Excision of the cyst and, if necessary, reconstructive coverage.

This study created an orthosis with several functions in addition to the triangular bandage. The triangular bandage positioned the forearm forward, suspended the arm from the neck, and secured the arm from the neck to the wrist. The design was modified from this limb position. Phase 1: Shoulder rotation was changed from extreme internal rotation to 30 degree internal rotation, Kapandji's physiological reference position (flexion/extension, 0 degree; abduction/adduction, 0 degree; rotation, 30 degree internal rotation position), allowing for the partial use of the hand. Phase 2: The sling knot position was changed from the neck to above the ipsilateral shoulder to avoid neck pain. Phase 3: A sling with elbow pads and straps replaced the Velcro to prevent the knot from loosening. Phase 4: To prevent the shoulder straps of the sling from being pulled off by the forearm during external shoulder rotation, the twisted straps pass through the shoulder and forearm loops. Phase 5: Additional straps around the shoulder and axilla were placed outward to prevent the straps from falling off due to scapular movement. Because the humeral head is rotated 30 degree posteriorly, immobilization in the 30 degree internal rotation position of the shoulder joint improves scapulohumeral joint conformity and achieves rotator cuff equilibrium. Suspension from the ipsilateral shoulder also counteracts gravity and reduces the load on intrinsic muscles such as the rotator cuff. Allowing anterior-posterior pendulum motion not only stabilizes the trunk but can also be used for early range-of-motion training. The sling has evolved as an immobilization and a suspension device.

Objective: To investigate the surgical method and clinical effects of the modified proper digital artery island flap in repairing complex fingertip defects. Methods: A retrospective observational study was conducted. From January 2017 to December 2021, 15 patients (15 fingers) with complex fingertip defects, involving the pulp, nail bed, and lateral wall of the nail, who met the inclusion criteria were admitted into General Hospital of Northern Theater Command, including 11 males and 4 females, aged from 18 to 55 years. The area of the post debridement wound was from 2.5 cm×2.0 cm to 3.5 cm×3.5 cm, and all the wounds were repaired by using modified proper digital artery island flap (including 3 parts: main flap, tongue-shaped flap, and triangular flap), of which the main flap was used to cover the finger pulp defect, the tongue-shaped flap was used to cover the nail bed and the nail lateral wall defect, and the triangular flap was inserted into the edge of the finger pulp wound to cover the vessel pedicle. The range of the flap ranged from 3.0 cm×2.0 cm to 4.5 cm×3.0 cm. The wound at the donor site was repaired with full-thickness skin graft of the groin, and the donor site of the skin graft was sutured directly. After operation, the survival of the flap and skin graft as well as and the appearance of the affected finger were observed. During the follow-up, the fingertip morphology of the affected finger was observed, two-point discrimination distance of the affected finger pulp was measured, and the patients' satisfaction with the efficacy (including very satisfied, satisfied, and dissatisfied) was asked, and the affected finger function was evaluated by the total active movement (TAM) system evaluation standard recommended by American Academy for Surgery of Hand. Results: After operation, the main flaps and skin grafts in 15 patients all survived; but the incision at the edge of tongue-shaped flap in one patient healed poorly, and one patient developed venous stasis at the distal end of the tongue-shaped flap; the triangular flap at the pedicle was slightly bloated in the early postoperative period and became smooth after 2 to 3 months. Overall, two patients developed subcutaneous hematoma in their flaps. All the complications were healed by appropriate dressing change, suture removal, or compression bandaging. After operation, the appearance of the flap was full and formed a prominent fingertip shape. During the follow-up of 6 months to 5 years, the fingertips of the affected fingers were prominent and full; the two-point discrimination distance of the affected finger pulp was (8.6±1.4) mm; 8 patients were very satisfied with the efficacy, 6 patients were satisfied, and one patient was dissatisfied; the functional assessment of the affected fingers were all excellent. Conclusions: The modified proper digital artery island flap can repair complex fingertip defects involving the pulp, nail bed, and lateral wall of the nail. The operation is simple, and the shape and function of the fingertip are good after surgery.

[Purpose] This study aimed to investigate how wearing a self-applied arm sling with a loop during rising, standing up, and walking affects the magnitude of arm swaying and activities among elderly individuals compared with wearing a triangular bandage. [Participants and Methods] Fourteen elderly individuals participated in the study. The methods involved attaching a triaxial accelerometer to an arm wearing a triangular bandage or arm sling and conducting a 5-m walk test, sit-to-stand test five times, and rising up. We then calculated the time required for each action, and the acceleration, vibration intensity, and coefficient of variation of the affected arm; these were then compared between the two groups. [Results] All the participants were able to put on the arm sling with a loop. The step rate with a triangular bandage was higher than that without one. Swaying in the front/back direction in standing up was greater with the triangular bandage. [Conclusion] The self-applied arm sling with a loop was shown to have less front/back swaying during standing up. Wearing a triangular bandage may have narrowed the stride and increased the step rate due to discomfort. This result should be applied with caution, because it remains unclear whether arm slings with loops are advantageous.

