Amaç: Fleksör tendon yaralanmalarında, konvansiyonel tendon greftlemesinin kabul edilebilir başarı sağlayamayacağı düşüŸnüŸlen olgularda, tendon protezi kullanılarak iki seanslı fleksör tendoplasti uygulamaları değerlendirildi.

ǂalışma planı: Fleksör tendon yaralanması nedeniyle 31 hastanın (24 erkek, 7 kadın; ort. yaş 23; dağılım 6-46) 37 elinde tendon protezi ile iki seanslı fleksör tendoplasti uygulandı. Yaralanma nedeni, 26 hastada kesici-delici alet, dört hastada iş kazası, bir hastada elektrik yanığı idi. Olgular ameliyat öncesinde Boyes’in tendon yaralanmaları sınıflandırmasına göre değerlendirildi. İlk seansta hastanın yaşına ve yatağın durumuna göre kalınlığı 4-6 mm arasında değişen silikon protez kullanıldı; 3-5 ay sonra protezler Çıkarılarak tendon greftleri ile fleksör tendoplasti ameliyatları yapıldı. Sonuçlar Strickland formülü kullanılarak değerlendirildi. İkinci ameliyattan sonra ortalama izlem süresi 37 ay (dağılım 12-80 ay) idi.

Sonuçlar: On bir protez uygulamasında mükemmel (Strickland %75-100), 15 uygulamada iyi (%50-74), dokuz uygulamada orta (%25-49), iki uygulamada kötü(%0-24) sonuç alındı. Strickland ortalaması %58 bulundu. Yedi olguda, ikinci seanstan en az dört ay sonra tenoliz ameliyatı uygulandı. Bir olguda enfeksiyon nedeniyle tendon protezinin çıkartılması gerekti.

Çıkarımlar: Parmak hareketlerini kısıtlayan eklem hasarı, parmakta trofik değişikliklere neden olan dijital sinir yaralanmaları ve multipl doku hasarının olduğu durumlarda, tendon protezi ile iki seanslı fleksör tendoplasti oldukça tatminkar sonuç sağlamaktadır.

Informed Consent: Written informed consents were obtained from the subjects.

Authorship Contributions: Design- D.P.; Data Collection or Processing- D.P.,

B.Ö.; Literature Search- T.Ö.M., R.T.; Supervision- K.A.; Writing- D.P.

Conflict of Interest: No conflict of interest was declared by the authors.

ABSTRACT

Objective: Wide awake local anesthesia no tourniquet (WALANT) is a local anesthetic technique that, in theory, reduces costs and surgical waiting periods. The purpose of this study was to compare axillary block (AXB) with WALANT in terms of pain scores, duration of hospital stay, and hand function in patients who underwent CTR surgery.

Methods: Between January 2015 and February 2020, a retrospective analysis was conducted on the outcomes of 410 patients who underwent CTS surgery. The Walant technique was utilized on 210 patients, while the AXB technique was utilized on 200 patients. These two groups were compared regarding operative time, hospital stay, VAS score at specific intervals before and after surgery, and hand function recovery.

Results: The mean operation time is 11 min (8-18) for the WALANT group and 12 min (5-34) for the AXB group. The average time of the length of hospitalization is 4.2 hours (2-6) for the WALANT and 14.2 hours (9-26) for the AXB groups. The mean hospitalization time and the VAS scores of the

WALANT group are significantly less than the AXB group (p=0.02 and p=0.03 respectively). The percentages of being able to use their hands compared to their nonoperative hands were evaluated. These rates were higher in the WALANT group than in the AXB group (65-75% vs. 45-60%).

Conclusion: Increased patient comfort was associated with the WALANT technique. It is superior to AXB in terms of patient satisfaction, postoperative long-term pain management, and hand function recovery. Assuming all safety recommendations are adhered to, the WALANT is an alternative to

tourniquets in CTS surgeries for obtaining a bloodless surgical field without the discomfort of tourniquet application.

Keywords: Carpal Tunnel Surgery, WALANT, Axillary Block, VAS, patient satisfaction.

Purpose
Chondral lesions of the lunate are one of the causes of ulnar-sided pain, but there has been little interest to date in treating them. In this paper, we describe a modification of the subchondral drilling technique in which an 18-gauge (G) needle was used as a sleeve to guide a K-wire to the lunate chondral defect. 

