Soft Cover Research Articles

A study on clinical, functional and radiological outcome of high velocity tibial plateau fractures managed by dual plating

BACKGROUND: Dual plating in comminuted bi-condylar tibial plateau fractures remains controversial. More methods of treatment have been described, each has got its own merits and demerits. We performed a prospective study to evaluate the Clinical , functional and Radiological outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a posteromedial approach. MATERIAL AND METHOD: We treated 21 high velocity tibial plateau fractures ( Schatzker type V and VI ) with lateral and medial plates through an anterolateral approach and a posteromedial approach over 2 years period . Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The outcome was evaluated according to the Honkonen Jarvinen criteria on follow up. RESULTS: The incidence of male was more compared to females in the ratio - 3.2 : 1. The nature of injury is high velocity injury as it is explained by all patient sustaining road traffic accident .None had sustained injury as a result of trivial trauma as occurs in elderly with osteoporotic bone.The incidence of fracture in right side was 42.9 % and in left side was 57.1 % which nearly equal.Among 21 cases, the incidence of fracture in age group 40 -50 was 52.4 %.Of 21 fractures , 7 patients ( 33.3 % ) had Type V fracture and 14 patients ( 66.7 %) had Type VI fracture.There were no associated injury in all patients .All patients underwent standard surgical procedure by anterolateral & posteromedial approach .Lateral locking plates were used for lateral plateau and T/L Buttress, Semi tubular, Recon plates were used for medial plateau.Bone Grafting was used for 9 patients ( 42.9%) to fill metaphy seal defect.Time required for union ranged from 11 to 16 weeks with average being 12.9 weeks. CONCLUSION: High velocity tibial plateau fracture have excellent to good clinical, functional and radiological outcome . Early mobilisation of the joint provides good range of motion . Posteromedial plating provides a buttress to posteromedial fragment and thereby prevents varus collapse.The patients with good soft tissue cover should undergo anatomical reduction and rigid fixation immediately without deferring time. This is a short term study and need follow up to predict the further outcome.

The Owlet Moths of Ohio, Order Lepidoptera Family Noctuidae, by Roy W. Rings, Eric Metzler, Fred J. Arnold, and David H. Harris. 1992. Published by College of Biological Sciences, The Ohio State University, in Cooperation with Ohio Department of Natural Resources, Division of Wildlife and the Ohio Lepidopterists, Columbus, Ohio 43210. VI + 219 pp., 9 text figures, 8 color

The Owlet Moths of Ohio, Order Lepidoptera Family Noctuidae, by Roy W. Rings, Eric Metzler, Fred J. Arnold, and David H. Harris. 1992. Published by College of Biological Sciences, The Ohio State University, in Cooperation with Ohio Department of Natural Resources, Division of Wildlife and the Ohio Lepidopterists, Columbus, Ohio 43210. VI + 219 pp., 9 text figures, 8 color

The Functions of the Executive, by Chester Barnard. Cambridge, MA: Harvard University Press, 1938. 334 pages, soft coverThe Functions of the Executive, by Chester Barnard. Cambridge, MA: Harvard University Press, 1938. 334 pages, soft cover

<i>The Functions of the Executive</i>, by Chester Barnard. Cambridge, MA: Harvard University Press, 1938. 334 pages, soft coverThe Functions of the Executive, by Chester Barnard. Cambridge, MA: Harvard University Press, 1938. 334 pages, soft cover

Innovations in Sustainability, by Alfred A. MarcusInnovations in Sustainability, by Alfred A. Marcus Cambridge: Cambridge University Press, 2015. 363 pages, soft cover.

<i>Innovations in Sustainability,</i> by Alfred A. MarcusInnovations in Sustainability, by Alfred A. Marcus Cambridge: Cambridge University Press, 2015. 363 pages, soft cover.

