Crush Type Research Articles

Outcomes of Composite Grafts for Pediatric Fingertip Amputations: A Systematic Review.

Introduction The aim of this study was to explore the outcomes of composite grafts in fingertip amputations in children as well as the contributing factors that may affect outcomes. Methods Literature search was conducted across six databases in March 2022 to select studies on the use of composite grafts on fingertip amputations in the pediatric population. Results Twelve articles with 735 composite grafts were identified for review. Most fingertip injuries occurred in the less than 5-year age group and were due to crush type injuries. In studies that reported "complete" graft take as a separate outcome measure, 17.3% of fingertips with this result were observed. In the studies that reported "complete" and "partial" graft take together as an outcome measure, 81.6% of fingertips achieved this outcome. A lower proportion of failed graft take was observed in more distal fingertip amputations. Infection (3.8%) and nail abnormalities (3.4%) were the most common complications following composite grafting. Conclusion Composite grafting can be considered as a useful method of treatment in this population. Clinicians should be aware of the potential complications following this method of treatment such as infection and nail abnormalities. More proximal fingertip amputations may warrant other surgical interventions (beyond Level II on the modified Ishikawa/Ishikawa classification). Significant heterogeneity was observed within the studies, mainly due to lack of standardization in assessment and reporting of outcomes.

Severity of All-Terrain Vehicle–Related Injuries by Age in Canada, 2002-2019

Rates of pediatric hospitalizations following an injury while riding an all-terrain vehicle (ATV) are increasing. Few studies have compared the rates of severe injuries among children, adolescents, and adults. To investigate whether younger ATV riders are at risk for more severe ATV-related injuries. This cross-sectional study was conducted using administrative data from hospitals in 9 provinces in Canada. Participants included patients admitted to hospitals with ATV-related injuries between 2002 and 2019. Statistical analysis was performed from June 2020 to September 2021. The primary exposure was age younger than 16 years. Comparison groups were youths aged 16 to 20 years and adults aged 21 years and older. The main outcomes of interest were death, spinal cord injury, and an Injury Severity Score (ISS) greater than 25. Secondary outcomes were less severe injuries, including head injuries, crush type injuries, and fractures. Among 52 745 patients with complete data, 15% were youths younger than 16 years, 13% were youths aged 16 to 20 years, 82% were male, and 47% lived in rural areas. After adjusting for covariates, the odds of dying were higher among youths aged 16 to 20 years (adjusted odds ratio [aOR], 1.64; 95% CI, 1.04-2.60) compared with those younger than 16 years. Youths aged 16 to 20 years also had higher odds of spinal cord injury (aOR, 2.72; 95% CI, 1.80-4.20) and an injury severity score greater than 25 (aOR, 1.63; 95% CI, 1.36-1.96) compared with youths 16 years of age or less. Sex-specific analyses revealed these associations were greater for male youths aged 16 to 20 years (spinal cord injury: aOR, 3.81; 95% CI, 1.38-11.10, and dying in a hospital: aOR, 4.37; 95% CI, 1.19-21.02) than female youths aged 16 to 20 years. In this cross-sectional study of patients hospitalized for ATV injuries in Canada, youths aged 16 to 20 years and adults aged 21 years and older were at an increased risk of death and severe injuries compared with youths younger than 16 years. The increased risk of death and severe injuries was most evident among male patients.

Recycle Plastic Waste Brick

Abstract: Disposal of large quantity of plastic waste has emerged as an important environmental challenge, and its recycling is facing a big problem due to non-degradable nature. Due to plastic does not decompose biologically, the amount of plastic waste in our surroundings is steadily increasing. The proposed sand bricks which is made up by adding plastic waste in crush form in sand bricks may help to reuse the plastic waste as one of the additives material of bricks, and to help the disposal problem of plastic waste. The properties of plastic bricks which contain varying percentages of plastic were tested for compressive strength, water absorption and efflorescence. It shows that an appreciable improvement in the performance of bricks can be achieved by introducing crush type of plastic waste into plastic bricks. In view of utilization of plastic waste material for developing sustainable construction material, the present paper reviews plastic waste materials in different compositions of 0% to 20% that were added to the raw material to develop plastic waste bricks. The compression strength of the bricks is reviewed and recommendations are suggested as the outcome of the study. It was found that the reduction in compressive strength, due to replacement of plastic by waste plastic waste, is minimal and can be enhanced by addition of super plasticizer. The water absorption and efflorescence however showed excellent performance Keywords: Plastic Waste, Compressive Strength, Water Absorption, Efflorescence, Environmental Issue

