Evidence‐based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome

Introduction: The purpose of this study was to develop an evidence‐based guideline for the use of neuromuscular ultrasound in the diagnosis of carpal tunnel syndrome (CTS). Methods: Two questions were asked: (1) What is the accuracy of median nerve cross‐sectional area enlargement as measured with ultrasound for the diagnosis of CTS? (2) What added value, if any, does neuromuscular ultrasound provide over electrodiagnostic studies alone for the diagnosis of CTS? A systematic review was performed, and studies were classified according to American Academy of Neurology criteria for rating articles of diagnostic accuracy (question 1) and for screening articles (question 2). Results: Neuromuscular ultrasound measurement of median nerve cross‐sectional area at the wrist is accurate and may be offered as a diagnostic test for CTS (Level A). Neuromuscular ultrasound probably adds value to electrodiagnostic studies when diagnosing CTS and should be considered in screening for structural abnormalities at the wrist in those with CTS (Level B). Muscle Nerve 46: 287–293, 2012Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92446/1/23389_ftp.pd

Raport z trzyletniej (2017-2019) działalności Serwisu Replantacyjnego dla amputacji rąk w Polsce

W pracy przedstawiono podsumowanie działalności Serwisu Replantacyjnego dla amputacji rąk w Polsce w latach 2017-2019. W analizowanym okresie, do Serwisu zgłoszono 551 przypadków amputacji i innych rozległych urazów kończyn górnych, z czego 330 zaakceptowano do operacji, a w 221 przypadkach, z różnych powodów odmówiono przyjęcia. Wśród 330 przyjętych było 165 (50%) amputacji całkowitych, 131 (40%) prawie całkowitych i 34 (10%) inne, ciężkie, zagrażające utratą kończyny urazy. W przeważającej liczbie ofiarami byli mężczyźni w młodym i średnim wieku. Najwięcej było amputacji kilku palców i kciuków - 251 (76%), następnie amputacji na poziomie śródręcza - 30 (9%), przedramienia - 23 (7%) i nadgarstka - 20 (6%). U 138 chorych (42%) z całkowicie amputowanymi kończynami lub palcami wykonano replantację, u 98 (30%) rewaskularyzację, a u 45 (14%) naprawę rozległych uszkodzeń (pierwotna rekonstrukcja). W 26 przypadkach (8%) wykonano pokrycie ubytków płatami, a w 23 (7%) nie podjęto próby replantacji i zaopatrzono kikut kończyny. Przeżywalność replantowanych i rewaskularyzowanych części kończyn wynosiła śr. 65% dla replantacji i 85% dla rewaskularyzacji. W porównaniu do raportu z okresu 2013-2016, liczba leczonych chorych była podobna, ale inna była struktura urazów: więcej było przypadków amputacji palców - o 22, za to znacznie mniej - o 50 amputacji proksymalnych: ręki, przedramienia i ramienia. Przedstawiony raport podkreśla znaczenie nieformalnej struktury, jakim jest Serwis Replantacyjny w ratowaniu kończyn ciężko okaleczonych pacjentów

Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities

Soft tissue defects of the lower extremity pose an important surgical challenge, often because of inviability of primary covering. Therapeutic modalities of choice comprise of local perforator flaps, as well as of free flaps created with the use of microsurgical skills. However, these methods cannot be applied in patients with important comorbidities, and it is in such cases where the reverse sural flap proves to be the best solution. The aim of the study was to present the results of treating lower extremity defects with various modifications of the reverse sural flap. Material and methods. Sixteen patients, males aged 17-56 years, were operated on from 2007 to 2013. Diabetes with multiple complications, disseminated atheromatosis, and extensive soft tissue trauma involving the arteries crucial for microsurgica anastomoses were the most common reason disqualifying from the free and perforator-based flap techniques. Results. All of the patients achieved very good results; in two cases distal and marginal flap necrosis was observed which, once exiced, covered with granulation, and was successfully covered with a partialthickness skin graft. Conclusions. The reverse sural flap, technically easy, offers a viable, low-risk alternative to free and perforator-based flaps

Three-year (2017-2019) activity report of the Replantation Service for hand amputations in Poland

This article summarises activity of the Replantation Service for hand amputations in Poland in years 2017-2019. Over this period a total of 551 cases of total and subtotal amputations as well as other complex injuries to the hand were referred to the referenced centres. Of these, 330 referrals were accepted and 221 rejected, for various reasons. Among these accepted, there were 165 total (50%) and 131 subtotal (40%) amputations; 34 patients (10%) had other severe hand injuries. Vast majority of the patients constituted young and middle-age males. The most common was amputation of several digits and thumbs - a total of 251 cases (76%), followed by transmetacarpal - 30 (9%), forearm - 23 (7%) and wrist - 20 (6%) amputations. Replantation of amputated extremity was performed in 138 patients (42%), revascularization in 98 (30%) and in 45 (14%) primary repair of the complex injuries. In 26 cases (8%), coverage of tissue defects was performed, and in 23 (7%) primary terminalization. Survival rate was of a mean of 65% for replantations and 85% for revascularizations. Comparing to the previously reported period 2013-2017, the number of treated patients was similar, but structure of injuries differed: number of digital amputations increased (of 22 cases), whereas number of proximal amputations (hand, forearm and arm) significantly dropped (of 50 cases). The importance of Replantation Service, an informal structure, in saving limbs of severely mutilated patients was emphasised