A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards

BackgroundOpen fractures of the lower limb represent a complex and varied array of injuries. The BOAST 4 document produced by BAPRAS and the BOA provides standards on how to manage these patients, and NICE have recently produced additional guidance. We aimed to assess concordance with these standards in a large cohort representative of UK orthoplastic centres. MethodsPatients admitted to the orthoplastic units at Norfolk and Norwich University Hospital and Royal Stoke University Hospital with open lower limb fractures between 2009 and 2014 were included. Data was gathered from notes and endpoints based on the BOAST 4 document. ResultsIn total, 84 patients were included across the two sites, with 83 having their initial debridement within 24h (98.8%). Forty-two patients had a documented out-of-hours initial surgery. Of these, 10 (23.8%) had an indication for urgent surgery. This pattern was consistent across both hospitals. A plastic surgeon was present at 33.3% of initial operations. Of 78 patients receiving definitive soft tissue cover, 56.4% had cover within 72h and 78.2% within 7days. Main reasons for missing these targets were transfer from other hospitals, plastic surgeons not present at initial operation and intervening critical illness. ConclusionsThis study has identified key areas for improving compliance with the national BOAST 4 and NICE standards. Out-of-hours operating is occurring unnecessarily and time targets are being missed. The development of dedicated referral pathways and a true orthoplastic approach are required to improve the management of this complex set of injuries.

Infected tibia defect fractures treated with the Masquelet technique.

The treatment after open and infected fractures with extensive soft tissue damage and bone deficit remains a challenging clinical problem. The technique described by Masquelet, using a temporary cement spacer to induce a membrane combined with reconstructive soft tissue coverage, is a possible solution. This study describes the work-up, operative procedure, complications, and the outcome of a homogenous group of patients with an open and infected tibia fracture and segmental bone loss treated with the Masquelet technique (MT).This retrospective study evaluates patients having sustained an open tibia fracture treated with the MT between 2008 and 2013 with a follow up of at least 1 year. The defect was either primary, caused by a high-grade open fracture or secondary due to a non-union after an open fracture. Prerequisite conditions prior to the procedure of the Masquelet were a defect zone with eradicated infection, an intact soft tissue cover and stability provided by an external fixation.Volume of the defect, time until the implantation of the spacer, time of the spacer in situ and the time to clinical and radiological union were evaluated. Patient records were screened for reoperations and complications. The functional clinical outcome was measured.Eight patients were treated with a follow up over 1 year. The spacer was implanted after a median of 11 (2–70) weeks after the accident. The predefined conditions for the Masquelet phase were reached after a median of 12 (7–34) operations.Seven patients required reconstructive soft tissue coverage. The volume of the defect had a median of 111 (53.9–621.6) cm3, the spacer was in situ for a median of 12 (7–26) weeks. Radiological healing was achieved in 7 cases after a median time of 52 (26–93) weeks.Full weight bearing was achieved after a median time of 16 (11–24) weeks. Four patients needed a reoperation. The lower limb functional index was a median of 60% (32–92%).Seven out of 8 patients treated in this group of severe open and infected tibia fractures did both clinically and radiologically heal. Due to the massive destruction of the soft tissue, patients needed several reoperations with soft tissue debridements and reconstruction before the spacer and the bone graft could be implanted.

Prospective study of management of close or compound segmental fracture tibia by close reduction and internal fixation with interlocking nail

