Investigation of safety and efficacy of a pneumatic finger tourniquet.

Finger tourniquets are widely used in hand surgery. However, they do not provide an estimate of the amount of pressure exerted and can potentially be left in situ with grave consequences. We assessed the pneumatic finger tourniquet in 57 adult patients in operations under local anaesthesia distal to the proximal interphalangeal joint. The average tourniquet time was 12 minutes. The tourniquet maintained its pressure for the length of the operation in 96.5% of cases. This airtight flat tubing is made of synthetic polymer, designed and manufactured by Barloworld Scientific Ltd (Staffordshire, UK). The tourniquet was easy to use and easily located after the operation. No complications were reported. This study supports the use of a pneumatic tourniquet in finger injuries requiring use of a finger tourniquet.

Role of staged endoprosthetic revision with flap cover for limb salvage in endoprosthetic failure.

Endoprosthetic replacement (EPR) is commonly required for limb salvage in bone malignancies. Endoprosthetic failure is a term used to denote mechanical failure or infection usually requiring removal of the prosthesis. Treatment of infection consists of EPR revision with or without placement of a temporary spacer. Flap cover (either local or free) may be required if the overlying soft tissues are of concern. It is claimed that the investment of the endoprosthesis in well-vacularised soft tissue facilitates the eradication of infection. This series included nine patients with endoprosthetic failure due to chronic infection who needed flap cover. These patients underwent revision of the EPR in two stages. The first stage of revision included removal of the endoprosthesis, insertion of a spacer and soft tissue reconstruction. If serial sampling of the periprosthetic space failed to demonstrate microbial growth, the spacer was exchanged for an endoprosthesis. A total of nine patients underwent staged revision of endoprosthesis. In five patients cover was provided by a local pedicled flap and in four by a free flap. Patients undergoing cover by a broad flat musculocutaneous flap (i.e. free/pedicled latissimus dorsi) performed better. This study reports the results of attempted limb salvage in endoprosthetic failure due to infection in nine cases. Initial findings in this small series indicate that staged revision and soft tissue reconstruction in the form of muscle flap investment of the endoprosthesis carries a higher rate of successful limb salvage.

The gold standard for decortication of rhinophyma: combined erbium-YAG/CO2 laser.

Rhinophyma is a benign condition of the nose that often is severely disfiguring and occasionally causes functional problems. A considerable proportion of the patients, with rhinophyma are elderly with chronic medical problems. Electrocautery, heated scalpel, carbon dioxide (CO(2)) laser, argon laser, Weck blade, dermabrasion, cryotherapy, radiotherapy, full-thickness excision, skin graft, flap reconstruction, and cold scalpel have been used either alone or in combination. All these techniques have disadvantages that are resolved by using the combined erbium:yttrium-aluminum-garnet (YAG)/CO(2) laser. The authors present their technique and the results from decortication of rhinophyma using a combined erbium:YAG/CO(2) laser. The technique requires only local anesthesia with a vasoconstrictor. The combination of an efficient vaporization tool consisting of the erbium:YAG laser and the CO(2) coagulation laser provides a nearly bloodless field for accurate sculpting of the nose and produces cosmetically pleasing results.