RESUMEN

BACKGROUND: Extensive arterial damage of arteries that were too small in diameter precluded finger replantation. Venous arterialization in which arterial blood inflows through a proximal arterial-to-distal venous anastomosis, allows performing replantation that was previously considered as impossible and has resulted in a successful outcome. The aim is to introduce the distinctive phenomenon of the reperfusion delay in finger replantation by vein arterialization and to analyze its clinical significance. MATERIALS AND METHODS: In 2012-2015, vein arterialization was involved in 18 digits of 13 patients. The duration that the replants restore reperfusion following the release of tourniquet, defined as revascularization time, was recorded. RESULTS: The results showed that revascularization time ranged from 0 to 540 min, with an average of 54.5 min. The revascularization time was shorter than 20 min in 8 digits, between 20 and 120 min in 9 digits, and 540 min in one digit. CONCLUSION: The study findings have shown that reperfusion delay is usual during vein arterialization. Failing to understand it would result in the premature endings of the procedure. It is worth maintaining further observation, thus rescue otherwise possibly abandoned replantation.

RESUMEN

OBJECTIVE AND BACKGROUND: There was no agreement with regard to the treatment for secondary radial nerve palsy. This study aimed to investigate at what point should exploration of the nerve be considered. METHODS: One hundred and twenty-five patients with fracture of the diaphyseal humerus treated with internal fixation at our hospital from February 2000 to February 2010 were reviewed retrospectively. There were six cases of secondary radial nerve palsy occurred soon after humeral internal fixation. No recognized intraoperative injuries to the radial nerve were recorded. Initial conservative observation was carried out in all six cases. RESULTS: Follow-up period averaged 28 months (range 24-37 months). In four cases, the beginning of electromyography recovery averaged 3.5 months (range 1-5 months), the meantime of onset of clinical recovery was 4.8 months (range 1-6 months), and the average time to full recovery of wrist and finger extension was 8.5 months (range 3-12 months). In other two cases, nerve exploration was made when there was no nerve recovery 3 months after internal fixation of humeral fracture at the request of patients. There were no macroscopic lesions of the radial nerve. At 2-year follow-up, extension of wrist and finger recovered to nearly normal in these two cases. CONCLUSIONS: For treatment for secondary radial nerve palsy, it seems reasonable to consider watchful waiting for about 5 months before nerve exploration if the decision as to the period of waiting was based on the clinical recovery onset time.

Asunto(s)

RESUMEN

Treatment of ring degloving injuries of the finger is one of the most demanding problems in hand surgery. Replantation has been advocated as the best solution if the vessels belonging to the degloved skin are not irreversibly destroyed. We present a case involving a ring finger with circumferentially avulsed skin. Debridement under microscopy showed that the peeled skin did not retain any arteries, but did have various superficial veins of good caliber. The neurovascular bundles of the finger remained in situ and did not appear to be disrupted. The degloved finger survived uneventfully by venous arterialization, retaining excellent function and appearance.

RESUMEN

OBJECTIVE: To determine the age-related expression features of slit2 mRNA at various intervals at the proximal and distal parts of sciatic nerve during re-innervation after severance injury, and to investigate the molecular biological reason why co-contraction occurs more commonly in the young rats than in the adults after peripheral nerve injury. METHODS: The right sciatic nerve was transected sharply at the midthigh in the young and adult rats, 28 in each group. The proximal and distal stumps were inserted into a medical silicone tube with a gap of 3 mm. Before the injury, and 1, 3 and 7 days (6 rats at each interval) after sciatic nerve severance injury, both stumps of the sciatic nerve were harvested. Reverse transcription polymerase chain reaction (RT-PCR) was use to examine the expression of slit2 mRNA in the young and adult group rats. In situ hybridization was done to detect the cell location of slit2 mRNA expression in young and adult rats, 4 rats in each group, 2 rats used before the injury and 2 rats used on the postoperative third day. RESULTS: RT-PCR results suggested that slit2 mRNA at both stumps was significantly lower in the young group of rats than in the adult except that at the proximal part on the postoperative 7th day. There was statistically significant difference (P < 0.01). In situ hybridization studies indicated that the slit2 mRNA was specifically expressed in the cytoplasm of Schwann cells both in the young and adult rats before injury and 3 days after injury. CONCLUSION: The expression of slit2 mRNA by Schwann cells in the young rats is lower than that in the adult rats after peripheral nerve injury. These findings suggests the lower expression of chemotactic factor (slit2) by Schwann cells in the young group is likely to be the molecular biological reason for the higher incidence of co-contraction between agonists and antagonists in the younger rats.

Asunto(s)

RESUMEN

Free latissimus dorsi muscle transfer is widely used for functional reconstruction of flexion of elbow and fingers after brachial plexus injury at later stage, as well as for soft tissue coverage because of its large size and long and reliable pedicle with adequate vessel diameter. Common complications recorded in literatures are hematoma and muscle atrophy due to a compartment syndrome. We treated a patient with soft tissue avulsion at forearm using free latissimus dorsi muscle transfer for soft tissue coverage in our hospital. Unfortunately during the transfer the patient's brachial plexus was injured. After timely treatment, he recovered completely.

Asunto(s)