RÉSUMÉ
BACKGROUND: Injuries caused by explosions or pyrotechnic devices can lead to severe hand injuries with potential long-term consequences for both the affected individual and the healthcare system. The implementation of a nationwide ban on fireworks during the New Year festivities was only temporarily enforced as part of the protective measures during the Covid-19 pandemic. These two exceptional years provide an opportunity for evaluation as a model experiment to demonstrate the impact of a fireworks ban on the frequency of explosion-related hand injuries. MATERIALS AND METHODS: In a multicentre study, five German hand trauma centres retrospectively collected and analysed all pyrotechnic-related injuries that occurred within seven days around the New Year celebration between 2017 and 2023. RESULTS: Severe hand injuries from explosions were significantly less frequent at New Year celebrations during the pandemic period compared with data collected in the years before and after Covid-19. After the return to regular sales laws and celebrations in December 2022, a significant increase in injuries was observed, surpassing even the pre-Covid period. Epidemiological data confirmed a high proportion of minors and male victims. The highest number of injuries was observed on New Year's Eve and the first day of January, with adults mainly being injured during the festivities, while children and adolescents were mainly injured during the first days of January. CONCLUSIONS: A national ban proved to be an effective method to prevent severe hand injuries caused by explosive devices and their lifelong consequences. The data obtained in this multicentre study can serve as a basis for informed policy action.
Sujet(s)
Traumatismes par explosion , COVID-19 , Blessures de la main , Humains , COVID-19/prévention et contrôle , COVID-19/épidémiologie , Allemagne , Blessures de la main/épidémiologie , Blessures de la main/prévention et contrôle , Mâle , Études rétrospectives , Femelle , Adulte , Traumatismes par explosion/prévention et contrôle , Traumatismes par explosion/épidémiologie , Adolescent , Enfant , Adulte d'âge moyen , Jeune adulte , Pandémies/prévention et contrôle , Sujet âgé , Explosions , Vacances , Centres de traumatologie , Enfant d'âge préscolaire , SARS-CoV-2RÉSUMÉ
Significance: Cartilage regeneration remains a significant challenge in the field of regenerative medicine. Acellular matrix (AM)-based cartilage tissue regeneration offers an innovative approach to repairing cartilage defects by providing a scaffold for new tissue growth. Its significance lies in its potential to restore joint function, mitigate pain, and improve the quality of life for patients suffering from cartilage-related injuries and conditions. Recent Advances: Recent advances in AM-based cartilage regeneration have focused on enhancing scaffold properties for improved cell adhesion, proliferation, and differentiation. Moreover, several scaffold techniques such as combining acellular dermal matrix (ADM) and acellular cartilage matrix (ACM) with cartilage tissue, as well as biphasic scaffolding, enjoy rising research activity. Incorporating bioactive factors and advanced manufacturing techniques holds promise for producing more biomimetic scaffolds, advancing efficient cartilage repair and regeneration. Critical Issues: Obstacles in AM-based cartilage regeneration include achieving proper integration with the surrounding tissue and ensuring long-term durability of the regenerated cartilage. Furthermore, issues such as high costs and limited availability of suitable cells for scaffold seeding must be considered. The heterogeneity and limited regenerative capabilities of cartilage need to be addressed for successful clinical translation. Future Directions: Research should focus on exploring advanced biomaterials and developing new techniques, regarding easily reproducible scaffolds, ideally constructed from clinically validated and readily available commercial products. Findings underline the potential of AM-based approaches, especially the rising exploration of tissue-derived ADM and ACM. In future, the primary objective should not only be the regeneration of small cartilage defects but rather focus on fully regenerating a joint or larger cartilage defect.
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Distal radius fractures rank among the most prevalent fractures in humans, necessitating accurate radiological imaging and interpretation for optimal diagnosis and treatment. In addition to human radiologists, artificial intelligence systems are increasingly employed for radiological assessments. Since 2023, ChatGPT 4 has offered image analysis capabilities, which can also be used for the analysis of wrist radiographs. This study evaluates the diagnostic power of ChatGPT 4 in identifying distal radius fractures, comparing it with a board-certified radiologist, a hand surgery resident, a medical student, and the well-established AI Gleamer BoneView™. Results demonstrate ChatGPT 4's good diagnostic accuracy (sensitivity 0.88, specificity 0.98, diagnostic power (AUC) 0.93), surpassing the medical student (sensitivity 0.98, specificity 0.72, diagnostic power (AUC) 0.85; p = 0.04) significantly. Nevertheless, the diagnostic power of ChatGPT 4 lags behind the hand surgery resident (sensitivity 0.99, specificity 0.98, diagnostic power (AUC) 0.985; p = 0.014) and Gleamer BoneView™(sensitivity 1.00, specificity 0.98, diagnostic power (AUC) 0.99; p = 0.006). This study highlights the utility and potential applications of artificial intelligence in modern medicine, emphasizing ChatGPT 4 as a valuable tool for enhancing diagnostic capabilities in the field of medical imaging.
