The reverse sural artery flap (RSAF) has emerged as a versatile option for soft tissue reconstruction in the distal lower extremity, particularly when microsurgical expertise or resources are limited. Despite its increasing use, comprehensive multicenter data on its survival outcomes and anatomical site-specific performance remain limited. This retrospective multicenter case series included all patients who underwent RSAF for distal lower extremity defects between 2015 and 2024 across military, governmental, private, and academic institutions. Data on patient demographics, defect characteristics, surgical technique, and postoperative outcomes were collected and analyzed using Jamovi. Kaplan–Meier survival analysis was used to assess flap survival over time, with subgroup comparisons based on defect site. A total of 60 patients were included. The overall flap survival rate was 96.7%, with a mean wound healing time of 21.5 days. Venous congestion occurred in 83.3% of cases. Persistent venous congestion occurred in 10% of cases, leading to partial flap necrosis. Flap width, pedicle length, prolonged operative time, and patient-specific factors such as body mass index (BMI) and smoking status were significantly associated with adverse outcomes. Site-specific analysis revealed that RSAFs used for ankle and lower leg defects had a 100% survival rate at 60 months, while heel-based flaps showed a decline in survival to 70.8% at 60 months. RSAF is a highly successful and reliable option for lower extremity reconstruction, especially in resource-variable settings. However, anatomical site, flap design parameters, and modifiable patient risk factors significantly impact outcomes. Long-term surveillance highlights excellent durability in ankle and lower leg reconstructions, while heel-based reconstructions require closer follow-up. Level of Evidence Level III (Retrospective Comparative Study).

Background: Pediatric lung abscess is an uncommon but potentially serious complication of pneumonia. Limited data exists on its clinical features, diagnostic workup, and outcomes in otherwise healthy children. Objective: To describe the clinical characteristics, management strategies, and outcomes of children diagnosed and treated for lung abscess in Jordan. Methods: We conducted a retrospective descriptive study of 23 pediatric patients diagnosed with and managed for lung abscess in Jordan. Data collected included demographic characteristics, clinical presentation, laboratory findings, treatment regimens, and outcomes. Results: The mean age was 7.2 years (SD 3.1), with 60.9% male and no underlying chronic diseases in any patient. Systemic symptoms such as fever (91%) and hypoactivity (91%) were common. Cough was reported in 87% of cases, with varying patterns (dry, wet, or both). Imaging confirmed that 56.5% of abscesses were located in the left lung and 43.5% in the right lung. TB was systematically excluded using PPD and PCR testing. All patients received initial broad-spectrum antibiotics; 87% required escalation to include piperacillin–tazobactam combined with aminoglycoside (either amikacin or gentamicin). The mean duration of antibiotic use was 4.8 weeks. Only one patient (4.3%) underwent surgical intervention, and two patients (8.7%) required ICU care. Follow-up imaging 1–2 weeks after completion of therapy showed full resolution in 91% of cases. Conclusions: Pediatric lung abscess in otherwise healthy children presents with significant systemic and respiratory symptoms but responds well to prolonged, escalated antibiotic therapy. Conservative management is effective in the majority of cases, with excellent clinical and radiological outcomes and low surgical intervention rates.

This study aimed to evaluate the clinical outcomes of pedicled groin flap coverage in such injuries and identify factors associated with postoperative complications and flap viability. A retrospective review of 23 patients who underwent pedicled groin flap reconstruction for finger or hand degloving injuries between 2015 and 2024 was conducted. Patient demographics, surgical details, complication rates, aesthetic outcomes, and functional recovery were analyzed. The cohort had a mean age of 27.9 years, with a male predominance (73.9%) and a high smoking rate (73.9%). Most defects involved the fingers (87%), with a mean defect size of 30.6 cm² and a mean flap size of 72.0 cm². The mean wound healing time was 32.5 days, and the average hospital stay was 3.6 days. Flap success was achieved in 91.3% of the cases. Postoperative complications occurred in 34.8% of the patients, including partial flap necrosis (26.1%), wound dehiscence (13.0%), and infection (4.3%). Intraoperative venous congestion was observed in 39.1% of the cases and was more frequent among patients who developed complications (P = .001). Other variables showing statistically significant differences between patients with and without complications included smoking status (P = .037), additional procedures performed (P = .037), and smaller defect dimensions (P = .011 for width; P = .032 for size). Aesthetic outcomes were rated as good or neutral in over 90% of the cases. Functionally, 91.3% of the patients experienced minimal-to-mild disability, with a mean QuickDASH score of 18.1 (SD = 14.1). Patients with complications had higher disability scores (mean: 27.9 vs 12.9; P = .012). Groin flap reconstruction remains a reliable and accessible option for managing hand degloving injuries, particularly in resource-limited settings, offering acceptable functional and aesthetic outcomes despite a relatively high rate of secondary procedures. Therapeutic III.

Background: Complicated pneumonia (CP) in children presents in various forms—including empyema, necrotizing pneumonia (NP), necrotizing pneumonia with pleural effusion (NP + PE), and parapneumonic pleural effusion (PPE)—and is associated with significant morbidity despite advances in antimicrobial therapy. This study aimed to describe and compare the clinical characteristics, laboratory findings, antibiotic use, and outcomes across different CP subtypes in hospitalized children and to assess the impact of prior antibiotic use on presentation and treatment outcomes. Methods: This retrospective observational study included 58 children admitted with CP to tertiary hospitals in Jordan. Patients were categorized into four subtypes: empyema (n = 4), NP (n = 4), NP + PE (n = 17), and PPE (n = 33). Demographic data, clinical features, laboratory results, antibiotic regimens, and clinical outcomes were analyzed. Multivariable regression was used to identify predictors of prior antibiotic use. Results: Fever and cough were the most common symptoms (96.6%). Over 40% of patients had received antibiotics prior to admission. Those pre-treated had significantly longer symptom duration (8.2 vs. 4.5 days, p < 0.001), longer hospitalization (18.2 vs. 14.6 days, p = 0.023), and more frequent chest tube insertion (66.7% vs. 35.3%, p = 0.019). Streptococcus pneumoniae was the most common organism isolated in culture-positive cases. Vancomycin-based regimens were the most frequently used treatments. Univariate regression analysis showed that patients with prior antibiotic use had significantly higher odds of longer hospitalization duration (OR = 1.11, p = 0.028) and chest tube insertion (OR = 3.67, p = 0.021). Conclusions: Complicated pneumonia in children remains a diverse and clinically significant condition. The findings demonstrate that prolonged symptom duration prior to hospitalization and certain clinical interventions were associated with prior antibiotic exposure. These results provide insight into local disease patterns and prescribing behaviors, which may help inform strategies to optimize antimicrobial stewardship and improve care pathways for affected children.