Meat grinder hand injury in children: A report of 5 cases.

BACKGROUND: Meat grinder injury is considered one of the leading causes that may result in mutilating hand injury. It is commonly occurred in children due to negligence, limited awareness and inexperience about the machine processing and its possible complications. CASE PRESENTATION: We reported five cases of grinder-induced hand injuries, presented with their hands yet firmly wedged inside the grinder. Each hand was freed from inside of the grinder by reversed turning of the machine except for one case which needed extrication with the using of a cutting torch. After releasing of the injured hand, we performed amputation at the wrist level in two cases, at metacarpophalangeal levels in one case and we could perform revascularization in two cases. CONCLUSION: Meat grinder hand injuries in children is challenging, gentle and careful releasing of the hand without causing further damages along with meticulous repair of hand structure to restore hand function. The most important thing is to prevent household meat-grinder-related injuries through keeping it away from the reach of the children's hand.

Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities.

INTRODUCTION: The middle and distal leg coverage is demanding procedure for reconstructive surgeon until evolution of local perforator flaps which becomes as valuable options in lower limb reconstruction. The goal of our study was to assess the results, reliability, safety, and possible complications of the local propeller perforator flaps in lower extremity reconstruction. PATIENTS AND METHODS: We demonstrate a case series of 11 patients in whom we cover small-to-medium soft-tissue defects of the middle and distal leg by application of local propeller perforator flaps. RESULTS: The site of soft tissue defects were in the distal third in 9 cases (81.8%) and 2 cases (18.1%) in the middle third. Flap dimensions ranged from 48 to 192cm2, with an average size of 88.9 cm2. The flap rotation was 180 degrees in (63.6%) of cases. The flaps were based on a single perforator of the posterior tibial artery in 8 (72.7%) cases and peroneal artery perforator in 3 (27.2%) cases. Complications were present in 18% of the perforator flaps which were based on peroneal artery perforator, one partial necrosis and one flap with a superfacial epidermolysis. The donor area is covered by split thickness skin graft in 63.6% of our cases and primary closure of in 36.3% of cases. CONCLUSION: The perforator propeller flaps are safe, relatively simple procedure and consider as an ideal option in reconstructing small-medium defects of the middle and distal third of the leg which provide similar skin texture with low donor site morbidity.

The square flap technique for burn contractures: clinical experience and analysis of length gain.

Post-burn contractures, affecting the joints especially, are demanding problems. Many surgical techniques have been designated for burn contracture release. The aim of this study is to investigate the efficiency of the square flap technique to release a post-burn scar contracture, and assess the post-operative length gain that can be achieved by simple mathematical calculation. In this study, sixteen patients with linear contracture bands were treated with the square flap technique. The anatomical distribution of the contractures was: axilla, cubital fossa, flank, perineum and popliteal fossa. Scar maturity ranged from 4 months - 9 years. Square flap width and contracture band length before and immediately after surgery were recorded by simple mathematical calculation. Flap complication was assessed. Patient satisfaction was also assessed during the follow-up period. All square flaps were effective in lengthening the contracture bands. The length of the contracture that was released ranged from 2 to 6 cm. The gain in length provided with this technique ranged from 212 to 350%, average 247%, and adequate contracture release was achieved in all cases postoperatively. All square flaps healed uneventfully except for one (6%), which demonstrated limited epidermolysis that healed by secondary intention. The follow-up interval ranged from 6 months to 1.5 years. Patients or their parents were satisfied with the results of the operations in terms of skin tightness and aesthetic results. The square flap method was shown to be a simple technique and easy to replicate. It has good lengthening potential and is effective in releasing contracture bands on long-term follow-up.

Les brides séquellaires de brûlures, en particulier celles qui atteignent les régions articulaires, sont une cause fréquente de consultation. De nombreuses techniques chirurgicales sont utilisables dans cette indication. Le but de cette étude est d'évaluer l'efficacité du double lambeau rhomboïde (DLB) dans cette indication et d'évaluer le gain d'extension obtenu, après un calcul pré opératoire simple. Seize patients ont bénéficié de cette technique, pour traiter des brides linéaires simples. Elles étaient situées dans la région axillaire, la fosse cubitale, le flanc, le périnée et le creux poplité. La maturation cicatricielle s'étendait de 4 mois à 9 ans. La largeur du DLB et la longueur de la bride, en pré comme en post opératoire, ont été objectivées par un calcul simple. Les complications ont été répertoriées, ainsi que la satisfaction du patient (suivi de 6 à 18 mois). Nous avons toujours observé un gain de longueur satisfaisant, évalué entre 2 et 6 cm soit 212% à 350% (moyenne 247%). Un seul patient (6%) a vu sa cicatrisation retardée par une épidermolyse partielle. Les patients étaient satisfaits des résultats fonctionnel comme esthétique. Le DLB apparaît comme une technique simple et reproductible. Son bon potentiel de libération le rend efficace dans le traitement des brides linéaires.