Management of Soft-tissue Defects of Hand in a Conflict Combat Zone: A Case Series.

Introduction: Managing soft-tissue defects of hand is a challenging problem for any surgical team, even more in a field hospital setting of a conflict combat zone, where resources are scarce and such cases due to blunt trauma, gunshot wound and deep tissue infections are common. Case Report: We present four different cases, all middle aged males, who sustained injuries due to crush, low velocity gun shot, and defects post-debridement of acute onset infections following abrasions. The first patient was managed with doubled pedicled abdominal flap, the second patient was managed with external fixation for fracture, and cross finger flap for the defect. The third and fourth patients had similar presentations of acute onset deep soft tissue and bony infection, out of which one was managed with full thickness skin graft from anterior abdominal wall and the other with bi-pedicled abdominal flap. All the patients had good functional outcomes with no functional restrictions at follow-up of 12 weeks. Conclusion: All the cases were performed in a challenging situation of a highly active combat field zone, with limited resources and lack of availability of a trained hand surgeon. An early soft-tissue coverage, as soon as possible, was crucial in saving the hand function and guaranteeing a speedy return to function in view of lack of a professional hand surgery team and specialized microsurgery equipment.

A Rare Case of Soft Tissue Osteoma of Hand.

Osteomas are benign, slow-growing, differentiated tumours, which are primarily located in the region of maxillofacial skeleton. Osteoma involving the soft tissues with no bony attachments is a very rare event. A 68-year-old woman with comorbidities (diabetes mellitus type II, primary hypertension, pacemaker in situ) presented with a painless solid mass in the thenar region of her right palm, which appeared almost 1 and half years ago and showed a progressive enlargement in the last few months. Under regional anaesthesia, an excisional biopsy was performed and the histopathological evaluation of the lesion confirmed the diagnosis of soft tissue osteoma. The postoperative follow-up period was uneventful without any complication.

Osteopenia in Scaphoid Fracture: An Indicator of Good Prognosis or Is it Cause for Concern?: A Case Report.

CASE: A 32-year-old man sustained a scaphoid waist fracture and was managed nonoperatively in a short-arm cast. Radiographic follow-up at 6 weeks showed marked loss of radiodensity of the whole scaphoid, although the fracture was clinically united. Patchy ossification at 3 months was followed by the complete restoration of radiodensity and trabecular pattern by 20 weeks. The patient had an uneventful and full functional recovery. CONCLUSION: This, perhaps unreported, finding seems to be an indicator of preserved vascularity in scaphoid fractures. Further research/reporting of this radiological pattern in these fractures will help improve their understanding and management.