[Compartmental syndrome in a traumatized patient under VKA a case report]

Oral anticoagurlation inducing bleeding is a worrying problem because of its frequency and potential gravity. The major determinants of haemorrhage are drug interactions and patient characteristics such as heredity, kind of food and age. Authors report the case of a 76 years old diabetic man with a history of atrial fibrillation treated by vitamin K antagonists [VKA] for more than two years. He presented with a compartmental syndrome of the upper right limb consecutive to a trauma that had been treated by nonsteroidal anti-inflammatory [NSAI] drugs. So he was admitted in an intensive care unit, the NSAI drugs were interrupted and the VKA substituted by low-molecular-weight heparin, while the affected limb was elevated and the patient prepared for operation. But a prolonged prothrombin time [Fr], along with the patient's delayed presentation, were reasons to delay surgery. Course was unusually favourable, nerve suffering signs disappeared and resorption of haematoma was noted. Authors remind in this paper the high risks of drug interactions VKA-NSAI, which can lead to a compartmental syndrome. They also remind the indications of surgical decompression depending on the time of presentation

[ importance of pediculous latissimus dorsi flap in reconstructive surgery about 44 cases]

The authors present a series of 44 cases of pediculous latissimus flaps operated these last ten years at Sahloul Hospital Sousse. They insist on the vascular reliability of this flap and on the importance of its rotation arch for covering the lost of cutaneous substances of the cervico-thoraco-brachial area

Forearm island flaps in the coverage of soft tissue defects of the hand: about 22 cases

Soft-tissue defects of the h and exposing deep structures, and those interesting whole plastic units, especially web spaces, do require coverage by flaps. The use of forearm isl and flaps has widely improved the surgical treatment of h and soft-tissue defects. The authors describe in this series the use of three isl and flaps for the optimum reconstruction of the dorsal and volar skin of both h and and wrist, as well as the digital web spaces.Chinese flap was used in 11 cases, dorsal ulnar artery flap in 9, and retrograde posterior interosseous artery flap in 2. The choice of the kind of flap should warrant the recovery of a good functional and aesthetic result to the h and, and this work shows that the three flaps herein used don't rule each other out, but advantages of one are limitations of the other