RESUMEN
BACKGROUND: The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications. METHODS: From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases. RESULTS: Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps. CONCLUSIONS: The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.
Asunto(s)
Traumatismos de la Mano , Colgajo Perforante , Procedimientos de Cirugía Plástica , Arteria Radial , Humanos , Femenino , Masculino , Colgajo Perforante/irrigación sanguínea , Adulto , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Arteria Radial/trasplante , Traumatismos de la Mano/cirugía , Mano/cirugía , Mano/irrigación sanguínea , Adulto Joven , Estudios de Seguimiento , Resultado del Tratamiento , Estudios de FactibilidadRESUMEN
Burns of the hand are prevalent and must be managed aggressively in the acute phase to prevent deformity and disability. Proper early wound management, achieving durable soft tissue coverage, and appropriate positioning in the acute period offer substantial benefits to patients long-term. When contractures occur, secondary procedures are often indicated, and they range from laser therapy to local/regional flap coverage; rarely free flaps are used. Boutonniere deformities are common, and unfortunately, at times finger amputation renders the hand more functional than further efforts at reconstruction.
Asunto(s)
Quemaduras , Traumatismos de la Mano , Procedimientos de Cirugía Plástica , Humanos , Quemaduras/cirugía , Quemaduras/terapia , Quemaduras/complicaciones , Traumatismos de la Mano/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Contractura/cirugía , Contractura/etiología , Contractura/prevención & control , Resultado del Tratamiento , Deformidades Adquiridas de la Mano/cirugía , Deformidades Adquiridas de la Mano/etiologíaRESUMEN
Reconstruction of bony defects is challenging. Most cases can be solved by means of nonvascularized bone grafts, either corticocancellous or cancellous. However, when the defect is long, there is a combined soft tissue defect, infection, a poor scarred bed, and when a piece of cartilage needs to be included, a vascularized bone graft is preferred. This article features a review of the most useful flaps for small and long defects in the hand and upper limb.
Asunto(s)
Trasplante Óseo , Colgajos Quirúrgicos , Humanos , Trasplante Óseo/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Procedimientos de Cirugía Plástica/métodos , Extremidad Superior/cirugía , Resultado del Tratamiento , Traumatismos de la Mano/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Traumatismos del Brazo/cirugíaRESUMEN
Objective: To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. Methods: The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm. Results: All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. Conclusion: The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.
Asunto(s)
Traumatismos de la Mano , Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Traumatismos de la Mano/cirugía , Adolescente , Estudios Retrospectivos , Anciano , Adulto Joven , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodos , Cicatrización de Heridas , Desbridamiento/métodos , Resultado del Tratamiento , Mano/cirugía , Traumatismos de los Tejidos Blandos/cirugíaRESUMEN
BACKGROUND: The neurocutaneous flap was developed based on the understanding that every superficial cutaneous nerve includes vessels, also known as vasa nervorum or paraneural vessels, which run around and inside the nerves and deliver blood to the skin above. A cutaneous perforator connected to paraneural vessels that vascularize the skin and nerves is referred to as a neurocutaneous perforator. The lateral antebrachial cutaneous nerve (LACN), the most dependable blood supply from the primary underlying veins of the neurocutaneous flap, is the subject of this study. METHODS: We reviewed the results of 30 flap coverage procedures in 10 children. The applied flap was based distally along the radial aspect of the hand and wrist. The pivot point of the flap was located dorsally. This study considered patients with posttraumatic tissue loss, vital structure exposure, or hand contractures with an LACN flap. There was a case-by-case assessment. RESULTS: Thirteen male patients were included; their ages ranged from 6 to 65 years. Demographic data, preoperative cause of trauma, and postoperative complications were collected. Statistically significant improvements were observed after flap healing. CONCLUSIONS: The LACN flap is a more versatile flap with less morbidity than other alternative flaps for coverage of soft tissue defect restoration around the hand, wrist, and distal forearm.
