Medial Arm Research Articles

Giant Fibroadenoma in the Axilla: A Common Entity of Uncommon Size in a Rare Location

A 20-year-old patient presented at our department with a slow-growing mass spanning from her right axilla to the medial upper arm. She had first noted the asymptomatic mass 10 months previously. Physical examination revealed a firm but relatively mobile mass measuring 8 cm×2 cm in the right upper medial arm. The mass was painless and nontender, with no fluctuation. No neurological signs and no infection signs with respect to the right arm were observed (Fig. 1). Computed tomography showed a lobulated mass measuring 8.5 cm×4.0 cm×2.1 cm with intermediate density in the subcutaneous layer of the right axilla and the upper medial arm (Fig. 2). Under the impression of a soft-tissue tumor of nerve origin, an excisional biopsy was performed through an axillary incision. A well-encapsulated, lobulated, pink, rubbery mass was found in the deep subcutaneous fat layer and was excised from the surrounding tissue (Fig. 3). Histopathologically, a biphasic pattern of epithelial and stromal proliferation was noted. The ductal epithelium was composed of an inner cuboidal/columnar epithelium and an outer myoepithelial layer. The fibrous stromal tissue showed an intracanalicular growth pattern, corresponding to the diagnosis of fibroadenoma (Fig. 3). The patient underwent sonography evaluation for any lesions in both breasts with negative findings. Fig. 1 Preoperative and intraoperative findings. (A) The bulging, palpable mass spanning from the right axilla to the upper portion of the arm is seen preoperatively. (B) A well-encapsulated, pink, rubbery, and lobulated mass was found. Fig. 2 Computed tomography findings of a lobulated mass measuring 8.5 cm×4.0 cm×2.1 cm with intermediate density in the subcutaneous layer of the right upper medial arm and the axilla. Fig. 3 (A) The excised specimen measuring 11.5 cm×5 cm. (B) Histological findings of both epithelial hyperplasia and stromal hypercellularity (H&E, ×100). Fibroadenoma is a benign, fibroepithelial tumor of the breast. While a vast majority of these tumors have been found in females, rare occurrences have been reported in males [1]. Due to their benign nature, some have thought that these lesions are not neoplasms but hyperplastic lesions. However, recent studies observing the transformation of breast fibroadenoma to malignancies have reported differently. Pacchiarotti et al. [2] reported the transformation of fibroadenoma into high-grade malignant tumors after ovarian stimulation in in vitro fertilization patients. Specific variants of fibroadenoma include giant fibroadenoma, juvenile fibroadenoma, multiple fibroadenomas, and fibroadenoma of pregnancy and lactation. Giant fibroadenomas have a diameter of more than 5 cm and/or weigh more than 500 g, as in this case. Multiple fibroadenomas are associated with a related family history or several cancer syndromes such as the Maffucci syndrome, Cowden syndrome, and Carney complex [3]. Juvenile fibroadenoma usually presents as a breast mass in patients between the age of 10 and 18 years. Jung et al. [4] reported a case found in a 13-month-old child, but such incidence is extremely rare. The incidence of breast lesions in the general adolescent population is low (2.2%), and a majority of these lesions are fibroadenomas. Definitive diagnosis is done through histopathological examination. Ultrasonography may help distinguish between solid and cystic lesions of the breast, and fibroadenomas typically have a longer width than height, surrounded by an echogenic capsule. Fine-needle aspiration is not reliable in distinguishing a fibroadenoma from a phyllodes tumor. Core-needle biopsy has strong negative (93%) and positive (83%) predictive power, but only by histopathological examination of the entire specimen can a definite diagnosis be made. The pathophysiology of this entity has not been fully established. Hormonal influences have been suggested to be a factor, due to the increase in prevalence during puberty or pregnancy, or during the intake of oral contraceptives. Suggested hypotheses are an imbalance of estrogen levels or hypersensitivity of breast tissue to estrogen, resulting in mammary gland hyperplasia [5]. Thus, a vast majority of fibroadenomas are found in the breast. Although there have been rare reports of lesions found in the axilla, this is the first report of a fibroadenoma of this dimension solitarily occurring in the axilla [5]. In this report, we have included the relevant clinical, gross, and micrographic pathological images.

