Does the shoe-lace technique aid direct closure of fasciotomy wounds after acute compartment syndrome of the lower leg? a retrospective case-control study

Background and objective:

Tibia fractures are relatively common injuries that are accompanied with acute compartment syndrome in approximately 2% to 20% of cases. Although the shoe-lace technique, where vessel loops are threaded in a crisscross fashion and tightened daily, has been widely used, no studies have compared the shoe-lace technique with the conventional one. The aim of this study was to compare the shoe-lace technique with the conventional technique.

Methods:

We identified 359 consecutive patients with intramedullary nailed tibia fracture and complete medical records including outpatient data between April 2007 and April 2015 from electronic patient database of our institute. The use of the shoe-lace technique was compared to conventional one (in which wounds were first left open with moist dressings). Main outcome measurement is direct closure of fasciotomy wounds.

Results:

From 359 consecutive patients with intramedullary nailed tibia fracture, fasciotomy was performed on 68 (19%) patients. Of these, the shoe-lace technique was used in 47 (69%) patients while in 21 (31%) patients, the shoe-lace technique was not applied. Side-to-side approximation was successful in 36 patients (77%) in the shoe-lace+ group and 7 patients (33%) in the shoe-lace– group (p = 0.002).

Conclusions:

The main finding of our comparative study was that the shoe-lace technique seems to ease direct closure of lower leg fasciotomy wounds, and thus reduces the frequency of free skin grafts. Our finding needs to be confirmed in a high-quality randomized controlled trial.

Finnish translation and validation of the FACE-Q Eye module

BACKGROUND AND AIMS

The aim of this study was to first produce and cross-culturally validate a Finnish version of the FACE-Q Eye module, a patient-reported outcome measure designed for patients undergoing eyelid surgery for esthetic reasons, and second assess the suitability of this instrument for use in a university hospital setting.

MATERIAL AND METHODS

The FACE-Q Eye module and the general FACE-Q components Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress, and Satisfaction with Outcome were translated according to established guidelines. A postal survey study was conducted with the translated instrument and the generic health-related quality of life instrument 15D on 245 patients operated in the Helsinki University Hospital between 2009 and 2019. Cronbach's alpha, floor and ceiling effects, measurement reliability with repeat administration, and convergence with 15D dimensions were analyzed.

RESULTS

The FACE-Q Eye module and general components translated readily into Finnish. Eighty-one patients (33%) responded to the survey, most of whom (78%) had undergone blepharoplasty. Most subscales demonstrated acceptable internal consistency with Cronbach's alphas 0.79-0.96. A ceiling effect was observed for four of the seven subscales evaluated. Intra-class correlation coefficients were high (0.82-0.91) indicating good reliability. Results of the FACE-Q subscales correlated at best moderately with the 15D dimensions.

CONCLUSION

The Finnish versions of the FACE-Q Eye module and the FACE-Q components Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress, and Satisfaction with Outcome perform well when assessing outcomes relevant to patients after eyelid surgery. However, when used in patients operated on for mainly functional reasons, subtle variations may be missed.

The structural validity of the Finnish version of the Disabilities of the Arm, Shoulder and Hand: A Rasch model analysis

Introduction

The construct validity of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) has previously been questioned. The purpose of this study was to evaluate the measurement properties of the Finnish version of the DASH for assessing disability in patients with hand complaints using Rasch Measurement Theory.

Methods

A cohort of 193 patients with typical hand and wrist complaints were recruited at a surgery outpatient clinic. The DASH scores were analysed using the Rasch model for differential item functioning, unidimensionality, fit statistics, item residual correlation, coverage/targeting and reliability.

Results

In the original DASH questionnaire, the item response thresholds were disordered for 2 of 30 of the items. The item fit was poor for 9 of 30 of the items. Unidimensionality was not supported. There was substantial residual correlation between 87 pairs of items. Item reduction (chi square 95, degrees of freedom 50, p < 0.001) and constructing two testlets led to unidimensionality (chi square 0.64, degrees of freedom 4, p = 0.96). Person separation index was 0.95. The testlets had good fit with no differential item functioning towards age or gender.

Conclusion

Unidimensionality of the original Finnish version of the DASH was not supported, meaning the questionnaire seems to gauge traits other than disability alone. Hence, the clinician must be careful when trying to measure change in patients’ scores. Item reduction or the creation of testlets did not lead to good alternatives for the original Finnish DASH. Differential item functioning showed that the original Finnish scale exhibits minor response bias by age in one item. The original Finnish DASH covers different levels of ability well among typical hand surgery patients.

Health-related quality of life after oncological resection and reconstruction of the chest wall

OBJECTIVES

There is limited information of the health-related quality of life (HRQoL) after surgical treatment of chest wall tumors. This cross-sectional study aimed to assess long-term HRQoL after chest wall reconstruction following oncological resection.

METHODS

Seventy-eight patients having undergone chest wall tumor resection and reconstruction during 1997-2015 were invited to complete the 15D and QLQ-C30 HRQoL instruments.

RESULTS

Altogether, 55 patients (17 men and 38 women), with a mean (SD) age of 68 (14) years, completed the questionnaires (response rate 71%). Patients had been operated due to soft tissue sarcoma (n = 16), advanced breast cancer (n = 15), osteo- or chondrosarcoma (n = 14), or other tumor (n = 10). Median time after primary surgery was 66 (IQR 38, 141) months. The resection was full thickness in 29/55 cases and partial thickness in 26/55 cases. Chest wall reconstruction was required for 47/55 cases (85%). Reconstruction was performed using soft-tissue flap in eight cases, skeletal stabilizations with mesh or mesh-cement-mesh (sandwich method) in 15 cases, and skeletal stabilizations and soft-tissue flap in 24 cases. Patients' mean 15D score (0.878, SD 0.111) was comparable to that of the age- and gender-standardized general population (0.891, SD 0.041). Limitations in breathing and usual activities were noted. The QLQ-C30 cancer-specific HRQoL was 72 points (maximum 100). Scores in the QLQ-C30 Functional scales ranged from 78 (Physical) to 91 (Social).