Effects of Theranekron and alpha-lipoic acid combined treatment on GAP-43 and Krox-20 gene expressions and inflammation markers in peripheral nerve injury

ABSTRACT Peripheral nerve injury (PNI) is a major health problem that results in loss of motor and sensory functions. In treatment of PNI, various methods such as anastomosis, nerve grafts, nonneural tissue grafts, and nerve conduits are applied. In the present study, it was aimed to investigate the effects of Theranekron and Alpha-lipoic acid (ALA) combined treatment on nerve healing in experimental PNI by using histomorphometric, electron microscopic, immunohistochemical and molecular biological methods. Sixty-two Wistar rats were divided into six groups; the normal control group, sham operation group, experimental control group having a crush type injury with no treatment, Theranekron treatment group, ALA treatment group and Theranekron+ALA combined treatment group. Sciatic nerve tissue samples were obtained on days 1, 7 and 14 following injury in all groups. GAP-43 expression was upregulated in all PNI received groups compared to the control group. Krox-20 expression was downregulated in all groups that received PNI compared to the control group. While intensely positive TNF-α and IL-6 expressions were observed up to the 1st to the 14th day for the experimental control group, these expressions were seen as “weakly positive” in the treatment groups from the 1st day to the 14th day. The number of myelinated fibers was higher in the control and sham operation groups. Additionally, the number of myelinated nerve fibers increased in the combined treatment group. In conclusion, these findings suggest that combined therapy of Theranekron and ALA promotes structural recovery and it should be considered as an effective treatment protocol following PNI.

Intramedullary fixation with bioabsorbable and osteoconductive hydroxyapatite/poly-L-lactide threaded pin in digital replantation

In digital replantation, Kirschner wire (K-wire) fixation has commonly been used for osteosynthesis. On the other hand, K-wires are often obtrusive because of protrusion from the replanted digit. We describe a case series treated using hydroxyapatite/poly-L-lactide (HPLLA) threaded pins, which are not only bioabsorbable, but also osteoconductive, for osteosynthesis in crushed amputation or comminuted fracture, including distal phalanx amputation. Using an HPLLA threaded pin, 10 digital replantations were performed between July 2016 and April 2018. The precisely cut pin is manually pushed into the fracture site as an intramedullary nail. The pin is first pushed into the distal site, and then into the proximal site, after drilling with a K-wire of the same diameter as the pin. All amputations were crush type, and levels of amputations were Tamai zone I in three cases, zone II in two and zone III in five. Eight of the 10 digits survived. The two digits that did not survive showed venous insufficiency. Bone union of the eight digits was successfully obtained after 9–19 weeks (median 12 weeks). No adverse events occurred such as distortion of the pin, infection or foreign body reaction. The HPLLA threaded pin may be an adequate device to fix fractures in digital replantation.

Seymour Fractures: A Retrospective Review of Infection Rates, Treatment and Timing of Antibiotic Administration.