Reliable assessment of forearm photoageing by high-frequency ultrasound: a cross-sectional study.

High-frequency ultrasound is a non-invasive tool used in skin ageing research to assess dermis thickness and echogenicity. This study evaluated the reliability of a range of high-frequency ultrasound parameters and tested their correlation with age and a validated clinical scale for the assessment of forearm skin photoageing; the difference between two body sites according to environmental exposition patterns was also investigated. Twenty-three volunteers aged 28-82 years were divided into three groups according to forearm photoageing degree. A 20 MHz ultrasound unit was used to obtain cross-sectional images of the skin by two trained investigators on two different sites: the dorsal forearm (chronically photoexposed skin) and the proximal medial arm (non-photoexposed skin). Several echogenicity parameters were studied for each skin compartment: total dermis, upper dermis and lower dermis, and the ratio between upper and lower dermis. The intraclass correlation coefficient (for complete agreement) between investigators was higher for upper and total dermis echogenicity measures compared with the lower dermis. At the non-photoexposed site, the upper and lower dermis parameter ratio was better correlated with age. At the photoexposed area, total dermis parameters demonstrated higher correlations with clinical score. The authors discuss the choice of parameters for forearm photoageing assessment using high-frequency ultrasound.

Ideal or Young-Looking Brow Height and Arch Shape Preferred by Koreans.

The aim of this study is to see which brow height and arch shape is preferred as ideal or young-looking by Koreans. A survey was conducted between June and Dec 2014 on 186 women who visited the brow bar ("Benefit" of Incheon city). They were asked to choose which they believed ideal and youngest amongst the 3 brow archetypes according to their height and 4 types of modification of Anastasia (rotation of medial and lateral arms), which was illustrated. Approximately half (52.5%) of the respondents answered that their brow matches them very well or well. Most (81.2%) believed there might be a method to yield an ideal brow archetype and almost all (97.3%) would change the brow shape if the expert advised. The most preferred ideal brow height was of a middle height (63.2%, the distance from the lateral canthus to the lateral end of eyebrow, which was 2/3 of the eye width). The most preferred ideal brow arch shape was the arched type (57.6% arches on a line drawn from the center of the nose through the center of the pupil). The most preferred young-looking brow height was of an upper height (46.2%, the distance from the lateral canthus to the lateral end of eyebrow was 3/4 of the eye width) followed by a middle height (39.7%). The most preferred young-looking brow arch shape was the head-up position (53.3%, medial arm of the brow was rotated upward to the horizontal plane). The result of this study might be useful in facial rejuvenation surgeries as well as in brow esthetics or tattooing of the eyebrows.

Too much anticipation? Large anticipatory adjustments of grasping movements to minimal object manipulations

When humans grasp objects, the grasps foreshadow the intended object manipulation. It has been suggested that grasps are selected that lead to medial arm postures, which facilitate movement speed and precision, during critical phases of the object manipulation. In Experiment 1, it has been tested whether grasp selections lead to medial postures during rotations of a dial. Participants twisted their arms considerably before grasping the dial, even when the upcoming dial rotation was minimal (5°). Participants neither assumed a medial posture at any point during a short rotation, nor did they assume any of the postures involved in short rotations in the opposite direction. Thus, grasp selections did not necessarily lead to specific postures at any point of the object manipulation. Experiment 2 examined the effect of various grasps on the speed of dial rotations. A medial initial grasp resulted in the fastest dial rotations for most rotation angles. Spontaneously selected grasps were more excursed than necessary to maximize dial rotation speed. This apparent overshot might be explained by participants’ sensitive to the variability of their grasps and is in line with the assumption that grasps facilitate control over the grasped object.

