Yazar: Sude Yılmaz

Sporcularda yüksek fiziksel aktivitenin sonucu olarak travmatik ve aşırı kullanım yaralanmaları sık görülmektedir.El, el bilek yaralanma sıklığı spor yaralanmaları içerisinde %25’lere kadar yükselebilmektedir.

Sporcularda yaralanmaların çoğunluğu travmatik kökenlidir. Tüm spor dallarında dirsek ekstansiyonda iken el bileği üzerine düşmek temel risk faktörüdür. Özellikle atlama, tırmanma, kayak, jimnastik ve paten gibi spor dallarında sporcunun güvenli düşmeyi öğrenmesi gerekir. Aşırı kullanım yaralanmaları ise tenis, golf gibi tekrarlayan hareketlerin yapıldığı sporlarda daha sık görülür. Yaralanmaların %50’den fazlası bağ ve yumuşak doku yaralanmaları şeklinde görülür.

Yaralanma öncesi koruyucu atelleme ve doğru egzersiz programları uygulanması; yaralanma sonrasındaysa spora hızlı ve sorunsuz geri dönüşü sağlamak için uygun ortopedik tedavilerin seçilmesi kritik öneme sahiptir.

Cilt vücudun en büyük organıdır. En önemli görevleri arasında dış ortama karşı bir bariyer oluşturmak, ısı regülasyonu ve duyu bulunmaktadır. Duyu fonksiyonu elde, özellikle de palmar bölgede ayrı bir öneme sahiptir. Eldeki cildin başka bir önemli işlevi de altta yatan tendonlar, damarlar, kemikler ve eklemler için bir zarf oluşturmasıdır. Bir elin çalışması için, içindeki yapıların iyi çalışması kadar derinin de yeterli bir esneklikte ve elin hareketlerini engellemeyecek boyutlarda olması, alttaki dokuların kayarak hareketlerine izin vermesi ve yeterli bir duyuya sahip olması gereklidir. Ayrıca tutma ve kavrama işlevlerinin oluşturduğu basınç ve sürtünmeye dayanacak kuvvette olması gerekir. Bu nedenle el cerrahisinde cilt ve cilt altı örtüsüne ait komplikasyonlar, yalnızca onarılması gereken açık birer yara olarak görülmemelidir. Cilt eksikliklerinin, yetersiz veya kalitesiz dokular ile kapatılması, ya da olması gerekenden fazla kalınlıkta cilt flepleri ile onarımı elde ciddi işlevsel kayıplara ve kozmetik sorunlara neden olur. Üst ekstremitedeki cilt komplikasyonları çok yönlü olarak düşünülmelidir.

Aim: Distal finger replantation is a challenge in microsurgery.Replantations distal to the flexor
digitorum superficialis were initially termed as distal finger replantations but today what
is meant by a distal replantation is replantation througt or distal to the distal interphalangeal joint.

Key words: Distal falanks replantation, distal interphalangeal joint

Objectives: The spectrum of soft tissue tumors of the hand is wide. The type of tumor can vary based on demographic factors, such as a patient’s gender and age. Furthermore, certain tumors arise more commonly in particular locations on the hand. This study aimed to determine the incidence and recurrence rates of soft tissue tumors of the hand and to discuss the most common types of tumors based on tumoral parameters, demographic data, and histopathological findings with a brief review of the literature.

Methods: We analyzed the clinical data and the pathology reports of all patients who underwent surgery in our hand and microsurgery department between January 1, 2007, and January 1, 2016. We evaluated the demographic data, surgical information, tumor type, size and location, histopathological diagnoses and immunohistochemical findings. We also determined the recurrence rates of the patients after a 2-year follow up.

Results: In our center, 302 surgical resections were performed between January 1, 2007, and January 1, 2016. Ganglion, which is a pseudotumoral lesion, was the most common space occupying lesion (n=102, 34%). Of the 302 resections, 66% were tumoral cases (n=200). Giant cell tenosynovial tumor (n=55, 27.5%) was the most common benign tumor, followed by glomus tumor (n=34, 17%), pyogenic granuloma (n=15, 7.5%), and cystic hygroma (n=14, 7%).

Conclusion: In accordance with the literature, in the present study, most of the patients (99%) that underwent surgery had benign diagnoses. Synovial sarcoma was the only malignant tumor observed in the study population.

Key words: Hand, tumor, soft tissue, microsurgery

Background/Aim: Many different flaps described in the reconstruction of fingertip amputations may not provide optimal esthetic appearance due to hyponychial tissue loss and the lack of volar support of the nail bed. Except for free nail transfer and composite graft, the number of techniques described for nail reconstruction of the finger is limited. We aimed to investigate the utility of the reverse dorsal facial flap and to determine satisfaction rate of the esthetic and functional results obtained. Patients and Methods: Sixteen patients who were referred due to fingertip amputation including loss of nail bed between 2014 and 2017 and who could not be replanted were prospectively included. Flap planning was made from the proximal part of the nail bed toward the middle phalanx depending on the defect size. The skin was harvested superficially to the lateral side and kept on the fascial layer at the bottom. A fascial flap was harvested by preserving the paratenon. The flap was transposed, and the reconstructed area of the nail bed or defect of the nail bed was closed. A full‑thickness skin graft was applied over the fascia.

Results: There was no total flap loss or partial necrosis in any patient. None of the patients had complications that would require a second flap surgery. The mean Visual Analog Scale score of the patients control was 1.06. The calculated Disabilities of Arm, Shoulder, Hand score was 3.08. The mean Likert score of the patients was 17.

