S. Roh, Chang Park, S. Koh, Jin Soo Kim, Dong Chul Lee, K. Lee
Purpose: This study compared the surgical outcomes and quality of life of patients who underwent fasciocutaneous and fascial anterolateral thigh (ALT) free flaps for the reconstruction of traumatic soft tissue defects in the foot.Methods: A single-institution retrospective review of medical data from 2008 to 2021 was conducted on 20 patients who underwent a fasciocutaneous ALT free flap or fascial ALT free flap in the foot. Information was collected on patients’ baseline information, preoperative characteristics, and postoperative courses. Quality of life was measured through the Foot and Ankle Disability Index (FADI) score. A questionnaire survey was administered to evaluate aesthetic satisfaction and subjective improvement of dryness and sensory function at the surgical site.Results: The mean flap dimensions were 13.96×4.58 cm and 10.75×3.50 cm in the fasciocutaneous and fascial groups, respectively. The overall flap failure and complication rates were higher in the fasciocutaneous group (total necrosis in one case, partial flap loss in two cases, and vascular complications in three cases). While aesthetic satisfaction and functional outcomes (FADI Sports) showed better outcomes in the fascial group, subjective improvement of dryness and sensory recovery showed better results in the fasciocutaneous group.Conclusion: In comparison to fasciocutaneous flaps, fascial free flaps demonstrated lower rates of wound complications, higher aesthetic satisfaction, and better functional outcomes, but less improvement in dryness and sensory recovery at the flap site. Therefore, the choice of a flap for foot reconstruction should depend on the plastic surgeon’s discretion and a thorough discussion with the patient.
{"title":"Comparison of fasciocutaneous and fascial anterolateral thigh free flaps in foot reconstruction","authors":"S. Roh, Chang Park, S. Koh, Jin Soo Kim, Dong Chul Lee, K. Lee","doi":"10.12790/ahm.23.0004","DOIUrl":"https://doi.org/10.12790/ahm.23.0004","url":null,"abstract":"Purpose: This study compared the surgical outcomes and quality of life of patients who underwent fasciocutaneous and fascial anterolateral thigh (ALT) free flaps for the reconstruction of traumatic soft tissue defects in the foot.Methods: A single-institution retrospective review of medical data from 2008 to 2021 was conducted on 20 patients who underwent a fasciocutaneous ALT free flap or fascial ALT free flap in the foot. Information was collected on patients’ baseline information, preoperative characteristics, and postoperative courses. Quality of life was measured through the Foot and Ankle Disability Index (FADI) score. A questionnaire survey was administered to evaluate aesthetic satisfaction and subjective improvement of dryness and sensory function at the surgical site.Results: The mean flap dimensions were 13.96×4.58 cm and 10.75×3.50 cm in the fasciocutaneous and fascial groups, respectively. The overall flap failure and complication rates were higher in the fasciocutaneous group (total necrosis in one case, partial flap loss in two cases, and vascular complications in three cases). While aesthetic satisfaction and functional outcomes (FADI Sports) showed better outcomes in the fascial group, subjective improvement of dryness and sensory recovery showed better results in the fasciocutaneous group.Conclusion: In comparison to fasciocutaneous flaps, fascial free flaps demonstrated lower rates of wound complications, higher aesthetic satisfaction, and better functional outcomes, but less improvement in dryness and sensory recovery at the flap site. Therefore, the choice of a flap for foot reconstruction should depend on the plastic surgeon’s discretion and a thorough discussion with the patient.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126330642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hand fractures are the most common fractures in orthopedic surgery. In most cases, conservative treatment is sufficient for stable fractures, but surgical treatment is required for unstable fractures, fractures that cannot be maintained after reduction, and fractures with severe soft tissue injuries. In the management of hand fractures, the focus should be on restoring the function of the hand after fracture healing. Rapid rehabilitation exercises are an important factor in restoring the function of the hand by reducing swelling at the fracture site, preventing joint stiffness, and reducing soft tissue adhesion. Therefore, conservative treatment that can minimize soft tissue damage is usually prioritized, and in specific situations, if surgical intervention can help facilitate early rehabilitation exercises, then it could be a desirable choice. This review article aims to help readers decide on a treatment method by presenting various treatment methods for hand fractures and the academic basis for those options.
