Effect of pronator teres muscle botulinum neurotoxin type-A injection on proximal median nerve entrapment.

PURPOSE: We aimed to evaluate the effect of botulinum neurotoxin type-A (Btx-A) injection into the pronator teres muscle in proximal median nerve entrapment (PMNE). METHODS: Intramuscular injection of 30 IU Btx-A into the pronator teres muscle was performed in 12 patients (14 extremities) diagnosed with PMNE. The injection was made under nerve stimulator control. One patient with thoracic outlet syndrome was excluded from the study and not included in the clinical evaluation. Grip and pinch strength, 2-point discrimination, Q-DASH score, and pain on VAS were evaluated and compared before and 6-8 months after injection. The patients were contacted again by phone after the first and fifth years and asked about PMNE symptomatology. RESULTS: None of the patients had complications. No significant difference in pinch strength was observed following Btx-A injection, but there was significant improvement in grip strength, 2-point discrimination, and Q-DASH and VAS pain scores. CONCLUSION: The outcomes of our study were promising: Btx-A injection improved symptoms in patients with PMNE. LEVEL OF EVIDENCE: Level IV.

Evaluation of the bonding effectiveness of a universal adhesive to the plasma-activated dentin surface.

This study aimed to evaluate the effect of non-thermal atmospheric pressure plasma on the bond strength of a universal adhesive used in etch-and-rinse mode. Dentin surfaces were etched with phosphoric acid and samples were divided into groups exposed to either dry bonding, plasma-dried bonding, plasma-dried and rewetted bonding, or wet bonding (n  =  10). Dentin surfaces of the plasma-dried specimens were treated with a plasma jet before the adhesive procedure. After application, composite blocks were built, and specimens were subjected to micro-tensile bond strength testing after 24 h and after 10,000 thermal cycles. The hybrid layer formation was evaluated by micro-Raman spectral analysis; the resin-dentin interface was analyzed by scanning electron microscopy. One-way ANOVA and Tukey's post hoc multiple comparison tests were used to statistically analyze the data. The bond strength values of the plasma-dried bonding groups were statistically higher than the non-plasma-treated groups both before and after aging. After the thermal cycles, bond strength values decreased significantly only in the wet bonding group. Micro-Raman spectral analysis revealed that plasma-drying increased adhesive penetration, especially hydrophobic monomer infiltration. This may increase the mechanical properties and durability of the resin-dentin interface, provide long-term stability, and improve the polymerization rate of the adhesive layer.

The effect of single plate and double plate application on union and functional results in humeral diaphyseal nonunions.

In this study, we assessed and compared the outcomes of two different fixation techniques for humeral diaphyseal fracture nonunions. A retrospective evaluation of 22 patients who underwent single-plate and double-plate fixation due to humeral diaphyseal nonunions was conducted. Union rates, union times, and functional outcomes of the patients were assessed. There was no significant difference between single- plate and double-plate fixation in terms of union rates or union times. The double-plate fixation group achieved significantly better functional outcomes. Nerve damage or surgical site infection were not encountered in either group.Due to its considerable effect on stability, double-plate fixation, offers both patients and surgeons confidence in terms of early adaptation to daily life in the postoperative period.

Comparison of the Modified Moberg Flap Versus First Dorsal Metacarpal Artery Flap for Thumb Pulp Reconstruction.

ABSTRACT: We assessed and compared outcomes of 2 different flap techniques for thumb pulp defect reconstruction. Twenty-three patients who underwent modified Moberg and first dorsal metacarpal artery flap because of thumb pulp defect were retrospectively evaluated. Flap survival; venous congestion; cold intolerance; static 2-point discrimination (s2-PD); Semmes-Weinstein monofilament (SWM) test scores; paresthesia; defect size; time to return to work; interphalangeal and metacarpophalangeal joint flexion of the thumb; Disability of the Arm, Shoulder and Hand questionnaire scores; and follow-up time were evaluated. Flap survival, venous congestion, time to return to work, paresthesia, defect size, SWM test scores, range of motion of the proximal interphalangeal and metacarpophalangeal joints, and Disability of the Arm, Shoulder and Hand questionnaire scores were similar in both groups. Cold intolerance and s2-PD were found to be statistically better in the modified Moberg flap group. Although these techniques provided similar results, the modified Moberg was found to be superior in terms of cold intolerance and s2-PD.