An investigation of gender-dependent perception of thermal and pain: a quantitative sensory testing study

Background: Pain is the most common health problem in the world and requires quantitative sensory testing (QST). The consequences of gender inequality with respect to sensations such as pain need to be identified. Purpose: To examine the thermal and pain of health subjects with QST, and to explore the gender differences. Methods: Healthy adults were tested on the perception of temperature change and pain, the pain tolerance, by thermal QST. A 30× 30mm Peltier type thermode (TSA-2001, Medoc Inc., Israel) was placed on the middle part of left medial arm of subjects. The thermode was used to induce temperature changes and pain by increase or decrease temperature, the baseline temperature was set at 32 ◦C. The testing parameters included the cold detection threshold (CDT), warmth detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), cold pain tolerance (CPTol) and heat pain tolerance (HPTol). The Student’s t test was used to assess the differences between men and women. Results: Two hundred eighteen (114 female) healthy adults, 41.3± 17.0 years (range 18–80) participated the study. The cold change was detected after the temperature decrease 1.9± 1.4 ◦C, and the warm change was detected after temperature increase 2.4± 1.2 ◦C of all participants. However, the values of CPT, HPT, CPTol, and HPTol were greater variation among participants. The cold pain was detected after the temperature decrease 13.6± 9.1 ◦C, heat pain was detected after temperature increase 8.0± 3.8 ◦C, cold pain cannot be tolerated after the temperature decrease 23.7± 7.7 ◦C, and heat pain cannot be tolerance after temperature increase 13.9± 3.3 ◦C. Only WDT, HPT and HPTol were significant different between men and women (p= 0.001, 0.003, and 0.001 respectively). Women perceived the temperature change of warm earlier (women vs. men 2.1 ◦C and 2.7 ◦C respectively), perceived the pain of heat earlier (women vs. men 7.3 ◦C and 8.8 ◦C respectively) and unable to tolerance heat pain earlier than men (women vs. men 13.2 ◦C and 14.8 ◦C respectively) after temperature increase from32 ◦C. Conclusion(s):Although the value of CDT andWDT are more consistent, the threshold and tolerance of pain induced by cold seems to be varied among general population. In sensory perception behavior, especially the values of WDT, HPT and HPTol, Women are more sensitive to temperature increase and less tolerance of the heat pain. Implications: Women are sensitive to detect warm or heat pain sensation. No different was found of cold detection, cold pain detection, and cold pain tolerance for men and women. For those QST parameters, the CDT and WDT are well indicators for differential the normal and abnormal detection ability of a person.

Medial Arm Pain - Baseball

Medial Arm Pain - Baseball

The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres : an experimental study.

In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty.Cite this article: Bone Joint J 2015; 97-B:484–91.

Increased Numbers of Tryptase-Positive Mast Cells in the Healthy and Sun-Protected Skin of Tobacco Smokers

Background: Tobacco smoking may cause skin aging through mast cell proteinases. Objective: To compare the numbers of mast cells showing tryptase and chymase in the healthy-looking skin of smokers and non-smokers. Methods: The study subjects consisted of 80 males, 42 of whom were smokers and 38 non-smokers. A skin biopsy from the medial arm was processed for immunohistochemical staining of tryptase and chymase, as well as chymase inhibitors alpha-1-proteinase inhibitor (alpha-1-PI) and alpha-1-antichymotrypsin (alpha-1-AC). Results: The number of tryptase⁺ mast cells was significantly higher in the smoker group (84 ± 32 cells/mm²) than in the non-smoker group (70 ± 32 cells/mm²) (p = 0.044). Likewise, the number of chymase⁺ mast cells was higher in the smoker group (89 ± 20 vs. 80 ± 22 cells/mm²), though statistical significance was not reached (p = 0.07). No significant difference was observed in alpha-1-PI⁺ and alpha-1-AC⁺ cells. Conclusion: Especially tryptase, but probably also chymase, may have an influence on the skin of smokers, such as wrinkling and aging.

