查看更多>>摘要：There are many ways that rehabilitation therapists,including occupational and physical therapists,treat nerve-related pain.Commonly used interventions include neurodynamic treatment,pain neuroscience education,desensitization,exercise,physical agent modalities,mirror box therapy,and Kinesio taping.Despite common practice and anecdotal support,it can be challenging to determine the appropriate intervention for each patient.In this article,each of these treatment approaches is discussed,including indicated pain phenotypes and diagnoses,timing,efficacy,mechanism,contraindications,and limitations.
查看更多>>摘要：A mangled upper extremity often involves injury to soft tissue,bone,nerves,and vessels and presents a unique challenge to hand surgeons.The complexity of such injuries requires a multidisciplinary approach to achieve an optimal functional outcome.After obtaining a thorough history and performing a secondary survey,initial management is built upon a strong understanding of the likelihood of limb salvage.Initiation of antibiotics upon presentation,timely and thorough surgical debridement,and early revascularization efforts should be pursued.The surgical team should create a long-term plan involving skeletal stabilization and soft tissue reconstruction along with postoperative rehabilitation and social support.This article reviews current concepts of upper extremity limb salvage and recommendations for surgical management of the mangled extremity.
查看更多>>摘要：Aim:Centrocentral anastomosis(CCA)can be applied in the treatment of painful neuromas,by connecting nerve ends or fascicles after neuroma resection,with or without an interposed nerve graft.While this technique was developed directly after the introduction of microsurgical techniques,it is currently not frequently applied in neuroma treatment.Methods:In this article,the literature on CCA was systematically reviewed,both for clinical and experimental studies.Specific attention was paid to the different surgical techniques,potential applications,and pathophysiologic mechanisms that might explain how CCA can prevent neuroma formation.Results:A total of 15 articles were found on this subject,11 clinical and 4 experimental studies.In clinical studies,CCA was mostly applied for neuroma treatment following amputation of fingers and lower limbs.In experimental studies,different combinations of nerve connections and grafts were investigated in the rat sciatic nerve model.Pain reduction in the clinical studies overall was good to excellent,but only in two studies control groups were used.Results from experimental studies showed that the use of an interposed graft was beneficial by entrapment of axons inside the graft.Conclusion:Although CCA has shown promising results for neuroma treatment,there are only a few case series to date,one cohort and one randomized study,and in the latter two,no graft was used.More research is needed to investigate the outcome of CCA,especially for the option of an interposed nerve graft.This investigation should involve comparisons with alternative techniques,utilization of standardized outcome measures,and,preferably,inclusion of longer follow-up periods.
查看更多>>摘要：As rates of oropharyngeal squamous cell cancer(OPSCC)increase and patients survive longer,the number of patients with recurrence will also increase.Surgery is the primary tool for the management of locoregional recurrence when feasible,and transoral robotic surgery(TORS)techniques are a useful adjunct in effectively managing these cases.Careful patient selection,surgical planning,a thoughtful reconstructive plan,and postoperative supportive therapy are crucial for adequate oncologic and functional outcomes.
查看更多>>摘要：Aim:Lymphedema is a progressive degenerative disease that can cause severe swelling and recurrent infections.Conservative and surgical treatments,such as lymphaticovenous anastomosis(LVA),are available;however,the optimal timing for LVA after the initiation of complex decongestive therapy(CDT)remains unclear.This study aimed to evaluate the effect of CDT duration prior to LVA on the treatment outcomes of upper extremity lymphedema.Methods:Fifty patients with stage II upper extremity lymphedema who underwent LVA were retrospectively evaluated.Patients were divided into two groups based on the duration of CDT before LVA:<6 months(early group)and>6 months(non-early group).The primary outcome measures were percent excess volume(PEV)and reduction rate 12 months after LVA.Results:The early group(CDT<6 months)showed significantly better outcomes than the non-early group(CDT>6 months).The early group had a lower PEV(4%)and a higher reduction rate(56%)than the non-early group(PEV of 10%and reduction rate of 25%)at 12 months after LVA.Conclusions:Early indication for LVA(within 6 months of CDT initiation)resulted in better treatment outcomes for stage II upper extremity lymphedema.This study highlights the potential benefits of early surgical intervention for improving the prognosis of lymphedema.
查看更多>>摘要：Management of clinically negative necks(cN0)in oral cavity(OCSCC)and oropharyngeal(OPSCC)squamous cell carcinoma(SCC)has evolved over time.Historically,the clinically negative neck has been managed with elective neck dissection(END)or observation,but more recently sentinel lymph node biopsy(SLNB)has emerged as a technique to detect occult metastases.In this review,we will discuss the role of SLNB in early-stage OCSCC and in the management of OPSCC.
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