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Objective To compare the effectiveness of silicone sheets and paper tape in the prevention of postoperative cesarean section scars. Methods Patients undergoing horizontal cesarean section were included in this randomized controlled trial. Surgical wounds were divided into two halves. Patients randomly applied silicone sheets or paper tape to each side of their wound as assigned for 3 months. Wounds were assessed at 1, 3, 6, and 12 months after surgery. Researchers used the objective Vancouver Scar Scale (VSS) to evaluate the scars and the subjective visual analog scale (VAS) to evaluate itch, pain, and scar appearance. Results No significant differences between the silicone sheet and paper tape groups were noted at postoperative follow-ups with respect to VSS scores. The silicone sheet group had significantly better VAS scores for scar appearance than the paper tape group at 6 (6.81 ± 1.47 vs 6.19 ± 1.62, P = .03) and 12 (6.88 ± 2.01 vs 6.2 ± 2.08, P = .04) months' follow-up, respectively. Conclusions The silicone sheet group showed statistically significant differences in comparison with the paper tape group in terms of scar appearance as determined by the VAS. However, the differences were too small to be clinically meaningful.

Background: Radial nerve palsy (RNP) associated with humeral shaft fracture is a common injury pattern in trauma patients. The management of RNP associated with humeral fractures in high-energy trauma is controversial and poses a challenge to surgeons treating it. Purpose: Based on a review of our experience over the past 15 years, we determined the prognostic factors of radial nerve recovery after humeral fractures, evaluated the diagnostic role of nerve conduction studies and electromyography (EMG), and compared the outcomes of different treatment strategies. Materials and Methods: The data of 26 patients having RNP associated with humeral shaft fractures over a 15-year period were collected for a retrospective review. For statistical analysis, the patients were divided into groups on the basis of their recovery from RNP and the treatment strategies used. Results: The incidence of RNP associated with humeral fractures was 2.05%. In total, 91.3% of patients with primary RNP in this series experienced high-energy trauma. Spontaneous recovery was observed in 9 of 26 patients (34.6%). Radial nerve lesions were found in 7 of 8 patients with high-energy trauma. The severity of humeral shaft fractures was found to be a significant prognostic factor for spontaneous recovery from RNP. The rate of spontaneous recovery was significantly higher in the AO Foundation and Orthopaedic Trauma Association Type A humeral shaft fractures (P = 0.028) and lower in Type C fractures (P = 0.055). The median time to detect initial radial nerve recovery using EMG was 34 and 75 days after injury (P = 0.033). In high-energy trauma, tendon transfers were associated with more predictable outcomes than nerve reconstruction (favorable functional recovery: 100% for tendon transfers vs. 25% for nerve reconstruction, P = 0.007). Moreover, tendon transfers were associated with a shorter overall treatment duration (median treatment duration: 190 days for tendon transfers vs. 422 days for nerve reconstruction, P = 0.007). Conclusion: The prognosis of RNP associated with humeral shaft fractures in high-energy trauma is less favorable, with a low rate of spontaneous recovery. EMG is helpful for the early detection of initial nerve recovery. The outcomes of tendon transfers in high-energy trauma are predictable and the treatment duration is shorter. First-intention tendon transfer is a reasonable treatment strategy in patients with difficult nerve exploration, lower requirement for functional recovery, and lower compliance with treatment.

Background Xanthelasma palpebrarum is a common periorbital lesion that occurs in middle-aged woman. Dyslipidemia was strongly associated with the occurrence of xanthelasma. Different treatment methods for xanthelasma were applied with comparable results. Materials and methods This was a retrospective chart review series performed at a single institute. The surgical pathology of 69 patients who received surgical excision from 1994 to 2012 was obtained. In addition, International Classification of Diseases, Ninth Revision, Clinical Modification code of xanthelasma (374.51) of 44 patients who underwent nonsurgical treatment at an outpatient department was acquired from 2006 to 2012. The serum lipid levels, comorbidities, recurrence, and treatment methods were obtained and analyzed with Statistical Analysis System (SAS) 9.4. Results Of a total of 113 identified patients, 50 had lipid profile data. Of these 50 patients, 25 (50%) had dyslipidemia, which is higher than general population in Taiwan. The recurrence rate was 17.5%, and there was no statistical difference in the recurrence rate between the different treatment methods. Conclusions Xanthelasma was found to be associated with dyslipidemia. Thus, we recommend patients with xanthelasma to check their lipid profile and receive diet control and lipid-lowering medications for lipid abnormalities.