Seymour fractures are important to recognize and treat promptly because injuries may result in growth disturbance, nail deformity, or infection. We hypothesize that the administration of antibiotics within 24 hours of injury will be associated with a decreased rate of infection. Patients younger than 18 years were included if clinical examination and radiographs demonstrated a Seymour fracture. The timing of antibiotic administration and treatment details were reviewed. The presence of superficial infections or radiographic evidence of osteomyelitis was recorded. A total of 52 patients with 54 fracture that had greater than 30 days of follow-up and were included in data analysis. The average age at the time of injury was 10.2 years. Thirty-four (63%) of 54 patients were most commonly injured secondary to a crush type mechanism. The overall infection rate was 27.3% (15/54 fractures). Among the 29 fractures that received antibiotics within 24 hours of injury, 2 infections (6.9%) were noted at final follow-up. Delayed administration of antibiotics beyond 24 hours postinjury was observed in 17 fractures and was associated with an increased infection rate of 76.5% (13/17, P = 0.000). Early administration of antibiotics within 24 hours of injury is associated with a reduction in the development of infections. Patients with delayed antibiotic administration may be at high risk for early superficial infection or osteomyelitis. This study highlights the importance of early identification and appropriate treatment of Seymour fractures including the prompt administration of antibiotics following injury.

Complicated fingertip defects: Clinical approach to their reconstruction and the flaps that can be used in emergency settings

Aim: Numerous flaps have been described for the reconstruction of complicated defects of the fingertip. The aim of this study was to evaluate our experience on flaps that can be used in emergency settings, and analyze the outcomes of these procedures. Materials and Methods: A retrospective analysis of 81 patients, who presented to the emergency unit with complicated fingertip defects between 2009 and 2014 and in whom replantation was deemed unsuitable due to various reasons including crush or avulsion type of injury mechanism, absence of the amputated part, or unrepairable vascular injury in the amputate, was carried out. Results: Eighty-nine flaps were performed in 81 patients. The defects were repaired with V-Y advancement flaps in 57% (45 patients – 51 fingers) of the defects, kite flap in 15% (13 patients – 13 fingers), cross-finger flap in 12% (11 patients – 11 fingers), Kutler flap in 6% (4 patients – 5 fingers), digital artery perforator flap in 6% (4 patients – 5 fingers), and thenar flap in 4% (4 patients – 4 fingers) of the injuries. One patient operated with the digital artery perforator flap, and one other operated with the kite flap, developed partial flap necroses. There were no other complications. Conclusion: Functional and esthetic restoration of soft tissues in the fingers is possible with the use of appropriate flaps and meticulous surgical technique.

A predictive model to analyze factors affecting the presence of mild whiplash-associated disorders in minor motor vehicle crashes based on the Korean In-Depth Accidents Study (KIDAS) Database

Objectives: We aimed to analyze factors affecting the severity of mild whiplash-associated disorders (WADs) and to develop a predictive model to evaluate the presence of mild WAD in minor motor vehicle crashes (MVCs).Methods: We used the Korean In-Depth Accident Study (KIDAS) database, which collects data from 4 regional emergency centers, to obtain data from 2011 to 2017. The Collision Deformation Classification code was obtained as vehicle’s damage information, and Abbreviated Injury Scale (AIS), Maximum Abbreviated Injury Scale (MAIS), and Injury Severity Score (ISS) were used as occupant’s injury information. The degree of WAD was determined using the Quebec Task Force (QTF) classification, comprised of 5 stages (QTF 0–4), depending on the occupant’s pain and the physician’s findings. QTF 1 was defined as mild WAD, and we used QTF 0 to define those who were uninjured. For KIDAS data between 2011 and 2016, a logistic regression model was used to identify factors affecting the occurrence of mild WAD and a predictive model was constructed. Internal validity was estimated using random bootstrapping, and external validity was evaluated by applying 2017 KIDAS data. Of the 2,629 occupants in the KIDAS database from 2011 to 2016, after applying several exclusion conditions, 459 occupants were used to develop the predictive model. The external validity of the derived predictive model was assessed using the 13 MVC occupants from the 2017 KIDAS database meeting our inclusion criteria. Among the 137 MVC occupants from the 2017 KIDAS database for analysis of the external validity of the derived predictive model, the predictive model was verified for 13 MVC occupants.Results: Logistic regression analysis was used to derive a predictive model based on sex, age, body mass index, type of vehicle, belt status, seating row, crush type, and crush extent. This predictive model had an explanatory power of 65.5% to determine an actual QTF of 0 and 1 (c-statistics: 0.655). As a result of the external validity analysis of the predictive model using data from the 2017 KIDAS database (N = 13), sensitivity, specificity, and accuracy were 0.500, 0.857, and 0.692, respectively.Conclusions: Using the predictive model, the results of the external validity analysis showed low sensitivity but high specificity. This predictive model provided meaningful results, with a high success rate for determining no injury to an occupant. Given our study results, future research is needed to create a more accurate predictive model that includes relevant technical and sociological factors.

