Paraumbilical Perforator Flap: A Reliable Option for Coverage of Soft Tissue Defects of Forearm and Hand.

Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.

Orthopedic postoperative infection profile and antibiotic sensitivity of 2038 patients across 24 countries - Call for region and institution specific surgical antimicrobial prophylaxis.

Purpose: Improper utilization of surgical antimicrobial prophylaxis frequently leads to increased risks of morbidity and mortality.This study aims to understand the common causative organism of postoperative orthopedic infection and document the surgical antimicrobial prophylaxis protocol across various institutions in to order to strengthen surgical antimicrobial prophylaxis practice and provide higher-quality surgical care. Methods: This multicentric multinational retrospective study, includes 24 countries from five different regions (Asia Pacific, South Eastern Africa, Western Africa, Latin America, and Middle East). Patients who developed orthopedic surgical site infection between January 2021 and December 2022 were included. Demographic details, bacterial profile of surgical site infection, and antibiotic sensitivity pattern were documented. Results: 2038 patients from 24 countries were included. Among them 69.7 % were male patients and 64.1 % were between 20 and 60 years. 70.3 % patients underwent trauma surgery and instrumentation was used in 93.5 %. Ceftriaxone was the most common preferred in 53.4 %. Early SSI was seen in 55.2 % and deep SSI in 59.7 %. Western Africa (76 %) and Asia-Pacific (52.8 %) reported a higher number of gram-negative infections whereas gram-positive organisms were predominant in other regions. Most common gram positive organism was Staphylococcus aureus (35 %) and gram-negative was Klebsiella (17.2 %). Majority of the organisms showed variable sensitivity to broad-spectrum antibiotics. Conclusion: Our study strongly proves that every institution has to analyse their surgical site infection microbiological profile and antibiotic sensitivity of the organisms and plan their surgical antimicrobial prophylaxis accordingly. This will help to decrease the rate of surgical site infection, prevent the emergence of multidrug resistance and reduce the economic burden of treatment.

Study of Nutrient Foramina of Dry Adult Human Clavicle.

As a modified long bone, the clavicle is most important bone for transmission of body weight from upper limb to the axial skeleton, for attachment of muscles and is a significant source of bone grafting. This descriptive cross-sectional study was conducted among 150 (65 right and 85 left) fully ossified dry human clavicle in Mymensingh Medical College, Mymensingh, Bangladesh from January 2020 to December 2020. Sample was collected by the help of nonrandom purposive sampling technique from Anatomy department of Mymensingh Medical College and Community Based Medical College, Bangladesh, Mymensingh. In this study, nutrient foramen was present in 86.67% (130) cases. On the right side, 87.69% (57) cases and on the left side, 85.88% (73) cases were found present. Out of 130 clavicles where nutrient foramen were present, 52.31% (68) nutrient foramina were on inferior surface, 46.92% (61) on posterior surface and 0.77% (1) on superior surface. On the right side, 49.12% (28) cases were found on inferior surface and 49.12% (28) were on posterior surface and remaining 1.75% (1) was on superior surface. On the left side, 54.79% (40) cases were found on inferior surface and 45.21% were on posterior surface whereas none was found on superior surface. Among the present 130 cases, 1 nutrient foramen was found in total 80% (104) cases and 2 in 20% (26) cases. In right side, the numbers of cases were 75.44% (43) for 1 and 24.56% (14) for 2 nutrient foramina. In left side, the number of cases of 1 was 83.56% (61) and 16.44% (12) for 2 foramina. The nutrient foraminal direction was 98.46% (128) towards acromial end and 1.54% (2) to sternal end. In the right side, the direction was 100% (57) towards acromial end. In the left side, the direction was 97.26% (71) towards acromial end and 2.74% (2) to sternal end. In the current study, the mean ±SD nutrient foramina of 65 clavicles of right side were 71.04±13.91 and 67.13±16.30 in 85 left sided clavicles. The purpose for undertaking this study was to obtain baseline data on nutrient foramen to help to predict the success rate and different surgical interventions regarding fractures and grafting.