Comparison of static and dynamic splinting regimens for extensor tendon repairs in zones V to VII.

The aim of this prospective, randomised, controlled trail was to compare two methods of rehabilitating extensor tendon repairs in zones V-VII. Patients who incurred simple and complete lacerations of their extensor tendons in zones V-VII enrolled into the study and underwent either static splinting (n = 25) or dynamic splinting (n = 27) after primary acute repair of tendons. Extension lag, flexion deficit, total active motion (TAM), grip strength, and functional status of upper extremities were measured. TAM was improved in the dynamic group when compared with the static group in the injured digits at 4 weeks (p = 0.001), at 12 weeks (p = 0.05), and at 6 months (p = 0.001). Grip strength outcomes demonstrated improved grip force for the dynamic group when compared with the static group at 12 weeks (p = 0.001). There were no ruptures in either group. Also, a better functional level was found in the dynamic splinting group at 6 months (p = 0.001). The findings of the current study suggest that dynamic splinting of complex lacerations of the extensor tendons in zones V-VII provides improved functional outcomes at 4 and 12 weeks and 6 months when compared with static splinting.

Application of ATC/DDD methodology to evaluate perioperative antimicrobial prophylaxis.

OBJECTIVE: To evaluate quality of perioperative antibiotic prophylaxis (PAP) and to calculate the cost per procedure in a Turkish university hospital. SETTING: A 352-bed teaching hospital in Denizli, Turkey. METHOD: An prospective audit was performed between July and October 2010. All clean, clean-contaminated and contaminated elective surgical procedures in ten surgical wards were recorded. Antimicrobial use was calculated per procedure using the ATC-DDD system. The appropriateness of antibiotic use for each procedure was evaluated according to international guidelines on PAP. In addition, the cost per procedure was calculated. RESULTS: Overall, in 577 of the 625 (92.3%) of the studied procedures, PAP was used. PAP was indicated in 12.5% of the group where it was not used, and not indicated in 7.1% of the group where it was used. Unnecessarily prolonged antimicrobial prophylaxis was observed in 56.9% of the procedures, mean duration was 2.6 ± 2.7 days. The most frequently used antimicrobials were cefazolin (117.9 DDD/100-operation) and sulbactam/ampicillin (102.2 DDD/100-operation). The timing of the starting dose was appropriate in 545 procedures (94.5%). In the group that received PAP, only 80 (13.7%) of the procedures were found to be fully appropriate and correct. The density of antimicrobial use per operation was 2.8 DDD. The mean cost of the use of prophylactic antimicrobials 18.6 per procedure. CONCLUSION: The density of antimicrobial use in PAP was found to be very high in our hospital. Antibiotic overuse extended into the postoperative period.

Use of medial arm skin as a free flap.

BACKGROUND: Free transfer of the medial arm flap has not gained popularity despite the hidden donor-site scar as well as the hairless and elastic skin. This may be because of variations in vascular anatomy, leading to confusion during dissection of the flap. METHODS: In five preserved cadaver arms, the vascular pattern of medial arm skin was examined. Twenty-two upper extremity angiograms were examined, and 12 free medial arm flaps were elevated for various defects in 12 patients. RESULTS: In cadaver and clinical dissections, the authors found that blood supply to the flap is multiple: from the superior ulnar collateral artery, the direct cutaneous artery, or both. A superficial brachial artery may also be present, which was observed in four angiograms and two clinical cases (15 percent). Dissections showed that the medial arm skin may be elevated based on the superficial brachial artery, direct cutaneous artery, or superior ulnar collateral artery. A neurosensory flap may be obtained by including the medial brachial cutaneous nerve of the arm. CONCLUSIONS: A medial arm free flap is a plausible reconstructive option with good knowledge of the anatomical variations, as the defect on the medial arm is cosmetically more acceptable and has a better color match for head and neck reconstructions.