Asunto(s)
Procedimientos de Cirugía Plástica , Humanos , Masculino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Anciano , Adulto Joven , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/cirugía , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/trasplante , Colgajo Perforante/inervación , Resultado del Tratamiento , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/inervación , Colgajos Quirúrgicos/trasplante , Traumatismos de la Mano/cirugíaRESUMEN
The study included 40 patients of both genders who underwent skin transplantation after a hand injury. The study aims to evaluate the oxidative stress parameters in patients' blood and serum levels of galectin-3 in order to investigate gender differences pre- and post- skin transplantation. The results of the study suggest a significant increase in superoxide anion radical levels, catalase activity, and reduced glutathione levels in females before skin transplantation. The surgical treatment caused significant increase in superoxide anion radical and hydrogen peroxide levels as prooxidants in males, while superoxide dismutase and catalase activity were also increased 7 days after the procedure. In females, superoxide anion radical and TBARS levels increased after surgical procedure as well as the activity of catalase. Regarding galectin-3 levels, a significant interaction between gender and time was observed (gender×time; p=0.000). Correlation analysis of different oxidative stress markers with gal-3 revealed the existence of a significant negative correlation of superoxide anion radical, catalase, and reduced glutathione with gal-3, but only in female patients. It can be concluded that OS as well as galectin-3 play important roles at least in the first 7 days of the postoperative period.
Asunto(s)
Catalasa , Galectina 3 , Glutatión , Traumatismos de la Mano , Estrés Oxidativo , Trasplante de Piel , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Proteínas Sanguíneas , Catalasa/sangre , Catalasa/metabolismo , Galectina 3/sangre , Galectina 3/metabolismo , Galectinas , Glutatión/sangre , Glutatión/metabolismo , Traumatismos de la Mano/cirugía , Traumatismos de la Mano/sangre , Traumatismos de la Mano/metabolismo , Peróxido de Hidrógeno/sangre , Peróxido de Hidrógeno/metabolismo , Caracteres Sexuales , Factores Sexuales , Superóxido Dismutasa/sangre , Superóxido Dismutasa/metabolismo , Superóxidos/metabolismo , Superóxidos/sangre , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismoRESUMEN
OBJECTIVE: Severe hand electrical injuries often occur in functional areas such as joints; the repair requires attention to both appearance and function due to the visibility of the hand. This study aimed to present the clinical experience of successfully repairing hand electrical injuries using improved forearm venous flaps. METHODS: From 2020 to 2022, 15 cases of severe hand electrical injuries were diagnosed, including 10 males and 5 females. Among them, 6 cases were repaired in the first web space, 4 in the thumb, 3 in the index finger, 2 in the middle finger, 2 in the ring finger, and 2 in the little finger. The size of venous flaps ranged from 2.0 cm × 1.8 cm to 12 cm × 4.0 cm. All patients underwent repair using improved forearm venous flaps. The follow-up period ranged from 5 to 8 months. RESULTS: All flaps survived without serious complications. All patients were satisfied with the postoperative aesthetics and function of their hands. CONCLUSION: The improved forearm venous flap is a simple and reliable method for repairing hand electrical injuries.
Asunto(s)
Traumatismos por Electricidad , Antebrazo , Traumatismos de la Mano , Colgajos Quirúrgicos , Humanos , Masculino , Femenino , Estudios Retrospectivos , Adulto , Antebrazo/cirugía , Antebrazo/irrigación sanguínea , Traumatismos de la Mano/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/trasplante , Traumatismos por Electricidad/cirugía , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Adulto Joven , Adolescente , Venas/cirugía , Venas/lesiones , Venas/trasplante , Resultado del TratamientoRESUMEN
Cartilage injuries of the hand and wrist can be debilitating in the athlete. Diagnosis is difficult given the broad spectrum of presenting symptomatology. History and physical examination is crucial to achieve the correct diagnosis, and advanced imaging can offer helpful assistance to the clinician as well. TFCC injuries and ulnar impaction syndrome are among the most common conditions in athletes with hand and wrist pain. Treatment of these injuries is initially nonoperative, but elite athletes may elect to bypass nonoperative treatment in favor of earlier return to sport. Surgical treatment varies but can include open and arthroscopic methods. The clinician should tailor treatment plans to each athlete based on level of competition, type of sport, and individual preferences and goals.
Asunto(s)
Artroscopía , Traumatismos en Atletas , Cartílago Articular , Traumatismos de la Mano , Traumatismos de la Muñeca , Humanos , Traumatismos de la Muñeca/terapia , Traumatismos de la Muñeca/cirugía , Traumatismos de la Muñeca/diagnóstico , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos en Atletas/terapia , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/cirugía , Traumatismos de la Mano/terapia , Traumatismos de la Mano/cirugía , Traumatismos de la Mano/diagnóstico , Artroscopía/métodos , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Volver al Deporte , Examen FísicoRESUMEN
Residual intravenous foreign bodies following hand trauma are relatively rare; only a few previous reports of this situation are available. It has been reported that foreign bodies often migrate to the heart and atrium dextrum. Herein, we report a recent case of needle breakage in the dorsal vein of the hand that was removed with lignification using an intraoperative C-arm fluoroscopy machine and tape tourniquet to avoid proximal movement during removal. The mandate should be to remove within the capacity allowed so that rare cases and terrible complications can be avoided. The case was seen at The Yanji City, Jilin Province, China at the Yanbian University Hospital emergency at February 20, 2023.
