Operative Time Directly Correlates with Blood Loss and Need for Blood Transfusion in Total Joint Arthroplasty.

BACKGROUND: Allogeneic blood transfusion in patients undergoing total joint arthroplasty (TJA) has been shown to negatively affect patient outcomes. This study aimed to examine if there is a correlation between operative time and the need for allogeneic blood transfusions during TJA. METHODS: We performed a retrospective review of 866 patients who underwent primary TJA during a one-year period at our institution. Logistic regression was performed to identify the association between operative time and need for allogeneic blood transfusion, controlling for other patient and surgical factors. Multiple linear regression analysis was also performed to see how the same factors affected CBL. RESULTS: Of the 866 cases, 13%(115) were simultaneous bilateral. 52%(449) of patients received preoperative autologous blood donation. The average operative time for unilateral and bilateral patients was 74.1±(33.9) and 132.6±(36.0) minutes, respectively. Average CBL for unilateral patients was 2120mL±(1208) and 4051mL±(1311) for bilateral cases. The average number of allogeneic transfusions was also higher within the bilateral group (0.49 vs 1.15 units). Multivariate analysis indicated that duration of surgery (odds ratio [OR]:1.35 per 15 minutes) and bilateral TJA (OR: 2.97) increase the risk of allogeneic blood transfusion, while patients having total knee arthroplasty are less likely to receive allogeneic blood transfusion (OR: 0.50). CBL also increased significantly with surgical duration (211.5 mL per 15 minutes). CONCLUSION: A subgroup analysis confirmed that there was a correlation between operative time and need for allogeneic transfusion following unilateral TJA. Expeditious surgery can minimize blood loss and subsequent need for blood transfusion and its associated adverse consequences. LEVEL OF EVIDENCE: III.

A comparison of the effects on postoperative bleeding of the intra-articular application of tranexamic acid and adrenalin in total knee arthroplasty.

OBJECTIVE: To compare the efficacies of intra-articular applications of tranexamic acid and adrenaline on postoperative bleeding after total knee arthroplasty. METHODS: The single-center, retrospective, controlled study was conducted at Selcuk University , department of orthopedic surgery and comprised data of patients who underwent primary, unilateral, cemented total knee arthroplasty between July 2012 and December 2014. Group 1 had received tranexamic acid 1g after closure of articular capsule. Group 2 had received adrenalin. Group 3, the control group, received no medication intraarticularly after total knee arthroplasty. The amount of blood collected in the drain and postoperative alterations in haemoglobin and haematocrit values were compared. RESULTS: Of the total 90 subjects, there were 30(33.33%) in each of the three groups. The decrease of haemoglobin and haematocrit values in Group 1 was statistically significant compared to both Group 2 and Group 3 (p<0.05). The amount of blood collected in the drains was remarkably lower in Groups I and 2 compared to Group III (p<0.05). No deep venous thrombosis or pulmonary emboli were encountered across the sample. CONCLUSIONS: Intra-articular administration of tranexamic acid was found to be beneficial and safe for the achievement of effective haemostasis after total knee arthroplasty.

Effect of curcumin on tendon healing: an experimental study in a rat model of Achilles tendon injury.

PURPOSE: This in vivo study aims to investigate the effects of curcumin which is recently developed for tendon healing using a rat Achilles tendon injury model. MATERIALS AND METHODS: Eighteen male Wistar albino rats weighing 300-400 g were used in this study. Under anesthesia, Achilles tendon injuries were created and repaired surgically. Nine rats of the study group received curcumin (suspended in saline at a dose of 200 mg/kg orally) and eight rats of the control group received only saline solution by oral gavage for a period of 28 days. Animals were euthanized on the 28th post-operative day, and all the Achilles tendons were removed and transferred immediately for biomechanic and histological analysis. RESULTS: Macroscopically, all the tendons were fully healed. Total mean Bonar score was higher in the control group. When the parameters of Bonar score were analysed separately, tenocyte morphology, collogen, and ground substance scores were statistically lower than the control group (p = 0.03, 0.041, 0.049, respectively). Vascularity parameter did not show any statistical difference (p > 0.05). Of the nine biomechanical parameters, five of them (failure load, cross-sectional area, length, ultimate stress, strain) showed better results which were also statistically significant (p = 0.046, 0.027, 0.011, 0.021, 0.002, respectively). When the remaining four parameters were examined, the study group also had better results, but this difference was not statistically significant. CONCLUSION: Curcumin had better results for total tendon healing not only histologically but also biomechanically. Curcumin could be an additional agent in the management of surgically repaired tendon injuries.