The Immediate Effects of Kinesiotm Taping on Shoulder External Rotation in People with Shoulder Pain

Objectives:Observing the immediate effect of KinesioTMTaping (KT) on shoulder external rotation in people with shoulder pain.Methods:The mean ages of participants (n=17;7W&10M) were 47,11± 1,28yrs, weight 72,4±13,10kg, height 1,68±0,069cm, and body mass index were 25,57±3,41kg/cm2. All were under physiotherapy with moderate degree of shoulder pain during movement and rest. They gave their own written consent to participate voluntarily to the test protocol. Their sosciodemografic features (physical features, habit of physical activity) were taken with a specially prepared questionnaire for this study. Their muscle power (JTech Myometry) and range of motion-ROM of shoulder joints were assessed before the test protocol. The active external-internal rotations were tested as before and after KT while the participants sat on a stable chair, forearm was supported on the table with as much as possible 90° of shoulder abduction within the pain limits. The hand was in supination and the line drawn on the dorsum of the hand and forearm was to nominate the longitudinal axis. The photographs of each participant were taken by IPhone 4 (Apple) in direct line just opposite to the forearm to record the last position of the forearm during shoulder rotations. An eye band and a headphone were used during the test. Through a universal on-screen digitizer (Desktop Ruler™) the goniometric measurements were double checked on the computer. Their pain was assessed through Visual Analogue Scale (VAS) and McGill Pain Questionnaire (MPQ) as before and after KT application. The disability they faced to during their daily life was assessed by Disability of Arm Shoulder and Hand Questionnaire (DASH) as before and after KT application. Y shaped KT was applied to subscapular muscles, the medial arm reaches towards the spine of scapula and the lateral arm was towards the acromion. All data were analysed statistically. The descriptive statistics were used for the physical features of the participants. Wilcoxon Signed Rank test was used for the significance of the data (p< 0.05) and Spearmen Correlation was used to understand the relation between the data.Results:KT was found effective on muscle strength; M.Subscapularis, M.Supraspinatus, M.Infraspinatus and M.Teres Minor strengths were significantly higher after KT(p< 0.05). KT also improved ROM of the shoulder external-internal rotations (p<0,05). The shoulder joint pain was decreased after KT (p<0,05) according to VAS and Pain Rate Index (PRI) of MPQ.Conclusion:The shoulder pain during external-internal rotations decreased due to the immediate effects of KT. A positive correlation was found between the data achieved by the universal goniometer and desktop ruler programe. Therefore we may suggest KT for patients with shoulder pain to improve the amount of rotation.

The medial arm pedicled perforator flap: Application of phenomenon of one perforator perfusing multiple perforator angiosomes

BackgroundThe medial arm is an optimal potential donor site for treating skin defects around the elbow. However, whether a reliable pedicled perforator flap could be harvested from the medial arm remains unanswered. The purpose of this study was to report the technique and our results using the medial arm pedicled perforator flaps. MethodsA total of eight flaps in seven patients underwent the medial arm pedicled perforator flaps to treat skin defects around the elbow. The flap was pedicled on one perforator 1.3±0.3mm in diameter within 3cm above the medial epicondyle. The flap size varied between 10 and 20cm in length and between 6 and 10cm in width. ResultsOf the eight flaps in seven patients, seven flaps survived uneventfully except that one suffered venous insufficiency. Six patients were followed up for 1 month to 2 years. One patient was lost to follow-up after 7 days. The wounds in all patients healed satisfactorily. No deep wound infection and wound dehiscence developed. No revision surgery was performed in the survived flaps. ConclusionsThe survival of the medial arm pedicled perforator flap confirms the phenomenon of one perforator perfusing multiple perforator angiosomes in the medial arm, although this study has the retrospective clinical nature and limited number of the patients. The medial arm pedicled perforator flap is a useful tool to treat skin defects around the elbow.