Background: Fractures of tibia are rated as one among the list of common and major skeletal injuries as one third of its surface is subcutaneous. Segmental tibial fractures feature a unique fracture type characterized by a completely isolated intercalary osseous fragment separated by at least two different fracture lines. Since tibia is a large bone and one of the principal load bearing bones in the lower extremity, fractures can cause prolonged morbidity, extensive disability unless treatment is appropriate. Treatment of such fractures in adults is a challenge to orthopaedic surgeons due to its poor soft tissue coverage and poor blood supply. Moreover, compartment syndrome, neurovascular injuries and infection might add to the burden. Later non union, delayed union and Mal-union may occur. The acceptable treatment goal for the segmental fracture tibia is union maintaining normal length, normal alignment without rotational deformity, normal joint movements and reduced hospital stay. Interlocking nailing has proven to be the method of choice for fixation of these fractures. The intramedullary nailing under image intensifier fulfills the objective of stable fixation with minimal tissue damage resulting in better and quicker fracture unions. Materials and methods: This study included 51 patients admitted in the Department of Orthopaedics with either open (37) or close segmental tibia fractures with compromised soft tissue (14) and treated with interlocking nail. Anterioposterior and lateral radiograph were done to diagnose fracture type. Routine preoperative investigation was followed. Patients were operated within 48 hours of hospital admission. Patients were followed up periodically on an outpatient basis on 2nd, 4th, 6th, 10th, 14th, 18th week and 6th month. Clinical and radiological assessment was done for pain, deformity, shortening, range of motion of knee, ankle, subtalar joints and radiological union.The final outcome was assessed using Johner and Wruh’s criteria Results and Discussion: In our series, out of 51 cases, 47 (92.15%) had acceptable Johner and wruth's criteria for functional results (sum of excellent and good results). Excellent in 36 (70.59%), good in 11 (21.57%), fair in 3 (5.87%) and poor in 1 (1.97). These results were comparable with results btained by Ekeland and Alho who reported results excellent in 29, good in 13 and fair in 2 and poor in one out of 45 cases.Conclusion: From this study, it was concluded that the preferred method of initial fracture stabilisation is the use of unreamed interlocking inramedullary tibial nail with immediate soft tissue cover whenever possible, this procedure require less surgical time, hospital stay, is cost effective and have minimum complications with good functional outcome.

Sex and Gender in Acute Care Medicine. By Alyson J.McGregorEsther K.Choo and Bruce M.Becker. New York: Cambridge University Press, 2016; 235 pp + index; $99.99 (softcover).

Sex and Gender in Acute Care Medicine is an evidence-based textbook that draws the reader's attention to the underappreciated sex and gender based differences in acute medical care and the gender bias that historically exists in medical research. In a tour through the major disciplines of acute care medicine the authors provide a sex and gender focused perspective on the presentation, management and pathophysiology of key medical conditions in an evidence-based format. The reader may find some of the many disparities discussed surprising and others well known from clinical practice. The editors are leaders in this new field, and this textbook is the first to provide a comprehensive review of sex and gender focused acute medical care. This soft cover is a valuable stimulus for the researcher and a quick-read resource for the practicing physician that has the potential to positively impact patient care in the emergency department. This article is protected by copyright. All rights reserved.

Management of Gustilo Anderson III B open tibial fractures by primary fascio-septo-cutaneous local flap and primary fixation: The 'fix and shift' technique.

Background:Open fractures of tibia have posed great difficulty in managing both the soft tissue and the skeletal components of the injured limb. Gustilo Anderson III B open tibial fractures are more difficult to manage than I, II, and III A fractures. Stable skeletal fixation with immediate soft tissue cover has been the key to the successful outcome in treating open tibial fractures, in particular, Gustilo Anderson III B types. If the length of the open wound is larger and if the exposed surface of tibial fracture and tibial shaft is greater, then the management becomes still more difficult.Materials and Methods:Thirty six Gustilo Anderson III B open tibial fractures managed between June 2002 and December 2013 with “fix and shift” technique were retrospectively reviewed. All the 36 patients managed by this technique had open wounds measuring >5 cm (post debridement). Under fix and shift technique, stable fixation involved primary external fixator application or primary intramedullary nailing of the tibial fracture and immediate soft tissue cover involved septocutaneous shift, i.e., shifting of fasciocutaneous segments based on septocutaneous perforators.Results:Primary fracture union rate was 50% and reoperation rate (bone stimulating procedures) was 50%. Overall fracture union rate was 100%. The rate of malunion was 14% and deep infection was 16%. Failure of septocutaneous shift was 2.7%. There was no incidence of amputation.Conclusion:Management of Gustilo Anderson III B open tibial fractures with “fix and shift” technique has resulted in better outcome in terms of skeletal factors (primary fracture union, overall union, and time for union and malunion) and soft tissue factors (wound healing, flap failure, access to secondary procedures, and esthetic appearance) when compared to standard methods adopted earlier. Hence, “fix and shift” could be recommended as one of the treatment modalities for open III B tibial fractures.

