Case report of substantial reconstruction of second ray segment by osteo-tendo-cutaneous pedicled radial forearm flap.

Introduction and importance: The hand is one of the most vital organ that the surgeon aims to preserve its function and natural appearance. Gunshot injuries are common, especially in a war zone, and unfortunately, they create complex wounds that are hard to reconstruct and infection is very common. In this article, we report rebuilding segment of index finger with a pedicled osteo-tendo-cutaneous radial forearm flap. Case presentation: A 50-year-old man-African with no past medical comorbidities, sustained trauma to his left index finger by high-velocity injury that led to composite tissue loss including metacarpal and proximal phalanx. After applying the initial irrigation and dressing to the wound, his hand was supported by a volar cast then he was referred to the hospital. The hand was examined at the operation room and the index finger was found to be hanged with a medial skin pedicle with necrotic and exposed bone and tendon. He underwent a session of debridement followed by reconstruction using a pedicled osteo-cutaneous radial forearm flap accompanied with metacarpophalangeal joint arthrodesis. Clinical discussion: A significant number of war-related hand injuries resulted in amputations because there were not enough facilities or doctors. While they are alternatives to free flap, abdominal and regional flaps won't yield the same outcomes. The second ray of the hand is reshaped using a radial flap, producing an acceptable result. Conclusion: The Radial forearm flap was used to reconstruct segment of index finger and fulfill our requirements, which include bone, tendon, and skin cover. Additionally, this is a simple and single stage procedure and micro-surgical equipment is not necessary.

Modified intermittent low negative pressure wound therapy for complex injuries: A case series.

INTRODUCTION AND IMPORTANCE: Combat wounds can be difficult to manage and can lead to disfigurement and infection. The closure of these wounds is crucial, as delayed closure also increases the risk of further complications. Military medicine has introduced negative pressure wound therapy, which modulates wounds perfectly through the microscopic and macroscopic configurations of the wound environment. It is expensive and not available worldwide, and several modifications using low cast materials were mentioned in literature. METHODS: We present a case series of four patients using the previously mentioned modified technique in combat wound management, and discuss the results, outcome, and justification for choosing this modality of treatment. All patients underwent a thorough debridement, followed by a modified negative pressure wound treatment for three weeks, employing readily available medical devices. RESULTS: All wounds healed successfully without complication and a simple closure was used to cover the resultant wound. CONCLUSION: Modified NPWT with limited resources is capable of promoting healing in conflict-related wounds through multifactorial properties and transforming reconstructive methods from complex to simple procedures in areas with a shortage of medical supplies and surgeons in addition to busy operating rooms.

Case report of unique presentation of spontaneous calf hematoma.

INTRODUCTION AND IMPORTANCE: The presentation of spontaneous hematomas remains different between all affected populations, but advanced age and use of anticoagulants are common risk factors in the majority. The progression of the hematoma may require some time to be detected; however, it can prove fatal if it reaches a significant size. A spontaneous calf hematoma can be mistakenly diagnosed as deep vein thrombosis, and the management of both conditions is varying. CASE PRESENTATION: A 26-year-old man had recently undergone multiple left lower limb surgeries and was using Rivaroxaban for deep vein thrombosis prophylaxis. He presented with a painful contralateral calf swelling for a duration of one month, which was later diagnosed as a spontaneous chronic calf hematoma. Despite the fact that blood tests were within the normal range, imaging confirmed the diagnosis. After extensive discussion among multidisciplinary teams, a surgical exploration was conducted, resulting in the complete evacuation of the hematoma. Subsequently, a meticulous monitoring of the re-administration of anticoagulant was conducted. CLINICAL DISCUSSION: spontaneous calf hematoma is not common pathology and affecting elderly and presentation in young is unique and diagnosis will not be reached easily especially in chronic case. CONCLUSION: A spontaneous calf hematoma can occur in a young, fit population with coexisting anticoagulant administrations. A thorough history, examination, and imaging must be applied urgently in order to reach a diagnosis.

Case report of uneventful resurfacing of the dorsum of foot degloving injury using pedicled lateral supramalleolar flap.

INTRODUCTION AND IMPORTANCE: Foot degloving injuries are serious problem and presented regularly to plastic surgery department. Proper identification of this condition followed by suitable reconstruction reduces disability and limb loss. This study highlights the effectiveness of a supramalleolar flap for covering a foot defect. CASE PRESENTATION: An 18 year- old man was involved in a road traffic accident and received trauma to his left foot which led to loss of the skin of the dorsum of his foot. He was referred to a plastic surgery unit after initial stabilization. After reassessment, he was diagnosed as a left dorsum foot degloving injury. Then he underwent multiple sessions of debridement followed by resurfacing of the foot using pedicaled lateral supramalleolar flap. The flap covers the dorsum aspect of the left foot and the post-surgery period passed uneventfully. CLINICAL DISCUSSION: The Lateral supra malleolar flap reaches distal defects, preserves a main limb neurovascular supply and is aesthetically acceptable. All these advantages, besides ease of harvest, make it more useful for cover of foot defects. Although it is not an ideal reconstructive method, when microvascular surgery is not applicable, this technique will cover foot defects. CONCLUSION: We present this case because foot degloving injury is common but there is limited options for covering, although free flap is gold standard reconstructive tool but pedicaled supramalleolar flap can reach final result similar to complex surgeries. Although complications exist in literature, benefits promote using this method.

Case report of Hand salvage post burn using pedicled tensor fascia lata (TFL).

INTRODUCTION AND IMPORTANCE: Burn still the major cause of disabilities and challenge facing both patient and surgeon, and when hands were affected a comprehensive planning and work must be obtained to restore functional and aesthetic aspects of hand. Tensor fascia lata (TFL) considered since centuries a useful tool to save hand post burn either it was been harvested with pedicle or as free flap. Although pedicle TFL became seldom but it may be the best option for hand reconstruction. In this article we report a case of hand burn that was managed by pedicle TFL. CASE PRESENTATION: A 32 year- old man was involved in thermal burn affected multiple areas of his torso and limbs. He was referred to hospital from primary health care center. At hospital reassessment of the patient done was hemodynamic stable and inhalation injury was excluded. Burn estimated at 36 % total body surface area (TBSA) distributed through trunk and left upper limb, but left hand was the most affected area. CLINICAL DISSOCIATION: After stabilization, he underwent serial debridement and dorsum of hand became skeletonized with exposed bones and tendon. Pedicled tensor fascia lata eventually choose to resurface hand, and fortunately enough covered all hand. CONCLUSION: Tensor fascia late flap still has favorable use, easy applicable and expected outcome. in this article we report post burn hand injury that managed by pedicled tensor fascia lata.