Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair

BACKGROUND: Optimal surgical management of digital nerve lesions remains uncertain despite the publication of numerous studies. The purposes of this review were primarily to analyze whether there is a superior surgical technique for digital nerve repair and secondarily to statistically verify the variables to be predictors of sensory recovery. METHODS: A literature search was performed using PubMed including citation from MEDLINE. Studies were included if they involved patients with digital nerve lacerations in whom end-to-end neurorrhaphy, nerve grafts, conduits, or end-to-side neurorrhaphy were performed. Further, the sensory outcome had to be assessed according to the modified American Society for Surgery of the Hand guidelines to stratify for two-point discrimination in millimeters. The variables age, follow-up, delay in repair, type of trauma, and gap length were extracted. The association between each predictor and response was assessed using a linear mixed model and corrected for heterogeneity between studies. Significance was considered present at p ≤ 0.05. RESULTS: Of the 34 articles found, 14 articles were included giving appropriate individual data for 191 nerves. There was no statistically significant difference in outcome between operation techniques. Age and follow-up were verified predictors of sensory recovery. CONCLUSION: In this review, the type of operation for digital nerve repair does not influence sensory outcome. However, we verified outcome to be influenced by the patient’s age and the follow-up period. To add more scientific evidence to our results, larger cohort prospective studies need to be done with better detailed description of data

Hyperbaric oxygen treatment for skin flap necrosis after a mastectomy: a case study

The rate of complications in immediate breast reconstruction is in 15% to 20% due to partial loss of the mastectomy skin flaps. In the case of skin necrosis or ischemia, a therapy that reduces skin loss could be of additional benefit. Hyperbaric oxygen has been used to treat compromised flaps and grafts, an indication recognized and reimbursed according to the Undersea and Hyperbaric Medical Society (UHMS). So far, hyperbaric oxygen has not been previously reported as therapy for full-thickness breast skin flap necrosis on patients with a direct reconstruction with silicone implants after a skin-sparing mastectomy. This report presents such a case, in which a 52-year-old woman carrier of the BRCA2 mutation gene was successfully treated with hyperbaric oxygen therapy

A comparative study of colour and perfusion between two different post surgical scars. Do the laser Doppler imager and the colorimeter measure the same features of a scar?

BACKGROUND/PURPOSE: The purpose of this study was to investigate the influence of different located post surgical scars on both perfusion and redness. The pattern of change and correlation between perfusion and redness of post surgical scars is also examined. METHODS: In this study, we measured redness and perfusion of the abdominal and breast scar of 24 women undergoing breast reconstruction with Deep Inferior Epigastric Perforator Free Flap surgery with the Minolta Chromameter CR-400/410 and the Moor Instruments laser Doppler imager 12IR, respectively, at different intervals post-operatively. RESULTS: The laser Doppler imager gives significantly higher values for the abdominal compared with the breast scar. There was no consistent correlation found between perfusion and redness at the different test moments for both locations. The scores of both parameters were significantly associated after 9 months follow-up for both locations. CONCLUSION: Scars closed with higher mechanical force show higher perfusion and prolonged activity; and more redness is associated with more perfusion for both post surgical scars. Nevertheless, there was no consistent correlation found between these parameters making the laser Doppler imager and the Colorimeter still non-replaceable instruments