{"title":"Management of metacarpal and phalangeal fractures","authors":"Seungbum Chae, Il-Jung Park","doi":"10.12790/ahm.23.0005","DOIUrl":"https://doi.org/10.12790/ahm.23.0005","url":null,"abstract":"Hand fractures are the most common fractures in orthopedic surgery. In most cases, conservative treatment is sufficient for stable fractures, but surgical treatment is required for unstable fractures, fractures that cannot be maintained after reduction, and fractures with severe soft tissue injuries. In the management of hand fractures, the focus should be on restoring the function of the hand after fracture healing. Rapid rehabilitation exercises are an important factor in restoring the function of the hand by reducing swelling at the fracture site, preventing joint stiffness, and reducing soft tissue adhesion. Therefore, conservative treatment that can minimize soft tissue damage is usually prioritized, and in specific situations, if surgical intervention can help facilitate early rehabilitation exercises, then it could be a desirable choice. This review article aims to help readers decide on a treatment method by presenting various treatment methods for hand fractures and the academic basis for those options.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129897335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tae-Yul Lee, Hyung-kyu Kim, Hi-Jin You, Deok-Woo Kim
Purpose: Lymphedema is a chronic disease that affects patients’ quality of life. Vascularized groin lymph node transfer is a reliable treatment that requires detailed anatomic knowledge of the superficial inguinal lymph nodes (SILNs). This study compared the anatomy of SILNs between patients with upper-extremity lymphedema and individuals without lymphedema using pelvic computed tomography (CT).Methods: The CT scans of 17 patients (the patient group) with upper-extremity lymphedema and 34 individuals without lymphedema (the normal group) were studied. The reference point was marked 3 cm perpendicularly below one-third of the line from the pubic tubercle to the anterior superior iliac spine. The number, distance, and concentration of SILNs were measured relative to the reference point.Results: The SILNs in the normal group had a mean count of 6.47±1.19, a mean distance from the reference point of 21.10±9.66 mm, and a mean concentration of 84%. The patient group had a mean lymph node count of 7.68±1.63, a mean distance of 22.48±9.51 mm, and a mean concentration of 77%. The normal and patient groups had significantly different mean lymph node counts (p=0.01). The mean distance from the reference point (p=0.07) and the mean lymph node concentration (p=0.20) did not differ significantly between groups. Conclusion: Pelvic CT is a reliable method to evaluate the anatomy of SILNs in detail. A statistically significant difference was found in the number of lymph nodes between the lymphedema patient group and the normal group, but not in their distribution.
{"title":"Comparison of groin lymph node anatomy in patients with upper-extremity lymphedema and healthy subjects using contrast-enhanced computed tomography","authors":"Tae-Yul Lee, Hyung-kyu Kim, Hi-Jin You, Deok-Woo Kim","doi":"10.12790/ahm.22.0070","DOIUrl":"https://doi.org/10.12790/ahm.22.0070","url":null,"abstract":"Purpose: Lymphedema is a chronic disease that affects patients’ quality of life. Vascularized groin lymph node transfer is a reliable treatment that requires detailed anatomic knowledge of the superficial inguinal lymph nodes (SILNs). This study compared the anatomy of SILNs between patients with upper-extremity lymphedema and individuals without lymphedema using pelvic computed tomography (CT).Methods: The CT scans of 17 patients (the patient group) with upper-extremity lymphedema and 34 individuals without lymphedema (the normal group) were studied. The reference point was marked 3 cm perpendicularly below one-third of the line from the pubic tubercle to the anterior superior iliac spine. The number, distance, and concentration of SILNs were measured relative to the reference point.Results: The SILNs in the normal group had a mean count of 6.47±1.19, a mean distance from the reference point of 21.10±9.66 mm, and a mean concentration of 84%. The patient group had a mean lymph node count of 7.68±1.63, a mean distance of 22.48±9.51 mm, and a mean concentration of 77%. The normal and patient groups had significantly different mean lymph node counts (p=0.01). The mean distance from the reference point (p=0.07) and the mean lymph node concentration (p=0.20) did not differ significantly between groups. Conclusion: Pelvic CT is a reliable method to evaluate the anatomy of SILNs in detail. A statistically significant difference was found in the number of lymph nodes between the lymphedema patient group and the normal group, but not in their distribution.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115863215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The theoretical rationale of synovectomy is to reduce or eliminate the aggressive inflammatory cell mass, thereby reducing swelling, decreasing pain, and improving joint function. Traditionally, open-wrist synovectomy is the standard treatment, as it allows an inspection of all compartments and extensor tendons. Arthroscopic synovectomy of the wrist was first introduced by Roth and Poehling in 1990. Since then, it has been successfully performed in selected patients. Arthroscopic synovectomy might be indicated in any disease that leads to long-standing synovitis of the wrist and when other treatment modalities do not provide satisfactory symptom reduction or may be contraindicated. Arthroscopic synovectomy is a surgical procedure with minimal morbidity. It results in less damage to the joint capsule and ligaments, thereby hastening rehabilitation and shortening the hospital stay. Therefore, we think that understanding the surgical technique for wrist arthroscopic synovectomy and appropriately applying it to patients could prevent disease progression in patients with wrist arthritis and overcome incapacitating dysfunction of the upper limb, including the wrist, hand, and forearm.