Asunto(s)
Cuerpos Extraños , Agujas , Humanos , Agujas/efectos adversos , Cuerpos Extraños/cirugía , Cuerpos Extraños/diagnóstico por imagen , Masculino , Traumatismos de la Mano/cirugía , Fluoroscopía , Venas/lesiones , Venas/diagnóstico por imagen , Venas/cirugía , Administración IntravenosaRESUMEN
Ectopic transplantation of the hand remains a rare, innovative yet valuable operation in select cases of trauma and amputation. We aim to describe a novel technique of complex hand reconstruction using a two-stage ectopic implantation of the contralateral upper limb. A male patient with a near complete avulsion amputation of the right upper limb at the level of the mid-forearm and a crushing injury to his left hand was admitted after a farming accident. The right palm was ectopically transplanted to the left lower limb and both upper limbs underwent debridement with vacuum assisted dressings (VACs). There was eventual dieback of the left thumb, ring and little finger with a large palmar soft tissue defect that was eventually reconstructed using segments of the ectopically transplanted limb in two separate operations. The patient made an uneventful postoperative recovery and managed to regain protective sensation and gross motor function of his reconstructed hand.
Asunto(s)
Amputación Traumática , Traumatismos de la Mano , Procedimientos de Cirugía Plástica , Humanos , Masculino , Traumatismos de la Mano/cirugía , Amputación Traumática/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Lesiones por Aplastamiento/cirugíaRESUMEN
BACKGROUND: The management of upper limb injury is aimed at a timely return to work, and other activities of daily living. The modified hand injury severity score (MHISS) has been found to predict a return to work. Upper limb injuries are common in our subregion, but there is little or no data on the time to return to work. AIM: This study, therefore, aimed to determine the prevalence of return to work and to identify the predictors of time to return to work following reconstruction of upper limb injuries. METHOD: This was a cross-sectional analytic study carried out between April 2022 and March 2023. The statistical test was at a confidence interval of 95%, and statistical significance set at a P value of <0.05. RESULT: A total of 49 upper-limb-injured patients had reconstruction in the time under review. Male-to-female ratio was 4.4:1. The mean MHISS was 87.9 ± 79.2. Of the 43 patients who participated in the return-to-work analysis, 41.9% had returned to work, with a mean time of 14.3 ± 10.5 weeks. Work-related injuries (r = 0.357, P = 0.019), male gender (r = 0.354, P = 0.020), and MHISS (r = 0.333, P = 0.029) correlated significantly with late return to work. On multiple logistic regression, work-related injuries (ß =0.321, P = 0.037), MHISS (ß =0.376, P = 0.032), and male gender (ß =0.326, P = 0.044) were found to be the significant predictors of late return to work. CONCLUSION: There is a low prevalence of return to work, with a high mean time to return. Work-related injuries, MHISS, and male gender are significant predictors of time to return to work.
Asunto(s)
Reinserción al Trabajo , Extremidad Superior , Humanos , Masculino , Femenino , Reinserción al Trabajo/estadística & datos numéricos , Estudios Transversales , Nigeria/epidemiología , Adulto , Persona de Mediana Edad , Extremidad Superior/lesiones , Extremidad Superior/cirugía , Factores de Tiempo , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Adulto Joven , Traumatismos de la Mano/cirugía , Traumatismos de la Mano/rehabilitación , Traumatismos de la Mano/epidemiología , Adolescente , Puntaje de Gravedad del Traumatismo , Traumatismos del Brazo/cirugía , Traumatismos del Brazo/epidemiología , Traumatismos del Brazo/rehabilitaciónRESUMEN
Background: The use of robotic systems for microsurgery has gained popularity in recent years. Despite its drawbacks, such as increased learning time and lack of haptic feedback, robot-assisted microsurgery is beneficial for emergency care due to its reduced risk of tremor and fatigue. The Symani Surgical System® is 1 example of this advanced technology. The device offers a range of possibilities in the field of microsurgery by combining precision and dexterity, revolutionizing microsurgical procedures. This article explores the applications of the Symani in microsurgical procedures in emergency hand trauma care, highlighting its advantages and limitations. Material and Methods: We present the results of 62 anastomoses of blood vessels under .8 mm diameter after hand trauma. 31 anastomoses were conducted using the Symani Surgical System®, and the other 31 were done as a control group in hand-sewn technique. Study Sample: The patient characteristics, including sex, age, and risk factors, were matched. Results: We found no significant differences in the anastomosis surgery length when performed with the Symani (arterial 17.3 ± 1.9 min; venous 11.5 ± 1.3 min) vs the hand-sewn technique (arterial 16.1 ± 1.4 min; venous 10.2 ± 1.8 min). Additionally, the learning curve consistently decreased over time, with the 10th surgery taking 30% (arterial) less time. Conclusion: Our study indicates that robot-assisted microsurgery can help surgeons maintain a relaxed and focused state while producing results comparable to hand-sutured procedures in emergency care.
