The retrograde approach to the reverse dorsal metacarpal artery flap.

We present a short communication on the use of a retrograde approach in the DMCA Perforator flap in cases of reconstruction post SCC excision of the hand. We illustrate the anatomy, and present intra- and post-operative findings.

Experience of nail bed injuries at a tertiary hand trauma unit: a 12-month review and cost analysis.

The aim of this study was to analyse the management of nail bed injuries from a clinical and economic perspective. We carried out a retrospective analysis of nail bed injuries treated operatively at a tertiary Plastic Surgery Hand Trauma Unit during 2016. The National Schedule of Reference Costs (2015-2016) was used to estimate the costs of treating 630 patients. The most common mechanism was a crush injury in a door (33%). Fifty-five per cent of patients had an associated tuft fracture. The minimum cost per annum for patients treated for nail bed injuries in our unit was calculated to be £511,560 (€573,362; US$666,664). Many nail bed injuries are preventable and because they present a very high financial burden on the National Health Service, targeted prevention strategies should be considered. Level of evidence: IV.

Functional Outcome After Reconstruction of Traumatic Soft Tissue Defects in the Lower Half of the Leg With Distally Based Medial Hemisoleus Muscle Flaps: A Case Series and Literature Review.

BACKGROUND: Data regarding donor-site morbidity, postoperative clinical course, and functional outcome after hemisoleus muscle flap reconstruction are rare. The aim of this study was to determine the clinical and functional outcome of distally based medial hemisoleus flaps used for the reconstruction of defects in the lower half of the leg. METHODS: Data regarding 31 patients who underwent medial hemisoleus flap reconstruction between 2011 and 2017 were analyzed retrospectively. Epidemiological data and data on clinical outcomes and complications were obtained from hospital records. Functional outcome data were recorded in 14 cases. RESULTS: All soft tissue defects were secondary to trauma; 90.3% were male and 9.7% were female. Mean age was 52 years (range, 16-77 years). Mean defect size was 48 ± 9.5 cm. Flap survival was complete in 29 patients and partial in 2 patients. The maximal plantar flexion force in the ankle joint of the operated leg was 78.1% (P < 0.05) compared with the unaffected side. Strength endurance was reduced by 16.5% (P < 0.05) in the operated leg compared with the unaffected side. CONCLUSIONS: Medial hemisoleus flaps should be included in the armamentarium for reconstruction of small to middle traumatic lower leg defects. They are quick to raise and inset and provide robust coverage. Although there is an objective reduction in plantar flexion and endurance, this did not translate into functional limitations in our group of patients. To our knowledge, this represents the largest case series to date of functional outcome of distally based medial hemisoleus flap reconstruction in lower limbs.

Burns ITU admissions: length of stay in specific levels of care for adult and paediatric patients.

Prediction of total length of stay (LOS) for burns patients based on the total burn surface area (TBSA) is well accepted. Total LOS is a poor measure of resource consumption. Our aim was to determine the LOS in specific levels of care to better inform resource allocation. We performed a retrospective review of LOS in intensive treatment unit (ITU), burns high dependency unit (HDU) and burns low dependency unit (LDU) for all patients requiring ITU admission in a regional burns service from 2003 to 2011. During this period, our unit has admitted 1312 paediatric and 1445 adult patients to our Burns ITU. In both groups, ITU comprised 20% of the total LOS (mean 0.23±0.02 [adult] and 0.22±0.02 [paediatric] days per %burn). In adults, 33% of LOS was in HDU (0.52±0.06 days per %burn) and 48% (0.68±0.06 days per %burn) in LDU, while in children, 15% of LOS was in HDU (0.19±0.03 days per %burn) and 65% in LDU (0.70±0.06 days per %burn). When considering Burns ITU admissions, resource allocation ought to be planned according to expected LOS in specific levels of care rather than total LOS. The largest proportion of stay is in low dependency, likely due to social issues.