{"title":"Arthroscopic synovectomy of the wrist","authors":"Young-Keun Lee, Jong-Hong Kim","doi":"10.12790/ahm.22.0073","DOIUrl":"https://doi.org/10.12790/ahm.22.0073","url":null,"abstract":"The theoretical rationale of synovectomy is to reduce or eliminate the aggressive inflammatory cell mass, thereby reducing swelling, decreasing pain, and improving joint function. Traditionally, open-wrist synovectomy is the standard treatment, as it allows an inspection of all compartments and extensor tendons. Arthroscopic synovectomy of the wrist was first introduced by Roth and Poehling in 1990. Since then, it has been successfully performed in selected patients. Arthroscopic synovectomy might be indicated in any disease that leads to long-standing synovitis of the wrist and when other treatment modalities do not provide satisfactory symptom reduction or may be contraindicated. Arthroscopic synovectomy is a surgical procedure with minimal morbidity. It results in less damage to the joint capsule and ligaments, thereby hastening rehabilitation and shortening the hospital stay. Therefore, we think that understanding the surgical technique for wrist arthroscopic synovectomy and appropriately applying it to patients could prevent disease progression in patients with wrist arthritis and overcome incapacitating dysfunction of the upper limb, including the wrist, hand, and forearm.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129235749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yong Been Kim, In Cheul Choi, J. H. Park, J. Nam, K. Hwang, Jong Woong Park
Purpose: Ultrasonography (US) and magnetic resonance imaging (MRI), which has better resolution, have been suggested as appropriate diagnostic tools for digits; however, comparative studies of both modalities are scarce. This study compared the diagnostic performance of high-resolution US and MRI in characterizing subungual glomus tumors. Methods: We retrospectively analyzed the data of consecutive patients who were examined with high-resolution US and MRI before surgical exploration for subungual tumors from January 2017 to April 2020. The patients’ clinical data and radiological findings were collected. Historical reports for diagnostic confirmation and measurements of mass size were reviewed. We conducted the McNemar test and evaluated the degree of agreement between the size measurements made using both techniques.Results: Overall, 22 patients (age range, 19–72 years) underwent surgical exploration and had subungual glomus tumors. The mean duration from initial symptom presentation to diagnosis was 7 years (range, 5–30) years. Only nine patients (40.9%) presented with the symptomatic triad of pain, cold sensitivity, and tenderness. MRI detected lesions in 19 cases (86.4%); three cases (13.6%) were undetected. Contrastingly, US was able to detect all lesions. Nine patients (40.9%) had visibly rich blood flow in tumor tissues on Doppler US. MRI and US showed bone erosion in eight and 15 cases, respectively. Conclusion: The detection rate of high-resolution US for subungual glomus tumors was as high as that of MRI. US can be applied easily and quickly and can be more useful as a primary diagnostic tool.
