Fournier's gangrene: what are the prognostic factors? Our experience with 40 patients

Fournier's gangrene [FG] is a serious, extensive fulminant infection of the genitals and perineum. Indeed, despite antibiotics and aggressive debridement, the mortality rate of FG remains high. Through our experience, we intent to identify effective factors in the survival of patients with FG and we try to determine how the Fournier's gangrene severity index score [FGSIS] is accurate. Between 1995 and 2010, 40 patients with Fournier's gangrene were treated in our institution. All of them were treated with broad spectrum triple antimicrobial therapy, broad debridement and exhaustive cleaning. Then they underwent skin grafts or delayed closure as needed. Data were collected on demographics, medical history, predisposing factors of FG, etiological infection agents, admission signs and symptoms, physical examination, admission laboratory studies and bacteriology. Timing and degree of surgical debridement as well as outcomes were also reviewed. The extent of disease was calculated from body surface area nomograms. All the 40 patients included in this study were males; their mean age was 52,75 years [21-75 years]. Twelve patients [30%] had FG secondary to anorectal pathological conditions. No etiologic factors of FG were found in 6 patients [15%]. Diabetes mellitus as predisposing factor was found in 13 patients [32.5%]. The mean hospital stay was 8.72 days [range, 3 to 30]. All the patients underwent surgical debridement. Orchidectomy was done in 7 cases [17.5%]. Skin grafts were applied to 6 patients [15%] and the remaining wounds, once cleaned, were approximated. The overall mortality rate was 17.5% [7 patients] due to severe metabolic acidosis in relation to diabetic decompensation and sepsis. We individualized two groups: those who died [n = 7] and those who survived [n = 33]. We evaluated the admission laboratory parameters that are significantly correlated with outcome included hematocrit [p=0.003] and serum sodium [p=0.05]. The extent of body surface area involved among patients who died was not found significantly different statistically between the two groups [4.07% and 3,14%, p=0,4]. The mean FGSIS [without counting bicarbonate serum level] for survivors was 9.1 compared with 6,8 for non-survivors [p=0.16]. FG is a rapidly progressive, fulminant infection's condition. Hematocrit and serum sodium levels were found to be the only prognostic factors. It doesn't seem that the FGSIS has a prognostic value

Nonunion of the scaphoid treated by anterior vascularized bone graft: a review of 26 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical and radiological outcome of anterior vascularized bone graft in the treatment of primitive nonunion of the scaphoid.</p><p><b>METHODS</b>This is a retrospective study of 26 scaphoid nonunion cases treated by this technique between 2004 and 2009. The mean age was 38 years. Nonunion was of types IIA and IIB according to the Alnot's classification and only one case showed a proximal pole necrosis (type IV). The fixation was ensured by K-wire. The mean immobilization period was 9 weeks.</p><p><b>RESULTS</b>At mean 19 months follow-up, the bone union rate was 88.5%. Failure was noted in three cases. No significant complications secondary to this technique were observed. The mobility in extension and flexion had an average recovery of 18 degree Nineteen patients (73%) were free of pain, and the others had occasional pain.</p><p><b>CONCLUSIONS</b>It is a meticulous surgical technique that provides better union rates than those of conventional scaphoid graft. This technique is first adopted in cases of failure of conventional grafts in the treatment of scaphoid nonunion but the encouraging results suggest expanding indications to primitive nonunion.</p>

Upper limb compartment syndrome after an adder bite: a case report / 中华创伤杂志(英文版)

Compartment syndrome after an adder bite is extremely rare, whose effects are only secondary to the cytotoxic and hemorrhagic effects of venom. Here we reported a case of compartment syndrome in the upper limb following an adder bite in the thenar eminence. Elevated compartment pressure was documented and immediate surgical fasciotomy was practiced. The patient achieved complete recovery with a good functional result. We discussed the controversies on fasciotomy and non-invasive measures in such a situation, and recommended intracompartmental pressure monitoring during the management of compartment syndrome following adder bites.

[Pseudotumoral villonodular synovitis: a case report]

Pseudotumoral pigmented villonodular synovitis is rare and diagnosis is difficult. Report of new case. We report an original observation of a pseudotumoral pigmented villonodular synovitis occurred in a 28 years old patient with no recurrence after surgical treatment. A review of the literature was made in order to precise the epidemiological, diagnostic and therapeutic characteristics

[Osteomalacia and giant cell tumor: a rare case]

Oncogenic octeomalacia is an unusual and rare clinicopathologic syndrome characterized by mesenchymal tumors that apparently produce osteomalacia and biochemical abnormalities consisting of hypophosphatemia and normocalcemia. We have investigated the mechanism by which a giant cell tumor of bone caused biopsy-proved osteomalacia in a 50-year-old woman. A 50-year-old woman presented with generalized bone and pelvicrural pain, associated with fatiguability and muscle weakness. The diagnosis of osteomalacia was retained, associated with a giant cell tumor. The coexistence of giant cell tumor of bone and osteomalacia suggested the diagnosis of oncogenic osteomalacia. Resolution of the biochemical abnormalities of the syndrome after tumor resection, established this diagnosis. oncogenic osteomalacia can be a form of vitamin-D-refractory osteomalacia due to altered vitamin D3 metabolism

[ sacrified of sacrifice day]

This prospective study was carried out in the plastic and reconstructive surgery department of Kassab's hospital in Tunis and the hospital of Monastir [Tunisa] during the sacrifice day [Aid el kebir]. The study involved 50 patients. Our purpose was to identify the injuries of the hand occurring during this religions festival. The average age of patients was 39 years with sex ratio of 1.17. All socials and occupational sectors were affected. The lesions concern the dorsal face of non dominant hand [72%] with a peak in the frequency for the thumb [40%] and the index [37%]. Extensor system of the radial finger on the non dominant hand was the main delicate element which is most exposed during such festival. The thumb is being worthy of special mention, for it is the most serious lesions [amputation 10%]. The lesions of flexor tendons are generally associated with nerve and vascular injury. 46% of patients had to undergo surgery

[About a short series of Swanson arthroplasty]

The authors report a series of 12 patients who underwent digital arthroplasty using a Swanson implant. Six patients had the sequellae of an injured hand, and the other six patients had rheumatoid arthritis. The majority of patients were men with an average age of 33 years. The patients were examined again about 4 years later on average. The lateral stability of the operated finger was considered to be satisfactory in 11 cases. The mean movement gain was 40. There was no sign of silicone particle synovitis, because it was fixed arthroplasty

main de toupie aspect medico legal

The hand is frequently exposed to professional risks. It is offen the target of accident during non protected work on a topia and many complex and grave lesions can be caused. The authors report a serie of 280 cases of topary hand treated in private and hospital sectors. The purpose of our work is is on the hand to insist on the frequency of topiary work accidents and on the other hand to make people of the importance of applying preventive measures in orde to protect man by reducing professional risks