Long-term dynamics of a high-latitude coral reef community at Sodwana Bay, South Africa

Dynamics in reef cover, mortality and recruitment success of a high-latitude coral community in South Africa were studied over 20 yr with the aim to detect the effects of climate change. Coral communities at this locality are the southernmost on the African continent, non-accretive, attain high biodiversity and are dominated by soft corals. Long-term monitoring within fixed transects on representative reef was initiated in 1993 and has entailed annual photo-quadrat surveys and hourly temperature logging. Although sea temperatures rose by 0.15 °C p.a. at the site up to 2000, they have subsequently been decreasing, and the overall trend based on monthly means has been a significant decrease of 0.03 °C p.a. Despite this, minor bleaching was encountered in the region during the 1998 El Nino–Southern Oscillation event, again in the summer of 2000/2001 and in 2005. A significant decreasing trend of 0.95% p.a. in soft coral cover has been evident throughout the monitoring period, attributable to significant decreases in Sinularia and Lobophytum spp. cover. In contrast, hard coral cover gradually and significantly increased up to 2005, this being largely attributable to increases in cover by Acropora spp. Recruitment success and mortality of both soft and hard corals has displayed high inter-annual variability with increasing but non-significant trends in the last 5 yr. The reduction in soft coral cover has been more consistent and greater than that of hard corals, but it is difficult at this stage to attribute this to changes in water quality, acidification-linked accretion or temperature.

Susanne Kreutzer and Karen Nolte (eds), Deaconesses in Nursing Care: International Transfer of a Female Model of Life and Work in the 19th and 20th Century (Stuttgart: Steiner, 2016), pp. 230, €46.00, soft cover, ISBN: 978-3-515-11355-7.

Susanne Kreutzer and Karen Nolte (eds), Deaconesses in Nursing Care: International Transfer of a Female Model of Life and Work in the 19th and 20th Century (Stuttgart: Steiner, 2016), pp. 230, €46.00, soft cover, ISBN: 978-3-515-11355-7.

Abundance and physiology of dominant soft corals linked to water quality in Jakarta Bay, Indonesia.

Declining water quality is one of the main reasons of coral reef degradation in the Thousand Islands off the megacity Jakarta, Indonesia. Shifts in benthic community composition to higher soft coral abundances have been reported for many degraded reefs throughout the Indo-Pacific. However, it is not clear to what extent soft coral abundance and physiology are influenced by water quality. In this study, live benthic cover and water quality (i.e. dissolved inorganic nutrients (DIN), turbidity (NTU), and sedimentation) were assessed at three sites (< 20 km north of Jakarta) in Jakarta Bay (JB) and five sites along the outer Thousand Islands (20–60 km north of Jakarta). This was supplemented by measurements of photosynthetic yield and, for the first time, respiratory electron transport system (ETS) activity of two dominant soft coral genera, Sarcophyton spp. and Nephthea spp. Findings revealed highly eutrophic water conditions in JB compared to the outer Thousand Islands, with 44% higher DIN load (7.65 μM/L), 67% higher NTU (1.49 NTU) and 47% higher sedimentation rate (30.4 g m−2 d−1). Soft corals were the dominant type of coral cover within the bay (2.4% hard and 12.8% soft coral cover) compared to the outer Thousand Islands (28.3% hard and 6.9% soft coral cover). Soft coral abundances, photosynthetic yield, and ETS activity were highly correlated with key water quality parameters, particularly DIN and sedimentation rates. The findings suggest water quality controls the relative abundance and physiology of dominant soft corals in JB and may thus contribute to phase shifts from hard to soft coral dominance, highlighting the need to better manage water quality in order to prevent or reverse phase shifts.

The cost of infection in severe open tibial fractures treated with a free flap.

