noninvasive therapy for patients with PTS, can be prescribed as compression stockings, bandaging, adjustable compression wrap devices, and intermittent pneumatic compression. Medications may be used to both prevent and treat PTS and include anticoagulation, anti-inflammatories, vasoactive drugs, antibiotics, and diuretics. Exercise, weight loss, smoking cessation, and leg elevation are also recommended. Areas of further research include the duration, compliance, and strength of compression stockings in the prevention of PTS after DVT; the use of intermittent compression devices; the optimal medical anticoagulant regimen after endovascular therapy; and the role of newer anticoagulants as anti-inflammatory agents.

Multinational, pilot audit of a Velcro adjustable compression wrap system for venous and lymphatic conditions.

The aim of this small pilot audit was to record the performance of an adjustable Velcro compression wrap, ReadyWrap, and the experiences of patients and health-care professionals using the system as a self-care option for the management of venous and lymphatic leg conditions in both the treatment and maintenance phases. This audit was held within a 4-week review period. Participants included venous leg ulcer (VLU) patients with and without oedema, and patients with lymphoedema. Where open wounds were present they were managed with debridement, skin care and dressings according to clinical need. Lymphoedema patients received manual lymphatic drainage and skin care regimens as per standard practice. The Velcro system evaluated formed part of a treatment pathway with compression bandages and/or compression hosiery as clinically indicated. Patients, carers and health-care professionals applied the garments following assessment and training. Objective data recorded included change in circumferential measurements and improvement in wound status. Observation of health-care professionals, patients and carers with regard to the comfort and ease of application/removal of the device were recorded. There were 17 patients included in the audit. Within the 4-week period a reduction in limb circumference was recorded in all cases. Improvements in open wounds were recorded in most cases. Following the 4-week audit period 94% of the application of the device was performed by either the patient (59%) or the carer (35%) thereby reducing the health-care professional contact that was required for application. Early results in this small audit demonstrate that this adjustable Velcro compression wrap may provide a simple, clinically effective and patient-acceptable solution for self-care with compression. Use of this type of device could have the potential to reduce overall health-care burden by reducing necessary skilled treatment visits and/or cost while still achieving good clinical outcomes. Further studies are required to confirm this pilot study and provide additional data.

A review of the evidence for adjustable compression wrap devices.

Compression therapy is a key component in the effective management of people with lower limb problems associated with venous, lymphatic and fat disorders such as lipoedema. Individuals with lymphoedema, venous ulceration and lipoedema often require long-term compression therapy to prevent and manage problems such as chronic ulceration and skin changes, persistent swelling and shape distortion. Challenges remain in achieving acceptable, safe, effective and cost-efficient compression therapy choices. Adjustable compression wrap devices using hook and loop fasteners, commonly called VELCRO brand fasteners, present new opportunities for improving treatment outcomes, supporting patient independence and self-management in the use of compression therapy. This paper reports the findings of an evidence review of adjustable compression wrap devices in people with lymphoedema, chronic oedema, venous ulceration and lipoedema. The authors have no conflict of interest to declare.

Morel-Lavallée Lesion of the Knee in a Recreational Frisbee Player.

Traumatic swelling/effusion in the knee region is a relatively common presenting complaint among athletes and nonathletes. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. Knee joint effusion can be differentiated from other types of swelling by careful physical examination. Imaging, including plain radiography, ultrasound, and magnetic resonance imaging (MRI), is preferred modality. Aspiration of a local fluctuating mass may help with the diagnosis and management of some of these conditions. We present a case of a 26-year-old gentleman with superomedial Morel-Lavallée lesion (MLL) of the knee with history of a fall during a Frisbee game. His MLL was successfully treated with therapeutic aspiration and compression wrap without further sequelae. MLL is a rare condition consisting of a closed degloving injury caused by pressure and shear stress between the subcutaneous tissue and the superficial fascia or bone. Most commonly, MLL is found over the greater trochanter and sacrum but in rare cases can occur in other regions of the body. In most cases, concurrent severe injury mechanisms and concomitant fractures are present. MLL due to sports injuries are very rare. Therapeutic strategies may vary from compression wraps and aspiration to surgical evacuation.