Objective Spontaneous extensor tendon rupture is often seen in rheumatoid arthritis (RA) patients, but the risk factors are not clearly defined. We therefore collected the data of RA patients with previous extensor tendon rupture and those with tenosynovitis and analyzed the relationship between extended tenosynovectomy and spontaneous extensor tendon rupture. Methods We retrospectively reviewed 17 spontaneous extensor tendon rupture episodes in 15 RA patients and 14 tenosynovitis episodes that required tenosynovectomy in 12 RA patients from 1997 to 2013. Correlations between the incidence of tendon rupture, X-ray findings, and clinical findings in the affected wrists before tendon rupture were analyzed statistically using the test for proportion. Results The following parameters were significantly correlated with spontaneous extensor tendon rupture: disease duration longer than 8 years, persistent tenosynovitis longer than 1 year duration, and Larsen grade greater than 4 (P = 0.02, 0.03, and 0.01, respectively). Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray contributed to a higher spontaneous extensor tendon rupture rate among RA patients (P = 0.01, 0.05, and 0.03, respectively). Extended tenosynovectomy was performed on 14 wrists in 12 RA patients with persistent tenosynovitis longer than 6 months, and Larsen grade did not deteriorate in this group compared with those who did not undergo the surgery. No spontaneous extensor tendon rupture occurred following the surgery. Conclusions Risk factors of spontaneous extensor tendon rupture included disease duration longer than 8 years, persistent tenosynovitis longer than 1 year, and wrist Larsen grade greater than 4. Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray indicated a higher probability of extensor tendon rupture. Rheumatologists should consult with hand surgeons promptly to preserve hand function before tendon rupture. Prophylactic extended tenosynovectomy surgery to prevent more severe damage of extensor tendon should be recommended in patients who had the above risk factors.

Background Silicone sheet is commonly used for scar management but hard to apply to irregular surfaces or mobile areas, and difficult to conceal. On the contrary, silicone gel is easy to apply and nearly unnoticeable. Therefore, we conducted this study to compare their effectiveness. Methods Patients undergoing horizontal cesarean section were included. Surgical wounds were divided into 2 halves. Patients randomly applied silicone sheets and silicone gel on either side of their wounds for 3 months. The wounds were assessed at 1, 3, 6, and 12 months after surgery. We used the Vancouver Scar Scale (VSS) for an objective evaluation and the visual analog scale (VAS) for a subjective evaluation. Results There was no statistical significance between the silicone sheet and silicone gel groups with respect to VSS score. The silicone sheet group showed a statistically significant higher VAS score for itch at 1 month follow-up (1.18 ± 2.04 vs 0.35 ± 0.85, P = .01). However, the difference was less than 1 on a scale of 10, so it might not be clinically meaningful. Conclusion Silicone sheet group showed statistically significant worse VAS score in terms of itch. However, the difference was too small to be clinically meaningful.

Background Surgical treatment of axillary bromhidrosis or hyperhidrosis involves the removal of apocrine glands. There are several methods to eliminate apocrine glands; however, many methods reported significant rates of skin necrosis. To avoid this problem while preserving comparable results, we used a modified method sparing several subcutaneous septa, which successfully avoided skin necrosis completely in our series of 19 consecutive cases. Methods This is a prospective case series in a single center by a single surgeon. Unlike other series using suction-curettage shaver, we preserved some septa. The skin flaps between septa were approximately shaved as thin as 2 mm. The patients rated their smell on a 0-10 numeric rating scale (NRS-11) preoperatively and postoperatively. The results were analyzed with Mann-Whitney U test and Wilcoxon signed-rank test. Results A total of 19 consecutive patients were included. The mean degree of preoperative and postoperative smell on the NRS-11 scale was 7.200 and 2.825, respectively. There was only one patient who developed postoperative ecchymosis. No other complications, such as skin necrosis, hematoma, or infection were found. Conclusions We modified the suction-curettage cartilage shaver to eliminate the complications. Our method reveals a satisfying result, and there were no significant complications.

