Volkmann's ischaemic contracture of the upper extremity - raising a red flag in the setting of developing countries.

INTRODUCTION: Volkmann's ischaemic contracture (VIC) is a disabling condition resulting from tissue necrosis due to impaired vascular supply to the limb. Over the years VIC has become rare in developed countries with many different aetiologies described. It was alarming to have high incidence of established VIC in our practice in Nepal. A detailed analysis was conducted to accurately describe this issue. METHODS: We collected 47 cases of VIC over six years and noted the age, sex, district of origin and cause of VIC, duration of injury to presentation, and the grade of VIC. Then we compared these characteristics of VIC of each Nepal province and created a map to show the problematic regions. RESULTS: Out of 47 patients, 46 could have been prevented by an early treatment. The most common cause was a tight cast in 25 patients (53.19%), followed by unintentionally self-caused VIC by applying tight bandages in 21 patients (44.68%). Most cases came from province 6 (29.78%). Our group included three mild (6.4%), 35 moderate (74.5%) and nine severe (19.1%) cases of VIC. Only 14 cases (29.78%) had a timely fasciotomy in the past. CONCLUSION: VIC is an irreversible complication of the compartment syndrome which is an easily preventable condition in the setting of developing countries. Our focus should, therefore, aim at preventing such disastrous conditions as 97.87% of cases we encountered could have been avoided by proper primary care. In the case of Nepal most cases came from province 6 and province 3.

Main pitfalls of skin surgical suturing - review for junior surgeons and medical students.

Every surgeon starts the training with suturing, which can be very confusing as most of the senior surgeons have their own style, approach, tricks and different rules to follow. It is hard for residents and medical students to know what is an evidence-based rule that should be followed and what is a personal trick of their teacher that can be modified. We provide a review of current data on surgical suturing with all the reasons for specific techniques. Parameters of the correct skin suture, practical guide and all the complications are mentioned in the text.

Cada cirujano empieza su carrera profesional con el entrenamiento de la sutura cirúrgica. Dado que todos los cirujanos con experiencia tienen sus propios trucos, estilo y enfoque, la enseñanza y el aprendizaje de la técnica correcta pueden ser caóticos. Por esta razón, para los cirujanos residentes y los estudiantes de medicina les puede resultar difícil distinguir entre el enfoque de "evidence-based medicine" - el cuál ha de ser tomado, y los trucos personales de sus superiores, cuáles pueden ser modificados. Ofrecemos una revisión de los datos disponibles sobre la sutura cirúrgica, incluyendo las razones para el empleo de algunas técnicas especiales. En el texto presentamos los parámetros para la correcta sutura del piel, un guía práctico y las complicaciones que pueden surgir.

Acute and chronic Achilles tendon ruptures - current diagnostic and therapeutic options.

This review presents information on the epidemiology and current trends in the diagnosis and therapy of acute and chronic Achilles tendon ruptures in middle-aged and elderly patients. Epidemiological data show an increasing incidence of ruptures among the entire population, especially in patients over 65 years of age. Dynamic sonography has become the gold standard diagnostic assessment, facilitating even therapeutic decision- making. The well established conservative-functional therapy can in indicated cases achieve results comparable to those of surgical treatment. Minimally invasive suture techniques using aiming devices reduce the risk of surgical damage and soft tissue complications, particularly in noncompliant patients and patients with restricted perfusion. Reconstruction of chronic tendon ruptures is mostly performed using static techniques, especially the combination of V-Y plasty and fascial flaps. In addition to reruptures and infections, the currently discussed complications also include deep vein thrombosis where a more generous indication scheme of thromboprophylaxis is under consideration.

Retrospective analysis of complications after treatment of acute Achilles tendon rupture by Kessler technique.

INTRODUCTION: Open surgical treatment of Achilles tendon rupture comes with high ratio of complications. We have retrospectively evaluated those complications to find patients that would benefit from the mini-invasive technique. METHODS: We analysed all patients after surgical treatment of acute Achilles tendon rupture between the years 2014 and 2020. Information about the surgery, the following complications and patients characteristics were extracted from our documentation. Statistical analysis was concluded to evaluate their significance. We have included 134 patients with the Achilles tendon rupture in our analysis. The majority of patients were men (83.6%) and left-sided injuries were more common (51.5%). The average age was 45 years. RESULTS: Our results show that the most common complications after the treatment of Achilles tendon rupture in our clinic are wound dehiscence, thrombosis and infection. On the other hand, paresthesia and rupture are rare. We have confirmed that most complications occur in smoking patients. Our data show that age is a risk factor as well. Contrary to the previous study, our data did not show the female sex to be a risk factor. CONCLUSION: Open surgical treatment of Achilles tendon rupture in our clinic is accompanied with relatively high complication rate. Mini-invasive techniques could improve the outcomes in the cohort of smoking older patients with acute Achilles tendon rupture. Please kindly refer to the corresponding author to obtain full data in English.

Spontaneous compartment syndrome of the forearm - case report.

INTRODUCTION: Acute compartment syndrome is a serious complication of trauma and pathological disorders. Non-traumatic acute compartment syndrome is very rare and has no coherence with trauma. The case report demonstrates diagnostics difficulties and the treatment strategy. CASE REPORT: We present a 36-year-old man with acute onset of pain after manual labor with a shovel. He had been treated with anticoagulation therapy due to a heart valve replacement. Blood clotting test showed prolongation of prothrombin time of more than four times due to iatrogenic bleeding disorder. Symptoms were considered consistent with the diagnosis of tendovaginitis, however the worsening of the symptoms was underestimated. Four days after the onset of the first symptoms, the acute compartment syndrome developed and urgent fasciotomy of the forearm and hand was performed. The convalescence lasted 10 months with restoration of the function and range of motion of the hand. The patient was able to fully self-service and manually work with a light load. The permanent consequence remained a limitation of the hand grip strength and paresthesia and neuropathic pain due to median nerve impairment. CONCLUSION: Spontaneous compartment syndrome of the upper extremity is a rare but very dangerous entity requiring thorough understanding. It should be considered in the case of non-traumatic limb pain that does not respond to analgesics in patients receiving systemic anticoagulation. Only early diagnosis and immediate fasciotomy can prevent catastrophic permanent consequences.

Sample preparation and image acquisition using optical-reflective microscopy in the measurement of fiber orientation in thermoplastic composites.

A complete sample preparation procedure used to determine three-dimensional fiber orientation from optical micrographs of glass fiber-reinforced thermoplastic composites is presented. Considerations for elimination of irregularities in the elliptical footprints, contrast enhancement between fibers and surrounding polymer matrix, controlled-etching that allows the identification of small shadows where fiber recedes into the matrix, and topographical reconstruction of the elliptical footprint are described in the procedure. This procedure has produced high-quality optical micrographs employed to obtain accurate fiber orientation data for thermoplastic composites using the method of ellipses. The optimal definition of the nonelliptical footprints' borders allows an accurate measurement of orientation in small sampling areas.