Reduction in Wound Complications After Total Ankle Arthroplasty Using a Compression Wrap Protocol.

The purpose of this study was to evaluate the clinical differences in wound complications after total ankle arthroplasty (TAA) between a cohort of patients that received a compression wrap protocol and a historical control group treated with cast immobilization. Patient charts and postoperative wound pictures were reviewed for 42 patients who underwent a compression wrap protocol and 50 patients who underwent circumferential casting after primary TAA from 2008 to 2013. A blinded reviewer graded each wound using a novel postoperative wound classification system, and recorded whether the wound was completely healed by or after 3 months. A second blinded review was performed to determine intraobserver reliability. Mean patient age was 55 years (range, 24-80) and all patients had at least 6-month follow-up. There were significantly more total wound complications (P = .02) and mild wound complications (P = .02) in the casted group compared to the compression wrap group. There were no significant differences in the number of moderate and severe complications between each group. A significantly higher proportion of TAA incisions took longer than 3 months to heal in the casted group (P = .02). Based on our clinical experience with postoperative wound care after TAA, use of a compression wrap protocol was safe and effective at reducing wound-related complications, and well tolerated by patients. Further prospective, randomized clinical trials are warranted to evaluate the utility and cost-effectiveness of a compression wrap protocol after TAA.

A prospective, randomised comparative study of weekly versus biweekly application of dehydrated human amnion/chorion membrane allograft in the management of diabetic foot ulcers

The aim of this study is to determine if weekly application of dehydrated human amnion/chorion membrane allograft reduce time to heal more effectively than biweekly application for treatment of diabetic foot ulcers.This was an institutional review board‐approved, registered, prospective, randomised, comparative, non‐blinded, single‐centre clinical trial. Patients with non‐infected ulcers of ≥ 4 weeks duration were included for the study. They were randomised to receive weekly or biweekly application of allograft in addition to a non‐adherent, moist dressing with compressive wrapping. All wounds were offloaded. The primary study outcome was mean time to healing.Overall, during the 12‐week study period, 92·5% (37/40) ulcers completely healed. Mean time to complete healing was 4·1 ± 2·9 versus 2·4 ± 1·8 weeks (P = 0·039) in the biweekly versus weekly groups, respectively. Complete healing occurred in 50% versus 90% by 4 weeks in the biweekly and weekly groups, respectively (P = 0·014). Number of grafts applied to healed wounds was similar at 2·4 ± 1·5 and 2·3 ± 1·8 for biweekly versus weekly groups, respectively (P = 0·841).These results validate previous studies showing that the allograft is an effective treatment for diabetic ulcers and show that wounds treated with weekly application heal more rapidly than with biweekly application. More rapid healing may decrease clinical operational costs and prevent long‐term medical complications.

Comment to: Prospective, randomized, controlled trial comparing the effectiveness of adjustable compression Velcro wraps versus inelastic multicomponent compression bandages in the initial treatment of leg lymphedema. J Vasc Surg 2013;1:13-9.

