Reconstruction of hand injuries with multiple metacarpal defects using free fibular osteoseptocutaneous flap.

Hand injuries with multiple metacarpal involvements often include midpalmar muscle, extensor tendon, and skin defects. Reconstruction method is decided according to the type and amount of structures to be restored. Bone reconstruction and resurfacing of the skin is regarded as priority, and restoration of tendon function and joint mobility can be left for further procedures. An ideal flap for such defects should provide bone for multiple metacarpal defects and a large enough skin paddle. Such flaps are few, and one of the most suitable of them all is the free fibular osteoseptocutaneous flap (free FOSCF). In this report, our experience with the use of free FOSCF for reconstruction of the mutilating hand injury in five patients with extensive skin integument and metacarpal involvement has been presented. Total lengths of fibular flaps were averagely 11 cm in length and were divided into averagely 2.4 segments. Average dimensions of the skin paddles were 7.75 × 8.75 cm. Although the nature of the devastating traumas limited the ultimate functional recovery; wound closure, stability, and various degrees of mobility were restored in all patients. In our experience, reconstruction with free FOSCF proved to be an effective tool in mutilating hand injuries with metacarpal involvement.

Finger pulp reconstruction with free dorsoulnar artery perforator (DUAP) flap.

Finger pulp is a common site for hand injuries, and pulp reconstruction is significantly important for optimal handling and sensation. Ideal substitute must provide matching texture, tenacity, and slim subcutaneous fat. This article presents six cases in which fingertip and finger pulp reconstruction were performed via free dorsoulnar artery perforator (DUAP) flap. All flaps survived and all patients healed uneventfully without any complications by the end of at least 3 months follow-up. Free DUAP flap has proved to be a suitable substitute for pulp reconstruction with its thin structure, minimally morbid donor site which is also close to the trauma zone, and possibility for neurotization. It can be especially favorable when splitting the surgical team for a glabrous flap harvest from the foot is not possible.

Contribution of a locking cross-stitch to a modified kessler core suture: a new technique.

We compared the gap-producing forces, ultimate tensile strength, and slip resistance of a new core suture technique and that of a modified Kessler suture in freshly harvested chicken tendons. Biomechanical trials were carried out using a tensile-strength testing machine. Our technique proved superior to the modified Kessler suture with respect to its ultimate tensile strength and slip resistance.

End-to-end microvascular anastomosis in the rat carotid artery using continuous horizontal mattress sutures.

This paper reports a continuous horizontal mattress suture technique with advantages such as decreased time for anastomosis, minimized anastomotic leakage, eversion around the vessel edges, and other advantages which the continuous anastomosis technique has. This technique was compared with the classical interrupted and classical continuous suture techniques on a total of 59 Sprague-Dawley rat common carotid arteries: Group 1 (n = 19), interrupted suture technique; Group 2 (n = 20), standard continuous technique, and Group 3 (n = 20), continuous horizontal mattress technique. Early (30 min) and late (21 days) patency rates, anastomosis time, leakage on clamp release, oozing duration, additional sutures needed, and total number of sutures placed were statistically compared between groups. Specimens were taken at the 21st day randomly, and light microscopy (LM), scanning electron microscopy (SEM), and angiographic studies were performed. Results revealed that the continuous mattress suture technique has the advantages of providing a water-tight anastomosis with less suture materials in a shorter time, and minimal intraluminal suture material which can incite thrombosis. On the other hand, a tendency to anastomotic stricture was found to be the sole disadvantage of this technique.