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Aneurysms of the ulnar artery and its palmar arch are usually rare events, which are mostly related to repetitive trauma of the extremity. This syndrome is also known as hypothenar hammer syndrome, which presents two pathologic entities: the aneurysmal type and the thrombotic type. Whereas surgical treatment is not necessary within the thrombotic type, it is the gold standard to treat aneurysms of the palm with resection of the aneurysm and reconstruction of the vessel with either end-to-end anastomosis, venous or arterial grafts. We report a case of a young male patient with an aneurysm of the right ulnar artery at the wrist with history of repetitive trauma. Reconstruction with a venous forearm graft showed recurrence of the aneurysm after 2 years from surgery. The authors want to elaborate an algorithm for surgical treatment to make the right decision for choice of reconstruction. Level of evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

The denervation of the wrist is a known method to treat the painful wrist. Pain relief and therefore functional improvement is the main goal to be achieved, but very little is known about other effects such the influence on proprioception. There are references that indicate an effect on reflex arcs after a certain stimulus on the wrist, and thus, changes in proprioception may come along with a surgical denervation. This systematic review was conducted to investigate if there is evidence that assesses the influence of surgical wrist denervation on proprioceptive changes and the methods that were used. Very few articles describe an effect of denervation on the proprioception of the wrist. Reliable tests to measure proprioception are rare. Such tests exist but still they comprise bias and lack of minimation of other influences such as optic input. Subject of further investigation should be proprioception itself and methods to test this quality objectively. Level II, risk/prognostic study. [ABSTRACT FROM AUTHOR]

Reconstruction of trochanteric pressure sores continues to challenge reconstructive surgeons because recurrence is not uncommon and patients typically have undergone previous surgery. We herein report on the use of a large adipocutaneous TFLPP rotated for 180° facilitating reconstruction of a recurring trochanteric decubital ulcer in a 37-year-old male morbidly obese patient with diabetes mellitus. The postoperative period showed no adverse events, and no recurrence was observed to date. The TFLPP is a valuable option because skin grafts are usually not needed for donor-site closure, the muscle is spared, and minimal donor-site morbidity as well as a less bulky appearance is observed. Level of evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]

A 45-year-old man suffered from a complex bone and soft tissue defect of the middle phalanx of his left middle finger after an electric saw injury. Here, we present the patient's clinical and radiological outcomes after reconstruction with a free vascularized metacarpal II bone graft and an extended distally based second dorsal metacarpal artery skin flap (DMCA). To our knowledge, this is the first description of a free vascularized metacarpal bone graft combined with DMCA for distal finger reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: Ultrasound elastography (USE) is a newly developed technique for the evaluation of tissue stiffness. It is known that malignancies often show a low-strain value. So far, only limited data for thyroid nodules is available. Methods: This study included 309 prospective evaluated patients with dominant, nontoxic thyroid nodules. All patients were referred to surgery. USE was performed preoperatively. Three measuring groups were formed: hard (< 0.15), intermediate (0.16-0.3), and soft (> 0.31). The measurements were correlated to the final histological findings. Results: The strain rated from 0.01 to 0.84 (mean 0.26 ± 0.13). A total of 50 thyroid malignancies (35 papillara carcinoma, 9 medullary carcinoma, and 6 follicular carcinoma) were observed. Patients (81) were within the hard group, 35 of them (43.2%) had thyroid cancer (TC) in final histology. Out of 132 patients in the intermediate group, 15 patients had TC (11.4%). All 96 patients from the soft group showed benign histological results (NPV 100%). Seventy percent of patients with TC were within the hard group (PPV 42%). These results were highly significant ( p < 0.001). Coarse calcifications and cystic nodules were not connected with reliable measurements and therefore are not suitable for USE. Conclusion: USE is a useful adjunctive tool in the workup of thyroid nodules. A low strain value needs surgical intervention, whereas a high strain value predicts a benign histology. It might substitute fine-needle aspiration cytology in the future. [ABSTRACT FROM AUTHOR]

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