Eti Gursel

Fascial release of the pectoralis major: a technique used in pectoralis major muscle closure of the mediastinum in cases of mediastinitis.

Background: The authors’ goal was to demonstrate a technique of gaining added width from the right pectoralis major muscle flap through muscle fascia release, with the hope of attaining sturdier, tension-free dead space closure of the debrided mediastinum in cases of mediastinitis. Methods: The authors measured the preincisional and postincisional widths of the right pectoralis major flap following release of the fascia in nine patients who underwent mediastinal reconstruction using pectoralis major muscle flaps from 2002 to 2004 at the Detroit Medical Center. Results: The average width of the nine muscles was 16.3 ± 1.7 cm before fascia release and 22.1 ± 1.3 cm after release. The average increase in width was 5.8 ± 1.3 cm, with a 95 percent confidence interval of 4.8 to 6.8 cm. A value of p < 0.0001 indicated that this increase in width was statistically significant. After fascial release, the width of the muscles increased by an average of 26.1 percent, with a 95 percent confidence interval of 21.6 to 30.6 percent. Conclusions: The authors present a new technique that can be used to gain additional width from the right pectoralis major muscle in cases of mediastinal reconstruction using the pectoralis major muscle flap. With the added 26 percent of width obtained from the right pectoralis major muscle with fascia release, the authors contend that a sturdier and tension-free closure of the mediastinal dead space can be obtained, further expanding the indications for use of the pectoralis major muscle flap as the sole closure modality in even the most complicated cases of mediastinitis.

Milk of calcium fluid collections in juvenile dermatomyositis: MR characteristics

Abstract Children with dermatomyositis may have extensive subcutaneous and intermuscular calcium-laden fluid collections referred to as “milk of calcium.” The distinctive MR appearance of such collections in an upper extremity of a 16-year-old girl is presented. MR can differentiate these collections from abscesses and guide appropriate therapy.

Microwave radiation injury

A case of momentary exposure of the right hand to irradiation from a microwave oven is described. Transient paresthesias and a cold, pale hand resulted but resolved spontaneously in 60 minutes without treatment. Even momentary exposure can result in severe coagulation necrosis, with eventual loss of the exposed extremity.

Nora's lesion: Case report and literature review of a bizarre parosteal osteochondromatous proliferation of a small finger.

A case of a left small finger tumour that was diagnosed on histopathological review as Noras lesion (bizarre parosteal osteochondromatous proliferation) is reported. There have been fewer than 150 cases reported in the literature to date and its pathophysiology is yet to be defined. Due to its rare presentation, Noras lesion can easily go unrecognized and therefore inappropriately managed.

Gasoline contact burns.

In the past four years, four cases of gasoline contact burns have been treated at the Detroit General Hospital Emergency Department. Signs are erythema and blister formation within 24 hours. Treatment is removal of contaminated clothing and washing the surface with soap and water plus open exposure of the wounds. Renal failure is not caused by skin absorption but may develop following inhalation.

Split Latissimus Dorsi Muscle Flap Repair of Acquired, Nonmalignant, Intrathoracic Tracheoesophageal and Bronchoesophageal Fistulas

The development of a fistula between the tracheobronchial tree and oesophagus due to nonmalignant causes is uncommon. Division of the fistula with muscle flap interposition eliminates contact between the tracheobronchial segment and the oesophagus, theoretically decreasing the chance of recurrence as well as providing a robust blood supply to aid in healing. The split latissimus dorsi muscle flap is a well-suited flap for such repairs because of the ability to simultaneously cover two separate apertures (tracheobronchial and oesophageal). The authors describe the split latissimus dorsi muscle flap with step-by-step technique for repair of intrathoracic aerodigestive fistulas.

The utility of deep soft-tissue cultures in diagnosing the causative agent of sternal osteomyelitis following median sternotomy

Background: The authors’ goal was to determine whether the bacteria cultured from the mediastinal deep soft tissues matched those identified by the sternal bone cultures in cases of mediastinitis with clinically suspected sternal osteomyelitis, in hopes of eliminating the need for sternal bone biopsy. Methods: The authors retrospectively reviewed the charts of 27 Detroit Medical Center patients who underwent median sternotomy and developed mediastinitis with clinical suspicion of osteomyelitis between 1996 and 2004. Results: Although only 18 of 27 of the authors’ patients had positive bone cultures, they demonstrate that in 94 percent (17 of 18) of these patients, the organisms cultured from the mediastinal deep soft-tissue cultures matched those cultured from the positive sternal bone cultures. Conclusions: With the results obtained from this study, the authors hope to promote a less-invasive means of investigating osteomyelitis in sternal wounds, to prevent the complications associated with obtaining a bone biopsy specimen in a contaminated soft-tissue setting. Instead, the authors suggest thoracic computed tomographic scanning as a noninvasive means of clinically demonstrating osteomyelitis of the sternum, and culture of the deep soft tissues of the mediastinum at the time of mediastinal debridement to determine the offending organism, if osteomyelitis is suggested by computed tomographic scan.

Drug injection injuries of the hands: Evaluation and treatment

Twenty-six patients with hand infections caused by drug injection were seen at Detroit General Hospital between 1974 and 1976 and were followed up. The duration of drug abuse was 2 to 25 years. The time before the patient sought medical help ranged from three days to 20 weeks. Among the 26 patients were three webspace infections, three finger abscesses, four gangrene of distal phalanx, nine cellulitis and abscess, one ulceration of the thenar eminence, and two ulcerations of the volar aspect. Follow-up was difficult due to unreliability of drug addicts.

Acute ligation of the radial and ulnar arteries: A case report and review of literature

Isolated injury to the radial or ulnar artery results in no significant complications in patients who undergo repair or ligation of the injured artery. However, ligation of both infrabrachial vessels of the upper extremity is associated with limb loss from ischemia due to lack of collateral circulation. A rare case of acute ligation of both the radial and ulnar arteries in a drug abuser where collateral vessels preserved the circulation to the hand is reported.

Acute median nerve compression neuropathy from a foreign body in the forearm.

Acute compression of the median nerve in the forearm usually occurs from compartment syndrome. A case of acute compression neuropathy of the median nerve from a foreign body, where there was no evidence of compartment syndrome, is reported. The diagnosis was made from the patients symptoms and radiographs. Early recognition and decompression of the forearm with removal of the foreign body led to full recovery.