Recurring Diffuse Annular Erythematous Plaques in a Newborn

A newborn female infant presented with an asymptomatic eruption that first began on her fifth day of life. The lesions developed over a 24-hour period, lasted for approximately 3 to 6 weeks before spontaneously resolving, and recurred several days later. When the patient was treated with prednisone by her primary physician for an upper respiratory tract infection, her lesions quickly cleared, only to recur a few days after stopping treatment with the medication. The infant was otherwise healthy with normal growth and development, and no household contacts were experiencing any eruptions or pruritus. Skin examination revealed discrete, annular, erythematous plaques with raised borders and central clearing on the infant’s chest, arms, and neck (Figure, A). At follow-up, it was found that the previous lesions had resolved completely without scarring or residual hyperpigmentation, and new lesions of variable size had developed on her scalp, neck, arms, vulva, and trunk (Figure, B). Results of a complete blood cell count with differential, peripheral smear, complete metabolic panel, and assays for C-reactive protein, antinuclear antibody, anti–double-stranded DNA antibody, anti-SSA, and anti-SSB autoantibodies were all normal. A punch biopsy was performed of a representative lesion of her left medial arm (Figure, C and D).

A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction

Quantitative descriptions of the hip joint capsular ligament insertional footprints have been reported. Using a three-dimensional digitizing system, and computer modeling, the area, and dimensions of the three main hip capsular ligaments and their insertional footprints were quantified in eight cadaveric hips. The iliofemoral ligament (ILFL) attaches proximally to the anterolateral supra-acetabular region (mean area = 4.2 cm(2)). The mean areas of the ILFL lateral and medial arm insertional footprints are 4.8 and 3.1 cm(2), respectively. The pubofemoral ligament (proximal footprint mean area = 1.4 cm(2)) blends with the medial ILFL anteriorly and the proximal ischiofemoral ligament (ISFL) distally without a distal bony insertion. The proximal and distal ISFL footprint mean areas are 6.4 and 1.2 cm(2), respectively. The hip joint capsular ligaments have consistent anatomic and insertional patterns. Quantification of the ligaments and their attachment sites may aid in improving anatomic repairs and reconstructions of the hip joint capsule using open and/or arthroscopic techniques.

Locomotion in ornithischian dinosaurs: an assessment using three‐dimensional computational modelling

Ornithischian dinosaurs were primitively bipedal with forelimbs modified for grasping, but quadrupedalism evolved in the clade on at least three occasions independently. Outside of Ornithischia, quadrupedality from bipedal ancestors has only evolved on two other occasions, making this one of the rarest locomotory transitions in tetrapod evolutionary history. The osteological and myological changes associated with these transitions have only recently been documented, and the biomechanical consequences of these changes remain to be examined. Here, we review previous approaches to understanding locomotion in extinct animals, which can be broadly split into form-function approaches using analogy based on extant animals, limb-bone scaling, and computational approaches. We then carry out the first systematic attempt to quantify changes in locomotor muscle function in bipedal and quadrupedal ornithischian dinosaurs. Using three-dimensional computational modelling of the major pelvic locomotor muscle moment arms, we examine similarities and differences among individual taxa, between quadrupedal and bipedal taxa, and among taxa representing the three major ornithischian lineages (Thyreophora, Ornithopoda, Marginocephalia). Our results suggest that the ceratopsid Chasmosaurus and the ornithopod Hypsilophodon have relatively low moment arms for most muscles and most functions, perhaps suggesting poor locomotor performance in these taxa. Quadrupeds have higher abductor moment arms than bipeds, which we suggest is due to the overall wider bodies of the quadrupeds modelled. A peak in extensor moment arms at more extended hip angles and lower medial rotator moment arms in quadrupeds than in bipeds may be due to a more columnar hindlimb and loss of medial rotation as a form of lateral limb support in quadrupeds. We are not able to identify trends in moment arm evolution across Ornithischia as a whole, suggesting that the bipedal ancestry of ornithischians did not constrain the development of quadrupedal locomotion via a limited number of functional pathways. Functional anatomy appears to have had a greater effect on moment arms than phylogeny, and the differences identified between individual taxa and individual clades may relate to differences in locomotor performance required for living in different environments or for clade-specific behaviours.