PURPOSE Rhabdomyolysis often occurs after traumatic compartment syndrome, and high morbidity and mortality have been reported with the acute kidney injury that develops subsequently. We focused on the risk factors for rhabdomyolysis and acute kidney injury in patients with traumatic compartment syndrome. We also analyzed the relation between renal function and rhabdomyolysis in these patients. MATERIALS AND METHODS A retrospective chart review was conducted from January 2006 to March 2012. Inpatients with traumatic compartment syndrome were included. We evaluated patients' demographics, history of illicit drugs use or alcohol consumption, mechanism of injury, symptoms, serum creatine kinase levels, and kidney function. RESULTS A total of 52 patients with a mean age of 40.9 years were included; 23 patients had rhabdomyolysis (44.2%), of which 9 patients developed acute kidney injury (39.1%). Significant predictive factors for rhabdomyolysis were history of illicit drugs or alcohol use (P=0.039; odds ratio, 5.91) and ischemic injury (P=0.005). We found a moderate correlation between serum creatine kinase levels and serum creatinine levels (R=0.57; P

Keloids and hypertrophic scars are fibroproliferative disorders of dermal tissue after skin injury. Many clinical control studies have reported evidence that silicone gel is effective in preventing and alleviating hypertrophic scarring. Whether silicone gel sheeting prevents hypertrophic scars or keloids requires clear evidence of its clinical effectiveness.This review investigated the effectiveness of silicone gel and silicone gel sheeting for the prevention of hypertrophic or keloid scarring in patients with newly healed wounds.The authors searched the MEDLINE, EMBASE, CINAHL, and CENTRAL databases (January 1, 1990 to September 24, 2014) for any randomized or quasi-randomized controlled trials or controlled clinical trials comparing silicone gel sheeting or silicone gel with a control group for prevention of hypertrophic scars or keloids. All collected trials were assessed for methodological quality, control group and treatment group, and number of participants developing hypertrophic scars and keloids. The authors calculated risk ratios (RR) from each trial for the development of abnormal scarring and combined these using random-effects model meta-analysis. Between-study heterogeneity was calculated by using the I2 statistic.Ten trials in 9 studies were pooled (random effect; I² = 88%). There was a significant difference between the silicone gel sheeting group and the placebo group (RR 0.70; 95% confidence interval, 0.49-0.99; P = .04) in preventing the risk of hypertrophic scars.There was statistical significance in the effectiveness of silicone gel and silicone gel sheeting on the prevention of keloids or hypertrophic scars, especially in skin lesion wounds. However, most of the trials evaluating silicone gel sheeting or silicone gel as a prevention of hypertrophic scars and keloids had poor quality with high or uncertain risk of biases either in study design or in conduct.

Snakebite usually results in various complications, such as significant soft tissue damage, infection, hematological, and neurological deficit. Surgical intervention, usually, is indicated in patients with tissue necrosis, infection, and compartment syndrome. To identify the contributing factors for complications and outcomes in different patients with snakebite so that outcomes can be evaluated and treatment of such patients can be initiated at the earliest. Information was collected regarding age, sex, underlying disease, species of snake, and the course of treatment of the victims of snakebite who visited the emergency department of a medical center in southern Taiwan between 2004 and 2014. The data obtained were analyzed using SPSS 20.0. The bites from Taiwan cobra (Naja naja atra) significantly resulted in more complications than those from other snakes and required surgical intervention. The use of antivenin and antibiotics, immediate presentation to the hospital, and the location of the bite also were significant contributing factors. Taiwan cobra significantly results in higher possibility of prolonged hospitalization, operation, tissue necrosis, infection, and necrotizing fasciitis. Location of the bite, immediate presentation to the hospital, and use of antivenin and antibiotics affect the outcome of snakebite. Knowledge of these factors will help in a better management of patients with snakebite.