Reconstruction of fingertip with hypothenar free perforator flaps

Introduction: In fingertip injuries where replantation is not possible, options for reconstructing the fingertip with similar type of tissue are limited. Palmar and plantar regions are the donor sites that offer similar characteristics. In this study, we aim to evaluate the clinical outcomes of the hypothenar perforator free flap from the palmar region, compare this flap with the reports available in the literature, and share our experience regarding the practicality of the flap. Patients and Methods: The two-center retrospective clinical study included 15 patients who were operated on between 1 June 2015 and 31 December 2017. All patients were analyzed according to their demographic characteristics, mode and level of injury. Perforator flaps used in fingertip reconstruction were analyzed for skin island size, number of anastomosed arteries and veins, and number of reconstructed nerves. Static and dynamic two-point discrimination tests were applied, and grip strength and pulp-to-pulp pinch measurements were performed in the 13th-month visit of each patient. Surgical results were assessed with the Michigan Hand Outcomes Questionnaire (MHQ). Results: Mean age of the 15 patients was 39.1 years (range: 27-61). While majority of the injuries were of crush type, 8 cases were classified as Ishikawa subzone 2 and 3 cases as Ishikawa subzone 1. One perforator artery and 2 veins were anastomosed in 13 cases. Neural reconstruction was performed in all of the cases. Mean dynamic two-point discrimination value was 3.0 mm (range: 2.8-3.2). Mean grip strength was 42.5 kg (range: 17.7-74.8) and mean pulp-to-pulp pinch strength was 10.7 kg (range: 5-19). MHQ results were 90% in subgroup 1, 95.3% in subgroup 2, 79.5% in subgroup 3, 92.9% in subgroup 5, and 93% in subgroup 6. Conclusion: In cases of fingertip injuries where replantation is not possible, hypothenar free perforator flaps come forth as a sophisticated reconstruction option with favorable outcomes suitable to the similar tissue principle.

Evaluation of Pediatric Fingertip Injuries Using Etiology, Demographics and Therapy.

Objectives:In this study, 354 pediatric cases were evaluated and treated at the emergency service department due to fingertip injuries in a four years period. The data were studied using etiology, demographics, treatment and complications. This study aims to draw attention to fingertip injuries that are very common in childhood and to help developing preventive strategies.Methods:Of the 354 patients, 191 were boys and 163 were girls. Their ages ranged from six months to 17 years. These patients were studied concerning sex, injured hand and fingers, injury mechanism, injury zone, selected treatment modalities and complications. All interventions were performed under local anesthesia at the emergency service department. Patients were discharged on the same day.Results:In our study group, the male patients (54%) were more affected than the girls (46%). It was observed that the right hand (65.3%) was much more vulnerable to the injury than the left hand (34.7%). It was determined that the most injured fingers were middle fingers in the 136 (38.4%) of the patients, followed by the ring finger (33.9%). Injury was most frequent at five years old patient group. The most frequent type of injury was crush type injuries with a rate of 83.3%, and among crush type injuries, the most common mechanism was trapping of fingers in the doors or windows. While many of these injuries required surgical intervention, appropriate patients were treated with wound care and secondary wound healing.Conclusion:In childhood, hand injuries are quite frequent and fingertip injuries constitute the majority of these entities. These childhood injuries lead to significant functional, aesthetic and psychological sequelae in these patients. The knowledge about the etiology, distribution and mechanisms of these injuries will enable the development of preventive measures in this regard.