Sudden onset of a widespread asymptomatic rash

A 75-year-old man presented with a 2-week history of a nonpruritic, painless rash over the lateral aspect of his trunk and his proximal extremities. He denied all American College of Rheumatology criteria for lupus. The patient had a history of kidney cancer, chronic renal failure, and hypertension treated with metoprolol beginning 3 weeks before presentation. There were no known drug allergies and no recent travel. Erythematous 1- to 3-mm dermal papules were symmetrically distributed on his trunk (Fig 1) and the posterior and medial upper arms.

Does an Unloader Brace Reduce Knee Loading in Normally Aligned Knees?

Unloading knee braces often are used after tibiofemoral articular cartilage repair. However, the experimental basis for their use in patients with normal tibiofemoral alignment such as those undergoing cartilage repair is lacking. The purpose of this study was to investigate the effect of varus and valgus adjustments to one commercially available unloader knee brace on tibiofemoral joint loading and knee muscle activation in populations with normal knee alignment. The gait of 20 healthy participants (mean age 28.3years; body mass index 22.9kg/m(2)) was analyzed with varus and valgus knee brace conditions and without a brace. Spatiotemporal variables were calculated as were knee adduction moments and muscle activation during stance. A directed cocontraction ratio was also calculated to investigate the relative change in the activation of muscles with medial (versus lateral) moment arms about the knee. Group differences were investigated using analysis of variance. The numbers available would have provided 85% power to detect a 0.05 increase or decrease in the knee adduction moment (Nm/kg*m) in the braced condition compared with the no brace condition. With the numbers available, there were no differences between the braced and nonbraced conditions in kinetic or muscle activity parameters. Both varus (directed cocontraction ratio 0.29, SD 0.21, effect size 0.95, p=0.315) and valgus (directed cocontraction ratio 0.28, SD 0.24, effect size 0.93, p=0.315) bracing conditions increased the relative activation of muscles with lateral moment arms compared with no brace (directed cocontraction ratio 0.49, SD 0.21). Results revealed inconsistencies in knee kinetics and muscle activation strategies after varus and valgus bracing conditions. Although in this pilot study the results were not statistically significant, the magnitudes of the observed effect sizes were moderate to large and represent suitable pilot data for future work. Varus bracing increased knee adduction moments as expected; however, they produced a more laterally directed muscular activation profile. Valgus bracing produced a more laterally directed muscular activation profile; however, it increased knee adduction moments. When evaluating changes in knee kinetics and muscle activation together, this study demonstrated conflicting outcomes and questions the efficacy for the use of unloader bracing for people with normally aligned knees such as those after articular cartilage repair.

Foot and ankle reconstruction: An experience on the use of 14 different flaps in 226 cases

The aim of this report was to present our experience on the use of different flaps for soft tissue reconstruction of the foot and ankle. From 2007 to 2012, the soft tissue defects of traumatic injuries of the foot and ankle were reconstructed using 14 different flaps in 226 cases (162 male and 64 female). There were 62 pedicled flaps and 164 free flaps used in reconstruction. The pedicled flaps included sural flap, saphenous flap, dorsal pedal neurocutaneous flap, pedicled peroneal artery perforator flap, pedicled tibial artery perforator flap, and medial plantar flap. The free flaps were latissimus musculocutaneous flap, anterolateral thigh musculocutaneous flap, groin flap, lateral arm flap, anterolateral thigh perforator flap, peroneal artery perforator flap, thoracdorsal artery perforator flap, medial arm perforator flap. The sensory nerve coaptation was not performed for all of flaps. One hundred and ninety-four cases were combined with open fractures. One hundred and sixty-two cases had tendon. Among 164 free flaps, 8 flaps were completely lost, in which the defects were managed by the secondary procedures. Among the 57 flaps for plantar foot coverage (25 pedicled flaps and 32 free flaps), ulcers were developed in 5 pedicled flaps and 6 free flaps after weight bearing, and infection was found in 14 flaps. The donor site complications were seen in 3 cases with the free anterolateral thigh perforator flap transfer. All of limbs were preserved and the patients regained walking and daily activities. All of patients except for one regained protective sensation from 3 to 12 months postoperatively. Our experience showed that the sural flap and saphenous flap could be good options for the coverage of the defects at malleolus, dorsal hindfoot and midfoot. Plantar foot, forefoot and large size defects could be reconstructed with free anterolateral thigh perforator flap. For the infected wounds with dead spce, the free latissimus dorsi musculocutaneous flap remained to be the optimal choice.