Pott's disease associated with bilateral psoas abscess: a case report on surgical management using anterior approach.

Pott's disease may accompany psoas abscesses, but bilateral psoas abscess is rarely encountered. Computerised Tomography (CT) is the gold standard for the diagnosis of psoas abscesses. Treatment of psoas abscess usually involves drainage of abscess and antibiotic therapy. CT and USG-guided catheters are often utilised for abscess drainage. In cases where neurological symptoms are observed, open surgery may be required. Pott's disease accompanied by bilateral psoas abscess was detected in a 21-year-old male patient who was admitted to the clinic with complaints of low back pain and weakness in his left leg at the Selcuk University, Turkey, in 2018. The reason for the development of neurological deficit only on the left side was the compression of the nerve roots by the abscess tissue. The patient underwent debridement and anterior instrumentation with an anterior approach. In the postoperative follow-up it was observed that the patient's complaints were relieved. Pott's disease with bilateral psoas abscesses, in which debridement and instrumentation with an anterior approach is applied, has not been previously reported in the literature, and the current case is a first in this respect.

A new complication of femur head core decompression surgery: compartment syndrome.

The basic surgical treatment for avascular necrosis of the femur head is core decompression. In this report we discuss a case where the patient developed compartment syndrome after core decompression surgery with history of anticoagulant use. A 49-year-old man, who was using Coumadin 5 mg once daily due to aortic valve replacement and atrial fibrillation, had undergone core decompression surgery done due to stage 2 femur head avascular necrosis (AVN). He later developed isolated anterior thigh compartment syndrome for which fasciotomy was performed. Every surgical intervention to the extremities of patients with anticoagulant treatment should be considered high risk for compartment syndrome, even if appropriate precautions are taken. It is necessary to clinically observe for a sufficient duration to be able to identify symptoms.

Arthroscopic treatment of tibial eminence fractures using double-loop endobutton device: Surgical technique and short-term treatment outcomes.

OBJECTIVES: This study aims to explain the arthroscopic surgical technique of double-loop endobutton device for tibial eminence fractures and share the outcomes of this treatment method. PATIENTS AND METHODS: Thirteen patients (10 males, 3 females; mean age 19.9±5.6 years; range, 14 to 34 years) with tibial eminence fractures type II, IIIa, and IIIb were analyzed retrospectively between March 2017 and March 2019. Knee laxity, Tegner Lysholm knee scores, the International Knee Documentation Committee (IKDC) scores, knee mobility, Lachman test, and bone union were analyzed after the arthroscopic fracture fixation with double-loop endobutton device at first and sixth months after surgery. RESULTS: First month mean IKDC scores were 38.0±7.0 and mean Tegner Lysholm scores were 50.3±5.8. Sixth month mean IKDC scores were 80.2±4.0 and mean Tegner Lysholm scores were 87.1±5.4. All patients showed negative Lachman test and negative pivot-shift test at final follow-up. Radiological bone union without reduction loss was also seen in all patients. CONCLUSION: Using double-loop endobutton device provides successful results to fix tibial eminence fractures.

Clinical, Radiological, and Electrodiagnostic Diagnosis of Pronator Syndrome Concurrent With Carpal Tunnel Syndrome.

PURPOSE: This is a retrospective observational study that assessed the prevalence of positive diagnostic imaging and electrodiagnostic (EDX) findings in patients diagnosed with pronator syndrome (PS), who previously had a carpal tunnel syndrome (CTS) surgery. The other purpose of our study was to determine how often PS occurred and was missed in patients treated surgically for CTS. METHODS: The files of 180 patients who underwent CTS surgery were reviewed retrospectively. We assessed all patients for a diagnosis of PS. We accepted the clinical findings and patient history as the reference standard for the diagnosis of PS. Anteroposterior and lateral radiographs of the elbow, bilateral upper limb magnetic resonance imaging (MRI) studies, and bilateral dynamic forearm ultrasound (US) were performed on patients with clinical symptoms and physical examinations that indicated PS. Bilateral upper limb EDX was also performed for these patients. One patient refused additional tests. RESULTS: A total of 174 extremities in 146 patients were included in the study. Pronator syndrome was diagnosed by 2 hand surgeons in 22 extremities (19 patients) through a clinical evaluation that included a history and physical examination. Diagnostic testing was positive for findings of PS in 24% of extremities (5 of 21) tested by EDX, in 57% of extremities (12 of 21) tested by US, and 5% of extremities (1 of 21) tested by MRI. There was no lower humeral spur that could cause median nerve compression on any plain radiographs. CONCLUSIONS: With clinical evaluation as the reference standard, EDX, US, and MRI are not helpful in making a diagnosis of PS concurrent with CTS. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.