Effects of alpha lipoic acid on motor function and antioxidant enzyme activity of nerve tissue after sciatic nerve crush injury in rats.

Background: Alpha lipoic acid (ALA) that is a strong antioxidant drug is tried for both protection and treatment of various diseases of central and peripheral nervous systems. Material and Methods: Protective effects of ALA on crush type peripheral nerve injury were evaluated. 28 Sprague-Dawley rats were divided into four groups: In Group 1, sciatic nerve was only explored. Sciatic nerve crush injury was performed after serum physiologic injection intraperitoneally in Group 2, and after ALA injection in Groups 3 and 4. In all subjects, Sciatic Functional Index (SFI) was calculated. All subjects were sacrificed 1 hour after injury in first three groups, and 48 hours after in Group 4. Nerve samples were taken. Superoxide dismutase, catalase and glutathione peroxidase activities were measured in nerve tissue. Results: Administration of ALA before injury provided significantly better SFI values and higher levels of antioxidant enzymes than control group. These effects were significantly prominent 48 hours after injury. Conclusion: ALA that was given before crush type peripheral nerve injury provided to decrease damage of the nerve. Specific mechanisms of this effect must be clarified and must be shown that it is whether effective when it is given after injury or not.

Effect of ozone and methylprednisolone treatment following crush type sciatic nerve injury.

To assess and compare the histopathological effects of ozone therapy and/or methylprednisolone (MPS) treatment on regeneration after crush type sciatic nerve injury. Forty Sprague-Dawley male rats were randomly allocated into four groups. Four groups received the following regimens intraperitoneally every day for 14 days after formation of crush type injury on sciatic nerve: Group I: ozone (20mcg/ml); Group II: methylprednisolone (2mg/kg); Group III: ozone (20 mcg/ml) and methylprednisolone (2mg/kg); Group IV: isotonic saline (0.9%). The histomorphological evaluation was made after biopsies were obtained from the sites of injury. Significant differences were noted between groups in terms of degeneration (p=0.019), nerve sheath cell atrophy (p=0.012), intraneural inflammatory cellular infiltration (p=0.002), perineural granulation tissue formation (p=0.019), perineural vascular proliferation (p=0.004), perineural inflammatory cellular infiltration (p<0.001) and inflammation in peripheral tissue (p=0.006). Degeneration was remarkably low in Group III, while no change in nerve sheath cell was noted in Group II. The combined use of methylprednisolone and ozone treatment can have beneficial effects for regeneration after crush type nerve injury.

Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study

Objectives: To evaluate the minor upper extremity replantation and revascularisation cases and to compare the clinical results with those in the literature. Materials and Methods: Our study covers upper extremity trauma repair operations of 35 fingers of 30 patients who recieved treatment in our clinic betwen 2008 and 2011 date. The total number of amputated fingers that underwent replantation was 15 (of 15 patients) while 20 fingers of 15 patients underwent revascularisation operation for amputated fingers. We have conducted a retrospective study of the early period results of patients, who have been followed for an average of 17 months (6 months - 3.5 years). Results: The survival rate for replantation cases was 93.3%; this rate was 80% for revascularised fingers. The survival rate for zone 2 injuries was 66.6%; the survival rate for zone 3 injuries was 92.3%. The survival rate for guillotine type injuries was 100% of the; this rate was 68.8% for crush and avulsion type injuries. The evaluation of functional results based on Chen criterion and in terms of injury patterns has shown that 89.9% of guillotine-type incision patients showed very good results while 33.3% of the crush and avulsion type injury patients returned with very good results as 44.4% of these patients showed moderate results. The statistical evaluation of the functional outcomes of the distal parts showed better improvemnet in guillotine-type injuries compared to crush and avulsion type injuries. Conclusions: Minor replantation and revascularisation operations are difficult and require various equipments. Our results are compatible with the literature in terms of the large replantation series. Keywords: Replantation; Revascularization; Total-Subtotal Amputation.