Other benefits of intra-articular injection of tranexamic acid in primary total knee arthroplasty apart from reducing blood transfusion rates.

OBJECTIVES: This study aims to evaluate the effect of intra-articular tranexamic acid (TA) administration on the amount of blood in the drains, the amount of blood transfusion, length of hospital stay, and the total cost in total knee arthroplasty (TKA) patients. PATIENTS AND METHODS: The study included a total of 118 patients (24 males, 94 females; mean age 67.0 years, range 52 to 81 years) who underwent primary unilateral TKA surgery. Patients were divided into two groups as 58 patients who were performed intra-articular injection of 2 g TA after closure of articular capsule (TA group; 10 males, 48 females, mean age 65.6 years; range 55 to 80 years) and 60 patients who were not performed any intra-articular injection (non-TA group; 14 males, 46 females; mean age 68.3 years; range 52 to 81 years). The maximum difference between pre- and postoperative hemoglobin levels, the amount of blood in the drains, the amount of blood transfusion, length of hospital stay, and cost of each patient were recorded. RESULTS: The mean difference between pre- and postoperative hemoglobin levels were higher in the non-TA group (1.7 g/dL vs 2.6 g/dL, p<0.05). The mean amounts of blood in drains (327.5 mL vs 800.0 mL, p<0.05), the amounts of blood transfusions (0 units vs 10 units, p<0.05), the mean lengths of hospital stay (4.03 days vs 4.53 days, p<0.05), and the hospital costs (1,935.26 United States dollars vs 1,959.64 United States dollars, p<0.05) were lower in TA group. CONCLUSION: Administration of intra-articular TA during primary TKA may reduce blood loss and the need for blood transfusion while significantly shortening the postoperative length of hospital stay and reducing the total hospital costs.

Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture.

PURPOSE: The purpose of this study was to investigate the mechanical strength of both monoplanar and biplanar medial opening-wedge high tibial osteotomy (MOWHTO) procedures and assess the risk of lateral cortex disruption for both techniques. METHODS: Twelve synthetic tibia models with cortical shells were used as test models. Saw cuts for monoplanar MOWHTO and biplanar MOWHTO were generated on the test models in equal numbers (n = 6 for both groups). Wedge opening load and wedge gap distance were evaluated via compressive tests. RESULTS: The mean gap distance just before the lateral cortex fracture in the monoplanar group was 14.7 ± 2.9 mm, which was significantly narrower than that in the biplanar group of 19.1 ± 2.0 mm (p = 0.015). The mean load just before the occurrence of lateral cortex fracture of 32.4 ± 3.2 N in the monoplanar osteotomy group was significantly lower than that in the biplanar osteotomy group of 111.8 ± 9.3 N (p = 0.009). CONCLUSION: Performing a MOWHTO via the biplanar rather than the monoplanar technique allows larger-sized wedges to be opened with less risk of lateral cortical fracture. Thus, larger gaps can be opened and higher angle corrections can be achieved using the biplanar osteotomy procedure. From a clinical viewpoint, the biplanar osteotomy technique reduced the risk of lateral cortical hinge fracture during MOWHTO.

Total Knee Arthroplasty due to Knee Osteoarthritis: Risk Factors for Persistent Postsurgical Pain.