Posterior Scar Brachioplasty with Fascial Suspension: A Long-term Follow-up of a Modified Technique.

Background:The traditional long medial arm incision with its resultant scar is not acceptable. The author presents his long-term experience in performing the posterior scar brachioplasty with fascial suspension. The technique is a modification described by other authors. The aim of the author is to demonstrate the reasons for the choice of the posterior scar technique with fascial suspension.Methods:Between 1999 and 2012, the posterior scar technique with fascial suspension was used to treat 205 patients with brachial deformities. Age at operation ranged between 21 and 66 years. All patients were examined, and the author reviewed their medical charts during the follow-up period (29–98 mo). A Likert scale and an evaluation questionnaire were used to assess the aesthetic outcome of the posterior scar brachioplasty technique.Results:All patients who underwent the posterior scar technique were free of postoperative contour deformities. Postoperatively, the scar was completely invisible when viewed from patient’s front and patient’s lateral but was partially visible when viewed from patient’s back. And 88.8% of patients tolerated the scar with high satisfaction.Conclusions:The current posterior scar maneuver with fascial suspension prevented the tension on the suture line and consequently prevented the widening of the scar and facilitated the modeling procedure by removing the appropriate amount of skin and subcutaneous tissues. It creates a low-lying, posterior, well-hidden scar when viewed from the patient’s front or patient’s lateral. The scar is partially (upper third) visible when viewed from patient’s back. The technique is avoiding injury to the sensory and motor nerves of the arm and decreases the insult to the lymphatic.

1258 A COMPARISON OF HAND-SEWN AND STAPLED W ILEAL RESERVOIR FOR ORTHOTOPIC BLADDER REPLACEMENT

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion (I)1 Apr 20131258 A COMPARISON OF HAND-SEWN AND STAPLED W ILEAL RESERVOIR FOR ORTHOTOPIC BLADDER REPLACEMENT Luigi Cormio, Vincenzo Pagliarulo, Giuliano Ciavotta, L Paccione, Oscar Selvaggio, E Chiarulli, Arcangelo Pagliarulo, and Giuseppe Carrieri Luigi CormioLuigi Cormio Foggia, Italy More articles by this author , Vincenzo PagliaruloVincenzo Pagliarulo Bari, Italy More articles by this author , Giuliano CiavottaGiuliano Ciavotta Foggia, Italy More articles by this author , L PaccioneL Paccione Bari, Italy More articles by this author , Oscar SelvaggioOscar Selvaggio Foggia, Italy More articles by this author , E ChiarulliE Chiarulli Bari, Italy More articles by this author , Arcangelo PagliaruloArcangelo Pagliarulo Bari, Italy More articles by this author , and Giuseppe CarrieriGiuseppe Carrieri Foggia, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2612AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Orthotopic bladder replacement (OBR) following radical cystectomy (RC), the treatment of choice for muscle-invasive bladder cancer, has gained increased popularity over the last two decades. Nevertheless, the complexity of the procedure and the additional surgical time needed for its creation continue to limit its routine use. METHODS Data of consecutive patients with invasive bladder cancer treated with RC and ORB at two university hospitals between December 2009 and June 2011 were prospectively collected and compared according to construction modality of W ileal reservoir, namely hand-sewn (Group/hospital 1) or stapled (Group/hospital 2). In both cases, approximately 50 cm of terminal ileum were used, with an approximate length of 15 cm for the 2 lateral arms and 10 cm for the 2 medial arms. The 4 arms were then detubularised and hand-sewn in Group 1 or stapled with 10 cm metallic GIA linear stapler in Group 2. In both cases the proximal and distal 5 cm of the harvested ileum remained not-detubularised and such horns of the neobladder were used for end-to-end uretero-ileal anastomosis. Time of reservoir construction and complications occurring up to 3 months postoperatively were analyzed. RESULTS Group 1 and Group 2 consisted of 10 and 11 patients, respectively. Mean time for reservoir construction was 6 min in Group 1 vs. 47 min in Group 2 (p<0.001). There were two cases of leakage from uretero-ileal anastomosis, one in each group, treated conservatively in Group 1 and by 6-weeks ureteric stenting in Group 2. There were no infective complications nor urinary stones in both groups. CONCLUSIONS The stapled reservoir provided the same results of the hand-sewn reservoir with a significant reduction in surgical time. The safety, ease and speed of the stapled technique may help expanding the indication to OBR after RC. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e515 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luigi Cormio Foggia, Italy More articles by this author Vincenzo Pagliarulo Bari, Italy More articles by this author Giuliano Ciavotta Foggia, Italy More articles by this author L Paccione Bari, Italy More articles by this author Oscar Selvaggio Foggia, Italy More articles by this author E Chiarulli Bari, Italy More articles by this author Arcangelo Pagliarulo Bari, Italy More articles by this author Giuseppe Carrieri Foggia, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1259 THE IMPACT OF RUNNING VERSUS INTERRUPTED ANASTOMOSIS ON RATE OF URETERO-INTESTINAL STRICTURE FOLLOWING RADICAL CYSTECTOMY