Lunotrikuetral (LT) eklem sorunları ulnar tarafın önemli ağrı sebeplerindendir. Muayenede LT eklem üzeri hassasiyet ve eklemde instabilite saptanabilir. Provokatif muayene testlerinde lunatum ile trikuetrum arasında hareketlenmenin varlığı test edilir. Manyetik rezonans (MR) görüntüleme LT eklemi değerlendirmekte her zaman yeterli bulgu vermeyebilir. MR artrografiler, dinamik radyografi incelemeleri ve kinematik bilgisayarlı tomografi (BT) incelemeleri tanı koymada yardımcı olmakla birlikte tanı için artroskopi altın standarttır. LT eklem yırtıkları kronik dönemde volar interkale segmental instabiliteye (VISI) ilerler. VISI, skafoid ve lunatumun daha fleksiyon, trikuetrumun daha ekstansiyon pozisyonuna gelmesidir. Tedavide planlama lezyonun akut veya kronik olmasına, travmatik ya da dejeneratif olmasına, beraberinde perilunat instabilite veya karpal çökme varlığına göre değişir. Cerrahi seçenekler artroskopik veya açık LT eklem debridmanı, LT ligament tamiri veya rekonstrüksiyonu, dorsal ligamentokapsülodez ve LT eklem artrodezidir.
Anahtar sözcükler: lunotrikuetral eklem; volar interkale segmental instabilite; Geissler sınıflaması; dorsal ligamentokapsülodez; lunotrikuetral eklem artrodezi Lunotriquetral (LT) joint disorders are among the reasons of ulnar side pain. At examination of LT joint, tenderness and stability should be checked. Additionally, provocative tests should be performed. In these tests, the presence of movement between the lunate and triquetrum is evaluated. Magnetic resonance imaging (MRI) may not always provide sufficient findings to evaluate the LT joint. While MR arthrography, dynamic radiographic examinations and kinematic computed tomography (CT) examinations are helpful in diagnosis; arthroscopy is the gold standard for diagnosis. Ligament ruptures of the LT joint progress to Volar Intercalated Segmental Instability (VISI) in chronic period. VISI is becoming of scaphoid and lunate to more flexed and triquetrum to more extended position. Planning of the treatment varies according to whether LT joint disorder is acute or chronic, traumatic, or degenerative, and the presence of perilunate instability or carpal collapse. Surgical options are arthroscopic or open LT debridement, repair or reconstruction of LT ligament, dorsal ligament capsulodesis and LT joint arthrodesis.
Key words: lunotriquetral joint; volar intercalated segmental instability; Geissler classification; dorsal ligamentocapsulodesis; lunotriquetral joint arthrodesis 

Purpose Proximal row carpectomy (PRC) can be performed in the late stages of Kienböck disease using the traditional open technique or arthroscopically. In this study, we describe the arthroscopically-assisted mini-open PRC technique. The aim of the study was to compare the functional results with the open PRC technique in advanced-stage Kienböck disease.
Methods The medical records of patients with Kienböck disease who underwent open PRC between 2006e2010 (Cohort A) and arthroscopically-assisted PRC (AAPRC) between 2010e2018 (Cohort B) were analyzed. The Quick Disabilities of the Arm, Shoulder, and Hand scores, visual analog scale, and Modified Mayo Wrist Scores were compared, which were obtained at the early postoperative (third month) and final follow-up.
Results Cohort A had 14 and Cohort B 21 patients. The preoperative, early, and final mean visual analog scale scores were 7, 3, and 0.3, respectively, for Cohort A, and 7, 0.3, and 0.1, respectively, for Cohort B. The preoperative mean Quick Disabilities of the Arm, Shoulder, and Hand scores decreased from 69 to 34 at the third-month and 6.1 on thefinal follow-up visit for Cohort A and from 77to 18, and 5 forCohortB.ThefinalMayowrist scores were excellentin 4, goodin 4, andmoderate in 6 of the Cohort A patients, and excellent in 11, good in 8, and moderate in 2 of the Cohort B patients. Mean flexion increased to 52
from 43
for Cohort A and to 62
from 41
for Cohort B.
Conclusions AAPRC, compared to the open PRC, resulted in increased wrist motion and increased Mayo wrist scores in the long-term. Also, the third-month patient-related outcomes revealed favorable results in the AAPRC group. We attribute these findings to the earlier initiation of postoperative wrist motion and the less invasive character of the AAPRC procedure. (J Hand Surg Am. 2022;-(-):1.e1-e8. Copyright
2022 by the American Society for Surgery of the Hand. All rights reserved.)
Type of study/level of evidence Therapeutic IV.
Key words Kienböck disease, proximal row carpectomy, arthroscopically-assisted mini open surgery.

Objectives: In this study, we aimed to evaluate the short-to-midterm results of the resection and reconstruction of large cystic lesions of the humerus.

Patients and methods: Eight male patients (median age: 22.9±10.4 years; range, 12 to 42 years) with large cystic lesions of the humerus operated between January 2017 and December 2019 were retrospectively analyzed. The age of the patients, their previous treatments and follow-up periods, the size and location of the cysts, postoperative functional scores, presence of a union,recurrence of the cyst, and graft resorption were examined.