CONCLUSIONS

Long-term HRQoL in patients after chest wall reconstruction following oncological resection is fair and comparable to that of the general population. Limitations in breathing and usual activities can occur.

Reliability and Validity of The Finnish Version of The Boston Carpal Tunnel Questionnaire among Surgically Treated Carpal Tunnel Syndrome Patients

BACKGROUND AND AIMS

The Boston Carpal Tunnel Questionnaire is the most commonly used outcome measure in the assessment of carpal tunnel syndrome. The purpose of this study was to translate the original Boston Carpal Tunnel Questionnaire into Finnish and validate its psychometric properties.

MATERIALS AND METHODS

We translated and culturally adapted the Boston Carpal Tunnel Questionnaire into Finnish. Subsequently, 193 patients completed the Finnish version of the Boston Carpal Tunnel Questionnaire, 6-Item CTS Symptoms Scale, and EuroQol 5 Dimensions 12 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire was re-administered after a 2-week interval. We calculated construct validity, internal consistency, test-retest reliability, and coefficient of repeatability. We also examined floor and ceiling effects.

RESULTS

The cross-cultural adaptation required only minor modifications to the questions. Both subscales of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Functional Status Scale) correlated significantly with the CTS-6 and EuroQol 5 Dimensions, indicating good construct validity. The Cronbach's alpha was 0.93 for both the Symptom Severity Scale and Functional Status Scale, indicating high internal consistency. Test-retest reliability was excellent, with an intraclass correlation coefficient greater than 0.8 for both scales. The coefficient of repeatability was 0.80 for the Symptom Severity Scale and 0.68 for the Functional Status Scale. We observed a floor effect in the Functional Status Scale in 28% of participants.

CONCLUSION

Our study shows that the present Finnish version of the Boston Carpal Tunnel Questionnaire is reliable and valid for the evaluation of symptom severity and functional status among surgically treated carpal tunnel syndrome patients. However, owing to the floor effect, the Functional Status Score may have limited ability to detect differences in patients with good post-operative outcomes.

Cross-Cultural Adaptation and Validation of the Finnish Version of the Michigan Hand Outcomes Questionnaire

BACKGROUND AND AIMS

Michigan Hand Outcomes Questionnaire is a widely used patient-reported outcome measure in hand surgery. The aim of this study was to translate and validate the Michigan Hand Outcomes Questionnaire into Finnish for Finnish patients with hand problems following international standards and guidelines.

MATERIAL AND METHODS

The original English Michigan Hand Outcomes Questionnaire was translated into Finnish. Altogether, 115 patients completed the Finnish Michigan Hand Outcomes Questionnaire, and reference outcomes: Disabilities of the Arm and Shoulder, EQ-5D 3L and pain intensity on a visual analog scale. Grip and key pinch forces were measured. After 1-2 weeks, 63 patients completed the Finnish Michigan Hand Outcomes Questionnaire the second time. The Michigan Hand Outcomes Questionnaire was analyzed for internal consistency, repeatability, correlations with the reference outcomes, and factor analysis.

RESULTS

Cronbach's alpha ranged from 0.90 to 0.97 in all the Michigan Hand Outcomes Questionnaire subscales, showing high internal consistency. The intraclass correlation coefficient showed good to excellent test-retest reliability ranging from 0.66 to 0.91 in all the Michigan Hand Outcomes Questionnaire subscales. In factor analysis, the structure with six subscales was not confirmed. All the subscales correlated with Disabilities of the Arm and Shoulder score, and five subscales correlated with EQ-5D index.

CONCLUSION

The Finnish version of the Michigan Hand Outcomes Questionnaire showed similar properties compared to the original English version and thus can be used as patient-reported outcome measure for Finnish patients with hand problems.

Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: A cross-sectional study of long-term outcomes

BACKGROUND

Extensive compound tibial fractures present reconstructive challenges. The present study aimed to assess the outcomes of microvascular latissimus dorsi (LD) flap combined with the Ilizarov technique for extensive compound tibial fractures with bone loss and bone healing complications.

METHODS

Patient records were reviewed retrospectively. The Lower Extremity Functional Scale (LEFS), the Disabilities of the Arm, Hand and Shoulder (DASH), and the 15D health-related quality of life (HRQoL) instrument were applied.

RESULTS

Between 1989 and 2014, 16 patients underwent reconstruction with a microvascular LD flap and bone transport (11/16) or late bone lengthening (5/16). The mean clinical follow-up time was 6.6 (standard deviation (SD): 6.5) years. Three patients had minor complications requiring reoperation. Partial necrosis of one flap required late flap reconstruction in one case. Late bone grafting was used to enhance union in eight of 16 cases. The mean new bone gain was 3.8 cm (SD: 2.5). Overall, 11 patients completed the questionnaires in a mean of 22.3 years (SD: 2.4) after surgery. The main findings revealed a relatively good function of the reconstructed limb and good shoulder function. The mean HRQoL was comparable to that of an age-standardized sample of the general population.

CONCLUSION

Segmental tibia transport and lengthening to correct limb length discrepancy do not compromise the microvascular muscle flap. Combined microvascular LD flap reconstruction and the Ilizarov technique can be used in treating acute compound tibial defects, pseudoarthrosis, and osteitis, all associated with significant amputation risk. Fair long-term functional outcomes and HRQoL are achieved when these combined techniques are used.