{"title":"High-resolution ultrasonography is a more useful primary diagnostic tool than magnetic resonance imaging for subungual glomus tumors: a single-center retrospective study","authors":"Yong Been Kim, In Cheul Choi, J. H. Park, J. Nam, K. Hwang, Jong Woong Park","doi":"10.12790/ahm.22.0060","DOIUrl":"https://doi.org/10.12790/ahm.22.0060","url":null,"abstract":"Purpose: Ultrasonography (US) and magnetic resonance imaging (MRI), which has better resolution, have been suggested as appropriate diagnostic tools for digits; however, comparative studies of both modalities are scarce. This study compared the diagnostic performance of high-resolution US and MRI in characterizing subungual glomus tumors. Methods: We retrospectively analyzed the data of consecutive patients who were examined with high-resolution US and MRI before surgical exploration for subungual tumors from January 2017 to April 2020. The patients’ clinical data and radiological findings were collected. Historical reports for diagnostic confirmation and measurements of mass size were reviewed. We conducted the McNemar test and evaluated the degree of agreement between the size measurements made using both techniques.Results: Overall, 22 patients (age range, 19–72 years) underwent surgical exploration and had subungual glomus tumors. The mean duration from initial symptom presentation to diagnosis was 7 years (range, 5–30) years. Only nine patients (40.9%) presented with the symptomatic triad of pain, cold sensitivity, and tenderness. MRI detected lesions in 19 cases (86.4%); three cases (13.6%) were undetected. Contrastingly, US was able to detect all lesions. Nine patients (40.9%) had visibly rich blood flow in tumor tissues on Doppler US. MRI and US showed bone erosion in eight and 15 cases, respectively. Conclusion: The detection rate of high-resolution US for subungual glomus tumors was as high as that of MRI. US can be applied easily and quickly and can be more useful as a primary diagnostic tool.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133748862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A variety of benign and malignant neoplasms can develop in the hand, originating from skin, adipose tissue, tendons, muscles, nerves, and bones. However, most cases are benign; therefore, observation is recommended if they are small, painless and do not cause limitation of motion. When symptoms are present or a lesion is larger than 5 cm in the long axis, an excisional biopsy is required to relieve symptoms and exclude malignancy. Lipomas of the hand are quite rare and do not generally cause symptoms. Lipomas of the hand that do present with symptoms are usually giant (larger than 5 cm in diameter) or located in a deeper layer, compressing the nearby nerves and vessels. We report a rare case of a non-giant superficial lipoma of the wrist that resembled two separate masses and caused pain, limitation of motion, and neurological symptoms.
{"title":"A rare case of nerve compression caused by a connected lipoma of the wrist","authors":"Do-Whan Kim, J. Yoon, Surak Eo, Y. Han, SooA Lim","doi":"10.12790/ahm.22.0059","DOIUrl":"https://doi.org/10.12790/ahm.22.0059","url":null,"abstract":"A variety of benign and malignant neoplasms can develop in the hand, originating from skin, adipose tissue, tendons, muscles, nerves, and bones. However, most cases are benign; therefore, observation is recommended if they are small, painless and do not cause limitation of motion. When symptoms are present or a lesion is larger than 5 cm in the long axis, an excisional biopsy is required to relieve symptoms and exclude malignancy. Lipomas of the hand are quite rare and do not generally cause symptoms. Lipomas of the hand that do present with symptoms are usually giant (larger than 5 cm in diameter) or located in a deeper layer, compressing the nearby nerves and vessels. We report a rare case of a non-giant superficial lipoma of the wrist that resembled two separate masses and caused pain, limitation of motion, and neurological symptoms.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114843284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pediatric trigger finger (PTF) is a rare hand disorder caused by various anatomic abnormalities and systemic illnesses. We report a case of PTF in a 16-month-old boy, revealing a flexion deformity of his right middle finger. We noted an abnormally proximal location of Camper’s chiasm and bulging of the flexor digitorum profundus intraoperatively. We released the A1 pulley completely and resected an ulnar slip of the flexor digitorum superficialis (FDS). The short-term outcome was satisfactory; however, the patient experienced a mild flexion deformity and ulnar deviation of the right middle finger at a 4-year follow-up visit. During reexploration, we noted severe scar adhesion along the previously cut end of the ulnar slip of the FDS. Therefore, we performed en-bloc scar tissue release with additional resection of the remaining radial slip of the FDS. To prevent recurrence after PTF release, close monitoring with short-term follow-up and early physiotherapy should be emphasized.