This study was conducted as a prospective, randomized, controlled trial at the Lymphedema Department at Nij Smellinghe Hospital in Drachten, The Netherlands, from January 2010 to August 2011. The study enrolled 30 patients hospitalized for non-operative treatment of moderate to severe lymphedema of the leg, not responsive to ambulatory lymphedema treatment with compression and manual lymph drainage for at least 6 weeks. The participants were randomized into two groups. Group A was treated with the Juxta-Fit ACW (CircAid Medical Products, San Diego, CA, USA), consisting of an initial protective cotton tube liner covered by an adjustable inelastic compression wrap. The adjustable compression Velcro (ACV) wrap devices were individually tailored to patient legs. Group B was treated by means of a three-component Trico IMC system (BSN Medical GmbH, Hamburg, Germany) consisting of an initial protective layer (Tricofix; BSN Medical GmbH) and covered with two layers of synthetic cast wadding (Delta-Rol S; BSN Medical GmbH). Two layers of Trico (12 cm x 4 m) bandaging material were applied over the synthetic cast wadding. In both groups, the initial systems were removed after 2 h. After the initial application, the patients in Group A reapplied ACVs in co-operation with the hospital staff, and they were further instructed as to how readjust the straps for the remainder of the study. In Group B, the staff applied new bandages during the following 24 h. After application of both compression systems, all patients were encouraged to move as much as possible. No other therapeutic intervention was performed before or during the study period. Leg volumetry was performed on both groups before bandage application, after removal of the initial bandages (i.e. 2 h later), and after the second removal (i.e. 24 h later). Interface pressures were sampled in both groups by a PicoPress pressure transducer (Microlab Elettronica, Roncaglia di Ponte San Nicolò, Italy). The median lymphedema leg volume before bandaging was 3570 mL for the ACV group, and 3268 mL for the inelastic multicomponent compression (IMC) bandages group. After 2 h, a median volume reduction of 3.1% was measured in the ACV group compared with 2.4% in the IMC group, which was not significant. After 24 h, the median volume reduction was 339 mL in the ACV group and 190 mL in the IMC group (P<0.05). The median initial interface pressures were 53 mmHg for ACV and 49 mmHg for IMC bandages. In the next 2 h, interface pressures dropped significantly: by 26.1% under ACV, and 50% under IMC (both P<0.001). After 2 h, compression materials were reapplied: ACVs were reapplied by the patients under supervision, while IMC bandages by the staff. Median interface pressures after bandage renewal were 52 mmHg for ACV and 53 mmHg for IMC. After 24 h, median interface pressures decreased significantly to 33 mmHg underneath ACV and to 25 mmHg underneath IMC (P<0.001). Patients’ interventions in the ACV group were recorded. During the second phase of the study, nine patients made 26 readjustments: the ACV was tightened 14 times and loosened 12 times. In the present study, there was significantly greater edema reduction by ACV after 24 h than with the IMC bandaging system, despite the same initial compression pressure. Patients were allowed to tighten ACVs when they felt them loose. This also led to an increase of the working pressure, producing a stronger massaging effect during walking. The ACV system was less bulky compared with IMC; therefore, it was easier for patients to wear shoes and to walk. So far, ACV has been mainly used in the maintenance phase of lymphedema treatment. Patients’ involvement in their own treatment is a part of self-management and is becoming more and more common in chronic disease management. In principle, patients who are able to put on their shoes should also be able to apply the ACV system. In cases where self-application is a problem, such as extreme obesity, relatives may be able to take over home-therapy. Stiff material generally exerts a stronger massaging effect during walking, but leads to an immediate pressure loss due to edema reduction. This disadvantage of pressure loss is compensated by the readjustment of the straps by the patients. Cost effectiveness aspect was not included in the study deliberately, although ACV is much more expensive than a traditional IMC.

Quantified hemodynamics of compression garments

Various forms of compression therapy have been utilized for centuries in the treatment of venous disease, with inelastic bandage systems being used in the more acute treatment of severe venous disease and elastic compression stockings used for long-term management of the disease. However, with the advancement in inelastic adjustable compression wraps, we now have the option to consider long-term management of venous disease with an inelastic system and not just elastic systems. The aim of this study was to compare the hemodynamic effect of elastic compression stockings and inelastic compression wraps on venous disease patients when both products are applied to provide the same level of compression. Utilizing the APG device (ACI Medical, San Marcos, CA, USA), venous volumes, venous filling indexes and ejection fraction measurements were captured on 10 patients with varying degrees of venous disease. Measurements were obtained for each patient at baseline (without compression), with either 30-40 or 20-30 mmHg elastic compression stockings (ECS) and an inelastic compression wrap (ICW) (Juxta-CUREStm by Circaid Medical, San Diego, CA, USA). The compression level of the ECS was measured at the B1 point utilizing a Picopress® [Microlab Elettronica Sas, Roncaglia di Ponte San Nicolò (PD), Italy] and the ICW was adjusted to provide the exact compression level as the ECS in order to compare the effects of inelasticity versus elasticity independent of compression differences. As expected, the use of compression therapy significantly improved all measures of hemodynamics although it was found that the ICW (average static stiffness 14.3) further improved the measures over ECS (average static stiffness 2.4). Average venous volumes were reduced over baseline with ECS by 19% while ICW showed a reduction of 35%. Average venous filling indexes were reduced with ECS by 25% and 39% with ICW. The ejection fractions for both devices, ECS and ICW, improved an average of 27%. When applying the same compression level, the stiffness associated with ICW can further improve the venous hemodynamics of venous disease patients over ECS. For certain patients, using ICW could prove to be a significant benefit in the management of their disease.

