Reconstruction of Wrist Defects with Free Flaps in High Tension Electrical Burn Patients

High tension electrical burns affecting the wrist are likely to produce full thickness necrosis of the skin and to damage deep vital structures beneath the eschar, affecting he local tendons, nerves, vessels, even bones and joints which result in serious dysfunction of the hand. An aggressive approach to the treatment of these severe wounds and adequate wound coverage are essential for the successful result. From October 1997 to February 2000, we had treated 23 electrical wrist injuries in 20 patients with free flaps. Among these, 13 anterolateral thigh flaps, 5 forearm flaps, 2 scapular flaps, 2 parascapular flaps, and 1 medial leg flap were executed. About 2-4 weeks after initial injury, we tried free flaps. Preoperative debridement was not carried out. At the time of surgery, debridement of all nonviable tissue was done, but nerves, tendons, and bones were left in place with minimal or no debridement when they had anatomic continuity, regardless of their appearance of viability. In all cases, successful soft tissue coverage and wound healing were achieved, and we obtained the following conclusions. 1. Flap coverage should be executed before damage of the tendons, nerves, vessels. 2. As long as the free flap survives, the infected tendons, nerves, and denuded bone can be salvaged. 3. For later reconstruction of the wrist, fasciocutaneous flap should be preferred to promise tendon gliding and endure several operative procedures.

Combined Facial and Abducens Nerve Palsy in Pontine Infarction

Isolated cranial neuropathies involving the facial nerve are very rare manifestations of pontine infarction, and have not been described in paramedian pontine infarction. We report a 67-year-old woman who developed sudden and long-lasting right facial nerve paralysis accompanied by transient ipsilateral abducens nerve palsy. Brain magnetic resonance imaging showed two discrete simultaneous infarctions in the right inferior paramedian pontine area, which seemed to correspond to the facial nerve fascicle and the abducens nerve fascicle, respectively. Paramedian pontine infarction can be one of the causes of facial nerve palsy and present as an isolated or predominant sign.

A case of CNS Cryptococcosis with internucleat ophthalomoplegia

Ocular disturbances related to cranial nerve lesion or increased intracranial pressure are well known in cryptococcal meningitis, but internuclear ophthaloplegia is very rare and only two cases have been reported to our knowledge. We report the third patient of internuclear ophthalmoplegia in cryptococal meningitis. The internuclear ophthalmoplegia in our case persisted for one year with a demonstrable lesion in brain MRI, in contrast to the other cases in which intranuclear ophthalmoplegia was transient and no responsible lesion was observed.