Lymphaticovenous bypass of the thoracic duct for the treatment of chylous leak in central conducting lymphatic anomalies

Background

Central conducting lymphatic anomalies (CCLA) may cause chylous leaks and protein-losing enteropathy (PLE) owing to dysfunction of the central lymphatic channels. Most of the treatment strategies for these conditions are palliative and provide transient improvement.

Sliding free transverse rectus abdominis myocutaneous flap for closure of a massive abdominal wall defect: A case report

Despite considerable advances in reconstructive surgery, massive abdominal wall defects continue to pose a significant surgical challenge. We report the case of a 72‐year‐old morbidly obese female patient with Clostridium septicum‐related gas gangrene of the abdominal wall. After multidisciplinary treatment and multiple extensive debridements, a massive full‐thickness defect (40 cm × 35 cm) of the right abdominal wall was present. The abdominal contents were covered with a resorbable mesh to prevent evisceration. Finally, the composite defect was successfully reconstructed through a contralateral extended free transverse rectus abdominis myocutaneus (TRAM) flap (50 cm × 38 cm). An arterio‐venous loop to the superficial femoral vessels using the great saphenous vein was necessary to allow the flap to reach the defect. Postoperatively, a minor wound healing disorder of the flap was successfully treated with split skin grafting. Six month after surgery, the patient presented with a completely healed flap coverage area and a small abdominal hernia without the need of further surgical revision. This case illustrates the use of a sliding free TRAM flap for closure of a massive abdominal wall defect.     

Dynamic stretching is not detrimental to neuromechanical and sensorimotor performance of ankle plantarflexors

The acute effects of two dynamic stretching (DS) protocols on changes in the ankle range of motion (RoM), neuromechanical, and sensorimotor properties of the plantarflexor muscle group were examined. Eighteen participants received slow (SDS) or fast dynamic stretching (FDS) on two separate days. Outcome measures were assessed pre‐ and 2 minutes post‐interventions, and included maximum dorsiflexion angle, maximum isometric torque at neutral ankle position, maximum concentric and eccentric torques, force matching capacity, joint position sense and medial gastrocnemius muscle and tendon strain. Possibly and likely small increases in dorsiflexion RoM were observed after SDS (mean ± 90% confidence intervals; 1.8 ± 1.2°) and FDS (2.1 ± 1.2°), respectively. Very likely moderate decreases in muscle strain after SDS (?38.0 ± 20.6%) and possibly small decrease after FDS (?13.6 ± 21.2%) were observed. SDS resulted in a likely beneficial small increase in tendon strain (25.3 ± 29.7%) and a likely beneficial moderate increase after FDS (41.4 ± 44.9%). Effects on strength were inconsistent. Possibly small effect on positional error after SDS (?27.1 ± 37.5%), but no clear effect after FDS was observed. Both DS protocols increased RoM, and this was more due to an increase in tendon elongation rather than the muscle. However, SDS showed greater improvement than FDS in both neuromechanical and sensorimotor performance, and hence, SDS can be recommended as part of warm‐up in sporting contexts.