Sujet(s)
Fractures du radius , Humains , Fractures du radius/imagerie diagnostique , Radiographie/méthodes , Intelligence artificielle , Sensibilité et spécificité , Femelle , Mâle , Adulte d'âge moyen , Traumatismes du poignet/imagerie diagnostique , Sujet âgé , Adulte ,RÉSUMÉ
BACKGROUND: Wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist conditions. While perioperative antibiotic prophylaxis (PAP) is not generally recommended for elective hand surgery, there is no official standard for elective wrist arthroscopy. This study aimed to determine the actual clinical use of PAP in elective wrist arthroscopy in Germany and relate it to the structural conditions of clinics performing this procedure. MATERIAL AND METHODS: We conducted a systematic search of all facilities in Germany offering wrist arthroscopy. Among these, we performed an online survey using the SoSci Survey online tool via email. RESULTS: PAP is more frequently administered in cases involving simultaneous bone procedures. Cephalosporins are the most commonly used antibiotics in cases of PAP administration. Hospitals administer PAP more frequently than outpatient settings, with most surveyed institutions following facility-specific internal standards for antibiotic administration. The number of arthroscopies performed in the surveyed centres does not influence antibiotic administration. CONCLUSIONS: The use of PAP in wrist arthroscopies in Germany is inconsistent. The increased use in arthroscopies with bone involvement corresponds to AWMF guidelines, but a general recommendation for wrist arthroscopies, including soft tissue arthroscopies, is necessary to provide physicians with medical and legal certainty.
Sujet(s)
Antibioprophylaxie , Arthroscopie , Infection de plaie opératoire , Articulation du poignet , Humains , Allemagne , Articulation du poignet/chirurgie , Infection de plaie opératoire/prévention et contrôle , Interventions chirurgicales non urgentes , Adhésion aux directives , Antibactériens/usage thérapeutique , Antibactériens/administration et posologie , Céphalosporines/usage thérapeutique , Céphalosporines/administration et posologieRÉSUMÉ
Background: The reconstruction of plantar load-bearing foot defects faces many plastic surgeons with a major challenge. The optimal patient- and defect-oriented reconstructive strategy must be selected. Methods: To analyze the current trends and recommendations in reconstruction of plantar load-bearing foot defects, we conducted an international survey among plastic surgeons querying them about their recommendations and experiences. Results: The survey revealed that the most common strategies for reconstruction of the foot sole are locoregional and microvascular free flaps, emphasizing the relevance of plastic surgery. Among microvascular free flaps, muscle and fascio-cutaneous free flaps are by far the most frequently used. The target qualities of the reconstructed tissue to be considered are manifold, with adherence being the most frequently mentioned. We observed a noteworthy correlation between the utilization of muscle flaps and a preference for adherence. In addition, we identified a substantial correlation between the usage of fascio-cutaneous free flaps and further target qualities, such as good skin quality and sensitivity. Conclusions: Our findings provide insights into the clinical reality and highlight important aspects that must be considered in reconstruction of the weight-bearing areas of the foot providing support in the selection of the appropriate therapy.
