High-pressure injection injuries to the hand: A 14-year descriptive study.

BACKGROUND: High-pressure injection (HPI) injury is an unusual type of injury in hand trauma, which could lead to a serious morbidity. We aimed to assess the clinical presentation, management, and outcome with HPI injury of the hand. METHODS: A retrospective study was conducted between 2001 and 2015 for patients with HPI injuries who were admitted to a Level 1 trauma center. We reviewed the medical records, imaging files, and demographic data including gender, age, mechanism of injury, and site of hand injury. The kind of injected materials, time to first treatment procedure, clinical management, and complications were also described. RESULTS: A total of 32 cases of HPI injuries were included in the study. The average age of the patients was 32.7 ± standard deviation 8.3 years, and all the patients were right handed. The most common material involved was grease (53%), followed by paints (25.0%), chemicals (9.4%), and air (6.3%). The most commonly affected part of the hand was the palm (31.3%), followed by index finger (25.0%). The average delay in the presentation was 12 h (range 3-96 h), and the mean hospital stay was 5.8 days. Management included debridement (90.6%) or conservative treatment (9.4%). Complications included chronic pain (9.4%), followed by amputation (3.1%). CONCLUSIONS: HPI injury is not uncommon, usually underestimated, and needs more community awareness, particularly laborers. Delay of treatment could increase the risk of amputation. Therefore, it is important to inform the risk groups about the seriousness of such injuries and to take preventive measures.

A Rare Presentation of Axial Chordoma and the Approach to Management.

BACKGROUND Chordoma is a primary bone tumor that most commonly arises in the sacrococcygeal vertebrae and the spheno-occipital areas. Chordoma is a malignant tumor that should be distinguished from benign notochordal cell tumor (BNCT) of the spine. This report is of a rare case of axial chordoma and describes the challenging approach to diagnosis and management. CASE REPORT A 50-year-old woman presented with a one-year history of a slowly growing swelling in the sacral region. She complained of numbness and progressive weakness in both lower limbs, and urinary incontinence. Computed tomography (CT) imaging showed a large destructive lesion involving the sacrum and coccyx with cranial extension to level S2 and invasion of the right and left S2-S3 neural foramina, sacral nerves, left gluteus maximums muscle, and adjacent subcutaneous tissue. The management approach included the early involvement of a multidisciplinary clinical team. En bloc resection of the tumor through an anterior and posterior approach was performed, and the defect was reconstructed later using bilateral rotational gluteal fascial flaps. CONCLUSIONS Axial chordoma is a very rare, locally aggressive, and highly recurrent primary tumor of bone. The clinical management is challenging and requires early involvement of a multidisciplinary team. Following surgical resection, careful selection from limited available reconstructive surgical options is necessary to ensure that the surgical defect is repaired.

Intravascular extra-digital glomus tumor of the forearm.

Intravascular glomus tumor in the forearm is very rare and usually presents with persistent pain and focal tenderness. The diagnosis of this condition can be easily missed or delayed. There is no successful treatment so far other than surgical excision in most of cases. We presented a 45-year-old female presented with intravascular glomus tumor in her left forearm. The swelling was excised and the post-operative course was uneventful. Intravascular glomus tumor of the forearm is extremely rare and the persistent pain and tenderness are very suspicious. Diagnostic imaging may not be indicated in every case.

Management of Giant cell tumor occupying the 5th metacarpal bone in 6 years old child.

Giant cell tumor of the bone (GCTOB) is a relatively uncommon tumor of the bone. It is characterized by the presence of multinucleated giant cells. Giant-cell tumor of the bone accounts for 4-5% of primary bone tumors and ∼20% of benign bone tumors. Giant cell tumors of the hand are rare, accounting for only 2-4% of all giant cell tumors. Giant cell tumor (GCT) of the bones of the hand has some special features as compared to GCT at other sites. Because of the aggressive nature of this lesion, adequate assessment of the treatment method is required. The aim is to eradicate the disease but preserve as much hand function as possible. Methods of treatment include curettage with or without bone grafts, local resection possibly combined with reconstruction using homologous or autologous bone, amputation, and resection of one or more rays.

Extended step-advancement flap for avulsed amputated fingertip--a new technique to preserve finger length: case series.

PURPOSE: The conventional step-advancement flap does not restore fingertip length after avulsion amputation with projecting bone owing to the limited size of the distal triangular flap. To overcome this problem, the extended step advancement flap using the stepladder principle, described in this article, provides an extended distal triangular flap that can be wrapped around the projecting tip of the distal phalanx while avoiding longitudinal volar scarring. The purposes of this study were to present a modification of the original step-advancement technique and to report on results in 6 patients. METHODS: Between 2007 and 2009, 6 men (mean age, 29 y; range, 18-45 y) presented with a large projecting tip of exposed bone of the distal phalanx after avulsion injury. All 6 had reconstruction using the described technique. After surgery, the finger was immobilized with a splint, followed by rehabilitation. During the follow-up of 9 to 12 months, we clinically assessed flap-site skin quality, scar contractures, and finger mobility. We measured the finger's range of motion with a goniometer. Sensibility was evaluated using the static 2-point discrimination test. RESULTS: The postoperative course was uneventful. All flaps survived completely, except one that had mild marginal necrosis. We observed near-total active range of motion in all patients. The average static 2-point discrimination was 4 mm with a range of 3 to 5 mm. All patients resumed normal daily activities after 8 weeks. CONCLUSIONS: The extended step-advancement flap is ideal for closure of challenging fingertip amputation wounds because it maintains length and minimizes scars while providing a well-padded, sensate tip. It is a viable alternative to replantation of the fingertip. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Subtotal reconstruction of the burned auricle.

The goal for external ear reconstruction is to restore the function of the helical rim in order to provide support for eyeglasses and to provide a cosmetically acceptable auricle. Reconstruction necessitates both flap coverage and flexible framework formation. This article reviews 22 patients who underwent subtotal reconstruction of the auricles after burns. The study was conducted from 1996 to 2003. The study group consisted of 14 male and 8 female patients aged 6-43 years (mean 21.9 years). Different modalities have been used: the temporoparietal fascial flap (eight patients), the subcutaneous pocket technique (11 patients), the pre-auricular skin flap (four patients), and the post-auricular skin flap (three patients). The flaps were used for coverage of fabricated autogenous cartilage in all patients. Both aesthetic and functional outcome was satisfactory.