Thoracic outlet syndrome (TOS) is a group of symptoms caused by the compression of neurovascular structures of the superior thoracic outlet. The knowledge of its clinical presentation with specific symptoms, as well as proper imaging examinations, ranging from plain radiographs to ultrasound, computed tomography and magnetic resonance imaging, may help achieve a precise diagnosis. Once TOS is recognized, proper treatment may comprise a conservative or a surgical approach.

Introduction: The Oberlin nerve transfer is widely used to restore elbow flexion after brachial plexus injury. However, donor-site morbidity, particularly permanent motor deficit, has been rarely reported. This retrospective case series describes permanent donor-site morbidity following the Oberlin procedure and explores its association with poor elbow flexion outcomes. Methods: Nine patients (mean age, 38 years) with upper-type brachial plexus paralysis, including seven C5–C8 injuries, were referred to a tertiary centre after undergoing a primary Oberlin transfer at external institutions. All patients described immediate hand paralysis and/or failure of elbow flexion recovery after the surgery. Patients were reassessed at a mean follow-up of 27 months (range, 9–48). Outcome measures included assessment of hand motor deficits, grip strength and elbow flexion recovery using the Medical Research Council scale. Results: Six of nine patients failed to achieve functional elbow flexion (M0, n = 4; M2, n = 2). Eight patients had ulnar nerve involvement, most commonly paralysis of the first dorsal interosseous muscle ( n = 7) and clawing deformity ( n = 6). One patient exhibited isolated anterior interosseous nerve paralysis. Mean grip strength was markedly reduced, averaging 14 kg compared with reported normal values of 30–50 kg. Conclusions: The frequent association between irreversible hand weakness and unsatisfactory elbow flexion recovery highlights the limited functional reserve of donor nerves in selected clinical scenarios. These findings emphasize careful patient selection and microsurgical expertise in Oberlin transfers. Level of evidence: IV

Article: Implications and limitations of the current literature on Dupuytren’s contracture treatment - Minerva Orthopedics 2023 December;74(6):496-503 - Minerva Medica - Journals

Nasal reconstruction represents a challenge for the three-dimensional structure with a three-layer structure. Internal lining remains the most demanding tissue to be reconstructed. We utilized the free temporal artery posterior auricular skin (TAPAS) flap for reconstructing the internal nasal lining of the vault and septum of a single coana following hemi-rhinectomy. A case study of a 79-year-old male patient with a malignant melanoma illustrates the effectiveness of this approach. A free TAPAS flap was harvested to restore the lining, together with a homolateral forehead flap for the external skin resurfacing. Cartilage was raised from the septum and auricular concha to recreate the nose framework. Although it is relevant, lining reconstruction remains underestimated, especially when approaching hemi-nasal defects. Our technique allows for one-stage reconstruction through the usage of the TAPAS flap, a thin and pliable tissue with a negligible aesthetic impact. The features of the TAPAS flap match the necessities of lining reconstruction of complex nasal defects.