Closure or reduction of the donor defect of a sural flap with a purse-string suture: long-term results

We aimed to reduce the defect with a purse-string suture to minimise the deformity of the flap donor area and to assess the later efficiency at long-term follow-up. We studied 20 patients who required a sural flap for the reconstruction of defects of the lower extremity. The mean (SD) area of the donor defect was roughly 28.7 (20.3) cm(2). The mean (SD) defect area after closure with a purse-string was 8.2 (5.8) cm(2) (p < 0.001). The measurements made in the third year were 8.4 (5.3) cm(2). The purse-string can be used successfully in the distal lower extremity, the long-term cosmetic outcome is good, and the scar has not expanded since the postoperative period.     

Acute ophthalmic artery obstruction secondary to subperiosteal abscess with retrobulbar phlegmonous infection

A 57-year-old diabetic woman experienced a sudden severe visual loss and total ophthalmoplegia in her left eye. Magnetic resonance imaging studies showed orbital cellulitis, located mainly in the posterior orbit, secondary to ethmoid and maxillary sinusitis. Fundus examination and fluorescein angiograms were suggestive of left ophthalmic artery occlusion. Subsequent ethmoidectomy and incisional biopsies failed to show any specific microorganism, particularly mucormycosis. This case represents an unusual complication of orbital subperiosteal abscess with retrobulbar phlegmonous infection which left the patient with no light perception as a result of ophthalmic artery obstruction. Posterior orbital infections should be more closely monitored and surgery should be considered in early stages of the disease.     

Osteoid osteoma of the cuboid bone: a rare cause of foot pain

Osteoid osteoma, a common bone lesion of benign nature, is more rarely seen in feet. It most commonly involves the talus yet rarely the cuboid. The atypical symptoms of foot involvement may delay the diagnosis. Differential diagnosis most commonly includes ankle sprain, monoarticular arthritis, anterior impingement syndrome, tarsal spur, osteomyelitis, stress fracture, eosinophilic granuloma. The delay in diagnosis and treatment of osteoid osteoma in the foot may be a cause of chronic foot pain. In this study, we present a 17-year-old boy with osteoid osteoma in his right cuboid bone. The patient was undiagnosed during the first year of his symptoms. After surgical removal of the tumor, his complaints were resolved. The pathological examination confirmed the diagnosis of osteoid osteoma. Osteoid osteoma is an unusual bone tumor of the foot. It should be included in the differential diagnosis of patients exhibiting foot pain. In speculative cases with no obvious radiographic findings, further imaging studies, such as CT, should be considered.     

Low-power holmium:YAG laser urethrotomy for urethral stricture disease: comparison of outcomes with the cold-knife technique

In this prospective randomized clinical trial, we aimed to evaluate the safety and efficacy of endourethrotomy with holmium:yttrium-aluminium-garnet (HO:YAG) laser and compare the outcomes with the conventional cold-knife urethrotomy. Fifty-one male patients with single, iatrogenic, annular strictures of the urethra were randomly divided into two groups; 21 patients who underwent direct-vision endoscopic urethrotomy with Ho:YAG laser (15 W; 1,200–1,400 mJ; 8–12 Hz) at 12 o’clock position (laser group) and 30 patients who underwent direct-vision endoscopic urethrotomy with cold-knife incision at 12 o’clock position (cold-knife group). The results obtained were analyzed and compared at 3 months, 6 months, 9 months, and 12 months postoperatively by clinical evaluation, uroflowmetry, and retrograde urethrographies. Variables were compared among groups using Fisher’s exact and Mann Whitney U tests. There were no differences between two groups in terms of patient age, preoperative Qmax value, stricture location, and length. Operative time was shorter in laser group (16.4 ± 8.04 minutes) when compared with cold-knife group (23.8 ± 5.47 minutes) (p < 0.001). Recurrence-free rate at 3 months was similar between two groups (p = 0.122). However, recurrence-free rates at 6 months, 9 months, and 12 months were significantly higher in laser group when compared with cold-knife group (p values were 0.045, 0.027, and 0.04, respectively). No intra- or postoperative complications were encountered. Use of Ho:YAG laser in the management of urethral stricture disease is a safe and effective method. In addition, it provides shorter operative time and lower recurrence rate when compared with the conventional technique.