Asunto(s)
Traumatismos de la Mano , Microcirugia , Humanos , Femenino , Masculino , Microcirugia/métodos , Microcirugia/instrumentación , Traumatismos de la Mano/cirugía , Adulto , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentación , Persona de Mediana Edad , Anastomosis Quirúrgica/métodos , Mano/cirugía , Mano/irrigación sanguíneaRESUMEN
ABSTRACT: Intravenous plasminogen replacement therapy for patients with plasminogen deficiency type 1 (hypoplasminogenemia) was recently approved for marketing in the US. In this case report, the authors describe a 33-year-old man with hypoplasminogenemia who developed nonhealing postsurgical wounds following trauma to his right hand despite receiving standard treatment for 4 months. The patient was enrolled in a compassionate-use protocol with intravenous plasminogen replacement therapy and experienced prompt resolution of surgical wounds. He was the first human patient to receive replacement therapy with plasminogen, human-tvmh in the US and first to demonstrate cutaneous wound healing in addition to resolution of ligneous lesions attributable to plasminogen deficiency type 1.
Asunto(s)
Plasminógeno , Cicatrización de Heridas , Humanos , Masculino , Adulto , Cicatrización de Heridas/efectos de los fármacos , Plasminógeno/deficiencia , Plasminógeno/uso terapéutico , Administración Intravenosa , Resultado del Tratamiento , Traumatismos de la Mano/complicaciones , Traumatismos de la Mano/cirugía , Herida Quirúrgica/tratamiento farmacológico , Herida Quirúrgica/complicaciones , Conjuntivitis , Enfermedades Cutáneas GenéticasRESUMEN
Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.
Asunto(s)
Traumatismos de la Mano , Colgajo Perforante , Traumatismos de los Tejidos Blandos , Humanos , Colgajo Perforante/trasplante , Masculino , Traumatismos de los Tejidos Blandos/cirugía , Femenino , Adulto , Estudios Prospectivos , Traumatismos de la Mano/cirugía , Persona de Mediana Edad , Antebrazo/cirugía , Adolescente , Traumatismos del Antebrazo/cirugía , Adulto Joven , Procedimientos de Cirugía Plástica/métodos , NiñoRESUMEN
BACKGROUND: The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery. METHODS AND ANALYSIS: The databases Embase, MEDLINE, CINAHL and CENTRAL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will be searched. Abstracts will be screened by two persons independently to identify eligible studies. This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery; bite injuries will be excluded. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device). The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials, and the Newcastle-Ottowa scale (NOS) will be used to assess the risk of bias in non-randomised studies. A random-effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, injury type, and operation location. Sensitivity analyses including only low risk-of-bias studies will be conducted, and the confidence in the results will be assessed using Confidence in Network Meta-Analysis (CINEMA). DISCUSSION: This systematic review and network meta-analysis aims to provide an up-to-date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023429618.
Asunto(s)
Antibacterianos , Profilaxis Antibiótica , Traumatismos de la Mano , Infección de la Herida Quirúrgica , Humanos , Cirugía de Cuidados Intensivos , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Traumatismos de la Mano/cirugía , Metaanálisis en Red , Proyectos de Investigación , Infección de la Herida Quirúrgica/prevención & control , Revisiones Sistemáticas como Asunto , Metaanálisis como AsuntoRESUMEN
The hand is commonly affected in thermal injuries. Hand burns account for 39% of all burns and they are involved in 34% of instances when the total body surface area of a burn exceeds 15%. Inadequate or inappropriate treatment could result in significant morbidity. The ultimate integration of a burn patient into the society largely depends on the functionality of the hands. Hence, it is important to reduce complications by providing good care during the acute stage.