{"title":"Resection of one slip of the flexor digitorum superficialis resulting finger deformity in pediatric trigger finger: a case report","authors":"Do-Whan Kim, J. Yoon, SooA Lim, Y. Han, Surak Eo","doi":"10.12790/ahm.22.0058","DOIUrl":"https://doi.org/10.12790/ahm.22.0058","url":null,"abstract":"Pediatric trigger finger (PTF) is a rare hand disorder caused by various anatomic abnormalities and systemic illnesses. We report a case of PTF in a 16-month-old boy, revealing a flexion deformity of his right middle finger. We noted an abnormally proximal location of Camper’s chiasm and bulging of the flexor digitorum profundus intraoperatively. We released the A1 pulley completely and resected an ulnar slip of the flexor digitorum superficialis (FDS). The short-term outcome was satisfactory; however, the patient experienced a mild flexion deformity and ulnar deviation of the right middle finger at a 4-year follow-up visit. During reexploration, we noted severe scar adhesion along the previously cut end of the ulnar slip of the FDS. Therefore, we performed en-bloc scar tissue release with additional resection of the remaining radial slip of the FDS. To prevent recurrence after PTF release, close monitoring with short-term follow-up and early physiotherapy should be emphasized.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115130038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: If the primary suture is difficult due to the large size of a tendon defect, reconstruction of the defective tendon is attempted through tendon transfer or tendon graft. The Pulvertaft technique is most commonly used, but it increases bulk and friction, and it could cause adhesion formation. In order to overcome these problems, we aimed to introduce a new technique.Methods: We retrospectively reviewed 22 patients who underwent tendon reconstruction using the modified Pulvertaft technique due to tendon defects from January 2016 to December 2021. An abbreviated version of the original DASH (Disabilities of Arm, Shoulder and Hand) outcome measure (QuickDASH) was measured 3 months after surgery. Until the final follow-up observation, tendon rerupture, infection, tendon-related complications (quadriga effect, motion limitation due to bulky size of the suture site), and contracture were measured. QuickDASH was compared according to the cause of the tendon defect and the type of operation using the Mann-Whitney test.Results: The mean QuickDASH score measured 3 months after surgery was 10.42±7.83. No statistically significant difference in the QuickDASH score was found between patients who underwent tendon transfer and those who underwent tendon grafts (p=0.988). Rerupture occurred in 1 case, and there were no cases of infection, tendon-related complications (quadriga effect, motion limitation due to bulky size of the suture site), or contracture.Conclusion: The orthogonal passing-through suture technique could be a new alternative to the tendon reconstruction technique.
{"title":"Modified Pulvertaft orthogonal passing-through suture technique: a preliminary study","authors":"M. B. Kim, S. Jung, Dong Hoon Sung","doi":"10.12790/ahm.22.0037","DOIUrl":"https://doi.org/10.12790/ahm.22.0037","url":null,"abstract":"Purpose: If the primary suture is difficult due to the large size of a tendon defect, reconstruction of the defective tendon is attempted through tendon transfer or tendon graft. The Pulvertaft technique is most commonly used, but it increases bulk and friction, and it could cause adhesion formation. In order to overcome these problems, we aimed to introduce a new technique.Methods: We retrospectively reviewed 22 patients who underwent tendon reconstruction using the modified Pulvertaft technique due to tendon defects from January 2016 to December 2021. An abbreviated version of the original DASH (Disabilities of Arm, Shoulder and Hand) outcome measure (QuickDASH) was measured 3 months after surgery. Until the final follow-up observation, tendon rerupture, infection, tendon-related complications (quadriga effect, motion limitation due to bulky size of the suture site), and contracture were measured. QuickDASH was compared according to the cause of the tendon defect and the type of operation using the Mann-Whitney test.Results: The mean QuickDASH score measured 3 months after surgery was 10.42±7.83. No statistically significant difference in the QuickDASH score was found between patients who underwent tendon transfer and those who underwent tendon grafts (p=0.988). Rerupture occurred in 1 case, and there were no cases of infection, tendon-related complications (quadriga effect, motion limitation due to bulky size of the suture site), or contracture.Conclusion: The orthogonal passing-through suture technique could be a new alternative to the tendon reconstruction technique.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127216748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Song, Chan Yeong Lee, H. Ryu, J. Byeon, Hwanjun Choi
Cefepime is a fourth-generation cephalosporin that covers gram-positive bacteria and gram-negative bacteria, such as Pseudomonas. A 48-year-old male patient underwent a posterior tibial artery perforator-based fasciocutaneous turnover flap and was administered cefepime. After 2 days, the patient showed neurological symptoms, such as cognitive decline and aphasia. We immediately stopped cefepime and changed to ciprofloxacin. In addition, thiamine was administered and additional dialysis was performed. The neurological symptoms were resolved after tapering cefepime and hemodialysis. In patients undergoing flap surgery, especially those with impaired renal function, cefepime should be administered carefully considering the risk of neurotoxicity.