A comparison of the effects on postoperative bleeding of the intra-articular application of tranexamic acid and adrenalin in total knee arthroplasty.

OBJECTIVE: To compare the efficacies of intra-articular applications of tranexamic acid and adrenaline on postoperative bleeding after total knee arthroplasty. METHODS: The single-center, retrospective, controlled study was conducted at Selcuk University , department of orthopedic surgery and comprised data of patients who underwent primary, unilateral, cemented total knee arthroplasty between July 2012 and December 2014. Group 1 had received tranexamic acid 1g after closure of articular capsule. Group 2 had received adrenalin. Group 3, the control group, received no medication intraarticularly after total knee arthroplasty. The amount of blood collected in the drain and postoperative alterations in haemoglobin and haematocrit values were compared. RESULTS: Of the total 90 subjects, there were 30(33.33%) in each of the three groups. The decrease of haemoglobin and haematocrit values in Group 1 was statistically significant compared to both Group 2 and Group 3 (p<0.05). The amount of blood collected in the drains was remarkably lower in Groups I and 2 compared to Group III (p<0.05). No deep venous thrombosis or pulmonary emboli were encountered across the sample. CONCLUSIONS: Intra-articular administration of tranexamic acid was found to be beneficial and safe for the achievement of effective haemostasis after total knee arthroplasty.

Comparison of Innervated Digital Artery Perforator Flap Versus Homodigital Reverse Flow Flap Techniques for Fingertip Reconstruction.

PURPOSE: The aim of this study was to investigate and compare outcomes of 2 different flap techniques for fingertip reconstruction: innervated digital artery perforator (IDAP) flap and homodigital reverse-flow flap. METHODS: Medical records of 33 patients who underwent fingertip reconstruction either with an IDAP flap (15 patients) or with a homodigital reverse-flow flap (18 patients), between 2014 and 2016, were evaluated retrospectively. In both study groups, full-thickness skin grafts harvested from the proximal/volar side of the forearm were used to cover the flap donor site. Flap survival, venous congestion, cold intolerance, static 2-point discrimination, flap size, duration of surgery, time to return to work, proximal and distal interphalangeal joint range of motion, Disability of the Arm, Shoulder, and Hand questionnaire scores, and follow-up time were evaluated. RESULTS: All the major outcomes, including flap survival, cold intolerance, static 2-point discrimination, flap size, time to return to work, range of motion values for proximal and distal interphalangeal joints, Disability of the Arm, Shoulder, and Hand questionnaire scores, and follow-up time, were similar between the 2 flap methods. Mean duration of surgery was shorter in the IDAP flap group. Marginal flap necrosis occurred in 1 IDAP flap, and there was complete survival of the remainder of the flap after debridement. Temporary venous congestion was seen in 3 IDAP flaps, all of which resolved with nonsurgical measures. CONCLUSIONS: Similar success rates and satisfactory outcomes were achieved with IDAP flap and reverse-flow flap techniques used for fingertip reconstruction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Methyl methacrylate in external fixation of supracondylar humerus fractures: An experimental study.

Supracondylar humerus fractures are common fractures around the elbow. Open fractures, comminuted metaphyseal fractures and also fractures with bone loss may need to be treated with external fixators. The aim of this study is to compare two different external fixators, tubular external fixators and polymethyl methacrylate with K wires external fixators, with regard to stiffness and stability for metaphyseal-diaphyseal osteotomies of distal humerus close to the joint. Six matched pairs (24 specimens) of second-generation sawbone humerus were prepared in a standard fashion to create a metaphyseal fracture, 5 cm proximal to the distal joint line of humerus and were randomly divided into two groups of 12 specimens each. Each sawbone humerus was osteotomized transversely at the mid-olecranon fossa with a 2-mm oscillating saw to simulate a Gartland type III fracture. The osteotomy was then reduced and stabilized using two different external fixation methods: carbon tubular external fixator with Schanz screws and methyl methacrylate with multiple K wires. Three-point bending and torsion tests were performed on the specimens. Bending and torsional stiffness of specimens were obtained for the fixation methods. According to the results of the study, the methyl methacrylate group has provided higher stiffness than classical tubular fixator with Schanz screws in three-point bending test (7.79 ± 2.33 N/mm vs 3.78 ± 1.18 N/mm, p = 0.006). The methyl methacrylate group also showed better stiffness in torsion test (0.12 ± 0.042 N m/° vs 0.067 ± 0.013 N m/°, p = 0.02). We determined for the first time in literature that external fixation with methyl methacrylate was significantly superior to the classical tubular external fixator with Schanz screws with regard to stiffness and stability under three-point bending and torsional loads. Moreover, methyl methacrylate is inexpensive and easily applied.

