Leeching as salvage venous drainage in ear reconstruction: Clinical case and review of literature

Background: Ear avulsion is a rare complication of different traumas, such as car accidents, human or animal bites and stab wounds, and can result in dramatic cosmetic consequences for the patient. Ear replantation, revascularization, and reattachment are the options offering best aesthetic results. But venous outflow insufficiency is responsible for a high rate of failures. Leeching is one the most efficient methods to relieve venous congestion. It has been used as an alternative venous outflow in case of severe impairment of the physiologic one. Methods: We present a case of successful rescue of a congested reattached ear by leeching after subtotal avulsion, along with a review of the literature on cases of avulsed auricle reconstruction salvaged by hirudotherapy. Data were collected and analyzed to identify a best regimen to deal with venous congestion. Results: More than 130 cases of avulsed auricle savage are described in the literature, in a fourth of which leech therapy was used in the management of venous congestion. Discussion: In case of both venous outflow deficit or absence, leeches are a potentially successful option to correct the congestion while new veins reestablish normal physiology. The need for anticoagulant/antiaggregant therapy, antibiotics, and often blood transfusion are the main pitfalls of leeching. Conclusion: Leeches can be considered a salvage method for ear replantation and reattachment in those cases that lack venous outflow in the presence of valid arterial inflow

Extensor mechanism variation of the index finger

WOS:000377227900022PubMed ID: 27130399The extensor indicis proprius (EIP) tendon and extensor digitorum communis (EDC) tendons are the main extensor tendons of the second finger. Different variations of extensor tendons are frequently reported. In our report, we describe a variation of the index finger extensor mechanism in a healthy subject

JOURNAL OF WOUND CARE

Objective: In this study, effectiveness and reliability of negative pressure wound therapy (NPWT) in the early period after replantation will be examined retrospectively in a series of patients. Method: Patients who underwent replantation between 2007 and 2014, and had tissue defect or partial necrosis in the absence of a major circulation problem were included in this retrospective study. Following debridement of necrotic tissues on the postoperative 7-10 days, NPWT was applied to all patients one day later and adjusted as intermittent 75 mmHg pressure. Intermittent phase adjustment was arranged as 5 minutes suction and 2 minutes resting, and resting pressure was adjusted as 35 mmHg. NPWT was applied for six days and dressings were changed in every three days in the first six day period. Open wounds was debrided again and grafted with split-thickness skin graft and NPWT was continued over the graft for 4 days more. Results: There were 11 patients included of which nine amputations were complete and two were nearly total amputations of forearm. Granulation tissue was observed following 6 days of NPWT application in all patients. Graft survival was observed to be almost complete. Wound infection did not occur and tissue cultures obtained in the course of debridement were all negative. Partial oxygen saturations were between 96-99% during the NPWT. Conclusion: NPWT (75 mmHg) can be used in the intermittent mode in order to improve wound healing and shorten the period to start physical therapy in the early period after replantation and revascularisation

Use of a Temporary Shunt as a Salvage Technique for Distal Extremity Amputations Requiring Repair by Vessel Grafting during Critical Ischemia

Background Although the use of temporary shunts in proximal extremity amputations has been reported, no study has described the use of temporary shunts in distal extremity amputations that require vein grafting. Moreover, the total volume of blood loss when temporary shunts are used has not been reported. The aim of this study was to investigate the applicability of a temporary shunt for distal extremity amputations requiring repair by vessel grafting with an ischemia time of >6 hours. This study also aimed to determine the total volume of blood loss when temporary shunts were used. Methods Patients who underwent distal major extremity replantation and/or revascularization with a vessel graft and who experienced ischemia for 6–8 hours between 2013 and 2014 were included in the study. A 6-Fr suction catheter was cut to 5 cm in length after the infusion of heparin, and secured with a 5-0 silk suture between the distal and the proximal ends of the artery. While bleeding continued, the bones were shortened and fixed. After the complete restoration of circulation, the arterial shunt created using the catheter was also repaired with a vein graft. Results Six patients were included in this study. The mean duration of ischemia was 7.25 hours. The mean duration of suction catheter use during limb revascularization was 7 minutes. The mean transfusion volume was 7.5 units. No losses of the extremity were observed. Conclusions This procedure should be considered in distal extremity amputations requiring repair by vessel grafting during critical ischemia

Development of osteomyelitis secondary to a snakebite: Case Report

The Viperidae family is responsible for most of the venomous snakebites in Anatolia. Toxicity symptoms may be local such as edema, hyperemia, blisters, necrosis, lymphadenopathy, and ecchymosis or hematological, including high white blood cell (WBC), neutrophilia, decrease in hemoglobin, thrombocytopenia, international normalized ratio (INR) elongation, and increase in creatine kinase (CK), tumor necrosis factor alpha (TNF and #945;), and lactate dehydrogenase (LDH). Antivenom thera- py should be provided if hyperemia continues and/or edema does not regress. Complications are very low in envenomation cases related to Viperidae bites with proper treatment and follow-up. Otherwise, complications can progress to necrosis, acute renal failure, compartment syndrome, amputation, and death may be seen. However, no report in the literature has described osteomyelitis as a late complication of snakebite. In this study, we present an osteomyelitis case caused by snakebite culminating in amputation because of the inadequate treatment. [Arch Clin Exp Surg 2016; 5(3.000): 180-183