Fibrin glue as a non-invasive outpatient treatment for post-arthroscopic knee seromas

Post-surgical seromas and cysts have been reported across many surgical subspecialties including orthopaedics. Treatments include both invasive surgical approaches and more recently reported non-invasive techniques. Non-invasive approaches currently include compressive wrapping, vasopneumatic cryotherapy, and motion exercises. Persistent lesions have been treated with talc or doxycycline sclerodesis. This case presents a patient with a post-arthroscopic seroma that was treated with fibrin glue in an outpatient setting. Fibrin glue has not been reported in the post-arthroscopy outpatient setting to address cystic lesions. This case suggests a viable non-invasive treatment option for these lesions. Level of evidence V.

Diagnostic Biopsy of the Pronator Teres and a Motor Branch of the Median Nerve: Indications and Technique

Biopsy of muscle tissue and motor nerve is helpful in the neurological evaluation of patients who present with upper limb and/or diffuse motor weakness. The procedure is indicated to supplement clinical, serological, and imaging diagnostic work-up of myopathic and neuropathic disorders. We describe a surgical technique and clinical series of biopsy of the pronator teres muscle and a motor branch of the median nerve. We performed a retrospective review of 20 patients who underwent biopsy of the pronator teres and a motor branch of the median nerve as part of a clinical, serological, and radiographic evaluation for weakness of the upper extremity. All of the biopsies were performed by a single surgeon. The surgical technique is described. Follow-up visits with both the surgeon and the neurologist were reviewed to evaluate preoperative and postoperative neurological function to identify any changes in nerve or muscle function and any postoperative complications. Biopsied tissue was sufficient for pathological diagnosis in all 20 patients. Diagnoses included multifocal motor neuropathy in 14 patients, amyotrophic lateral sclerosis in 3 patients (2 sporadic; 1 familial), inclusion body myositis (1 patient), inflammatory myopathy (1 patient), and chronic inflammatory demyelinating polyneuropathy (1 patient). At a mean follow-up of 11 weeks (range, 5-31 wk), there were 6 minor surgical complications, all of which were superficial hematomas that resolved with use of a compressive wrap. Biopsy of the pronator teres and a motor branch of the median nerve was safe and effective. The technique is particularly useful when considering the diagnosis of multifocal motor neuropathy affecting the upper extremity.

Experience with a simple technique for pectus bar removal

BackgroundThere have been numerous reports of techniques used for pectus bar removal after correction of pectus excavatum. We use 2 operating tables positioned perpendicular to each other in a T-shaped configuration with the patients thorax circumferentially exposed so the bar is removed in 1 motion without bending the bar. In this study, we report the results of this procedure. MethodsA retrospective chart review of patients undergoing bar removal after repair of pectus excavatum at our institution from August 2000 to March 2010 was performed. ResultsThere were 230 patients with a mean age of 16.7 years (range, 7.8-25.3 years) at bar removal. Mean operative time for bar removal was 28.6 minutes, and average estimated blood loss (EBL) was 9.5 mL (range, 5-400 mL). One patient demonstrated significant hemorrhage from the bar tract after bar removal, which was controlled with circumferential compression wrap. Calcification was noted in 11 patients, and chondroma, in 8 patients. Wound infection after bar removal occurred in 3% of patients. No patient required the bar to be bent into a straight configuration for removal. ConclusionsRemoval of pectus bars using this 2-table T-configuration technique is safe, is time efficient, and obviates the need for bending the bar.