Open tibial fractures needing soft tissue cover are challenging injuries. Infection risk is high, making treatment difficult and expensive. Delayed skin closure has been shown to increase the infection rate in several studies. We aimed at calculating the direct and indirect cost of treatment, and to determine the effect of delayed skin closure on this cost. We reviewed all records of patients treated with a free flap in our institution for an open tibial fracture from 2002 to 2013. We calculated direct costs based on length of stay (LOS) and orthopaedic and plastic surgical procedures performed, including medications and intensive care. We analysed indirect cost in terms of absenteeism and unemployment benefits. The primary goal was to establish the extra cost incurred by an infection. We analysed 46 injuries in 45 patients. Infection increased the LOS from 41 to 74days and increased the cost of treatment from € 49,817 in uninfected fractures to € 81,155 for infected fractures. Employed patients spent 430days more on unemployment benefits, than a matched cohort in the background population. Achieving skin cover within sevendays of injury decreased the infection rate from 60 to 27%. Severe open tibial fractures covered with free flaps, cause over a year of absenteeism. Infection increases direct cost of treatment over 60% and roughly doubles LOS. Early soft-tissue cover and correct antibiotics have been shown to improve outcomes-underscoring the need for rapid referral to centres with an ortho-plastic set-up to handle such injuries.

Variation in practice preferences in management of open injuries of extremities-an international survey by SICOT research academy.

Open fractures are challenging injuries and there is a lot of variation in practice preferences which may reflect the wide variations in outcome in different units across the world. A survey was done amongst the international community of SICOT membership to document the practice preferences and variations. An online questionnaire containing 23 questions which were sub-divided into three sections covering the various aspects of open injury management was sent by email to orthopaedic trauma surgeons across the world. A total of 358 responses were evaluated and presented in this manuscript. The SICOT study confirmed wide variation in practice protocols. About 94.7% of orthopaedic surgeons around the world use the Gustillo Anderson scoring system for assessment of open injury and 50.6% of surgeons prefer lavage in operation theatre. For lavage, 84.6% of surgeons preferred normal saline and for antibiotic prophylaxis, 48.3% used a combination of second generation cephalosporin, metronidazole and an aminoglycoside for a minimum of three to fivedays. In 88% of patients, orthopaedic surgeons performed the initial debridement and 69.2% surgeons aimed for debridement within sixhours. Regarding wound management, 43.9% units preferred and were capable of soft tissue cover within 72hours and about 26.3% surgeons combined definitive fixation along with plastic procedure. Our study documented wide variations in practice preferences across the world and showed that information and awareness about current guidelines and practices will help many to update themselves in terms of basic questions about open fracture care.

Adam’s Nose, and the Making of Humankind

Stoddart, M. 2015. Adam’s Nose, and the Making of Humankind. World Scientific Publishing Co., Inc., Hackensack, New York, xxii + 258 pp. ISBN: 9781783265183, price (soft cover), $28. This book tells the story of the central role played by the sense of smell in the evolution of Homo sapiens . Consider the following: Do you feel comfortable with your natural body odor? Children do, but most adults do not. Huge batteries of apocrine scent glands, active after puberty and mainly concentrated in hairy axillary parts of our body, emit fatty acids and some steroids that, with the help of the millions of bacteria living on our skin, envelope us with what may be called our “olfactory signature.” Perhaps the above question even prompted you to unconsciously sniff your armpit! In general, we tend to consider our natural body odor as rather unpleasant and spend much time, energy, and money washing it away. Indeed, we do not want to smell as humans, but the very ancient and extended use of perfumes shows that we do not want to be odorless either. And what are perfumes anyway, but fragrances derived from sexual scent glands of mammals—such as musk deer, civet cats, and beavers—and from plants such as frankincense ( Boswellia spp.) that mimic those fragrances? Mate choice and the advertisement of the female’s reproductive status are controlled in most species by the sense of smell, our oldest sense, which appeared long before vision and hearing in animal evolution. … Universite catholique de Louvain, Earth and Life Institute, Biodiversity Research Centre, Carnoy, Croix du Sud 4-5 Bte L7.07.05, 1348 Louvain-la-Neuve, Belgium; e-mail: eric.leboulenge{at}uclouvain.be.

