Olecranon bone grafting for the treatment of nonunion after distal finger replantation

Aim: Although not very popular, the olecranon bone graft is a useful option for this type of operation due to the minimal donor morbidity and its ease of use in small bone defect reconstruction and non-union therapy. To our best knowledge, few studies have evaluated the use of the olecranon bone graft as a treatment for non-union after distal finger replantation. Our aim in this report was to present our experience of using olecranon grafts in our nonunion patients undergoing distal replantations.Methods: Between 2013 and 2019, a total of 14 patients who developed nonunion or had segmental bone defects due to the injury were included in the study. Retrospectively the results were analyzed in terms of complication and union rates.Results: The mean follow-up period was 37 months (range 8-72 months). No major complications were seen in the donor region or recipient regions. One patient developed necrosis in the nail bed and one patient had a hematoma in the donor site. The minor complications were solved without any problem.Conclusion: In conclusion, we found the olecranon bone grafting for the treatment of nonunion after distal finger replantation is a safe and convenient method. It can be preferred as the first choice for nonunions of distal finger replantations

Possibility of Taking an Offensive Stance in Extravasation Injury: Effects of Fat Injection in Vesicant (Doxorubicin) Induced Skin Necrosis Model in Rats

Introduction Extravasation injuries are one of the most feared complications of intravenous drug administration. The most common drugs associated with extravasation injury include chemotherapy agents and contrast media. Natural course of vesicant extravasation is discomfort, pain, swelling, inflammation, and ultimately skin ulceration. While diligence is the principle approach in prevention, immediate bed-side measures are as important in controlling the extent of tissue damage. Various options, either medical or interventional are next steps in treatment of the condition including antidotes, volume dilution, flushing, suction, hyperbaric oxygen therapy, and surgery. Materials and methods 12 male Wistar albino rats were divided into two groups; one group received fat injections following subdermal doxorubicin infiltration in their right thighs, while other group received saline injection following subdermal doxorubicin infiltration in their right thighs for dilution. Left thighs of both groups were left untreated following subdermal doxorubicin infiltration. Total area of necrosis, as well as resultant epidermal thicknesses were assessed. Histological analyses were conducted using modified Verhofstad scoring system for comparison. Results Mean necrotic area was significantly smaller in the fat injection group compared to other groups. Median Verhofstad score was lesser in the fat injection group as well. Median epidermal thickness, on the other hand, was greater in the fat injection group. Conclusion Injection of fat grafts following vesicant extravasation might be beneficial in preventing the progression of tissue damage, if employed early

Management of upper extremity war injuries in the subacute period: A review of 62 cases

Objective: In this study, we aimed to describe the relationship between the localization of rarely seen upper extremity war injuries and their complications in the subacute period, and define our preferences for surgery and antibiotic use. Methods: Patients with an upper extremity war injury who presented to our institution between 2015 and 2018 were retrospectively evaluated. Data regarding demographics, time between injury and presentation, location of injury, type of damage, complications, treatment methods, infection rates and antibiotic use were recorded. Tissue defects, fracture fixation, neurovascular damage, infection development and treatment approaches were analyzed. Results: Sixty-two male patients with isolated upper extremity injuries (mean age: 31.66 +/- 8.28 years) were included in the study. The average time between trauma and hospitalization was 14 days. The mean hematocrit (Hct) level at presentation was 36.3 +/- 6.8%. Patients had been followed up for an average period of 95.6 +/- 32.1 days. Twenty-nine patients (46.8%) had nerve injury, eight (12.9%) had arterial injury that required repair, and 23 had infection (37.1%), of which five developed osteomyelitis. Infection was polymicrobial in nine cases and monobacterial in 14. A positive correlation was found between the presence of fracture and nerve injury (p = 0.013). The frequency of nerve injuries due to gunshot wounds was higher in the mid-section and lower part of the arms and in the proximal forearm when compared to other regions (p = 0.011). The infection rates were significantly higher in patients with fractures (p = 0.033). The mean hematocrit (Hct) level at presentation of the patients with infection (32.1 +/- 6.3%) was significantly lower than that of those who did not have infection (38.8 +/- 5.9%) (p<0.001). Conclusion: Upper extremity war injuries require case-specific solutions. Microbiological samples should be taken prior to empirical antibiotic treatment for infection management and rational antibiotic use principles should be applied according to the culture and antibiogram results. The holistic and ambiguous character of nerve injuries often requires early exploration and combined reconstructive interventions. Arterial injuries can be overlooked by physical examination alone and thus routine angiography should be performed. Completion of the bone and soft tissue reconstructions in the same session using a holistic approach minimizes the possible risks. (C) 2020 Elsevier Ltd. All rights reserved