INTRODUCTION AND OBJECTIVES: Orthotopic bladder replacement (OBR) following radical cystectomy (RC), the treatment of choice for muscle-invasive bladder cancer, has gained increased popularity over the last two decades. Nevertheless, the complexity of the procedure and the additional surgical time needed for its creation continue to limit its routine use. METHODS: Data of consecutive patients with invasive bladder cancer treated with RC and ORB at two university hospitals between December 2009 and June 2011 were prospectively collected and compared according to construction modality of W ileal reservoir, namely hand-sewn (Group/hospital 1) or stapled (Group/hospital 2). In both cases, approximately 50 cm of terminal ileum were used, with an approximate length of 15 cm for the 2 lateral arms and 10 cm for the 2 medial arms. The 4 arms were then detubularised and hand-sewn in Group 1 or stapled with 10 cm metallic GIA linear stapler in Group 2. In both cases the proximal and distal 5 cm of the harvested ileum remained not-detubularised and such horns of the neobladder were used for end-to-end uretero-ileal anastomosis. Time of reservoir construction and complications occurring up to 3 months postoperatively were analyzed. RESULTS: Group 1 and Group 2 consisted of 10 and 11 patients, respectively. Mean time for reservoir construction was 6 min in Group 1 vs. 47 min in Group 2 (p 0.001). There were two cases of leakage from uretero-ileal anastomosis, one in each group, treated conservatively in Group 1 and by 6-weeks ureteric stenting in Group 2. There were no infective complications nor urinary stones in both groups. CONCLUSIONS: The stapled reservoir provided the same results of the hand-sewn reservoir with a significant reduction in surgical time. The safety, ease and speed of the stapled technique may help expanding the indication to OBR after RC.

Subgaleal–Subperiosteal Flap for Forehead and Scalp Reconstruction

Forehead soft tissue defects are most usually associated with motor vehicle accident and less commonly with physically assault, trauma resulting from falls, malignant tumor resection, and burn injury. These kinds of defects incorporate only the soft tissue in general but sometimes there are accompanying bone defects. Different reconstruction alternatives can be preferred depending on the defect type and the amount of tissue loss. In this report, a patient who underwent surgery for tumor excision is presented. After surgical excision, denuded frontal bones were covered with subgaleal-subperiosteal flap. Split thickness skin graft harvested from the medial upper arm was used for skin resurfacing. Optimal healing and cosmetic outcome were obtained using 1-step surgical procedure.