COVID-19: Initial experience of an international group of hand surgeons.

The emergence of the COVID-19 pandemic has severely affected medical treatment protocols throughout the world. While the pandemic does not affect hand surgeons at first glance, they have a role to play. The purpose of this study was to describe the different measures that have been put in place in response to the COVID-19 pandemic by hand surgeons throughout the world. The survey comprised 47 surgeons working in 34 countries who responded to an online questionnaire. We found that the protocols varied in terms of visitors, health professionals in the operating room, patient waiting areas, wards and emergency rooms. Based on these preliminary findings, an international consensus on hand surgery practices for the current viral pandemic, and future ones, needs to be built rapidly.

A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier.

In this experimental study, we aimed to examine the ability of absorbable oxidised regenerated cellulose (Interceed, TC-7, Johnson & Johnson, USA) to inhibit the formation of peritendinous fibrotic adhesions after tendon repair in rats. Both Achilles tendons of 23 female Wistar-Albino rats weighing between 350 and 450 grams were cut and repaired. On the right side, Interceed absorbable adhesion barriers were wrapped around the repaired tendon (group I). On the left, the same procedures were applied except for the Interceed wrapping and these were grouped as control (group II). Animals were sacrificed at postoperative day 28 and macroscopic and histological examination was performed. All the animals survived and no tendon rupture was observed. No wound dehiscence, wound infection or exposure of repaired tendons occurred. Macroscopically, there were three (13.1%) tendons without adhesion formation and 20 (86.9%) tendons with inferior adhesion formation in group I; on the other hand, there were 16 tendons (69.5%) with medium grade adhesion formation and seven tendons (30.5%) with severe peritendinous adhesion formation in group II (control group) (p<0.05). Histologically, adhesion formation was absent in 11 tendons (47.8%) and slight in 12 tendons (52.2%) in group I; while in group II, it was slight in two (8.6%), moderate in 15 (65.2%) and severe in six tendons (26.2%) (p<0.05). Sixteen (69.5%) of 23 tendons in group I and 11 (47.8%) of 23 tendons in group II showed no inflammatory reaction (p<0.05). Nineteen (82.6%) tendons in group I and only one tendon in group II showed excellent to good tendon healing (p=0.00). According to our results, we feel that Interceed may have an intraoperative role to play in the reduction of adhesions after surgical tendon repair. This study suggests that absorbable oxidised regenerated cellulose merits further evaluation as a potential treatment to inhibit the formation of peritendinous adhesions. Rigorous and extensive controlled trials should be undertaken on patients undergoing tendon repair with or without this barrier.

External fixation for surgical treatment of a mallet finger.

A new surgical technique is described for the treatment of mallet finger deformity which involves the application of a mini external fixator across the distal interphalangeal joint and resection of a portion of the extensor mechanism. We reviewed 19 patients who were treated with this technique, at a mean follow-up period of 36 (range, 24-48) months. The mean extensor lag was 2 degrees (range, -7 degrees to 13 degrees ) and the mean flexion range was 70 degrees (range, 20 degrees -90 degrees ).

Traumatic forearm amputation with avulsions of the ulnar and median nerves from the brachial plexus.

A case of a traumatic forearm amputation and associated complete avulsions of the ulnar and median nerves from the brachial plexus due to a crush-traction injury of the distal part of the right forearm is reported. The patient also suffered a traumatic head injury. The injury of the upper limb and the general condition of the patient were so serious that an amputation at the 1/3 middle part of the forearm had to be performed.

Bilateral traumatic dislocation of the hip: simultaneously one hip anterior and the other posterior.

The case of a 28-year-old man with bilateral dislocation of the hip, simultaneously one hip anteriorly and the other posteriorly is reported. In this case a very drunk driver without a seatbelt crashed his car. Uncontrolled trauma resulted in two different types of hip dislocation. At the 2-year follow-up he had a serious mobilisation problem with avascular necrosis of one hip.

Antioxidant effect of alpha-tocopherol on fracture haematoma in rabbits.

In this study, the effect of free oxygen radicals on lipid peroxidation and the antioxidant role of alpha-tocopherol (vitamin E) in these reactions were investigated in haematoma fluid and venous blood samples in rabbits with femoral fracture. There were 21 male rabbits, divided into 3 groups. Conjugated dienes values (as optical density) were compared in venous blood of the rabbits in Group I taken preanaesthesia and after the onset of anaesthesia and the difference between these values proved to be insignificant (P > 0.05). A control group (Group 2) was given saline before fracture occurrence and the other group (Group 3) was injected with alpha-tocopherol 20 mg/kg intramuscularly. Venous blood samples and fracture haematoma fluids in both Group 2 and Group 3 were assayed biochemically. It was established that conjugated dienes values in fracture haematoma fluid in rabbits in the control group were higher than the values in the venous blood of the rabbits in the same group (P < 0.05). However, conjugated dienes values in the alpha-tocopherol injected group both in the haematoma fluid and in venous blood were reduced compared with those in the control group (P < 0.5). In view of the fact that ischaemia and reperfusion develop in fractured regions and that general body ischaemia develops following serious fractures of the extremities, we consider that prophylactic administration of antioxidants such as alpha-tocopherol may be beneficial in suppressing the destructive effects of free oxygen radicals in cells.

Distal fibula resection in osteochondroma.

We evaluated the effects of distal fibula resection on the ankle function in a patient with osteochondroma. Osteochondroma is a benign tumour which localizes in the metaphysis of the long bones, in the knees and in the shoulders. Although it does not usually cause any symptoms in children under 10 years, we had a 4-year-old patient with a painful swollen ankle with limited motion. Resection of the lateral malleolus did not affect ankle function and he remained pain-free in daily activities during a 2.5 year follow-up period.

Retrograde-flow neurocutaneous island flaps in the forearm: anatomic basis and clinical results.

The neurocutaneous island flap is an axial flap whose arterial vascularization is provided by the vascular plexus around and inside the cutaneous nerve. In previous studies we successfully harvested neurocutaneous island flaps in the hand and in the forearm. Here we report on reverse-flow neurocutaneous island flaps for reconstructions in the distal third of the forearm. The vascularization of the cutaneous nerve of the forearm was studied in 15 fresh human upper limbs injected with polyester resin. The vascularization of the cutaneous nerve was found to be very closely connected with the vascularization of the skin. A vascular arcade followed the cutaneous nerve of the forearm. These paraneural vessels linked the neurocutaneous perforators and together with the cutaneous nerve overlay a major vascular axis. A close relationship between the cutaneous nerve and the neurocutaneous perforators was clearly identified. The cutaneous nerve crossed in every instance the point at which the neurocutaneous perforators reached the skin. Anastomosis between the paraneural vessels and the intraneural circulation was consistently found. On the basis of these anatomic findings, reverse-flow neurocutaneous island flaps were raised on the forearm of three patients and are reported on.