Background The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. Patients and methods Seven patients with a mean age of 35.2 years (range 17–64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based solely on the recurrent branch (Type B) in two cases. The type B flaps had longer pedicle lengths due to discarding the forearm skin. The donor sites were covered with skin grafts in six patients. Results The average size of the extended RPIAF was 3 × 3.5 cm to 10 × 6 cm (mean 8.28 × 4.14 cm). All of the flaps completely survived, and no complications were encountered during the postoperative period. Functional recovery of the operated hands were observed during the follow up period 13.5 months (8–24 months). Both the patient and our satisfactory levels were high and all of the patients returned to their works. Quick DASH score was used in the final functional evaluation retrospectively. Due to the pandemic, the evaluation could be made with a telephone. Two patients could not be reached in the evaluation. The mean quick DASH score of five patients was 28.64. Conclusion The extended RPIAF is a reliable choice in distally located thumb and finger defects if the recurrent branch of the posterior interosseous artery is included in the pedicle.

The role of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers: A retrospective comparative study

No abstract

Superior labrum anterior-posterior (SLAP) tears are a source of shoulder pain in orthopaedic patients. Magnetic resonance imaging (MRI) is a necessary tool for diagnosis in these patients. The aim of this study was to show correlation between MRI and arthroscopy evaluations of SLAP lesions. The study included a total of 52 patients, comprising 32 females and 20 males with a mean age of 50.40 years (range: 19-74 years) who underwent shoulder arthroscopy surgery for an existing shoulder pathology between April 2019-May 2020. The right shoulder was affected in 34 (65%) patients and the left in 18 (35%). The pre-operative diagnoses were rotator cuff syndrome (n:34), impingement syndrome (n:7), frozen shoulder (n:2) and Bankart lesion (n:9). MRI of the shoulder joint was applied followed by shoulder arthroscopy. Only SLAP type classifications were detected on arthroscopic examination and there were 13 Type 1 (33%), 23 (58%) Type 2, one (3%) Type 3, one (3%) Type 4, and one (3%) Type 5 lesion. SLAP lesions were detected on both MRI and arthroscopy in 12 patients. The lesion could not be detected arthroscopically in 3 patients although MRI reported a SLAP lesion. SLAP lesions were negative on both MRI and arthroscopy in 10 patients. In 27 patients, MRI was negative, but the SLAP lesions were detected in arthroscopy. In the diagnosis of SLAP lesions, MRI showed 31% sensitivity, 77% specificity, 80% positive predictive value, and 27% negative predictive value. The accuracy of MRI was found to be 42%. Reliability of agreement (Fleiss kappa) between MRI and arthroscopy was found to be 0.048 (p=0.596). Although MRI is a useful tool for diagnosing other shoulder pathologies, it is not sufficient for the detection of SLAP lesions compared to gold standard shoulder arthroscopy.

Amaç: Kemik dokusu sağlıklı bireylerde hematopoez ve osteogenezisin primer olarak yapıldığı organdır. Kemik dokusu en sık metastaz alan organlardan biridir. Ek olarak, tüm kanser türleri için kanserin artık iyileşemeyecek bir düzeye ulaştığının ve hastanın beklenen yaşam süresinin kısaldığının bir göstergesidir. Bu çalışmanın amacı, kemik metastazı nedeniyle ameliyat edilmiş olan olguların geriye dönük olarak değerlendirilmesidir. Gereç ve Yöntemler: Ocak 2020 ve Ocak 2022 tarihleri arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Hastanesi'nde kemik tümörü nedeniyle biyopsi yapılan veya ameliyat edilen toplam 67 hasta bu çalışmaya dahil edilmiştir. Bulgular: Metastatik olguların 49 (%73,1)'u erkek ve 18 (%26,9)'i kadın idi. Hastaların ortalama yaşı 61,7±19,8 (aralık, 9-88) yıl idi. En sık metastaz yapan tümörler erkeklerde akciğer karsinomu ve primeri bilinmeyen tümör iken, kadınlarda ise akciğer ve meme karsinomu olarak saptanmıştır. Tümörlerin en sık omurga bölgesine metastaz yaptığı tespit edilmiştir. Metastatik tümörlerin içinde primer odağın saptanamadığı 1'i (%1,5) mezenkimal olmak üzere toplam 6 (%9,0) olgu vardır. Sonuç: Kemik ağrısı kanser tanısı ile takip edilen bir hastada her zaman metastaz açısından şüpheli olan ve ileri tetkik yapılması gereken bir semptomdur. Kemik metastazı sonrasında tedavi daha çok palyatif olmaktadır. Metastazı önlemeye yönelik hedefe yönelik çalışmalara ihtiyaç vardır. Ayrıca bir grup hastada tüm klinik ve görüntüleme yöntemlerine rağmen primer odağın tespit edilemeyebileceği de akılda tutulmalıdır.