A Novel Cryotherapy Compression Wrap in the Management of Acute Ankle Sprains: Potential Use for Special Operators on the Battlefield

Musculoskeletal injuries related to training and operational missions frequently affect military personnel. A common treatment for these injuries is the PRICE (protection, rest, ice, compression, and elevation) method, which is time consuming and impractical in the field. Therefore, the primary objective of this study was to determine the effectiveness of the cryotherapy wrap compared to a traditional treatment in the management of acute ankle sprains.A randomized controlled clinical trial was conducted in a university research laboratory with 13 subjects (9 males and 4 females) with the following physical characteristics: age (yr) 20.6 ? 2.2, height (cm) 177.0 ? 14.3, weight (kg) 76.6 ? 20.6, and body mass index (kg/m2) 24.1 ? 3.7. Participants were instructed to perform PRICE with a traditional ice pack and compression wrap (control group) or with an Arctic Ease? cryotherapy wrap (test group) for 48 hours following enrollment in the study. The Numeric Pain Scale, Foot and Ankle Ability Measure, and ankle/foot volumetric measurement were performed at initial presentation and 24-hour, 48-hour, and 7-day follow-up intervals.While the comparison of the Numeric Pain Scale scores, Foot and Ankle Ability Measure scores, and volumetric changes between groups revealed no statistically significant differences (p > 0.01), there was an 86% compliance rate for subjects in the cryotherapy wrap group compared to a 17% compliance rate of subjects in the control group.The cryotherapy wraps performed comparably to ice therapy and therefore may be especially applicable to military personnel required to operate in austere and hostile environments where traditional therapies are unrealistic. Although this pilot study did not demonstrate that the cryotherapy wraps produce statistically superior results, trends emerged in the data suggesting that subject compliance rate may be improved by using an alternative form of cryotherapy compression, which could lead to better management of pain, edema, and functional recovery. Future research should include a larger sample size to verify this claim.

Rapid healing of chronic venous stasis leg ulcers treated by the application of a novel serum‐free cultured autologous epidermis

The efficacy and durability of wound closure was examined in a prospective randomized unbalanced clinical trial using the application of a living serum-free cultured epidermal autograft in conjunction with wound-area debridement and a four-layer compression wrap (N=10) compared with wound-area debridement and a four-layer compression wrap in patients with hard-to-heal leg ulcers arising from confirmed venous stasis (N=5). All 15 patients who presented with full-thickness venous ulceration were treated weekly for 8 weeks, with a 12-week final evaluation. The average time to wound closure for the grafted wounds was 4.1 weeks for 80% (8/10) of the cases that closed in 12 weeks compared with 12 weeks for the one closed in the control case. All of the grafted wounds remained closed at 12-month follow-up and one more healed at 30 weeks postenrollment. In the control group, one additional wound healed at 21 weeks postenrollment after the placement of an autograft. No serious adverse events were reported and subjective pain assessment was substantially reduced immediately after graft application. The graft treatment significantly improved outcome and provided durable wound closure. The data suggest that this adaption of this procedure may reduce the management costs of these wound types.

The Magnitude of Tissue Cooling During Cryotherapy With Varied Types of Compression