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BACKGROUND: In the event of an advanced rectal carcinoma, an evisceration with rectal amputation may become necessary. The resulting defects, due to their extent, depth, or local tissue damage from previous surgeries and radiation, can in many cases only be closed through free microvascular tissue transfer. In this case series, we demonstrate the successful combination of a musculocutaneous musculus vastus lateralis flap (MVL) with a direct connection to the superior gluteal artery. MATERIALS AND METHODS: Over a 47-month period, we retrospectively examined 11 cases of patients with dorsal pelvic defects after evisceration and rectal amputation that could not be closed using local or regional means. In cases of extensive defects with deep pararectal wound cavities, all these patients underwent defect coverage through a free myocutaneous MVL flap with a direct vascular anastomosis to the superior gluteal vessels. RESULTS: The mean defect size was 290.0 cm² (SD: 131.2; range: 200-600 cm²). The mean defect depth was 10.5 cm, necessitating MVL flap reconstruction with an average size of 336.3 cm². Three operative revisions were required due to postoperative bleeding. There were no arterial or venous thromboses, and no flap loss occurred. Only one necrosis of a distal flap tip was observed, which could be corrected secondarily by direct suturing. The case-mix evaluation yielded an average value of 24.251 (SD: 21.699; range: 7.036-65.748) points, emphasizing the complexity of the cases. CONCLUSIONS: Our results indicate that a free microvascular MVL flap is a viable therapeutic option for pararectal defects that cannot be closed by local or regional methods. The superior gluteal artery proves to be a safe and sufficient vascular connection. In combination, even extensive defects can be successfully closed.
Sujet(s)
Lambeau musculo-cutané , Tumeurs du rectum , Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Lambeau musculo-cutané/chirurgie , Lambeau musculo-cutané/vascularisation , Études rétrospectives , Tumeurs du rectum/chirurgie , Complications postopératoires/chirurgie , Complications postopératoires/étiologie , Microchirurgie/méthodes , Fesses/chirurgie , Fesses/vascularisation , Lambeaux tissulaires libres/chirurgie , Lambeaux tissulaires libres/vascularisation , Réintervention , Anastomose chirurgicale , Adulte , Amputation chirurgicale , Muscle quadriceps fémoral/chirurgie , Muscle quadriceps fémoral/vascularisationRÉSUMÉ
Background: Elective soft-tissue-only wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist pain. A number of pathologies can be treated arthroscopically, with the aim of pain reduction and improved wrist mobility. A postinterventional evaluation of the treatment using objective and patient-reported outcome measures (PROMs) allows for an evidence-based statement about the benefits of soft-tissue-only wrist arthroscopy. Methods: A dual-center study combining retro- and prospective clinical analyses of patient outcomes after soft-tissue-only wrist arthroscopies was performed. The data were collected at two hospitals with departments specializing in hand surgery. The outcome was measured by assessing the range of motion of the wrist and its manual strength, as well as PROMs, including Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: A total of 154 soft interventions met the study criteria and could be included. Seven months after the elective soft-tissue-only wrist arthroscopies, mobility improved significantly for active extension and flexion, as well as the ulnar and radial abduction of the wrist. The grip strength also improved significantly, by an average of 6 kg, during this period. The DASH score improved significantly, from 35 points to 14 points. Additionally, wrist pain at rest was reduced significantly. Conclusions: After elective soft-tissue-only wrist arthroscopy, patients showed an overall functional improvement in their wrist, with a significant reduction in pain and improvement of mobility and grip strength. This study emphasizes the importance of wrist arthroscopy as a successful treatment option for soft tissue pathologies of the wrist.
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This case report describes the interdisciplinary treatment of a complex shrapnel injury to the right femur of an 18-year-old Ukrainian soldier. This open multifragmentary fractur of the femur with a large bone defect, soft tissue damage and osteomyelitis was complicated by several multidrug-resistant bacteria, including Acinetobacter baumanii, which could not be eradicated by antibiotic treatment. Sterility was only achieved by multiple radical debridement and by negative pressure wound therapy with instillation (NPWTi) using hypochlorous acid. The femur was then reconstructed with a chimeric double-barrel fibula free flap. This report highlights the importance of multimodal antimicrobial wound treatments in an era of increasing antibiotic resistance to enable a successful und functional reconstruction of complex and infected fractures.
Sujet(s)
Fractures osseuses , Lambeaux tissulaires libres , Traitement des plaies par pression négative , Humains , Adolescent , Débridement , Fractures osseuses/chirurgie , Membre inférieur , Antibactériens/usage thérapeutique , Résultat thérapeutiqueRÉSUMÉ
Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy. A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained. The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms. We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results.
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Wounds and tissue defects of the hand and foot often lead to severe functional impairment of the affected extremity. Next to general principles of wound healing, special functional and anatomic considerations must be taken into account in the treatment of wounds in these anatomical regions to achieve a satisfactory reconstructive result. In this article, we outline the concept of wound healing and focus on the special aspects to be considered in wounds of the hand and foot. An overview of different treatment and dressing techniques is given with special emphasis on the reconstruction of damaged structures by plastic surgical means.