Purpose This study aimed to determine the thicknesses of the three locations used as donor sites for radial forearm (RF), anterolateral thigh (ALT), and peroneal flaps and to determine probable contributing factors of the thickness. Methods This study included 201 healthy participants (mean age: 45.8 ± 17.2 years; male: 114; female: 87; BMI: 24.3 ± 4.3). Sonography was used to measure the thickness of flap donor sites. Forward stepwise regressions were conducted to determine the contributing factors of flap thickness. Results The RF flap (0.28 ± 0.08 cm) was thinner than peroneal flap (0.47 ± 0.17 cm) (P

Background: Free sensate thoracodorsal artery perforator flaps that include the posterior divisions of the lateral cutaneous branches of the intercostal nerves have been described. The authors used preoperative color Doppler sonography to identify the nerves and demonstrate its clinical value. Methods: Fourteen free sensate thoracodorsal artery perforator flaps were collected. Preoperative color Doppler sonography was used to identify the locations of thoracodorsal artery perforators and the courses of the posterior divisions of the lateral cutaneous branches of the intercostal neurovascular bundles. These posterior divisions were preserved on flaps and classified into three types. Type A and B nerves sprouted cutaneous perforating fascicles over the lateral region of the latissimus dorsi muscle. Type C nerves went through the region without any dominant perforating fascicle. Results: Twenty-one nerves were mapped, and 24 were found during surgery. The sensitivity of preoperative color Doppler sonography was 87.5 percent. Of the 24 nerves, nine were type A (37.5 percent), 12 were type B (50 percent), and three were type C (12.5 percent). Ten of the 14 patients (sensate group) showed better tactile recovery at both the center and the periphery of flap than the other 10 patients who underwent reconstruction with nonsensate flaps. Conclusions: Preoperative color Doppler sonography is an indispensable tool for sensate thoracodorsal artery perforator flaps in locating the perforators and mapping the posterior divisions of the lateral cutaneous branches of the intercostal nerves. The information can be used to design and harvest sensate thoracodorsal artery perforator flaps, which are associated with earlier and better tactile recovery.

The high-temperature fatigue crack growth (FCG) behavior was investigated for a precipitation-hardening stainless steel, 17-4 PH, in three differently aged conditions. FCG tests were conducted at 400 and 500 °C under various load ratios (R-ratios) ranging from R = 0.1 to 0.7. Results indicated the fatigue crack growth rates (FCGRs) increased with R-ratio at the lower ΔK regime and merged together at the higher ΔK regime for all the given heat-treated conditions tested at 400 °C, except for Condition H900, in which the FCGRs increased with R-ratio for the entire ΔK range. At 500 °C, the FCGRs for a given heat-treated condition increased with R-ratio at lower R-ratios and became comparable at higher R-ratios for the entire ΔK range. The variations of FCGR with R-ratio could be described as an intrinsic behavior of FCG based on a Unified Approach. Accordingly, the dominating crack growth mechanism was similar to a general plastic blunting process except for Conditions A and H900 at 400 °C at the high R-ratio regime, in which the primary crack growth mechanism was associated with a crystallographic-faceted fracture mode. The variations of FCGR with R-ratio for all the given testing conditions were well correlated with a modified FCG driving force parameter, M∗ΔK.

Background: The thoracodorsal artery perforator flap is a versatile flap for resurfacing soft-tissue defects. However, it is too bulky for resurfacing shallow defects. The authors used preoperative color Doppler sonography to identify the suprafascial courses of skin perforators to facilitate the design and thinning procedures of thoracodorsal artery perforator flaps. Methods: Thin thoracodorsal artery perforator flaps were designed in 29 patients. Preoperative color Doppler sonography was used to identify the penetrating points and suprafascial courses of skin perforators. According to the different orientations of suprafascial courses, skin perforators could be classified into three types. The designs and thinning procedures of flaps relied on the findings of preoperative color Doppler sonography. Results: Fifty-eight ideal perforators were marked on the 29 patients. Intraoperative dissections proved that 55 perforators were thoracodorsal artery skin perforators, and three perforators were intercostal artery perforators. In one patient, no skin perforator derived from the descending branch of the thoracodorsal artery was found during intraoperative dissection (3.4 percent). Suprafascial courses could be demonstrated by preoperative color Doppler sonography in 54 of the 55 thoracodorsal artery skin perforators. Nineteen were type 1 perforators (35.2 percent), 26 were type 2 perforators (48.1 percent), and nine were type 3 perforators (16.7 percent). Complications were encountered in six patients (20.7 percent), all of whom recovered well. Conclusions: The suprafascial courses of skin perforators facilitate the design and thinning procedures of thoracodorsal artery perforator flaps. They improve the survivability of flaps and make thinning procedures more secure and efficient.

