OBJECTIVE: The aim of the present study was to assess results of rehabilitation of patients after finger replantation.
METHODS: The study examined 160 fingers amputated and replanted at various levels between 2000 and 2013 at the clinic. Mean patient age was 29.4 years. Mean follow-up time was 23 months. Rehabilitation of fingers began between postoperative fourth and eighth week and continued until the 24th week. Range of motion of affected hand, return to daily activities, aesthetic appearance, and patient satisfaction were assessed according to Tamai criteria.
RESULTS: Functional results according to Tamai criteria were perfect in 36 patients, good in 54 patients, average in 27 patients, and poor in 18 patients.
CONCLUSION: Post-operative rehabilitation of replanted fingers should begin as soon as possible. During the rehabilitation period, physiotherapist, surgeon, and patient must work in close cooperation. Functional results of patients who adjust to the rehabilitation program, home practice, and splint usage are better.
Aim: Although not very popular, the olecranon bone graft is a useful option for this type of operation due to the minimal donor morbidity and its ease of use in small bone defect reconstruction and non-union therapy. To our best knowledge, few studies have evaluated the use of the olecranon bone graft as a treatment for non-union after distal finger replantation. Our aim in this report was to present our experience of using olecranon grafts in our nonunion patients undergoing distal replantations.
Methods: Between 2013 and 2019, a total of 14 patients who developed nonunion or had segmental bone defects due to the injury were included in the study. Retrospectively the results were analyzed in terms of complication and union rates.
Results: The mean follow-up period was 37 months (range 8-72 months). No major complications were seen in the donor region or recipient regions. One patient developed necrosis in the nail bed and one patient had a hematoma in the donor site. The minor complications were solved without any problem.
Conclusion: In conclusion, we found the olecranon bone grafting for the treatment of nonunion after distal finger replantation is a safe and convenient method. It can be preferred as the first choice for nonunions of distal finger replantations.
Objective:In this study, we aimed to describe the relationship between the localization of rarely seen upper extremity war injuries and their complications in the subacute period, and define our preferences for surgery and antibiotic use.
Methods:Patients with an upper extremity war injury who presented to our institution between 2015 and 2018 were retrospectively evaluated. Data regarding demographics, time between injury and presen- tation, location of injury, type of damage, complications, treatment methods, infection rates and antibi- otic use were recorded. Tissue defects, fracture fixation, neurovascular damage, infection development and treatment approaches were analyzed.
Results:Sixty-two male patients with isolated upper extremity injuries (mean age: 31.66 ±8.28 years) were included in the study. The average time between trauma and hospitalization was 14 days. The mean hematocrit (Hct) level at presentation was 36.3 ±6.8%. Patients had been followed up for an average pe- riod of 95.6 ±32.1 days. Twenty-nine patients (46.8%) had nerve injury, eight (12.9%) had arterial injury that required repair, and 23 had infection (37.1%), of which five developed osteomyelitis. Infection was polymicrobial in nine cases and monobacterial in 14. A positive correlation was found between the pres- ence of fracture and nerve injury ( p = 0.013). The frequency of nerve injuries due to gunshot wounds was higher in the mid-section and lower part of the arms and in the proximal forearm when com- pared to other regions ( p = 0.011). The infection rates were significantly higher in patients with fractures ( p = 0.033). The mean hematocrit (Hct) level at presentation of the patients with infection (32.1 ±6.3%) was significantly lower than that of those who did not have infection (38.8 ±5.9%) ( p < 0.001).
Conclusion:Upper extremity war injuries require case-specific solutions. Microbiological samples should be taken prior to empirical antibiotic treatment for infection management and rational antibiotic use principles should be applied according to the culture and antibiogram results. The holistic and ambiguous character of nerve injuries often requires early exploration and combined reconstructive interventions. Arterial injuries can be overlooked by physical examination alone and thus routine angiography should be performed. Completion of the bone and soft tissue reconstructions in the same session using a holistic approach minimizes the possible risks.
Abstract: The number of venous anastomoses performed during fingertip replantation is one of the most important factors affecting the success of replantation. However, because vessel diameters decrease in the zone 1 level, vessel anastomoses, especially vein anastomoses, are technically difficult and, thus, cannot be performed in most cases. Alternative venous drainage methods are crucial when any reliable vein repair is not possible. In the literature, so many artery-only replantation techniques have been defined, such as arteriovenous anastomoses, forming an arteriovenous or venocutaneous fistula, manual milking and massage, puncturing, and external bleeding via a fishmouth incision and using a medical leech. It has been shown that, in distal fingertip replantations, the medullary cavity may also be a good way for venous return. In this study, we introduce an alternative intramedullary venous drainage system we developed to facilitate venous drainage in artery-only fingertip replantations. The results of 24 fingertip replantations distal to the nail fold by using this system are presented with a literature review.
Objectives: Bone grafts have been used for more than one hundred years in orthopedic surgery. Autografts are still the gold standard with respect to their osteoconductive, osteoinductive and osteogenetic peculiarities. Cancelleous grafts are the most commonly used autografts with their porous structure increasing the contact area. Although iliac crest is the preferred donor site, the femur, tibia, distal radius and olecranon are also employed when they are in a suitable location for the recipient site. The olecranon donor site can provide ample amounts of bone graft for reconstruction in the upper extremity. Here, the bone graft harvesting from the olecranon with the use of trephine as a safe and fast technique is presented. The bone graft harvested with trephine not only has the proper morphology to be used for phalanx and metacarpal reconstruction, but also can be utilized for wrist and forearm procedures.