A study of outcome of reamed intramedullary interlocking nailing in type I and type II open fractures of shaft of tibia

Background: Open fractures of tibial shaft are important for the reason that they are most commonly fractured long bone in the body & subcutaneous location of the anteromedial surface of the tibia makes their management controversial. The precarious blood supply and lack of soft tissue cover of the shaft of the tibia make these fractures vulnerable to delayed union, nonunion, malunion and infection. The treatment of tibial fractures has developed from a strictly non-operative to a variety of operative techniques. While reamed Intramedullary nailing offer improved stability of the fracture, their use carries a theoretical risk of infection and nonunion as a consequence of disturbing endosteal blood supply. Recent reports suggest that the reaming is safe for grade I, II and IIIA open fractures of tibia. Material & Method: A total of 25 patients presented to Father Muller Hospital, Mangalore from Jan’06 to July’07 with type I and II open tibial shaft fractures were included in the study and all cases underwent debridement within 6 hours of admission and treated with reamed intramedullary interlocking nailing. They were reviewed at every 2 weeks for 6 weeks and then monthly post operatively and x-rays were repeated at 6,12,24 weeks to check for fracture healing. The average duration of follow-up was 32 weeks. Functional results were graded according to criteria by klemm & borner. Result: The average time to union was 19.68 weeks. Type I united in 18.86 weeks as compared to 20.5 weeks for Type II fractures. The average range of motion in the knee joint was 135.6 degrees. Full ankle motion was observed in 19 patients. One patient showed a loss >25° of motion at ankle compared to normal side while 5 patients showed < 250 loss of joint motion. 92% patients achieved good or excellent results, fair results were obtained in one patient & in one patient functional results were poor. Conclusion: Anatomical & functional outcome of open tibial fractures type I and type II treated with reamed intramedullary interlocking nailing is excellent to good and it is safe and effective technique for the management of Gustilo type I and type II.

The semi-occlusive dressing in treating Allen III and IV fingertip injuries as an alternative to local skin flaps

Fingertip injuries are very common in emergency departments. According to the literature, AllenIII andIV fingertip injuries should be treated with local skin flaps. Instead, we have treated these kinds of injuries in recent years with a semi-occlusive dressing. The main purpose of this study was to evaluate the outcome after semi-occlusive dressing therapy with respect to soft tissue cover, recovery of sensibility and duration of disability. We retrospectively analysed 77fingertip injuries (39AllenI, 25AllenII, 9AllenIII, 4AllenIV) from 2008-2011 in 23women and 54men who were treated with a semi-occlusive dressing. The mean age was 36± 14years and the mean follow-up was sevenmonths. The bone was not shortened even if the bone was exposed up to the wound level. The primarily occlusive dressing was left as long as possible and was sealed when necessary. Furthermore, the treatment time with the semi-occlusive dressing and the period of disability was recorded. Patient sensitivity recovery was also analysed. The mean treatment duration was 21± 10days and the mean duration of disability was 30± 17days. The mean duration of disability was 19± 8days for AllenI injuries, 36± 16days for AllenII, 45± 20days for AllenIII and 58± 7days for AllenIV. All patients developed satisfactory tissue cover and sensibility recovery. For amputation injuries of AllenIII andIV, we recorded anormal light-touch 2‑point discrimination in the Semmes-Weinstein Test in 77 % and diminished in 23 %. There were no complications like tissue infections, neuroma or osteitis. Also, no secondary flap supply was necessary. The semi-occlusive dressing is agood therapy for all kind of fingertip injuries, regardless of the amputation level. Even if the bone is exposed up to the wound level, satisfactory soft tissue cover can be achieved.

“Rubber Band Syndrome of the Arm”