Asunto(s)
Quemaduras , Traumatismos de la Mano , Procedimientos de Cirugía Plástica , Humanos , Quemaduras/cirugía , Quemaduras/terapia , Traumatismos de la Mano/cirugía , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodosRESUMEN
Complex comminuted hand injuries are an urgent medical and social problem of national health systems, which is especially sensitive for countries with a low level of socio-economic development. The work aims to substantiate the effectiveness and safety of the shoelace method of hand bone osteosynthesis in complex comminuted fractures (a clinical case study). Clinical case: A 42-year-old female patient was admitted to the clinic with complaints of the presence of a crushed wound on the 2nd finger of the left hand. The shoelace method was applied for hand bone osteosynthesis. The surgical intervention time was 24 minutes, and the time before returning to work or daily activities equaled 7.1 weeks. The time to bone fusion was less than 45 days. The shoelace osteosynthesis method in complex comminuted fractures of the hand bones has prospects for modern clinical practice with the possibility of improving the performance and safety indicators.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Conminutas , Humanos , Femenino , Adulto , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Traumatismos de la Mano/cirugía , Huesos de la Mano/cirugía , Huesos de la Mano/lesiones , Huesos de la Mano/diagnóstico por imagenRESUMEN
Preservation and restoration of hand function after burn injuries are challenging yet imperative. This study aimed to assess the curative effect of a composite skin graft over an acellular dermal matrix (ADM) and a thick split-thickness skin graft (STSG) for treating deep burns on the hand. Patients who met the inclusion criteria at the First Affiliated Hospital of Wenzhou Medical University between September 2011 and January 2020 were retrospectively identified from the operative register. We investigated patient characteristics, time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery, donor site recovery, complications and days to complete healing. Patients were followed up for 12 months to evaluate scar quality using the Vancouver Scar Scale (VSS) and hand function through total active motion (TAM) and the Jebsen-Taylor Hand Function Test (JTHFT). A total of 38 patients (52 hands) who received thin STSG on top of the ADM or thick STSG were included. The location of the donor sites was significantly different between Group A (thick STSG) and Group B (thin STSG + ADM) (p = 0.03). There were no statistical differences in age, gender, underlying disease, cause of burn, burn area, dominant hand, patients with two hands operated on and time from burn to surgery between the two groups (p > 0.05). The time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery and days to complete healing were not significantly different between Group A and Group B (p > 0.05). The rate of donor sites requiring skin grafting was lower in Group B than in Group A (22.2% vs. 100%, p < 0.001). There were no statistically significant differences in complications between the groups (p = 0.12). Moreover, 12 months postoperatively, the pliability subscore in the VSS was significantly lower in Group A than in Group B (p = 0.01). However, there were no statistically significant differences in vascularity (p = 0.42), pigmentation (p = 0.31) and height subscores (p = 0.13). The TAM and JTHFT results revealed no statistically significant differences between the two groups (p = 0.22 and 0.06, respectively). The ADM combined with thin STSG is a valuable approach for treating deep and extensive hand burns with low donor site morbidity. It has a good appearance and function in patients with hand burns, especially in patients with limited donor sites.
Asunto(s)
Dermis Acelular , Quemaduras , Traumatismos de la Mano , Trasplante de Piel , Humanos , Quemaduras/cirugía , Masculino , Femenino , Trasplante de Piel/métodos , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Traumatismos de la Mano/cirugía , Adulto Joven , Cicatrización de Heridas/fisiología , Cicatriz , Resultado del TratamientoRESUMEN
Caring for hand and wrist injuries in the elite athlete brings distinct challenges, with case-by-case decisions regarding surgical intervention and return-to-play. Metacarpal fractures, thumb ulnar collateral ligament tears, and scaphoid fractures are common upper-extremity injuries in the elite athlete that can be detrimental to playing time and future participation. Treatment should therefore endure the demand of accelerated rehabilitation and return-to-activity without compromising long-term outcomes. Fortunately, the literature has supported emerging management options that support goals specific to the athlete. This review examined the advances in surgical and perioperative treatment of metacarpal fractures, thumb ulnar collateral ligament injuries, and scaphoid fractures in the elite athlete.