Effect of negative-pressure wound therapy on open fractures of the lower limb

<p><b>INTRODUCTION</b>Early debridement and coverage has long been regarded as the standard of care for open fractures of the lower limb, as infection is a serious complication. However, the best time for wound closure remains controversial. Negative-pressure wound therapy (NPWT) is thought to result in reduced flap infection and failure. To determine the effect of NPWT, we reviewed patients with open fractures of the lower limb and compared the rates of infection and flap failure in two time-based cohorts.</p><p><b>METHODS</b>Two cohorts of patients (periods 2003-2004 and 2008-2009) with Gustilo type IIIB open tibial fractures were recruited and their outcomes were compared. In the 2003-2004 cohort, wounds were dressed with occlusive dressing. In the 2008-2009 cohort, all patients underwent NPWT. Data was retrospectively analysed with regard to infection, failure, age, type of flap, comorbidities and defect size. The incidences of infection and flap failure were further analysed for any statistical difference between the different treatment protocols.</p><p><b>RESULTS</b>In the 2003-2004 cohort, 33% of patients developed infection and 11% had flap failure. However, in the 2008-2009 cohort, 10% of patients developed infection and 6% had flap failure. The difference in the incidence of infection was statistically significant between the two cohorts (p = 0.029).</p><p><b>CONCLUSION</b>Patients in the 2008-2009 cohort had better outcomes, and we are of the opinion that performing NPWT may have contributed to this result.</p>

Clinical assessment of absence of the palmaris longus and its association with other anatomical anomalies-- a Chinese population study

<p><b>INTRODUCTION</b>Ethnic variations in the prevalence of absence of the palmaris longus (PL) are well known. Many techniques for clinically determining the presence of the PL have been described. Studies have also attempted to correlate its absence with other anatomical anomalies. However, most studies have been done in Caucasian populations.</p><p><b>MATERIALS AND METHODS</b>The presence of the PL was clinically determined in 329 normal Chinese men and women using the standard technique. In subjects with an absent PL, 4 other tests were performed to confirm absence and an Allen's test was done to assess the palmar arches. All subjects were examined for the presence of the flexor digitorum superficialis (FDS) to the little finger.</p><p><b>RESULTS</b>The overall prevalence of absence of the PL was 4.6%. All techniques were equally effective in determining the absence of the PL. There was no significant difference in its absence with regard to the body side or sex. Absolute deficiency of FDS to the little finger was seen in 6.4%. No correlation could be detected between the absence of the PL and FDS of the little finger.</p><p><b>CONCLUSIONS</b>The prevalence of absence of the PL and absence of FDS to the little finger in a Chinese population is much lower compared to previous reports in the literature. There is no association between absence of the PL and absence of the FDS to the little finger. Although all techniques of examining for the absence of the PL are equally effective, the method suggested by Mishra seems the best as it was easily understood by subjects and can be used even when thumb abduction is not possible.</p>