Dear Sir, A 5 year old girl was brought to the plastic surgery outpatient clinic for the treatment of a discharging sinus within a circumferential scar in the right arm of 6 months duration. The scar was found to be unstable with firm consistency and multiple discharging sinus within the scar. The rest of the limb was clinically normal [1]. The scar and the sinus history dates back to 9 months where the girl had sustained fracture of the arm managed by a local bone setter. The parents noticed the scar and the sinus after the removal of wooden sticks used for immobilization. The radiograph showed united fracture shaft of humerus with no evidence of osteomyelitis. The blood parameters were normal. Considering the clinical and radiological bone union with a discharging sinus in the circumferential scar, we had planned for exploration, excision of the unstable scar and soft tissue cover by multiple Z plasties. Interestingly, on exploration we found a very unusual rubber band embedded circumferentially (Fig. 1) inside the scar along the subcutaneous plane which could be the reason for the discharging sinus. Thorough wound debridement, removal of the band and soft tissue cover was done. The girl was comfortable in the post-operative period and was discharged. The wound healed and the girl was symptom free since then. Fig. 1 Intra-operative picture showing rubber band being in the arm There has been few literature studies which described unsual foreign bodies tied circumferentially in the limbs for various reasons which later cause serious constriction bands, ulcers, discharging sinus and compartment syndrome [2–4]. These circumferential constricting foreign bodies produce inherent heat on stretching and coolness on relaxing. This thermodynamics makes the rubber band gradually breach the skin and remain in the planes of the limbs depending upon the place and its position. Our case is an unsual presentation of the rubber band tied around the arm during native treatment of bone fracture causing superficial skin necrosis, circumferential scar and discharging sinus. We propose this short communication as rubber band syndrome in the arm and suggest clinical suspicion in all native treated wounds, bone fractures and non allopathic treatments with circumferential scar and discharging sinus.

Therapy of Fingertip Injuries

Objective/Hypothesis: Fingertip injuries are very common in emergency departments, and reconstruction is a central aim of their management. According to the literature, fingertip injuries in the level of Allen 3 and Allen 4 should be treated by local skin flaps. Main purpose of this study was to evaluate the outcome after semiocclusive dressing therapy in respect to soft tissue cover, recovery of sensibility, and duration of sick leave. Materials and Methods: One hundred fourteen fingertip injuries from 2009 to 2011, treated with semiocclusive dressing, were retrospective analyzed. In all of the cases, the injured fingers were only cleaned, debrided, and covered with an occlusive dressing. The bone was not shorted, even if the bone was up to the wound level. The primarily occlusive dressing was left as long as possible and had been, when necessary, obdurated. The different types of fingertip injuries were classified according to the levels set by Allen. Furthermore, the treatment time with the semiocclusive dressing and the period of disability were recorded. On every patient, a Semmes-Weinstein test was performed to document the sensitive outcome. Results: A total of 114 patients were treated with a semiocclusive dressing. The mean age was 36 ± 14 years, and the mean treatment duration was 21 ± 10 days. The mean period of disability was 30 ± 17 days. After taking off the semiocclusive dressing, the main period of disability was 8 ± 13 days. According to Allen, following composition of fingertip injuries occurred: 49% Allen 1, 33% Allen 2, 13% Allen 3, and 5% Allen 4. All patients developed a satisfactory tissue cover, and the sensibility, according to the Semmes-Weinstein test, was normal. There were no complications like tissue infections, neuroma, or osteitis. Also no secondary flap supply was necessary. Conclusion: The semiocclusive dressing is an ideal therapy for all kind of fingertip injuries, regardless of the amputation level. There may be even bone exposed on the wound level. It is an easy, cheap, and safe therapy with no complications and leads to an excellent result in function, sensibility, and carry capacity. The semiocclusive dressing is a suitable alternative in treating fingertip injuries.

Reconstruction of Continuity Defects of the Mandible with Non-vascularized Bone Grafts. Systematic Literature Review.

The use of NVBG for mandibular defects seems to be gradually giving way for more advanced reconstructive techniques but it has the advantages of shorter operating time and lesser amount of blood loss. The aim of this study was to review the available data on the success and failure rates of use of NVBG and factors associated with failure. Studies published from 1978 to 2014 regarding the use of NVBG were searched. Most important information was graft success and failure outcomes. Information on graft success with particular focus on large defects was extracted and the quality of papers was rated. Defects > 6cm were considered long defects. Twenty publications were included in this review. The quality of the studies was low and there was high heterogeneity. All articles reported high graft success rates ranging from 67 to 100%. Success in defects > 6cm was considerable, the range was 72-100%. Three main factors were associated with failure; these were defect length, fixation method and infection. Infection contributed the highest complication rate which was 48.2%. NVBG seems to be appropriate for mandible reconstruction when there is vascular recipient bed and sufficient soft tissue cover and mucosal lining are achievable.