Myofascial Injection Using Fascial Layer-Specific Hydromanipulation Technique (FLuSH) and the Delineation of Multifactorial Myofascial Pain

Background and objectives: The aims of this study were to delineate the contribution of specific fascial layers of the myofascial unit to myofascial pain and introduce the use of ultrasound-guided fascial layer-specific hydromanipulation (FLuSH) as a novel technique in the treatment of myofascial pain. Materials and Methods: The clinical data of 20 consecutive adult patients who underwent myofascial injections using FLuSH technique for the treatment of myofascial pain were reviewed. The FLuSH technique involved measuring the pain pressure threshold using an analog algometer initially and after each ultrasound guided injection of normal saline into the specific layers of the myofascial unit (superficial fascia, deep fascia, or muscle) in myofascial points corresponding with Centers of Coordination/Fusion (Fascial Manipulation®). The outcome measured was the change in pain pressure threshold after injection of each specific fascial layer. Results: Deep fascia was involved in 73%, superficial fascia in 55%, and muscle in 43% of points. A non-response to treatment of all three layers occurred in 10% of all injected points. The most common combinations of fascial layer involvement were deep fascia alone in 23%, deep fascia and superficial fascia in 22%, and deep fascia and muscle in 18% of injected points. Each individual had on average of 3.0 ± 1.2 different combinations of fascial layers contributing to myofascial pain. Conclusions: The data support the hypothesis that multiple fascial layers are responsible for myofascial pain. In particular, for a given patient, pain may develop from discrete combinations of fascial layers unique to each myofascial point. Non-response to treatment of the myofascial unit may represent a centralized pain process. Adequate treatment of myofascial pain may require treatment of each point as a distinct pathologic entity rather than uniformly in a given patient or across patients.

Fistula after hypospadias: preliminary treatment results

Fistula is the commonest complication after hypospadias surgery ranged 10-30%. The results of surgery depending on the severity of hypospadias, surgical technique, and experience of the operating surgeon. This is a prospective study analysis the operational procedures in post-hypospadias urethral fistula repair. Through July 2015 to January 2017, 21 patients with 21 fistulas where classified their treatment into: 6 fistula with simple closure, 7 fistula simple closure with fascial layer, and 7 fistula dorsal slit with fascial layer. According to my experience I have successfully treated all urethral fistulas using my method, with success rate. We concluded that the midline urethral incision with the dartos flip flap is the main point for treatment of difficult urethral fistula after hypospadias operation.

Unilateral buccal space masses: a case series

The head and neck region consists of several potential tissue spaces that are formed by the fascial layer. The buccal space is an area of anatomic significance due to its small size and distribution of adipose tissue. Unilateral buccal space masses often pose a diagnostic challenge owing to the diversity of tissues in the area. Here, we report four such cases of buccal space masses arising from different tissues, which presented as unilateral buccal space swelling. This report also highlights the various causes and the differential diagnoses of unilateral buccal space masses.

Port site hernia: What are the risk factors?

<p><strong>Background &amp; Aim</strong>: The port site hernia is a type of incisional hernia that occurs at port sites after laparoscopic surgery. Various factors have been implicated in the development of port site hernia.</p><p>The aim of this study was to know the risk factors of the port site hernia.</p><p><strong>Patients &amp; Methods:</strong> A retrospective study of patients who underwent different elective laparoscopic procedures in Rizgary Teaching Hospital in Erbil in a period from March 2013 to September 2014.</p><p><strong>Results</strong>: Out of 300 patients only 8 (2.7%) patients developed port site hernia. The time of the hernia occurrence ranged from 3 weeks to six months postoperatively. Half of the hernias were found in cases of age group (60-80) years. Six (75%) of the cases were female patients. All 8 hernias developed after laparoscopic cholecystectomy. Six (75%) hernias developed after open port entrance technique. All hernias occurred when the fascia in 10 mm port was not closed. Seven hernias (87.5%) occurred in patients with BMI ranged (25-34).</p><p><strong>Conclusion:</strong> Age of the patients, technique of entrance, site and size of the port with unclosed fascial layer are important factors for developing port site hernia.</p>

Imaging findings of radiologically misdiagnosed nodular fasciitis

Background Nodular fasciitis rarely occurs in young adults and children; it usually resembles other tumors, even malignancy. Purpose To review the imaging findings of six cases of nodular fasciitis misdiagnosed radiologically. Material and Methods The clinical and radiologic features of six cases of histologically proven but radiologically misdiagnosed nodular fasciitis were reviewed retrospectively. Two cases underwent both plain and enhanced computed tomography (CT) scans and the other four had both regular and enhanced magnetic resonance (MR) scans. Results All six patients were young (five children and one young adult). A rapid growing mass, pain or painless, was the most frequent presentation. Most masses were oval, well-defined, and homogeneous, with an average diameter of 2.2 cm. Five were found in superficial fascia with a broad base. Two cyst-like masses showed hypodensity relative to muscle on plain CT and without enhancement. Compared to muscle, these masses showed isointensity (n = 3) or slight hyperintensity (n = 1) on T1-weighted imaging, hyperintensity on T2-weighted imaging (n = 4), with homogeneous notable enhancement (n = 3) or mild enhancement (n = 1). Five (83.3%) were found with a “fascial tail” sign characterized as thickening of adjacent fascial layer with notable enhancement. One mass showed an “inverted target” sign. Conclusion Nodular fasciitis in young adults and children is usually superficial, rapid growing, well-defined, and homogeneous, frequently with a “fascial tail” sign. Radiologically, it can resemble a benign cyst and might be easily misdiagnosed. Therefore, nodular fasciitis should be remembered in the differential diagnosis for superficial soft tissue tumor found in young adult and children.