{"title":"Cefepime-induced neurotoxicity after flap surgery: a rare case report","authors":"W. Song, Chan Yeong Lee, H. Ryu, J. Byeon, Hwanjun Choi","doi":"10.12790/ahm.22.0057","DOIUrl":"https://doi.org/10.12790/ahm.22.0057","url":null,"abstract":"Cefepime is a fourth-generation cephalosporin that covers gram-positive bacteria and gram-negative bacteria, such as Pseudomonas. A 48-year-old male patient underwent a posterior tibial artery perforator-based fasciocutaneous turnover flap and was administered cefepime. After 2 days, the patient showed neurological symptoms, such as cognitive decline and aphasia. We immediately stopped cefepime and changed to ciprofloxacin. In addition, thiamine was administered and additional dialysis was performed. The neurological symptoms were resolved after tapering cefepime and hemodialysis. In patients undergoing flap surgery, especially those with impaired renal function, cefepime should be administered carefully considering the risk of neurotoxicity.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116354781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Byungjoon Yoo, K. Oh, Junekyu Kim, K. Kim, H. Shin
There are no treatment guidelines for the extravasation of contrast medium. A 71-year-old man underwent coronary artery computed tomography. When contrast medium (iohexol) was injected through the right cephalic vein, massive leakage into the surrounding tissues occurred. A physical examination showed severe swelling of the hand and a prolonged capillary refill time. X-rays showed a massive accumulation of contrast medium in the hand. We immediately performed surgical treatment, including four skin incisions on the hand, subcutaneous dissection, and squeezing, which led to the removal of 50 mL of liquid. The immediate postoperative radiographic findings showed dramatic fading of most of the contrast medium. Four days postoperatively, radiography showed complete dissolution of all contrast medium, and a physical examination revealed full recovery of skin color and capillary refill time. We successfully managed massive extravasation of contrast medium in the hand with immediate surgical treatment. An immediate surgical approach for massive extravasation should be considered to achieve favorable outcomes.
{"title":"Immediate surgical treatment for massive extravasation of computed tomography contrast medium in the hand: a case report","authors":"Byungjoon Yoo, K. Oh, Junekyu Kim, K. Kim, H. Shin","doi":"10.12790/ahm.22.0051","DOIUrl":"https://doi.org/10.12790/ahm.22.0051","url":null,"abstract":"There are no treatment guidelines for the extravasation of contrast medium. A 71-year-old man underwent coronary artery computed tomography. When contrast medium (iohexol) was injected through the right cephalic vein, massive leakage into the surrounding tissues occurred. A physical examination showed severe swelling of the hand and a prolonged capillary refill time. X-rays showed a massive accumulation of contrast medium in the hand. We immediately performed surgical treatment, including four skin incisions on the hand, subcutaneous dissection, and squeezing, which led to the removal of 50 mL of liquid. The immediate postoperative radiographic findings showed dramatic fading of most of the contrast medium. Four days postoperatively, radiography showed complete dissolution of all contrast medium, and a physical examination revealed full recovery of skin color and capillary refill time. We successfully managed massive extravasation of contrast medium in the hand with immediate surgical treatment. An immediate surgical approach for massive extravasation should be considered to achieve favorable outcomes.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124709329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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