Quick and safe: why a k-wire-extension-block-fixation of a bony mallet finger is the favoured treatment.

INTRODUCTION: Mallet fingers are the most common tendon injuries of the hand. Bony avulsion distal finger extensor tendon ruptures causing a mallet finger require special attention and management. In this monocentral study, we analyzed the clinical and individual outcomes succeeding minimal invasive k-wire extension block treatment of bony mallet fingers. MATERIALS AND METHODS: In a retrospective study, we sent a self-designed template and a QUICK-DASH score questionnaire to all patients, who were treated because of a bony mallet finger between 2009 and 2022 and fulfilled the inclusion criteria. A total of 244 requests were sent out. 72 (29.5%) patients participated in the study. Forty-five men and twenty-seven women were included. RESULTS: 98.7% (n = 75) of the cases were successfully treated. Patients were highly satisfied with the treatment (median 8.0; SD ± 2.9; range 1.0-10.0). Based on the QUICK-DASH score, all patients showed no difficulties in daily life. The extent of avulsion did not influence the outcome. CONCLUSION: We conclude that the minimally invasive treatment of a bony mallet finger should be offered to every patient, because it is safe, fast, and reliable. Thus, we propose to perform extension-block pinning independently of the articular area.

Rare Pseudotumor-like Hematoma at the Latissimus Dorsi Muscle Flap Donor Site: A Treatment Strategy Utilizing Negative Pressure Wound Therapy With Instillation and Dwell Time.

INTRODUCTION: In reconstructive surgery, the latissimus dorsi (LD) muscle is known as a workhorse flap and is commonly used as a pedicled or free flap. Postoperative complications of a reconstructive procedure with an LD flap include seroma and hematoma formation at an early stage after LD transfer. Late-onset hematoma at the donor site are considered to be extremely rare postoperative complications; late, expanding pseudotumor-like hematoma can occur months or years after surgery. Shearing forces and poor coagulation are thought to be the primary reasons for these postoperative complications. CASE REPORTS: This report presents 2 cases of pseudotumors 12 and 29 years after LD transfer. Magnetic resonance imaging was performed prior to complete surgical excision. After surgical removal, patients received negative-pressure wound therapy with instillation and dwell time (NPWTi-d) for several days. After vacuum-assisted wound bed preparation, wound closure was performed with secondary sutures. CONCLUSIONS: The case report presented 2 incidences of rare late-onset pseudotumors many years after the initial LD reconstruction. To the authors' knowledge, this late-onset occurrence (ie, after 3 decades) has not been reported in the literature to date. If solidification of the late hematoma makes aspiration impossible, surgical intervention is required. Negative pressure wound therapy with instillation and dwell time potentially minimizes the wound size and reduces shear forces at the back donor-site.