Successful replantation in ten-digit amputation.

Amputations involving ten digits are very rare because of different lengths of the digits. A 34-year-old man working in a printing house presented one hour after guillotine amputation involving all ten digits. Surgery was initiated 80 minutes after admission and took seven hours. Under axillary anesthesia, the operation was performed by two teams each consisting of two microsurgeons and two assistants. Replantation was completed without the use of any skin graft or flap. Fingertip examination showed poor arterial circulation in the second, third, and fourth digits of the left hand after 24 hours of replantation and surgical exploration was performed, during which anastomosis of the ulnar digital artery of the second digit was re-established and a Y-shaped vein graft was placed at the level of the third web to restore revascularization of the third and fourth digits. However, these interventions did not prevent the development of necrosis in the distal segment of the fourth digit which resulted in dry gangrene that required amputation. After 38 months of replantation, radiographic examination showed complete union in all fingers without malunion or damage to the joint surface and about 8 degrees of medial angulation in the proximal phalanx of the fourth digit of the right hand. The patient did not have difficulty in performing daily activities and had a considerably good pinching. Losses of active range of motion of the metacarpophalangeal and interphalangeal joints were within the rage of 10 to 30 degrees in both hands. In the assessment of sensation, static and dynamic two-point discrimination test results were 6.1 mm and 4.0 mm, respectively.

[Intraosseous ganglions at the same localization in twin sisters]. / Ikiz kardeslerde ayni yerlesimde intraosseöz gangliyonlar.

Among radiolucent lesions of the carpal bones, intraosseous ganglions are the most frequent. Most cases involve the lunate or scaphoid bones in the wrist. Two twin sisters aged 23 years were examined for the complaint of left-sided wrist pain. Physical examination and radiologic findings showed unilateral and symmetrical lesions in the left scaphoid bone suggesting intraosseous ganglions. Both patients underwent ganglion excision and grafting using autografts taken from the ipsilateral distal radius. Both patients were free of wrist pain during a three-year follow-up. Histopathologic examination of the excised lesions was consistent with intraosseous ganglion. Unilateral and symmetrical involvement of the same bone in these twin sisters suggests genetic transmission, which has not been previously reported for intraosseous ganglions.

The versatile reverse-flow digital artery cross-finger flap.

Various flaps have been described for the reconstruction of the soft tissue defects of the digits, but these are not applicable to all kinds of defects. Moreover, these techniques are mostly 2-staged operations that require long-term immobilization. In this study, reverse-flow digital artery cross-finger flap was used to cover various volar and dorsal digital defects in 9 cases. Seven of 9 cases that had follow-up period longer than 2 years were evaluated, and all had good results. We recommend that reverse-flow digital artery cross-finger flap is a universal flap that can be used for almost all types of soft tissue defects of the digits.

[References to avoid complications in releases of the trigger thumb: a cadaveric study]. / Basparmak tetik parmak gevsetmelerinde olasi komplikasyonlardan kaçinma yollari: kadavra çalismasi.

OBJECTIVES: The aim of this cadaveric study was to demonstrate the utility of some visible landmarks in the hand in avoiding probable complications during percutaneous or open releases performed for the trigger thumb associated with flexor tendon tenosynovitis. METHODS: In this cadaveric study, we dissected 20 thumbs of 10 fresh cadavers (10 males; mean age 46 years; range 31 to 62 years) from the interphalangeal to the metacarpophalangeal creases to expose all digital arteries, nerves, the flexor tendon, and the A1 pulley. The following distances were measured: from the proximal edge of the A1 pulley to the digital arteries and nerves, and to the interphalangeal and metacarpophalangeal creases of the thumb. RESULTS: The proximal edge of the A1 pulley lies at a mean distance of 3.5 mm distal to the metacarpophalangeal crease, and about 35 mm distal to the interphalangeal crease. These values may be helpful during percutaneous releases in avoiding any injury to the radial digital nerve, which crosses the flexor tendon proximal to the A1 pulley. On the other hand, care should be taken for the ulnar digital nerve during open releases, which is at a higher risk than the radial digital nerve due to its closer proximity to the A1 pulley, the mean distances being 1.95 mm and 3.40 mm, respectively. CONCLUSION: These data are helpful in avoiding injuries to the digital nerves, which imply that the digital nerve on the ulnar side of the A1 pulley is more vulnerable during open releases, while the radial digital nerve proximal to the metacarpophalangeal crease is more vulnerable during percutaneous attempts. Complications can be avoided if the interphalangeal and palmar creases are taken into consideration.