Effect of curcumin on tendon healing: an experimental study in a rat model of Achilles tendon injury.

PURPOSE: This in vivo study aims to investigate the effects of curcumin which is recently developed for tendon healing using a rat Achilles tendon injury model. MATERIALS AND METHODS: Eighteen male Wistar albino rats weighing 300-400 g were used in this study. Under anesthesia, Achilles tendon injuries were created and repaired surgically. Nine rats of the study group received curcumin (suspended in saline at a dose of 200 mg/kg orally) and eight rats of the control group received only saline solution by oral gavage for a period of 28 days. Animals were euthanized on the 28th post-operative day, and all the Achilles tendons were removed and transferred immediately for biomechanic and histological analysis. RESULTS: Macroscopically, all the tendons were fully healed. Total mean Bonar score was higher in the control group. When the parameters of Bonar score were analysed separately, tenocyte morphology, collogen, and ground substance scores were statistically lower than the control group (p = 0.03, 0.041, 0.049, respectively). Vascularity parameter did not show any statistical difference (p > 0.05). Of the nine biomechanical parameters, five of them (failure load, cross-sectional area, length, ultimate stress, strain) showed better results which were also statistically significant (p = 0.046, 0.027, 0.011, 0.021, 0.002, respectively). When the remaining four parameters were examined, the study group also had better results, but this difference was not statistically significant. CONCLUSION: Curcumin had better results for total tendon healing not only histologically but also biomechanically. Curcumin could be an additional agent in the management of surgically repaired tendon injuries.

Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study.

BACKGROUND: To evaluate the efficiency of the percutaneous 18-G needle technique in releasing the fibro-osseous sheath over the first dorsal extensor compartment of the hand. METHODS: Using anatomic landmarks, percutaneous release was performed with an 18-G needle on 48 wrists of 24 cadavers. The specimens were then dissected and examined for the completeness of the first dorsal extensor compartment release and any tendon or neurovascular injuries. The tunnel length, number of abductor pollicis longus and extensor pollicis brevis tendons, presence of an intertendinous septum, and the effects of these parameters on percutaneous release were evaluated. RESULTS: Percutaneous release was performed on all of the wrists, and the evaluation of the adequacy of release revealed 25 complete releases, 21 partial releases, and 2 missed releases. There were 19 cases of tendon complications. No neurovascular injuries were noted. The mean tunnel length was 2.66 ± 30 cm, and the mean number of tendons was 2.75 ± 0.86. A septum was present in 33.3% of cases. Tunnel length and tendon number had no statistically significant effect on release, whereas the presence of a septum was significantly associated with inadequate tunnel release and the development of tendon complications. CONCLUSIONS: Percutaneous release of the first dorsal extensor compartment using an 18-G needle was associated with high rates of incomplete release and tendon damage in the presence of an intertendinous septum. Further study is required under ultrasound guidance to determine the usefulness of percutaneous release in the first dorsal extensor compartment. CLINICAL RELEVANCE: Release with a percutaneous needle tip in De Quervain's syndrome may provide the advantages of better cosmetic results with less scar formation and an early return to work.

Percutaneous double-button fixation method for treatment of acute type III acromioclavicular joint dislocation.