OBJECTIVE: The aim of this study was to identify whether different patient characteristics and clinical factors can be risk factors in patients with persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). METHODS: Patients who underwent TKA due to knee osteoarthritis were divided into two groups: those who experienced no or mild PPSP (Numerical Rating Scale [NRS] ≤ 3) (group 1, n = 91) and those who experienced moderate to severe PPSP (NRS > 3) (group 2, n = 183). Information on the characteristics of patients, comorbid diseases and pre-surgical NRS scores were obtained retrospectively from hospital charts. The follow-up time; pre-surgical and last control time walking distance; and ratings on the NRS, Pain DETECT Questionnaire (PDQ) and patient satisfaction scales were recorded from the standard questionnaire presented to patients during the telephone interview. RESULTS: The mean follow-up time was 22.8 ± 12.3 months. The rate of moderate to severe PPSP among patients amounted to 66.7% after TKA. No neuropathic pain was found in Group 1. In Group 2, 22.9% of patients experienced neuropathic pain, the results for 18% of patients were uncertain, and 59% of patients did not experience neuropathic pain. Group 2 had worse scores on the patient satisfaction scale following the last control time compared with Group 1. Being widowed, having a low education level, being a housewife, having employment that requires physical effort, pre-surgical pain intensity at rest and pre-surgical restricted walking distance are risk factors for Group 2. CONCLUSIONS: PPSP and the neuropathic component in PPSP after TKA are not underestimated for pain management and patient satisfaction. Subgroups of patients, particularly widowers, having a primary school education level or under, housewives, people with jobs that require physical effort, individuals with intense pre-surgical pain during rest and those suffering from pre-surgical restricted walking distance, are at higher risk of developing PPSP following TKA.

Incidence of Infection and Inhospital Mortality in Patients With Chronic Renal Failure After Total Joint Arthroplasty.

BACKGROUND: Patients with chronic renal failure (CRF) may require total joint arthroplasty (TJA) to treat degenerative joint disease, fractures, osteonecrosis, or amyloid arthropathy. There have been conflicting results, however, regarding outcomes of TJA in patients with chronic renal disease. The aim of this case-controlled study was to determine the outcome of TJA in patients with CRF, with particular interest in the incidence of infections and inhospital mortality. METHODS: We queried our electronic database to determine which patients among the 29,389 TJAs performed at our institution between January 2000 and June 2012 had a diagnosis of CRF. A total of 359 CRF patients were identified and matched for procedure, gender, age (±4 years), date of surgery (±2 years), and body mass index (±5 kg/m2) in a 2:1 ratio to 718 control patients. RESULTS: The incidence of infection and inhospital mortality was not significantly different between the nondialysis CRF patients and controls, whereas it was significantly higher in dialysis-dependent end-stage renal failure patients compared to controls. Of the 50 CRF patients receiving hemodialysis, 10 (20%) developed surgical site infection, of which 4 (8%) were periprosthetic joint infection, and 4 (8%) died during hospital stay. The odds ratio for infection in the dialysis group was 7.54 (95% confidence interval: 2.83-20.12) and 10.46 (95% confidence interval: 1.67-65.34) for the inhospital mortality. CONCLUSION: We conclude that end-stage renal failure patients receiving hemodialysis have higher postoperative infection and inhospital mortality rates after an elective TJA procedure, whereas nondialysis CRF patients have similar outcomes compared with the general TJA population.

Blood management after total joint arthroplasty in the United States: 19-year trend analysis.

BACKGROUND: Recent studies have failed to show reductions in rates of red blood cell (RBC) transfusion after total joint arthroplasty (TJA) in the United States. This study aims to report the 19-year trend analysis of blood use in TJA, to determine predictors of RBC transfusion and association between RBC transfusion and in-hospital mortality after TJA using a nationally representative database. STUDY DESIGN AND METHODS: Nationwide inpatient sample (NIS) data from 1993 to 2011 were used. ICD-9-CM codes were used to identify TJA cases, RBC transfusion, autologous blood transfusion, and/or transfusion from cell salvage. Logistic regression analysis was performed to determine predictors of RBC transfusion and if transfusion increases risk of in-hospital mortality. RESULTS: A total of 2,225,054 TJA cases were identified. Using multivariate analysis, there was an increase in the rate of RBC transfusion over the study period (odds ratio [OR], 1.049; 95% confidence interval [CI], 1.048-1.050; p < 0.001). One-stage bilateral TJA (OR, 3.30; 95% CI, 3.24-3.37; p < 0.001), anemia due to chronic blood loss (OR, 2.69; 95% CI, 2.59-2.74, p < 0.001), deficiency anemia (OR, 2.59; 95% CI, 2.56-2.62; p < 0.001), and Charlson comorbidity index (OR, 1.24; 95% CI, 1.23-1.24; p < 0.001) were independent predictors of allogeneic blood transfusion. Transfusion of autologous blood reduced need for RBC transfusion (OR, 0.84; 95% CI, 0.82-0.85; p < 0.001). RBC transfusion was an independent predictor of in-hospital mortality (OR, 1.537; 95% CI, 1.395-1.694; p < 0.001). CONCLUSION: An increase in the rate of RBC use after TJA and the association between allogeneic blood transfusion and mortality are worrisome. Implementing more effective blood conservation strategies is recommended.