Conclusion: The dorsal fascial flap can be applied as an alternative surgical method in patients with fingertip defects including nail loss or damage in order to provide esthetically favorable nail appearance.

Amaç: Volar ganglionların eksizyonlarında dikkat edilmesi gereken noktalar, ameliyat edilen hastaların verileri ışığında değerlendirildi.
Çalışma planı: Çalışmaya volar ganglion nedeniyle ameliyat edilen 40 hasta (10 erkek, 30 kadın; ort. yaş 32.5; dağılım 18-65) alındı. Tüm hastalarda tek taraflı tutulum vardı. Bütün ameliyatlar aksiller brakiyal pleksus rejyonel anestezisi ile ve mikrocerrahi ameliyathanesi şartları altında yapıldı. Ortalama izlem süresi 2.5 yıl (dağılım 1-5 yıl) idi.

Amaç: Kırık komponenti olan çekiç parmakların tedavisi tartışılmalıdır. Bu makale, eklem yüzünün üçte birinden daha büyük kırık içeren çekiç parmak olgularında yivli Kirschner teli kullanımının tekniğini ve sonuçlarını anlatmaktadır.
Yöntem: Nisan 2004 ve fiubat 2012 tarihleri arasında 47 hasta opere edildi. Ortalama takip süresi 19.6 (dağılım: 8-44) ay idi.
Bulgular: Crawford kriterlerine göre sonuçlar, 32 hastada (%69) çok iyi, 12 hastada (%26) iyi ve 3 hastada (%6) vasat idi. Ortalama hareket açıklığı 3º (0-15º, ekstensor zaafiyet) ile 71º (60-80º, fleksiyon) arasında idi. Komplikasyon olarak, beş hastada hafif dejeneratif değişiklikler, üç hastada Kirschner teline bağlı enfeksiyon, bir hastada geçici tırnak kabarıklığı ve üç hastada ciltte geçici dolaşım bozukluğu görüldü. Hiçbir hastada sürekli devam eden postopertif ağrı olmadı.
Sonuç: Yivli Kirschner telleri kırıklı çekiç parmak olgularında ameliyatta iyi redüksiyon sağlamış ve bu redüksiyonu postoperatif altı hafta boyunca korumuştur.

Purpose: Leaving extensor pollicis longus (EPL) tendon out of the retinaculum in cases performed through a dorsal ap­proach at the level of the extensor retinaculum after opening the 3rd extensor compartment reduces risk of adhesion and rupture. The aim of this study was to attempt to understand whether leaving EPL in the subcutaneous tissue that is released from the extensor compartment during surgery, without reconstructing the third extensor compartment, causes any change to extension strength and range of motion (ROM) of the interphalangeal (IP) and metacarpophalangeal (MCP) joints of the thumb.

Background: Nail bed deformity and tumor recurrence are the major complications of subungual glomus  tumor surgery. Therefore, alternative methods to approach glomus tumors in the hand have been proposed in order to avoid further nail bed injury after surgical treatment.   Methods: In this study, a series of 32 patients with glomus tumors in the subungual region of the hand, treated surgically with two different types of incisions, is reported. The clinical efficacy and safety of surgical treatment of glomus tumors performed using the lateral subperiosteal or transungual approaches were analyzed.   Results: In the transungual approach, as the nail plate is extracted and the nail bed is incised, there is a high risk of post­operative nail deformity and late recovery. However, with the lateral subperiosteal approach, because only the skin lateral to the nail is incised without extracting the nail plate and incising the nail bed, nail bed injury does not occur.   Conclusion: Overall, early recovery takes place and postoperative nail deformity is improved. The main  advantages of the lateral subperiosteal approach are that it permits reduction of postoperative nail deformity and early recovery. However, not every glomus tumor is suitable for the lateral subperiosteal approach. In tumors located peripherally, the lateral subpe­riosteal approach provides quick recovery of cosmetic appearance and less deformation of the nail.

Objectives: We aimed to evaluate the safety and outcomes of plate-screw fixation used for the immediate  treatment of type-IIIC open fractures of forearm bones with complex soft tissue injuries.   Methods: A total  of 22 patients (mean age: 31.6, range: 24-60) treated between 2004-2010 were retrospectively analyzed. All injuries resulted from high-energy traumas and fractures were classified using AO classification. All patients had vas­cular and nerve injuries, and four had skin defects associated with double fractures of the forearm. All patients were oper­ated on within the first eight hours following injury. Six patients with comminuted fractures or with bone defects underwent primary bone grafting, and one patient was treated with shortening. Primary skin closure was achieved in 17 patients and three patients underwent immediate repair using skin grafts, while two patients were repaired with immediate transposition flaps. Bony unions, complications, and functional results via a DASH questionnaire were investigated.   Results: Mean follow  up was 28 months (range: 14-70). In all patients, radius bone union was achieved. Two patients underwent a Sauve-Kapandji procedure, utilizing the fractured segment of the ulnar diaphysis as a graft for radius. In one patient, osteosynthesis was repeated after 6 months because of nonunion. Mean period to bony union was 4.59 months (range: 3-6). Superficial infection developed in three patients after the operation, and was resolved with antibiotic therapy. The mean DASH score after surgery was 25.6.   Conclusion: In high nergy traumas of the upper extremity associated with complex injuries and Type-IIIC forearm frac­tures, severity of soft tissue injuries determined the functional results in patients, demonstrating it is possible to achieve a safe and efficient fixation with immediate plate-screw osteosynthesis.