The aims of the article were to study the clinical characteristic of patients with pseudocysts and to compare different common modalities of treatment and introduce the concept of observation in pseudocyst management. Twenty-eight patients were diagnosed with pseudocyst of the auricle between June 2009 and June 2011 in a medical college hospital. The patients were divided into four groups each of seven patients on the basis of primary treatment offered. Four primary treatments offered were simple aspiration, aspiration with intralesional steroid, incision and drainage with removal of anterior cartilage leaflet with buttoning, and lastly, simple observation and reassurance. All 28 patients were male with involvement of right side more than left and no one had bilateral involvement. Adults in the age group of 30-40 were commonly affected. Most of the patients had history of significant trauma by security forces. Most common site of involvement was scaphoid and triangular fossa. The best form of treatment with minimum recurrence was incision and drainage with removal of anterior cartilage leaflet with buttoning. Simple observation as a treatment option was found to be as good as intralesional steroids. Pseudocyst of the pinna is a benign condition of unknown etiology affecting the pinna, commonly encountered in middle-aged men. It is a rare condition and is hardly encountered in routine ENT practice. Bilateral diseases are uncommon. Most common site of occurrence is triangular and scaphoid fossa. Many modalities of treatment have been recommended in literature with varied recurrence and failure rates. The best treatment is surgical deroofing followed by buttoning with minimum recurrences. An option of simple observation for 2-3 months should be discussed with each patient and was found to be as good as intralesional steroids.

In the management of partial thickness burns, it is difficult to balance between conservative management and surgical intervention. Our hypothesis was that a triangular relationship exists between protease/anti-protease profile at the burn wound surface, angiogenesis and re-epithelialisation. By manipulation of the biochemical profile at the wound level, we determined to affect the nature and extent of angiogenesis and resulting re-epithelialisation. We performed a randomised longitudinal observational study on partial thickness burns in adult patients presenting to two regional burns units. Our results demonstrated that a high-protease wound environment is associated with lower levels of the angiogenic factor VEGF, a lower more uniform change in wound bloodflow and a uniform well healed wound with an architecturally normal epidermis. In addition, we found that a low protease wound environment is associated with higher levels of the angiogenic factor VEGF, a higher wound bloodflow throughout the wound healing period and a more chaotic, hypercellular, overkeratinised, and chaotic thickened epidermis.

In Pakistani earthquake of 2005, there were many wounded patients needing orthopedic care. I present in this article the essential orthopedics knowledge, which is necessary for anesthetists in disaster area. The wound treatment consists of debriedment and delayed primary closure. Fracture of bone is mainly treated conservatively. Fractures of clavicle, or arm bones are treated with clavicle band, plaster of Paris or triangular bandage, and fractures of leg bones with traction. In the use of antibiotics, it is necessary to keep in mind that antibiotics do not reach the tissue if its blood circulation is poor.

A percutaneous endoscopic gastrostomy tube (PEG) is the means by which long-term artificial enteral nutrition can be provided to patients. PEGs differ in design and length of use but have one device common to all--the external fixation device or boister. This is a small piece of polyurethane or silicone that is usually circular or triangular in shape. It encircles the PEG and is designed to anchor the PEG externally and 'prevent it from being pulled into the stomach' (Colagiovanni, 2001) (Fig 1).

We present a case of penile and scrotal oedema in a young man. Although oestradiol treatment and compression bandaging provided some relief from the symptoms, neither therapy was ideal. Triangular resection of the foreskin was therefore performed, although the oedema persisted. The aetiology of the condition remains unknown.

A triangular shaped full-thickness skin graft harvested adjacent to the donor site of the radial forearm flap, as originally described by Liang et al, has successfully been used in seven consecutive patients for coverage of the donor site of the radial forearm free flap. In all patients this resulted in a robust coverage with no late wound breakdown and an aesthetic appearance far superior to split-thickness skin-graft coverage. We recommend this technique which is feasible in the majority of cases and reduces both donor site and graft site morbidity of the radial forearm flap.

The elbow joint is extremely prone to haemarthroses, and when these occur the elbow requires support and rest. Supporting the limb with a simple collar-and-cuff sling, a triangular bandage either with or without a shoulder immobilization device will provide an analgesic effect without adding an unnecessary heavy orthosis. As the swelling subsides and the pain lessens a dynamic orthosis aids in the support and compression. When considering functional branching of the elbow joints there are a number of basic principles to be followed. One requires to consider problems of orthosis suspension, two dimensional motion and stabilization in the functional range of motion. This article provides the rationale for the special needs of persons with haemophilia who suffer from involvement of their elbow joints.