Methods: 82 patients (21 female) had bone reconstruction with olecranon bone graft harvested with trephine between 2010 and 2015. The mean age was 34 (range: 20-62) years. The mean follow-up period was 26 (range: 6-48) months.
Results: None of the patients had pain or decrease in the range of motion in the early or late postoperative period. Only one patient (1.2%) had hematoma formation at the donor site and no other complications were observed in any patient. There was no difference in elbow extension strength between both elbows at the postoperative fifteenth day and at the end of the follow-up period.
Conclusion: Bone graft harvesting with trephine is technically easy and fast, and donor site morbidity is diminished compared other methods and donor sites. It can be performed under axillary anesthesia and provides adequate amounts of bone graft for upper extremity reconstructions.
Key words: Olecranon, bone graft, bone biopsy, trephine
Introduction: The recovery of recurrent motor branch of the median nerve might be delayed in high level median nerve injuries due to the long reinnervation distance. The aim of this study is to define a novel nerve transfer to restore the opposition and pinch.
Methods: Two fresh frozen hand cadavers were used for the study. The motor branch of the first palmar interosseous muscle of the ulnar nerve was identified and dissected. Thenar branch of the median nerve was dissected from its insertion site. The motor branch of the first palmar interosseous muscle of the ulnar nerve was transferred to the thenar motor branch of the median nerve. Axon counts were examined histopathologically. Clinically this nerve transfer was performed for two female patients with a highlevel median nerve injury. Mehta opposition scores were 21 and 20, respectively and the results were satisfactory six months after the surgery.
Discussion: Although exploration and repair are recommended as the first treatment for median nerve injuries, the waiting time until the motor branch is reinnervated is critical in high level lesions. Nerve transfers become very important for fast recovery.
Conclusions: This new nerve transfer proposal may be an important step in nerve transfer surgery
Introduction: This article aims to expand the microsurgical treatment options for extremity degloving injuries with perforator artery repairs of the specific degloved angiosomes in upper and lower extremity.
Methods: Fourteen perforator arteries were repaired in seven patients. Four of them had circumferential degloving and 3 of them have non circumferential degloving injury. All had repair of the perforator arter- ies of the specific degloved segments. Four patients had additional vein repairs but none of the patients had AV shunts.
Results: All perforators provided adequate arterial supply to their specific angiosomes with some necrotic areas in neighboring angiosomes.
Conclusions: Perforator artery repair within the degloved tissues provides a direct arterial supply suc- cessfully even if one could not find an intact venous plexus.
Objective: The scaphoid bone is the most injured carpal bone and is the cause of severe wrist dysfunction seen in nonunion cases. The probability of avascular necrosis is very high especially in fractures of the proximal pole, due to the retrograde blood flow in the region. In these cases, vascularized pedicle bone grafts, with high rates of union, is a good alternative to the conventional techniques. In this study, we present the results of vascularized bone grafting with grafts harvested from the 4-5 extensor compartment artery (ECA) and fixation with the Herbert screw in patients with avascular pseudoarthroses of the scaphoid proximal pole.
Methods: Fifteen patients who presented to our clinic due to nonunion of the scaphoid and who were applied vascularized pedicle bone grafts harvested from the ECA between 2006 and 2015 were included in the study. The mean age of the patients was 30.1 (19-42) and all patients were male. Patients were followed up for an average period of 22.7 (18-56) months. Union in the patients were evaluated with the preoperative and postoperative wrist ranges of motion. VAS (visual analog scale) and, for functional evaluation, the Turkish version of the Quick-DASH scale were used.
Results: Union was achieved in all patients after a mean period of 8.2 (6-10) weeks. The most significant improvements after surgery were detected in the VAS and functional Quick-DASH scores. No significant improvement was observed in wrist contractures. Other than the hematoma in one patient, no complication was observed.
Conclusion: In cases of nonunion of the scaphoid proximal pole fractures accompanied by avascular necrosis, pedicle grafts from the 4-5 ECA offer high rates of union and improvement in the pain and functional scores of the patients. Level of evidence Level IV, therapeutic study.
Abstract: Extracorporeal perfusion of organs has a wide range of clinical applications like prolonged vital storage of organs, isolated applications of drugs, bridging time to transplant, and free composite tissue transfer without anastomosis, but there are a limited number of experimental models on this topic. This study aimed to develop and evaluate a human extracorporeal free flap perfusion model using an extracorporeal membrane oxygenation device. Five patients undergoing esthetic abdominoplasty participated in this study. Deep inferior epigastric artery perforator flaps were obtained abdominoplasty flaps, which are normally medical waste, used in this model. Deep inferior epigastric artery perforator flaps were extracorporeally perfused with a mean of 6 days. The biochemical and pathological evaluations of the perfusions were discussed in the article.
Background: Degenerative arthritis of the first carpometacarpal (CMC) joint is a common degenerative condition in the hand. Many different surgical procedures have been applied for years. However, in the studies there is no consensus about the superiority of one technique to another.