Certified athletic trainers can choose different types of external compression (none, Flex-i-Wrap, and elastic wrap) when applying an ice bag to the body. However, which type facilitates the greatest magnitude of tissue cooling is unclear. To compare the effects of 2 common types of external compression on the magnitude of surface and intramuscular cooling during an ice-bag treatment. Randomized controlled trial. University research laboratory. Fourteen college students (10 women, 4 men; age = 22.4 +/- 1.8 years, height = 169.1 +/- 8.2 cm, mass = 73.3 +/- 18.5 kg, skinfold = 13.14 +/- 1.61 mm) with previous cryotherapy experience and a posterior lower leg skinfold equal to or less than 15 mm. On 3 different days separated by 24 to 48 hours, an ice bag was applied to the posterior lower leg surface of each participant for 30 minutes with no compression, with elastic wrap, or with Flex-i-Wrap. Posterior lower leg surface and intramuscular (2 cm) temperatures were recorded for 95 minutes. At 15 minutes, the elastic wrap produced greater surface temperature reduction than no compression (P = .03); this difference remained throughout the protocol (P range, .03 to .04). At 30 minutes, surface temperatures were 14.95 degrees C, 11.55 degrees C, and 9.49 degrees C when an ice bag was applied with no external compression, Flex-i-Wrap, and elastic wrap, respectively. Surface temperatures between Flex-i-Wrap and elastic wrap and between Flex-i-Wrap and no compression were never different. At 10 minutes, Flex-i-Wrap (P = .006) and elastic wrap (P < .001) produced greater intramuscular temperature reduction than no compression produced; these differences remained throughout the protocol. At 10 minutes, no compression, Flex-i-Wrap, and elastic wrap decreased intramuscular temperature by 1.34 degrees C, 2.46 degrees C, and 2.73 degrees C, respectively. At 25 minutes, elastic wrap (8.03 degrees C) produced greater temperature reduction than Flex-i-Wrap (6.65 degrees C) (P = .03) or no compression (4.63 degrees C) (P < .001 ). These differences remained throughout ice application and until 50 minutes after ice-bag removal. During an ice-bag application, external compression with elastic wrap was more effective than Flex-i-Wrap at reducing intramuscular tissue temperature. Elastic wraps should be used for acute injury care.

Calf Pain- Basketball

HISTORY: A 18-year-old female athlete sustained a right calf strain during preseason basketball training. She modified activity and within ten days noted resolution of symptoms. However, on the eleventh day she noted intense tightness and swelling in right calf after a four hour car trip. Her calf was noticeably bigger and she did not seek medical attention for five days. Past medical history is significant for right ACL tear and underwent reconstruction in August 2005 and May 2008. Current medications included oral contraception only. PHYSICAL EXAMINATION: Examination 5 days after onset revealed a tense right calf with majority of firmness over right medial gastronemius. Right calf was 2cm greater than left calf. Medial aspect of the right calf had mild discoloration of skin. She noted exquisite pain with dorsiflexion and resisted bearing full weight. Normal sensation and strength was elicited and mild pedal edema noted on exam. DIFFERENTIAL DIAGNOSIS: Deep Venous Thrombosis Muscle-Tendon Rupture Hematoma Popliteal Cyst Compartment Syndrome TEST AND RESULTS: Due to the concern for deep venous thrombosis, she was sent to emergency room for evaluation. Laboratory studies and venous ultrasound with dopplers were negative, however a fluid collection was noted in medial right calf. MRI of right calf noted a large communicating popliteal cyst which dissected inferiorly within the medial head of gastrocnemius muscle. FINAL WORKING DIAGNOSIS: Popliteal Cyst TREATMENT AND OUTCOMES: 1. The cyst was drained for both comfort and to hasten recovery. Aspiration from medial calf returned 180mL of bloody fluid. A compression wrap was applied for twenty four hours, and she progressed to full activity in five days after drainage. 2. The cyst reaccumulated within a week and initial symptoms returned. We repeated the procedure aspirating 120ml of clear viscous fluid, and 1ml of kenalog was subsequently injected. Fluid was sent for further evaluation. She was shut down completely from activity and will be reassessed on a weekly basis.