Retrospective analysis of acute hand injuries in an academic tertiary hospital that need plastic surgeon consultation

Hand surgery covers a major area of plastic surgery practice. To our knowledge, there is no publication directly investigating the characteristics of hand injuries that plastic surgery consultation was requested, which could be an essential information to guide the plastic surgery education programs. This study determined the features of the hand injuries presented to the plastic surgery department during a year from an academic trauma hospital in Turkey. Epidemiological information of the patients with hand injuries who were admitted to the emergency department of an academic tertiary hospital and needed plastic surgery consultation was evaluated. Patients were analyzed retrospectively in terms of gender, distribution of age, occupation, mechanism of injury, cause of injury, injured soft tissue structures, and duration of hospitalization. One thousand and forty-three (83.7 %) of the 1246 patients included in the study were male and 203 (16.3 %) were female. The mean age of patients was 32. The most common injured structure were the tendons with a rate of 41.2 %. The tendons were followed by fractures, tissue defects, nail injuries, nerve injuries, and vascular injuries with a rate of 18.8, 16.6, 10, 8.3, and 5.3 %, respectively. The most frequent mechanism of injury was crush type (38.6 %) followed by blunt cut (26.9 %), sharp cut (25.9 %), combined (4.8 %), and avulsion injuries (3.8 %). 7.8 % of the patients with hand injuries had amputations. Despite the limitations, our study can reflect emergency hand injuries that a plastic surgeon may be faced within a tertiary care center. By our work, a plastic surgeon will be aware of demographic features of a patient with a hand injury presented by the emergency department. Level of Evidence: Level IV, risk/prognostic.

An emerging etiological factor for hand injuries in the pediatric population: public exercise equipment.

The purpose of this study was to describe the role of public exercise equipment in pediatric hand traumas as a preventable etiological factor. Pediatric patients with hand injuries referred from the emergency department were evaluated retrospectively. Age and gender of the patients, timing, etiology, mechanism of hand trauma, localization of the injury, diagnoses of the patients, and hospitalization rates were reviewed. Amongst the 310 pediatric patients evaluated, 31 patients (10%) experienced injury related to public exercise equipment. Within this group of patients, most were between 5 to 9 years of age, and all injuries were blunt and crush type. Lacerations and fractures were the main diagnoses. Complex injuries that required inpatient care were reported in 19.3% of the patients. Public exercise equipment-related injuries are increasingly prevalent in pediatric hand traumas. Preventive actions such as shielding the moving parts should be taken to reduce these rates.

Six Years’ Experience in Crush and Avulsion Type Finger Amputation with Application of Vein Graft

Six Years’ Experience in Crush and Avulsion Type Finger Amputation with Application of Vein Graft

THE ROLE OF SATELLITE CELLS IN CRUSH INJURY OF RAT SKELETON MUSCLE

The crush type of injury in rat skeletal muscle is often used in tissue degeneration and regeneration. After crush injury muscle tissue begins to regenerate. In this process, it is accepted that satellite cells play an important role which are very sensitive to muscle injury. The aim of this microscopic study was to examine role of satellite cells in muscle regeneration in crush injury. This research was done the department of Histology&Embryology in Eskisehir Osmangazi University in 2008. Ethic approval of this study has been received. During the study, the whole essential and ethics conditions have been done. In the study 36 Spraque-Dawley rats were used. The rats were separated into 5 groups as test and control groups. Crush type of injury has been applied on muscles of right hind extremities of testing group rats by applying 3.5 kg of weight for 6 hours. In according to testing periods rats were anaesthetized intraperitoneally with ketamine 30mg/kg + xylazine 10mg/kg and sacrificied 3, 7, 14 and 21-day intervals. After crush injury, increased satellite cells were particularly observed on day 7. Also significant increased of satellite cells and regenerated myofibrils were detected on day 14. However, satellite cells were seen on day-21 were similar to control group. In crush injuries, number of satellite cells were markedly increased and actively involved into regeneration process of the skeleton muscle.

Forearm Compartment syndrome due to trapping in an industrial press machine.

