Does Low-Dose Heparin Have a Significant Role in Free Flap Surgery?

BACKGROUND: It is controversial issue that heparin decreases thrombosis for microsurgical anastomosis, and its effective role is under discussion. This study is for proving whether low-dose heparin is preventing thrombosis in free flap reconstruction. METHODS: Through chart reviews of 134 patients, using low-dose heparin for free tissue transfer from 2011 to 2016, retrospective analysis was performed. 33 patients received low-dose heparin therapy after surgery. And 101 patients received no-heparin therapy. Complications included flap necrosis, hematoma formation, dehiscence and infection. RESULTS: In no-heparin therapy group, comparing the flap necrosis revealed 16 cases (15.84%). And, flap necrosis was 6 cases (18.18%) in low-dose heparin therapy group. The statistical analysis of flap necrosis rate showed no significant difference (p=0.75). The results showed that there was no significant difference of flap necrosis rate between two groups. CONCLUSION: In this study, patients in the low-dose heparin group had no significantly lower rates of flap failure compared with no-heparin group. This suggests that low-dose heparin may not prevent thrombosis and subsequent flap failure to a significant extent.

Concurrent Two Types of Burn with Airbag in an Upper Extremity: Case Report

Automobile airbags have been shown to reduce morbidity and mortality in the event of a vehicle crash; however, new problems have been identified. Among these problems, direct injury from the airbag itself has become a serious concern. This suggests that an airbag itself may not be safe. Burn injury from airbags accounts for about 7.8% of all injuries caused by vehicle crashes. There are three types of burn injuries from airbags: Thermal, chemical, and frictional. Moreover, there are three subtypes within the category of thermal airbag burn, as identified by Tsunetuki in 2003. Herein, we review a case of an airbag burn and report a unique burn case on ‘an upper extremity’, including both thermal and frictional burns.

Reverse Digital Island Flap with Skin Strip Retention to Prevent Flap Congestion

PURPOSE: The reverse digital island flap is useful for the repair of various fingertip injuries. We present a modified surgical technique with skin strip elevation for the prevention of postoperative congestion. METHODS: From January 2005 to October 2015, we performed 31 reconstructive procedures for finger injury using a reverse digital artery island flap with and without skin strip retention. Patients' clinical characteristics, surgical outcomes, and complications were investigated. RESULTS: All flaps survived and there were no donor site problems. The mean follow-up time was 5 months (range, 3-8 months). In skin strip retention group, mild venous congestion was observed in 1 case, although it resolved spontaneously. Another case retained flexion contracture, and 2 patients had stiffness at the distal interphalangeal joint. Whereas, in no retention group, venous congestion was observed in 3 cases, 1 patient had partial flap necrosis and 2 patient suffer in flexion contracture at metacarpophalangeal joint. CONCLUSION: The reverse digital island flap procedure produces consistent results and is reliable for the treatment of fingertip injury. Our modified surgical technique of elevating the flap accompanied by skin strip retention helps prevent postoperative congestion.