OBJECTIVE: The aim of this study was to evaluate the functional and radiological results of patients treated with the percutaneous double-button technique for acute acromioclavicular (AC) joint dislocation. METHODS: A retrospective evaluation was performed of 13 patients surgically treated for acute Type III AC joint dislocation with the percutaneous double-button fixation method. The coracoclavicular (CC) distance of the affected side was compared with that of the healthy side on anterior-posterior radiographs obtained at the final follow-up. In the functional evaluation, Disabilities of the Arm, Shoulder and Hand (DASH), Constant, and visual analog scale (VAS) scores were used. RESULTS: The 13 patients in the study included 12 males and 1 female with a mean age of 43.4 years (range: 22-60 years). The mean follow-up period was 13.61 months (range: 9-24 months). The mean CC distance on the operated side was 9.23 mm (range: 8-15 mm), and when compared with the healthy side, no statistically significant difference was observed. Preoperative Constant scores of a mean of 30.3 (range: 18-42) increased to 84.4 (range: 70-90) at the final follow-up. Preoperative DASH scores had a mean of 14.1 (range: 11-28) and decreased to 0.4 (range: 0-3) at the final follow-up (p<0.001). Mean preoperative VAS score was 6.0 (range: 5-8), which decreased to 0.6 (range: 0-3) at the final follow-up (p<0.001). CONCLUSION: The percutaneous double-button fixation technique is a safe, practical, and effective fixation method that can be used as an alternative to arthroscopic and open methods for acute Type III AC joint dislocations.

Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients.

BACKGROUND: There are a limited number of published studies describing reconstruction with an anterolateral thigh (ALT) flap following lower extremity injury in pediatric patients. The aim of this study was to present our experiences with the application of a free ALT flap not only in the reconstruction of soft tissue defects around the pediatric foot and ankle but also in patients with bone, tendon, and ligament injuries that require repair. MATERIALS AND METHODS: Reconstruction with a free ALT flap was performed in 11 pediatric patients (mean age, 8.9 years; range, 3-15 years) between November 2010 and February 2013. The modes of injury were as follows: six traffic accidents, three firearm accidents, one agricultural machinery accident, and one bicycle chain accident. A retrospective evaluation of the applied surgical procedures was performed: flap size, perforator type and number, placement area, site of anastomosis, closure of the donor site, complications, and flap survival. RESULTS: The mean size of the skin flap was 83.2 mm(2) (range, 48-117 mm(2)). Except for two patients, there were two perforators in the obtained flaps, which were 75% musculocutaneous and 25% septocutaneous. To strengthen the Achilles tendon in one patient, the ALT, together with the fascia lata, was raised as a composite flap. This flap was used as a "sensate flap" in three patients with defects in the heel area and as a "perforator flap" in seven patients. Anastomosis was performed in the anterior tibial artery in five patients and in the posterior tibial artery in six patients. Primary closure was performed for the donor site in all patients. Due to venous thrombus after 24 hours in one patient, reexploration was performed, and blood flow was regained with a vein graft. In the same patient, partial necrosis developed on the lateral edge of the flap; after debridement of the necrotic areas, closure was performed with a split thickness skin graft. After the ALT flap procedure, the primary flap survival rate was 90.9%. CONCLUSION: The free ALT flap could be a safe, reliable, and aesthetically appealing option for foot/ankle resurfacing in children after traumatic soft tissue loss. The ALT flap can cover a far greater area and provide the versatility needed to optimize soft-tissue coverage. CLINICAL QUESTION/LEVEL OF EVIDENCE: Level IV.

Reconstruction of dorsal hand and finger defects with reverse radial fasciocutaneous forearm flaps.

OBJECTIVES: To evaluate the midterm outcome and the degree of satisfaction of patients who underwent reconstruction of dorsal hand and finger defects with reverse flow radial fasciocutaneous forearm flaps and to test whether or not this is a reliable method which can be applied without the need for microsurgery. PATIENTS AND METHODS: Eleven patients were admitted with post-traumatic complex hand defects and treated by reconstruction with reverse flow radial fasciocutaneous forearm flaps from January 2010 to May 2013. The patient demographics, size of the hand and finger defects, and complications were recorded. The functional status of each of the patients was evaluated using the quick disabilities of the arm, shoulder and hand (DASH) scoring system, and patient satisfaction was assessed using Likert scores. RESULTS: The patients comprised nine males and two females with a mean age of 30.7 ± 9.7 years. The mean follow-up period was 18.4 ± 5.2 months. The average defect size was 41 ± 14.3 cm². None of the patients had circulation defects caused by the sacrifice of the radial artery. The mean quick DASH score was determined as 30.2 ± 15.3. The Likert patient satisfaction evaluation was good in one patient, and very good in ten patients. All flaps survived well with only two complications; superficial skin necrosis occurred at the suture site in one patient and venous insufficiency occurred in the other patient. Both complications recovered with secondary healing following wound debridement. CONCLUSIONS: The reverse-flow radial forearm flap is a reliable method in the management of dorsal defects of the hand and does not require micro-surgical techniques.