Results: The mean follow-up was 42.8±7.5 (range, 34 to 54)months. Preoperatively, the mean length of the cystic lesions was 15.1±2.6 (range, 10 to 18) cm. At the final follow-up, the patients had a normal range of shoulder flexion-extension,internal rotation-external, abduction-adduction, and elbow flexion-extension, pronation-supination. The patients had a mean DASH score of 1.13±1.1 (range, 0 to 3.3) and MSTS score of 28.75±1.8 (range, 26 to 30) postoperatively. Complications such as pseudoarthrosis, graft resorption, or cyst recurrence were not observed in any of the patients.

Conclusion: Although the risk of recurrence is low in small cystic lesions of the humerus, it increases as the size of the lesion increases. This reconstruction technique using vascularized fibular grafts, which we applied, seems to be extremely successful in ensuring biological healing and preventing recurrence and complications in patients with large cystic lesions of the humerus.

Keywords: Cystic lesions, humerus, vascularized fibula graft.

Purpose: This study aimed to assess the results of volar V-Y advancement flap surgery without suturing the proximal part to reconstruct fingertip amputations.
Methods: Between 2018 and 2020, 18 patients (16 males, 2 females) who underwent volar V-Y advancement flap surgery without suturing the proximal part due to a fingertip amputation were retrospectively identified and included. All the clinical outcomes were obtained at the final follow-up appointment. The total range of motions of injured fingers and the same ones of the contralateral healthy DIP (distal interphalangeal) joint were measured. Fingertip tenderness was measured with Visual Analog Score (VAS). Cold intolerance and two-point discrimination (2PD) were assessed in the flap area.
Results: The mean age was 37 (range = 19–62) years, and the mean follow-up was 15 (range = 12–22) months. The thumb was injured in 5 patients, index finger in 7, long finger in 4, ring finger in 1, and little finger in 1. Partial or total flap necrosis was not encountered in any patient. There was 17.5 (range= 0-30)% deficiency in DIP joint range of motion in the injured finger compared to the contralateral healthy finger (p=0.38). The mean VAS for fingertip tenderness was 0.11 (range = 0–1). While no cold intolerance was encountered in 14 patients, it was minimal in 2 patients, mild in 1, and severe in 1. 2PD rate increased by 45% (range = 0–120) compared to the contralateral healthy finger(p < 0.034). Sensory function was preserved in all patients.
Conclusion: Volar V-Y advancement flaps without suturation of the proximal part can offer good clinical and aesthetical outcomes, protect the finger contour, and reduce the risk of flap necrosis.
Key words: Volar V-Y advancement flap, fingertip amputations, reconstruction surgery 

Acute correction of rigid drop foot deformity can be problematic due to the skin defect that may occur in the medial part of the ankle. The purpose of this study is to present an innovative solution for this problem. We hypothesized that acute correction for rigid ankle contractures without arthrosis might be possible if the medial skin defect could be closed. Therefore, we described a surgical technique for acute functional correction of rigid drop foot deformities. The closure of the medial defect was performed by applying a flap and partial-thickness skin graft. We have retrospectively evaluated the results of 18 patients who were treated between 2010 and 2016 with this technique. The mean age of the patients was 37 § 9.5 (22-56) years. Foot drop etiology was firearmrelated nerve injury. Corrections were performed after 14.6 § 7.9 (8-38) months following the injury. At the end of an average follow-up period of 44.4 § 6.2 (37-60) months, 14 of 18 patients (78%) recovered without complications, 3 patients experienced partial loss in the medial skin graft region, and 1 patient developed a superficial infection. None of the patients have developed pes planus. We observed that the ankle flexion contracture, which was 34° § 9.2° (20°-50°) preoperatively, could reach an average of 2.2° § 2.5° (0°-6°) dorsiflexion after surgery. We suggest that acute correction and tibialis posterior tendon transfer in the treatment of rigid foot drop deformity can be performed with an effective skin closure with low soft tissue complications.

ABSTRACT:
BACKGROUND: Defects due to car wheel injury at the anterolateral aspect of the foot are challenging due to the characteristics of the region and the trauma. The aim of this study was to present the results of the patients whose skin defects on the dorsolateral aspect of the foot due to tire injuries were treated with reverse sural artery fasciocutaneous flaps.
METHODS: Fourteen patients with a mean age of 26.9 years (range: 5–46 years) who experienced loss of tissue at the dorsolateral aspect of the foot due to tire injury between the years 2000 and 2014 were evaluated retrospectively. The mean defect size was 27.1 cm2. The patients were followed up for observing the tissue coverage and complications throughout a mean period of 32.4 months.
RESULTS: Despite the development of marginal necrosis in two flaps in the early period, tissues in all cases were successfully covered without requiring additional reconstruction. Primary donor site coverage was achieved in all patients without any donor site problems.
CONCLUSION: In case of tire injuries at the anterolateral aspect of the foot, low complication and high success rates can be achieved with a case-based approach with reverse sural artery fasciocutaneous flap coverage.

Keywords: Car tire; fasciocutaneous flap; foot and ankle; microsurgery; reverse sural artery flap.