Batia Yaffe | PubMed Health

PubMed2004

[Sex reassignment surgery].

Israel is among the few countries in the world where sex reassignment surgery (SRS) is performed in public hospitals. Today, the only center performing SRS in Israel is the Sheba Medical Center. A multidisciplinary committee grants authorization permitting surgery after a follow-up period of two years. We found that this multidisciplinary approach leads to the best therapeutic results. We briefly present the pre-operative evaluation, operative approach, post-operative course, final results and complications of sex reassignment surgery. This article aims to inform physicians of this therapeutic option, and the indications for referral.

Elective Surgical Procedures↗

PubMed2003

[Diffuse lichen sclerosus et atrophicus involving the palms].

Lichen sclerosus et atrophicus (LSA) is an extremely rare condition which usually involves the genitalia. There are sporadic reports of diffuse LSA with hand involvement apparently the rarest. Although the clinical course of the disease is often benign, there may be widespread lesions, disabling joint contractures, and cutaneous malignancies. We report on a patient in whom diffuse LSA appeared in the sixth decade. The condition led to multiple aggressive squamous cell carcinoma in the upper limbs and other anatomic sites and severe deforming and disabling contractures of the fingers and palms which prevented the patient's use of his hands even for simple tasks. On the basis of our experience, we suggest the application of aggressive primary treatment for cutaneous lesions in LSA.

Aged↗

PubMedDate not supplied

Combined Iliazarov and free flap for severe recurrent flexion-contracture release.

This article discusses the treatment of recurrent flexion-contracture of the knee after circumferential burns involving the entire limb. A two-team approach to surgery is used: the orthopedic team widely excises the scar tissue and releases tendons, muscles, and adjacent soft tissue that limit joint movement. The microsurgery team covers the exposed popliteal neurovascular elements with a latissimus dorsi free flap. However, full range of the knee is still limited by the short neurovascular bundle. Therefore, the orthopedic team applies a circular hinged Iliazarov external-fixator-frame to achieve gradual correction, until full range of the knee is achieved. Intensive physiotherapy and continuing use of extension splints for additional 6 months until the scars are deemed stable compliment the treatment regimen and prevent the recurrence of contractures. Between the years 2002 and 2003, we treated four patients (totaling five knee joints) with recurrent severe flexion-contractures after circumferential burns of the entire lower extremity. A significant limitation was caused by the abnormal scarring, which left the patients confined to a wheelchair. In all our patients, previous attempts to release the flexion-contracture failed. With the aforementioned technique, within 3 months after the procedure, all patients were able to walk. We encountered one major complication (ie, drop foot). At follow-up, all patients enjoyed a full range of motion and were able to walk. The strength of our approach comes from combining a free muscle flap with an Iliazarov external fixation and a detailed postoperative rehabilitation plan.

Adolescent↗