Limb Salvage Using Microsurgical Free Tissue Transfer in Severe Frostbite.

PURPOSE: Frostbite is often managed conservatively; however, in severe cases, microsurgical free tissue transfer is required for soft tissue coverage and limb salvage. Given its rarity, the techniques and outcomes of these cases are not well described. The purpose of this report is to present the largest case series, to date, of frostbite injuries requiring microsurgical reconstruction for limb salvage. METHODS: A single-center retrospective review was conducted of all patients who underwent free tissue transfer by a single surgeon from 2008 to 2022. Patients of all ages were included if they suffered a frostbite injury requiring free tissue transfer. Demographics, operative details, and surgical outcomes were recorded. RESULTS: Eight patients with frostbite injuries were included in the report. Patients had frostbite injuries either to the lower extremities (n = 4) or to both upper and lower extremities (n = 4). Sixteen free flaps were done in total including four paired chimeric and eight single free flaps. Flap recipient sites included knees (n = 5), foot/ankle (n = 3), dorsal hands (n = 2), and thumbs (n = 2). All 16 flaps survived. Five patients had complications: four with major complications requiring operative management and two with minor complications requiring conservative management. Mean follow-up time was 505.7 days (range 115-1564). All lower extremity reconstructions were able to weight-bear at an average of 125.2 days post-injury (range 87-164). CONCLUSIONS: This case series demonstrates that free tissue transfer is a robust option for soft tissue coverage and functional limb salvage in patients with severe frostbite injuries to both upper and lower extremities.

Peri-Operative Outcomes Comparison of General Anaesthesia and Brachial Plexus Block for Open Reduction Internal Fixation of Metacarpal Fractures.

INTRODUCTION: Brachial plexus blockade (BPB) is a procedure of growing popularity amongst surgeons and anaesthesiologists involved with upper limb surgery. The safety and benefit in hand surgery is unclear. METHODS: A retrospective chart review was performed examining all operative hand cases over a 2-year period. All cases of metacarpal open reduction internal fixation (ORIF) were included. Cases were excluded if paediatric patient, additional procedures performed, and/or a decreased LOC. Parametric statistical tests were performed. RESULTS: In total, 54 cases with general anaesthesia (GA) and 48 cases with BPB were identified for the study (n = 102). The average total time from operating theatre to discharge was 245 ± 72 minutes in GA group and 195 ± 54 minutes in BPB (P < .001). Of those who had a GA, 47/54 patients required analgesia post-operatively versus 12/48 in the BPB (P < .001). Of all, 25/52 and 5/48 patients required anti-emetics post-operatively in the GA and BPB groups, respectively (P < .001). Need for any parenteral medication post-operatively was also significantly different (P < .001). CONCLUSION: This is the first study to specifically examine anaesthetic techniques for ORIF of hand fractures; adding to the body of literature establishing BPB as a safe and efficient method of anaesthesia.

INTRODUCTION: Le bloc du plexus brachial (BPB) est une intervention de plus en plus utilisée par les chirurgiens et les anesthésiologistes qui font des opérations des membres supérieurs. Le caractère sécuritaire et les avantages de ces interventions ne sont pas définis pour les chirurgies de la main. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective de tous les dossiers d'opération de la main sur une période de deux ans. Ils ont inclus tous les cas de fixation métacarpienne interne par réduction chirurgicale et exclu les cas de patients pédiatriques, d'interventions supplémentaires ou de diminution du niveau de soins. Enfin, ils ont effectué des tests statistiques paramétriques. RÉSULTATS: Dans le cadre de l'étude (n = 102), Les chercheurs ont extrait 54 cas d'anesthésie générale (AG) et 48 cas de BPB. La durée moyenne totale entre l'opération et le congé était de 245 ± 72 minutes dans le groupe d'AG et de 195 ± 54 minutes dans celui du BPB (p < 0,001). Chez ceux qui ont subi une AG, 47 des 54 patients ont eu besoin d'une analgésie après l'opération par rapport à 12 des 48 patients ayant subi un BPB (p < 0,001). Par ailleurs, 25 des 52 patients et cinq des 48 patients des groupes d'AG et de BPB ont eu besoin d'antiémétiques après l'opération, respectivement (p < 0,001). Les besoins de médication parentérale après l'opération étaient également très différents (p < 0,001). CONCLUSION: C'est la première étude à porter expressément sur les techniques anesthétiques pour la fixation interne par réduction ouverte des fractures de la main et sur l'ajout du bloc du plexus brachial parmi les méthodes sécuritaires et efficaces d'anesthésie conseillées dans les publications scientifiques.