Capitate and hamate fracture in a child: the value of MRI imaging

Carpal bone fractures in children are rare, and little is known about the appropriate tools to diagnose them, particularly in toddlers. We present a 2-year-old child with a capitate and hamate fracture. Based on our experiences with this case and on a review of the literature, we discuss the value of magnetic resonance imaging in carpal trauma in children

Complications after surgery for the relief of dyspareunia in women with lichen sclerosus: a case series

IntroductionThe objective of this study was to analyse complications after surgical intervention on the vulva, especially with grafting of the vaginal epithelium, for the relief of dyspareunia in women with lichen sclerosus. Material and methodsA case series of 23 women with histologically confirmed lichen sclerosus who underwent vulvar surgery because of disabling sexual dysfunction. Surgical care was provided in a university hospital (tertiary referral center) between 2008 and 2012. The interventions were posterior vestibuloplasty (perineoplasty), dehooding of the glans clitoridis and anterior vestibuloplasty with grafts of vaginal epithelium. ResultsA posterior vestibuloplasty was performed in all 23 women. Short-term complications included postoperative infection with subtotal dehiscence of the advanced vaginal epithelium (n = 1), and reactivation of lichen sclerosus with the formation of bullae due to the postoperative discontinuation of dermatosteroid use (n = 1). The long-term complications included localized pain (n = 3); although the relation with the surgical intervention was unclear. Four women underwent dehooding of the glans clitoridis, all without complications. Anterior vestibuloplasty with a free full-thickness graft of vaginal mucosa was performed in five women. One woman underwent a second operation because of contraction and keratinization of the graft. The importance of estrogens for the condition of the graft was unclear. ConclusionsAfter reconstructive vulvar surgery in women with lichen sclerosus, issues such as infection, reactivation of the disease and pain require attention. The use of vaginal grafts in the repair of the anterior vestibule is a novel approach and deserves further exploratio

The osmotic tissue expander: a three-year clinical experience

Closure of defects after trauma or excision of neoplasms is a basic skill in plastic surgery. Local, regional and distant flaps lead to additional scars. Skin recruitment by serial excision or skin expansion is a Less damaging option for defects that must be closed. Advantages of tissue expansion include good colour and texture match. Disadvantages are the need for a second operation, use of an implant with the attendant risk of infection, time needed for inflation of the device, repeat visits to the clinic, and punctures to inflate the expander. To overcome the last disadvantage, an osmotic expander was developed in Germany in 1999 by OSMED GmbH (Ilmenau). (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserve

Malignant giant cell tumor in the carpal tunnel: a case report and review of literature

Background Malignant tenosynovial giant cell tumors (GCTs) are extremely rare, and their etiology is unknown. However, this type of malignancy is associated with high metastasis and mortality rates. Therefore, the treatment of choice is wide excision. Case Description A 66-year-old man complained of tingling and loss of sensation in the left hand, caused by a tumor that compressed the median nerve. The tumor was excised. Histopathologic examination revealed a ganglion cyst. Two years later, the patient visited our clinic with recurrent and similar complaints of the left hand. This time, however, the lesion turned out to be a malignant tenosynovial GCT and was treated by amputation of the forearm. Literature Review Since 1979, only 37 malignant tenosynovial GCTs have been reported in literature. Follow-up of these patients showed that 11 patients died of the disease, 4 patients were still living with the disease, and 14 patients had no evidence of disease after treatment. The other seven patients were lost to follow-up, and one patient died of other causes. In these 37 patients, a high incidence of lymph node metastasis (41%) and a high mortality rate (30%) were seen. Clinical Relevance Although this malignant tenosynovial GCT is very rare, high mortality rates have been observed because of the high incidence of lymph node metastases. Therefore, more awareness has to be created, to recognize and treat this tumor timel

Face Validity and Content Validity of a Game for Distal Radius Fracture Rehabilitation

Background  Patients recovering from a variety of wrist injuries are frequently advised to exercise to regain lost wrist and hand function. Treatment regimens to regain motion in the wrist are highly variable, and adherence to exercise protocols is known to be low. A serious game ReValidate! incorporating standardized exercise regimens was developed to motivate patients. In this study, the game is evaluated regarding its face validity and content validity. Methods  In this cross-sectional study, a mixed group of "users" ( n  = 53) including patients currently recovering from wrist injury, and a mixed group of "experts" ( n  = 46) including professionals advising patients on therapy regimen after wrist injury played at least one complete level of the serious game. Players evaluated the game by means of a structured questionnaire regarding its content, clinical applicability, and user experience. Questions were answered on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Results  All groups valued the game as being able to support wrist rehabilitation and being of use to patients recovering from a distal radius fracture (users: median 4, P25-P75 3-4 vs. experts: median 4, P25-P75 3.50-5; p  = not significant). The types of exercises performed during the game were considered to be both realistic and complete compared with regular physiotherapy exercises (users: median 4, P25-P75 3-4 vs. experts: median 4, P25-P75 3-5, p  = not significant). Conclusions  The ReValidate! serious game can be regarded as a valid tool for patients to regain their wrist function after injury. Level of evidence  This is a Level II study

Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications

OBJECTIVE: The aim of this study was to evaluate the efficacy of iNPWT for the prevention of postoperative wound complications such as SSI. SUMMARY OF BACKGROUND DATA: The 2016 WHO recommendation on the use of iNPWT for the prevention of SSI is based on low-level evidence, and many trials have been published since. Preclinical evidence suggests that iNPWT may also prevent wound dehiscence, skin necrosis, seroma, and hematoma. METHODS: PubMed, EMBASE, CINAHL, and CENTRAL were searched for randomized and nonrandomized studies that compared iNPWT with control dressings. The evidence was assessed using the Cochrane Risk of Bias Tool, the Newcastle-Ottawa scale, and GRADE. Meta-analyses were performed using random-effects models. RESULTS: High level evidence indicated that iNPWT reduced SSI [28 RCTs, n = 4398, relative risk (RR) 0.61, 95% confidence interval [CI]: 0.49-0.76, P < 0.0001, I = 27%] with a number needed to treat of 19. Low level evidence indicated that iNPWT reduced wound dehiscence (16 RCTs, n = 3058, RR 0.78, 95% CI: 0.64-0.94). Very low-level evidence indicated that iNPWT also reduced skin necrosis (RR 0.49, 95% CI: 0.33-0.74), seroma (RR 0.43, 95% CI: 0.32-0.59), and length of stay (pooled mean difference -2.01, 95% CI: -2.99 to 1.14). CONCLUSIONS: High-level evidence indicates that incisional iNPWT reduces the risk of SSI with limited heterogeneity. Low to very low-level evidence indicates that iNPWT also reduces the risk of wound dehiscence, skin necrosis, and seroma