Biomedical subjects
Publications and source records attributed to S V Zachary.
Establishing soft-tissue coverage adequate to retain an injured digit (preserve length) is not always possible or advisable. Careful evaluation combined with the skillful application of various reconstructive procedures (at the expense of length) may salvage the function and aesthetics of the injured hand.
Seventy-three wrist arthrodeses (71 patients) using AO/ASIF dorsal plate fixation and iliac crest bone graft were retrospectively reviewed to assess complications of this technique. There were 82 complications in 50 wrists. Nonunion of the radius to the carpus did not occur. Forty-five of the complications were related to the soft tissues; 29 were bone or articular complications. Chronic unexplained pain represented 8 of the complications. Overall, 63 of the 82 complications resolved. Nineteen wrists required additional surgery, most frequently for plate removal. Eighteen wrists were left with one or more residual difficulties after fusion. Thus, 55 of the wrist arthrodeses ultimately resulted in a stable, pain-free wrist.
Blastomyces is a pathogen that may infect healthy and immunocompromised hosts. Frequently entering the lungs, the initial pneumonitis usually is followed by skin and bony involvement secondary to hematogenous spread. Infection of the synovium without bone or skin involvement in the pediatric population has not been reported previously. A soft tissue mass of the forearm in a 9-year-old boy was the initial manifestation of blastomycosis. Radiographic images, ultrasound, and magnetic resonance imaging of the forearm could not distinguish inflammation from sarcoma. Frozen section during open biopsy revealed a granulomatous process and several budding yeasts. There was no evidence of a malignancy. Cultures of the tissue grew Blastomyces dermatitidis. The patient was treated successfully with surgical debridement of the mass and amphotericin B followed by itraconazole, for a total therapeutic course of 18 weeks. Although rarely diagnosed in children, blastomycosis must be included in the differential diagnosis of any soft tissue mass.