The influence of frequency on fatigue crack growth (FCG) behavior was investigated for three differently heat-treated 17-4 PH stainless steels, namely unaged "Condition A," peak-aged "Condition H900," and overaged "Condition H1150," at 673 and 773 K, and at frequencies ranging from 0.002 to 20 Hz. At 773 K, all heat-treated conditions exhibited similar FCG behavior in which no frequency effect was observed at frequencies higher than 2 Hz and the fatigue crack growth rates (FCGRs) increased with decreasing frequency below 2 Hz. The increase in FCGR at a lower frequency at 773 K was thought to be caused by a time-dependent, oxidation-assisted cracking mechanism. At 673 K, for a given heat-treated condition, the FCGRs increased with decreasing frequency at higher frequencies and leveled off at lower frequencies. Such an anomalous FCG behavior was attributable to a dynamic strain aging (DSA) effect. At a given frequency, when the temperature was increased from 673 to 773 K, the FCGR increased in Condition H1150, but decreased in Conditions A and H900 due to an in-situ overaging and precipitate-coarsening effect during the FCG test for the latter.

The fatigue crack growth (FCG) behavior was investigated for 17-4 PH stainless steels in three heat-treated conditions, i.e., unaged (condition A), peak-aged (condition H900), and overaged (condition H1150), at temperatures ranging from 300 °C to 500 °C. The high-temperature fatigue crack growth rates (FCGRs) of condition H1150 were increased with an increase in temperature. However, for conditions A and H900 tested at 500 °C, the FCGRs were lower than the lower temperature ones. At 300 °C and 400 °C, H1150 and H900 generally showed the lowest and highest FCGRs, respectively, with condition A demonstrating behavior between the two. At 500 °C, the FCGR curves for all material conditions merged together. The anomalous FCG behavior of 17-4 PH stainless steels at 500 °C was mainly caused by an in-situ precipitate-coarsening effect during test.

An experimental study concerning the performance of a rectangular fin in both dry and wet condition was carried out. The visual observation of the dehumidifying phenomenon identified four regions, including the fully dry, very fine droplet, larger droplet, and film-like region. Experimental results showed that the effect of dry bulb temperature on the wet fin efficiency is very small. The dry fin efficiency is about 15–25 percent higher than that of the corresponding wet fin efficiency. For fully wet condition, the effect of relative humidity on the fully wet fin efficiency is also small. For partially wet surface, a considerable influence of the relative humidity on the fin efficiency is encountered. Test results for the fully wet fin efficiency agree well with some of the previous studies but disagree with some of the previous investigations. The main cause to this controversy may be attributed to the formulation of the relation between the humidity ratio and the fin temperature. The fully wet fin efficiency decrease slightly with increase of fin base temperature. However, the effect of fin base temperature on the dry fin efficiency is relatively small.

Background The thoracodorsal artery perforator flap was first introduced in 1995. Many authors focused on using anatomical landmarks to identify skin perforators and on thinning procedures for a skin paddle. In this study, we used the superthin free thoracodorsal artery perforator flap for resurfacing shallow defects of the extremities in 10 patients. Methods Two anatomical landmarks previously presented by other authors were used for the guidance of flap elevation. The first landmark represented the site of the proximal skin perforator originating from the descending branch of the thoracodorsal artery, and the second landmark marked the site of the thoracodorsal neurovascular hilum. Ten flaps were performed, and all skin perforators originated from the descending branch of the thoracodorsal artery. The skin paddle carried only skin and the superficial adipose layer, and the largest skin paddle was 23 x 9 cm. Results All defects were resurfaced with smooth contour, except for one flap in which the authors encountered flap tip superficial necrosis. The operative findings did not coincide with the first anatomical landmark in five patients. Likewise, these findings were not consistent with the second landmark in eight patients. In four patients, the thoracodorsal neurovascular hilum was located at the same level of the scapular tip or even above it. These unwanted anatomical variations increased the difficulty of exploration for skin perforators. Conclusions The thoracodorsal artery perforator flap is a feasible choice for shallow defects in superthin form. Using a color Doppler device to identify the skin perforators preoperatively is highly suggested to prevent unexpected anatomical variations.