Extravasation of Calcium Solution Leading to Calcinosis Cutis Surrounding the Dorsal Cutaneous Branch of the Ulnar Nerve

A case of calcinosis cutis caused by calcium extravasation around the wrist is presented. During excision, the lesion was seen to be surrounding the dorsal branch of the ulnar nerve. The possibility of peripheral nerve involvement in extravasation injuries is emphasized.

Tumoral calcinosis infiltrating the biceps brachii tendon - excision and reconstruction with allograft: a case report

Two patients with limited elbow motion due to tumoral calcinosis underwent resection of calcified masses around the elbow joints. This necessilated removal of the distal two thirds and three fourths of the biceps muscles. The resulting defects were reconstructed with homologous Achilles tendon grafts. Both patients regained M4 muscle power and no recurrences were observed.

Protective effects of vitamins A and E pretreatment in venous ischemia/reperfusion injury

It has been suggested that venous ischemia is more injurious to tissue viability than is arterial ischemia of equivalent duration. The precise mechanism of tissue damage due to venous ischemia is still not well-determined. Current research has shown that it is multifactorial, and that lipid peroxides, prostanoid metabolism, and a free radical mechanism are the major contributors. Vitamins A and E are lipid-soluble vitamins that have been suggested to be successful in the treatment of arterial ischemia/reperfusion injury due to their antioxidant properties. In the present study, the authors examined the protective effects of vitamins A and E pretreatment on reperfusion injury induced by venous occlusion of rat epigastric island flaps based on an epigastric artery and vein pedicle. In the first part of the study, to determine critical ischemia time, epigastric island skin flaps (3 x 6 cm) were elevated on their vascular pedicles in 40 male Sprague Dawley rats. Total venous occlusion of the skin flap was produced by ligating all draining veins and clamping the epigastric vein. Arterial inflow was left intact. Rats were randomly assigned to five groups (n=8) for 2, 5, 7, 9, and 10 hr of venous ischemia. Despite the occurrence of widespread reperfusion injury, reflow was established (p<0.005) at 9 hr. In the second part of the study, 20 rats were randomly divided into four groups (n=5). The effects of vitamins A and E following 9 hr ischemia/reperfusion injury were examined. Rats were pretreated with vitamin E, vitamin A and vitamins A+E for 5 days. At the end of the fifth day, each rat had undergone an epigastric island skin flap and venous occlusion, as described above. Mean surviving flap area (percent) and plasma lipid peroxides (TBARs), total thiol content (t-SH), glutathione peroxidase (Gpx), and superoxide dismutase (SOD) were determined for each rat. Results suggest that, in the prevention of venous ischemia/reperfusion injury, vitamin A and vitamin E are not effective when used as single agents; however, when used in combination, they significantly increase surviving flap area by a synergistic effect.

Actinomycosis of the frontal and parotid regions

Cervicofacial actinomycosis still occurs infrequently and should be included in the differential diagnosis of neoplasms, and chronic suppurative and granulomatous lesions of the head and neck region. The authors present two cases of actinomycosis. Patient 1 was a 32-year-old man who was first seen with a firm, suppurative mass at his left frontal region. Patient 2 was a 36-year-old woman with an indurated mass at her left parotid area. Both patients were diagnosed histopathologically with cervicofacial actinomycosis, but each patient had a different clinical course and different response to antimicrobial and surgical treatments.

Effects of early pre- and postoperative irradiation on the healing of microvascular anastomoses

A comparative study was undertaken to evaluate the possible effects of time selection of irradiation on the healing of microvascular anastomoses. In this experimental study, 40 adult male Sprague-Dawley rats were divided into four groups, 10 animals in each. In Group 1, the rats were exposed to radiotherapy with a dose of 20 Gy in a single fraction at a 170,916 cby/min dose rate, at an 80-cm source to a skin distance from 3 to 4 cm in the right groin fields involving the femoral artery, using a Co60 megavoltage radiotherapy machine. The animals were operated on under general anesthesia 2 weeks later. During the operation, femoral microarterial anastomoses were performed. In Group 2, the rats were irradiated and operated on as in Group 1, on the same day. In Group 3, the rats were operated on and, 2 weeks later, irradiated, as in Group 1. In Group 4 (control group), the rats were operated on as in Group 1. No radiotherapy was performed. All rats were explored under general anesthesia after 1 month. Patency was evaluated, and the anastomotic sites were taken for histopathologic and electron microscopy studies. The authors found that there were no major differences in the healing of microvascular anastomoses in the early preoperative, immediate preoperative, and early postoperative irradiated groups. The patency rates of all radiotherapy groups were not statistically different from control arteries (p > 0.05).

Effect of distant septic foci on the patency of microvascular anastomoses

Despite all technical improvements, some free-tissue transfers are still subject to failure in the early postoperative period due to anastomotic occlusion. Local or distant foci of sepsis may be present in most of these cases. Using 40 Sprague-Dawley adult small female rats, distant septic abscesses were formed with Pseudomonas aeruginosa (including 2 x 10(8) bacteria/ml) suspension. Microarterial and microvenous anastomoses were carried out and animals were divided into experimental and control groups. With the use of postoperative exploration, anastomotic patency was evaluated, cultures of wound, blood, and tissue were taken, and the anastomosis line and thrombi were evaluated using different staining techniques on prepared histopathologic sections. Compared to the control groups, thrombus formation in animals with distant septic foci, both with arterial and microvenous anastomosis, was found to be greater, and the difference was statistically significant. Colonies of Pseudomonas were not demonstrated in samples taken from wound infections, hemocultures, cultures of vessel wall and thrombi, and in histopathologic sections. In this experimental model, it appears that distant septic foci have an occluding effect on the microanastomosis.

The combined scapular/parascapular flap for the treatment of extensive electrical burns of the upper extremity

The combined scapular parascapular flap was used for coverage of six high voltage electrical burn defects of upper extremity. The flaps resurfaced the exposed tendon, nerve, bone or blood vessels on the volar and dorsal side of the distal forearm and the hand. In all cases successful soft tissue coverage and wound healing was achieved. After the stabilisation of the wounds, secondary reconstructive procedures, such as nerve grafting, tendon grafting, tendon transfers were performed. Nerve healing and tendon gliding was found to be successful under the flap.