Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries.

OBJECTIVES: Degloving hand injuries have generally been viewed as among the most difficult of injuries to manage due to the extensive nature of associated damage. The traditional approach to the circumferentially degloved segment of problematic flap viability has been to resuture the flap and to wait and see. However, the waiting period or the specific hemorheological protocol remains uncertain. This study aims to acknowledge if Sivelestat, known to ameliorate ischemia-reperfusion injury, enhances the survival of avulsed flaps in a hind limb degloving model of rats and to compare Sivelestat's effects to Pentoxifylline. METHODS: In this study, total flap area (cm2), area of necrosis in the flap (cm2), and the ratio between the necrotic and total areas (percentage) were determined. Angiogenesis among the groups was documented with CD31, anti-PECAM staining. TUNEL assay was performed to allow the visualization of cell nuclei containing fragmented DNA, a typical feature of apoptosis. RESULTS: The findings obtained in this study showed that Sivelestat administered at 10 mg/kg/hour dosage will inhibit the ischemia-reperfusion injury more pertinently than Pentoxifylline, which exerts only hemorheological effects. CONCLUSION: The anti-inflammatory effects of Sivelestat will be beneficial for decreasing the early complications of degloving injury, such as inflammation, sepsis, and edema, better than Pentoxifylline, which exerts only hemorheological effects.

Anomalous large unique muscle belly of flexor digitorum superficialis and the absence of palmaris longus in the forearm.

Anomalies of muscles of the upper extremity are frequently encountered and anatomic variations of the flexor digitorum superficialis (FDS) muscle-tendon unit are frequently reported by anatomists and clinicians. FDS anomalies can be in forms of tendon interconnections, substitution, absence or muscle belly variations and most of the times the anomalies of FDS produce few clinical symptoms. We report a rare and unusual case of FDS anomaly with a unique and large muscle belly. The deformity is type V according to the classification of Elliot et al. in which the muscle belly extends to four digits (the index, middle, ring and little finger) in the right hand of patient and there is absence of the palmaris longus tendon. The hand surgeon should be able to realise all variations of the FDS tendon and should be prepared for unexpected findings during surgery.