One-stage reconstruction of the massive overlying skin defect combined with total loss of extensor tendon in zones V and VI using a reverse pedicled radial forearm tendinocutaneous flap: A case report.

Our case report involved a 36-year-old man who sustained injury during manual labor caused by a machine press. The patient had extensive fourth-degree burns in the right dorsal hand with total loss of extensor tendons in zones V and VI of the index, middle, and ring finger. We performed a reverse radial forearm tendinocutaneous flap (the radial artery flap permits the inclusion of three "strips" of vascularized tendons: brachioradialis, flexor carpi radialis, and palmaris longus) to cover his hand defects. Six months after the operation, the active extension of the index, middle, and ring metacarpophalangeal joints had recovered well. The patient is satisfied with the outcome.

Clinical Features, Bacteriology, and Antibiotic Treatment Among Patients with Presumed Naja Bites in Vietnam.

INTRODUCTION: Clinical and bacteriological features of cobra (Naja) bites are still relatively unknown in Vietnam. This study aimed to characterize the clinical and bacteriological characteristics of local wounds in patients with presumed Naja spp bite, as well as their antibiotic treatment. METHODS: A cross-sectional study was performed on presumed Naja bite patients who were admitted to Bach Mai Hospital in Hanoi, Vietnam. In vitro bacterial isolation, blood tests, and lesion measure were conducted, and antibiotic susceptibilities of localized bite wounds were assessed. The Mann-Whitney test was used to examine the difference in clinical characteristics between patients experiencing presumed Naja atra bites and Naja kaouthia bites. Data are presented as percentages or median with interquartile range, as appropriate. Statistical significance was accepted at P<0.05. RESULTS: Among 46 patients, all had typical clinical features of Naja bite. The median bite-to-hospital time was 6 h (interquartile range 4.0-11.3). The dominant organisms isolated from local wounds were Morganella morganii (11/36) and Enterococcus faecalis (25/36). All cultures were susceptible to ciprofloxacin. No difference was found with regard to pain, swelling circumference, swelling spread, or necrotic area between patients bitten by presumed Naja atra and Naja kaouthia (P>0.05). CONCLUSIONS: Wound necrosis and infection were important clinical issues in presumed Naja spp snake bites. Morganella morganii and Enterococcus faecalis were dominant in local wound swabs of such cases. Ciprofloxacin should be an effective first-line antibiotic for patients with presumed Naja bite.