Ectopic major transplantation for salvage of upper and lower extremity amputations / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Ectopic tissue transplantation is not a new idea. Godina and his colleagues pioneered this method in the 1980s. This method is a last resort method of preserving an amputated body part, which consists of banking the amputated segment in an ectopic area and returning it to its native place at a later date. In this article we present our experience with this demanding procedure.</p><p><b>METHODS</b>Debridement was the mainstay of this procedure. The stump and amputated part are carefully debrided and the stump was either closed primarily or covered by a flap. The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting.</p><p><b>RESULTS</b>Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study. The overall success rate was about 70%, lower than expected but these are cases of severe crush injury. Although the functional recovery of these patients are very low, all of the successful cases except one could find a job as a janitor or light manual worker. No patient could return to his previous job.</p><p><b>CONCLUSION</b>Ectopic transplantation of body parts is an accepted method of treatment of severely crushed extremity or finger injuries. In our country an amputee has very little chance of finding a job instead a disabled person can. In addition in Iran cultures amputation is seen as punishment of either the God or the society, so it is not well accepted and many patients persist on saving the limb even with no functional recovery. None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers.</p>

Management of treadmill hand injuries using soft tissue distraction

In the modern day cities, home treadmill usage is increasing. Toddlers are prone to a special injury by the treadmill, during workout the toddler tries to get on the belt and the roller action pulls the fingers under the belt and get caught between the belt and a ; metal rod under the machine and the belt scrapes the fingers. If untreated some of these injuries will lead to flexion contracture. The usual treatment is release of contracture and skin grafting, however, graft discoloration and recurrence of contracture are the complications of this method and the patients usually seek treatment for the brown discoloration of the grafts at a later age. In this study we assess the results of Z-plasty in combination with soft tissue distraction without skin grafting with long term usage of splint as an alternative treatment for these patients. In this retrograde descriptive cross-sectional study, we evaluated the patients presented with treadmill hand injuries between the years 2006 and 2011. Demographic data including age and sex in addition to other information including location of trauma, severity of trauma, time elapsed between the trauma and treatment, type of treatment including wound care and surgical method and treatment outcomes were assessed. A total of 8 patients [3 girls and 5 boys] following finger treadmill injury were assessed. 15 fingers in 7 patients had volar injury. The middle finger was the most commonly injured finger. In all patients a minimum of 2 fingers were injured and in just l patient 3 fingers were injured. In long-term follow-up all the patients had acceptable volar skin and complete ROM of the fingers. Due to discoloration of the skin graft and recurrence of contracture following skin graft as the sole treatment for the injury, application of Z-plasty with soft tissue distraction and long term splints seems to be a proper alternative treatment for these patients