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The ischial pressure wound usually comprises a large, extensive defect and involves the repair of more than a small opening. Most surgeons have used a musculocutaneous flap to fill the large dead space of an ischial pressure wound. However, sacrificing muscle tissue has a potential risk of postoperative bleeding. The transferred muscle ultimately loses function as a cushion to absorb pressure. Conservation of muscle structures may be beneficial for use in future recurrence, which is common with ischial pressure wound. We compared the difference in outcome between musculocutaneous and fasciocutaneous flaps and analyzed factors affecting complications with the flaps in ischial pressure wound reconstruction. This study reviewed the results of 64 flaps in 44 patients with ischial wounds. The wounds were reconstructed with 34 musculocutaneous flaps (53%) and 30 fasciocutaneous flaps (47%). Twenty-three cases (36%) had complete healing, and 41 (64%) had complications. There was no significant difference in outcomes between fasciocutaneous and musculocutaneous flap groups. Crude logistic regression analysis showed no significant risk factors for occurrence of major complications. When fasciocutaneous flaps were used, the neighboring perforators and muscle tissues could be conserved. With a perforator-based fasciocutaneous flap, a de-epithelized distal portion of the flap could be used to fill the dead space. Therefore, the fasciocutaneous flap may have priority over the musculocutaneous flap as a first-line option for ischial pressure wound reconstruction. [ABSTRACT FROM AUTHOR]

In diabetic foot patients, wound coverage options are quite limited due to vascular abnormalities. However, even though significant atherosclerotic changes are found in major vessels of the lower leg in diabetic foot patients, perforating vessels, which are used as the vascular pedicle of propeller perforator flaps, are often spared from atherosclerosis. Therefore, the propeller perforator flap could be an alternative option for diabetic foot patients. The purpose of this study was to compare the outcome of the propeller perforator flap between diabetic and nondiabetic patients in reconstruction of the distal lower leg. We retrospectively included all patients who underwent reconstruction of the distal lower leg with a propeller flap between 2014 and 2018. Thirty-five propeller perforator flaps in 20 diabetic patients and 15 nondiabetic patients were included. Of the 35 patients, 21 showed complete healing, and 14 showed flap complications. The rate of complications in diabetic patients was approximately 85.7%. Sex (p =.002), diabetes (p =.007), chronic renal failure (p <.001), and diabetic neuropathy (p =.011) were associated with flap complications. Crude regression analysis showed that the female sex (p =.002), diabetes (p =.01), and diabetic neuropathy (p =.012) were significant risk factors for the occurrence of any complications, but the significance of diabetes and diabetic neuropathy was not maintained in the adjusted models. Therefore, the propeller perforator flap might not be effective for reconstructing diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

Our study assessed the trends and patterns of tramadol prescriptions and possible correlations of a person being prescribed tramadol using the Korean National Health Insurance Service Sample Cohort from 2003 to 2013. The study population consisted of patients who were prescribed tramadol, opioids, or nonsteroidal anti-inflammatory drugs (NSAIDs) in an outpatient setting. From 2003 to 2013, the number of tramadol users increased from 2,476 (19.9% of the study population in 2003) to 124,592 (33.3% of the 2013 study population). The absolute change in the proportion of study patients prescribed tramadol (%) was +13.4%, a relative change (%) of +67.3%. In contrast, absolute changes in the number of opioid and NSAID users were -4.78% and -8.65%, respectively, which were relative changes of -73.5% and -11.8%, respectively. Of the studied pain types, arthritis and back pain were the most prominent diagnoses in tramadol users. Notable correlations for tramadol prescriptions, when compared with NSAIDs, were rural area (adjusted odds ratio (aOR): 1.64; 95% CI 1.61-1.66), co-prescription of a benzodiazepine (aOR 2.01; 95% CI 1.97-2.05), and tertiary hospital (aOR: 3.08, 95% CI 3.00-3.17). [ABSTRACT FROM AUTHOR]