Kemal Gokkus, Ozel Antalya Memorial Hastanesi, Kepez Antalya, Turkiye, Tel. 0533 7435641 Email. kgokkus@yahoo.com Gelis Tarihi: 11.05.2011 • Kabul Tarihi: 07.06.2011 ABSTRACT Forearm compartment syndrome is the most important complication of the humeral supracondylar and forearm fractures. If left untreated, Volkmann’s ischemic contracture develops. Earthquake injuries by prolonged direct pressure of collapsed buildings on crushed extremities or industrial injuries (such as trapping in an industrial clamp) may result in acute compartment syndrome without fracture. Delayed diagnosis results in a disaster for both the patient and the physician, and may cause many medico legal problems. The diagnosis of compartment syndrome is essentially based on clinical experience. Particularly in compression and crush type injuries of the forearm with or without fracture, physicians should be suspicious about the compartment syndrome. In this paper we aim to report the management of a case of compartment syndrome as a complication of improperly tight long arm cast and crush injury of the right forearm.

The outcome of direct-flow neurovascular island flaps in pulp defects

In this study we aimed to evaluate the results of the direct-flow neurovascular island flap (NIF) transfers in pulp defects. We reviewed the records of 96 patients with 115 NIF transfers performed for pulp defect reconstruction. The injury mechanism was crush type injury in 70 patients (72.9%). Ninety-three patients (97%) were emergency cases. Pulp reconstruction was performed by means of pedicled island flap transfer. The results were evaluated with proximal interphalangeal joint range of motion, the Semmes Weinstein monofilament test, static two-point discrimination and cold intolerance assessments. The relations between the injury mechanism, patient satisfaction, cold intolerance and scar problems were analyzed. Also, the association between skin grafting and hook nail deformity was investigated. The level of significance was set at p<0.05. All flaps survived. The mean follow-up time was 41±20.3 (range: 12-108) months. We observed proximal interphalangeal joint flexion contracture in 11 (9.5%) cases. In seven of these, the limitation was less than 10 degrees. Hook nail deformity was seen in 8 fingers (7%). Cold intolerance was found in 16 (17%) cases. Semmes Weinstein monofilament and static-two point discrimination tests of flaps revealed satisfactory results. There was no relation between the injury mechanism and cold intolerance, patient satisfaction and scar problems (p>0.05). Among patients, 91.7% were satisfied with their results. The transfer of direct-flow island flaps, from the same finger, causes minimal morbidity on the donor site and appears to be a safe method, providing satisfactory functional and aesthetic results in the reconstruction of pulp defects.

Hand Replantation with Proximal Row Carpectomy

The purpose of this study is to present our operative technique and postoperative results of the hand replantation with proximal row carpectomy in cases of complete amputation at the level of wrist joint. From May 2003 to April 2005, five patients suffered from complete amputation of the hand due to industrial trauma. Amputation level was radiocarpal joint in three cases and midcarpal joint in two cases. Three cases represented guillotine type and two cases with local crush type injuries. All were men and the mean age was 26.6 years. The mean follow-up period was 26.8 months. At the time of replantation, the wrist joint was stabilized with transarticular fixation using three to four Kirschner's wires after performing proximal row carpectomy. Postoperatively, functional results such as muscle strength, range of motion of the wrist and fingers, and sensory recovery were assessed according to Chen's criteria. Joint width and arthritic changes of the radio-capitate joint were evaluated with radiologic tools. According to Chen's criteria, the overall results in five cases were classified as grade II. Intrinsic muscle power of hands was found to be grade 4. The mean grip and pinch powers were 41% and 45%, respectively, compared to contralateral hand. The mean arc of flexion-extension of wrist was 53 degrees . Total mean active motion of fingers was 215 degrees. Static two-point discrimination of fingertip ranged from 8 to 13 mm. On the follow-up, computerized tomography showed well-preserved radio-capitate joint space without any arthritic changes. While performing hand replantation after amputation at the radiocarpal or midcarpal level, proximal row carpectomy is a useful procedure to preserve joint motion of the wrist in selected cases.