Pustular irritant contact dermatitis caused by dexpanthenol in a child.

Pustular irritant contact dermatitis is rare and unusual clinic form of contact dermatitis. Dexpanthenol is the stable alcoholic analogue of pantothenic acid. It is widely used in cosmetics and topical medical products for several purposes. We present the case of 8-year-old girl with pustules over erythematous and eczematous areas on the face and neck. To the best of our knowledge, this is the first case reported that is diagnosed as pustular irritant contact dermatitis caused by dexpanthenol.

Triggering of the Digits After Carpal Tunnel Surgery.

INTRODUCTION: Carpal tunnel syndrome (CTS) and trigger finger may be seen simultaneously in the same hand. The development of trigger finger in patients undergoing CTS surgery is not rare, but the relationship between these conditions has not been fully established. The aims of this prospective randomized study were to investigate the incidence of trigger finger in patient groups undergoing transverse carpal ligament releasing (TCL) or TCL together with distal forearm fascia releasing and to identify other factors that may have an effect of these conditions. MATERIALS AND METHOD: This prospective randomized study evaluated 159 hands of 113 patients for whom CTS surgery was planned. The patients were separated into 2 groups: group 1 (79 hands of 57 patients) undergoing TCL releasing only and group 2 (80 hands of 56 patients) undergoing TCL and distal forearm fascia releasing together. The age and gender of the patients, dominant hand, physical examination findings, visual analogue scale (VAS), and electromyography (EMG) results were recorded. Follow-up examinations were made at 1, 3, 6, 12, and 24 months for all patients. We noted development of trigger finger in the surgical groups, and its location and response to treatment. RESULTS: The incidence of trigger finger development was statistically significantly different between group 1 and group 2 (13.9% and 31.3%, respectively). The logistic regression analysis of factors affecting the development of trigger finger posttreatment found that the surgical method and severity of EMG were significant, whereas the effects of the other factors studied were not found to have any statistical significance. CONCLUSION: There was an increased risk of postoperative trigger finger development in patients undergoing TCL and distal forearm fascia releasing surgery for CTS compared to those undergoing CTL only. There is a need for further studies to support this result and further explain the etiology.

Reconstruction of multiple fingertip injuries with reverse flow homodigital flap.

AIM: Hand trauma may lead to multiple fingertip defects, causing functional restrictions. We evaluated the use of reverse-flow homodigital flap reconstruction of the distal phalanx and pulp defects associated with multiple finger injuries. METHODS: We retrospectively evaluated 11 male patients who presented at our emergency department (January 2011-March 2013) with multiple fingertip injuries and who were treated with a reverse-flow homodigital flap. Evaluations included age, sex, defect size, flap survival rate, complications, cold intolerance, two-point discrimination, range of motion (ROM), quick disabilities of the arm, shoulder, and hand (DASH) score, and return to work time. RESULTS: Completely, 22 reverse-flow homodigital flaps were applied to at least two fingertip injuries at the distal phalanx. Ten flaps survived postoperatively. The exception was partial flap loss on one finger. The mean follow-up was 14.2 months. At the final follow-up, the mean static two-point discrimination value was 10.3mm. Mean ROMs of interphalangeal joints were 65.31° (distal) and 105.77° (proximal). Donor sites were covered with full-thickness skin grafts from the wrist or antecubital area. There were no complications related to the donor site and no development of cold intolerance in any finger. The mean quick DASH score was 4.12. All patients returned to work in an average of 8.3 weeks. CONCLUSIONS: The reconstruction of multiple fingertip injuries with reverse-flow homodigital flaps is a safe, effective method that can be combined with other local finger flaps. These flaps can be applied to two consecutive fingers without reducing finger length or function.

Baboon syndrome induced by ketoconazole.

A 27-year-old male patient presented with a maculopapular eruption on the flexural areas and buttocks after using oral ketoconazole. The patient was diagnosed with drug-induced baboon syndrome based on his history, which included prior sensitivity to topical ketoconazole, a physical examination, and histopathological findings. Baboon syndrome is a drug- or contact allergen-related maculopapular eruption that typically involves the flexural and gluteal areas. To the best of our knowledge, this is the first reported case of ketoconazole-induced baboon syndrome in the English literature.