Management of Morel-Lavallee Lesion of the Knee

Background The Morel-Lavallee lesion is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. It also occurs in the knee as a result of shearing trauma during football and is a distinct lesion from prepatellar bursitis and quadriceps contusion. Purpose To review the authors’ experience with Morel-Lavallee lesion of the knee in the elite contact athlete to construct a diagnostic and treatment algorithm. Study Design Case series; Level of evidence, 4. Methods Twenty-seven knees in 24 players were identified from 1 National Football League team's annual injury database as having sustained a Morel-Lavallee lesion between 1993 and 2006. Their charts were retrospectively reviewed. Results The most common mechanism of injury was a shearing blow on the playing surface (81%). The most common motion deficit was active flexion (41%). The mean time for resolution of the fluid collection and achievement of full active flexion was 16.3 days. The mean number of practices missed was 1.5. The mean number of games missed was 0.1. Fourteen knees (52%) were treated successfully with compression wrap, cryotherapy, and motion exercises. Thirteen knees (48%) were treated with at least 1 aspiration, and 6 knees (22%) were treated with multiple aspirations for recurrent serosanguineous fluid collections. In 3 cases (11%), the Morel-Lavallee lesion was successfully treated with doxycycline sclerodesis after 3 aspirations failed to resolve the recurrent fluid collections; return to play was immediate thereafter in each case. Conclusion In football, Morel-Lavallee lesion of the knee usually occurs from a shearing blow from the playing field. Diagnosis is confirmed when examination reveals a large suprapatellar area of palpable fluctuance. Elite athletes are typically able to return to practice and game play long before complete resolution of the lesion. Recurrent fluid collections can occur, necessitating aspiration in approximately half the cases for successful treatment. Recalcitrant fluid collections can be safely and expeditiously treated with doxycycline sclerodesis.

Feeding by Philoponella vicina (Araneae, Uloboridae) and how uloborid spiders lost their venom glands

Feeding by uloborid spiders is unusual in several respects: cheliceral venom glands are absent; prey wrapping is extensive (up to several hundred metres of silk line) and severely compresses the prey; the spider’s mouthparts usually never touch the prey; and the entire surface of the prey is covered with digestive fluid. This paper presents observations on Philoponella vicina O. Pickard-Cambridge, 1899, which provide possible causal links between these traits. The spider begins ingesting soon after it wets the prey, gaining access to the prey’s interior through a broken cuticle that was broken during wrapping and by digestion of the prey’s membranes. The more abundant of the two types of wrapping lines is also digested, but the remaining shroud of wrapping silk is dense and filters digested prey particles. Robust setae on the palpal tarsus and the spread position of the anterior legs during feeding probably protect the spider from contact with the digestive fluid. Spiders extracted about 65% of the wet contents of the prey, but feeding was slow and involved substantial water evaporation. We propose that selection in uloborid ancestors to recover wrapping silk led to increased wetting of the prey’s surface and that compressive wrapping facilitated this wetting. These traits could have led to loss of the now superfluous cheliceral poison glands.

Core‐Collapse Supernovae with Nonuniform Magnetic Fields

We perform two-dimensional numerical simulations on the core collapse of a massive star with strong magnetic fields and differential rotations using the numerical code ZEUS-2D. Changing field configurations and laws of differential rotation parametrically, we compute 14 models and investigate the effects of these parameters on the dynamics. In our models we do not solve the neutrino transport but instead employ a phenomenological parametric EOS that takes into account the neutrino emissions. As a result of the calculations, we find that the field configuration plays a significant role in the dynamics of the core if the initial magnetic field is large enough. Models with initially concentrated fields produce more energetic explosions and more prolate shock waves than the uniform field. Quadrupole-like fields produce a remarkably collimated and fast jet, which might be important for gamma-ray bursts (GRBs). The Lorentz forces exerted in the region where the plasma β is less than unity are responsible for these dynamics. The pure toroidal field, on the other hand, does not lead to any explosion or matter ejection. This suggests that the presupernova models, in which toroidal fields are predominant are disadvantageous for the magnetorotation-induced supernova considered here. Models with initially weak magnetic fields do not lead to explosion or matter ejection, either. In these models magnetic fields play no role, as they do not grow on the timescale considered in this paper and the magnetic pressure could be comparable to the matter pressure. This is because the exponential field growth as expected in MRI is not seen in our models. The magnetic field is amplified mainly by field compression and field wrapping in our simulations.