ABSTRACT
Background Injuries on the hand due to burns affect the quality and functions of activities of daily living (ADL). Severe burns cause lasting complications and deformities, such as contracture of the hand, which require multiple staged surgeries and rehabilitation for extended periods to regain function. This is of major significance to children, as they are in the growing and developmental age group, which should be considered while planning a reconstructive procedure. Psychological counselling is equally important for these patients to accept the residual deformity and cosmesis of the hand following surgery. Methods A prospective interventional study was conducted on 40 patients to assess the functional outcomes of various reconstructive procedures for post-burn contracture of the hand and to find out which is the better surgical intervention for restoring the hand functions needed for ADL. Functional outcomes were analyzed using the Modified Jebson Hand Function Test (JHFT) after a minimum of four months. Results In the group of children operated on with flap procedures, the maximum number of patients had average functional outcomes. Functional outcomes were assessed using the Modified JHFT, in which fine motor, weighted, and non-weighted hand function activities were assessed and analyzed. However, in the group of children operated on by the Z-plasty procedure and skin graft procedure, the maximum number of patients had poor functional outcomes. Conclusion The management of burn injuries on the hand and subsequent contractures is often challenging, especially in pediatric patients. Timely intervention, patient education, and surgical skills with an appropriate choice of reconstructive procedures play a vital role in achieving good postoperative results. This study showed that hands reconstructed using flap procedures had good functional outcomes compared to graft and Z-plasty procedures.
ABSTRACT
Background and objective Brachial plexus injuries more commonly affect the younger generation who constitute the productive workforce. The patients who sustain avulsion injuries of the brachial plexus are more often involved in high-velocity accidents. The avulsion injuries are surgically managed by nerve transfers. This study aimed to evaluate the demography of brachial plexus avulsion injuries. Materials and methods This retrospective study was conducted in January 2013 and included 21 patients treated from January 2007 to December 2011. Results Of the 21 patients, 20 were male and the most commonly affected patients were in the age group of 21-30 years. The mean age of the affected patients was 27.24 years. Six of the patients had pan palsy (C5-8 and T1), nine had C5-7 injury, and six had C5-6 injury. Twenty patients underwent spinal accessory to suprascapular nerve transfer, nine patients underwent ulnar nerve fascicle to nerve to biceps branch transfer, and one patient underwent intercostal nerve to musculocutaneous nerve transfer. Of note, 40% of the patients regained more than M3 power for abduction and external rotation of the shoulder, and 30% of the patients regained more than M3 power for elbow function. Conclusions Road traffic accidents are the most common cause of brachial plexus injuries. Nerve transfers for shoulder and elbow function play a significant role in improving the function of the upper extremity.
ABSTRACT
BACKGROUND: Fingertip injuries are very common and require a stable and durable cover. The end result after reconstruction must be a painless finger with good aesthetic appearance. Skin loss in fingertip, with or without partial loss of pulp fat, is often managed with a split-thickness skin graft, which causes a poor aesthetic result due to color mismatch of the grafted skin in the glabrous volar skin of fingertip. The full-thickness and partial-thickness skin graft harvested from palmar skin provide color match but may cause donor site morbidity in the form of painful scar or contour deformity. Harvest of the second layer from the palm (intermediate part of dermis) allowed the first layer (epidermis with superficial part of dermis) to be reposed over the remaining dermis in palm, thus allowing closure of donor defect without any tension. This technique provides a good color match for the primary defect, along with reduced donor site morbidity. AIM: The study aims to analyze the outcomes of second-layer palmar graft (SLPG) in patients with fingertip injuries. MATERIALS AND METHODS: The retrospective study was conducted in January 2012 on 40 patients who underwent SLPG. RESULT: The graft take was 100% in 36 patients with an average static two-point discrimination (2PD) of 6 mm. The average cosmetic visual analog score for the donor area was 100 and recipient site was 80. CONCLUSION: The SLPG is a good surgical procedure for reconstructing fingertip defects, providing excellent aesthetic appearance and optimal function.