Anthropometric measurements of tibial plateau and correlation with the current tibial implants.

PURPOSE: The aim of the study was to make an anthropometric analysis at the resected surfaces of the proximal tibia in the Turkish population and to compare the data with the dimensions of tibial components in current use. We hypothesized that tibial components currently available on the market do not fulfil the requirements of this population and a new tibial component design may be required, especially for female patients with small stature. METHODS: Anthropometric data from the proximal tibia of 226 knees in 226 Turkish subjects were measured using magnetic resonance imaging. We measured the mediolateral, middle anteroposterior, medial and lateral anteroposterior dimensions and the aspect ratio of the resected proximal tibial surface. All morphological data were compared with the dimensions of five contemporary tibial implants, including asymmetric and symmetric design types. RESULTS: The dimensions of the tibial plateau of Turkish knees demonstrated significant differences according to gender (P < 0.05). Among the different tibial implants reviewed, neither asymmetric nor symmetric designs exhibited a perfect conformity to proximal tibial morphology in size and shape. The vast majority of tibial implants involved in this study tend to overhang anteroposteriorly, and a statistically significant number of women (21 %, P < 0.05) had tibial anteroposterior diameters smaller than the smallest available tibial component. CONCLUSION: Tibial components designed according to anthropometric measurements of Western populations do not perfectly meet the requirements of Turkish population. These data could provide the basis for designing the optimal and smaller tibial component for this population, especially for women, is required for best fit. LEVEL OF EVIDENCE: II.

Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain.

PURPOSE: Anterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. METHODS: This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. RESULTS: Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30° of knee flexion than did the controls. CONCLUSION: Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. LEVEL OF EVIDENCE: Diagnostic study, Level III.

Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast.

Randomized controlled clinical trial.The main purpose of the present study was to comparatively analyze the effectiveness, advantages, and the complications of using semirigid synthetic softcast with respect to plaster of Paris (POP) during the treatment of clubfoot deformity.The study group consisted of 196 babies (249 feet). A total of 133 feet treated by an orthopedic referral center using semirigid synthetic softcast were included in group A whereas the other 116 feet treated by another orthopedic clinic using POP cast were included in group B. The Pirani scores, number of cast applications, time period until Achilles tenotomy, any skin problems due to the cast itself, and/or cast removal were recorded. A final parent satisfaction score was also obtained.The mean Pirani sores were significantly improved from the first administration to the time before Achilles tenotomy in both groups. There was no significant difference according to the number of casts applied until tenotomy. The slippage of the cast and skin lesions was significantly more common in group B. Higher parent satisfaction levels were detected in group A.Semirigid softcast has been found as superior to POP in the aspects of parent satisfaction and cast-related complication rates.

A new diagnostic parameter for patellofemoral pain.

PURPOSE: Q-angle measurement procedure have not been well standardised. There is a lack of consensus about subject position and knee flexion angle while measuring the Q-angle. Morover Q-angle value which obtained in a single position is a static value and gives an information about the subject's current position. The aim of this study is to obtain a more significant parameter which includes different postures (supine, standing, sitting) and different knee flexion angles instead of a single Q-angle in a fixed position. At the same time this parameter must be functional and dynamic,not a static value like Q-angle. We named this parameter as ΔQ. METHODS: Our study was applied on case and control groups. All subjects in both groups were male. Case group was consisted of 14 subjects who had patellofemoral pain. Control group was consisted of 14 subjects who had normal knees and normal lower extremities with no reported knee problems. We obtained 3 different Q-angle values and 3 different ΔQ values for each subject in both groups. Pearson correlation analysis was used for investigation of continuous variables in normal distribution, Spearman correlation analysis was used in abnormal distribution. t test was used in the comparison of values. Logistic regression analysis(forward conditional mod) was used for detecting of determinants of pain. RESULTS: ΔQ1s of both groups were found as the only statistical significant predictive value for patellofemoral pain. CONCLUSION: There is not an agreement about a standardised q-angle measurement procedure in the literature. Moreover, present procedures provide information about a single and fixed position. In this situation Q-angles which obtained in these fixed positions are static values. We think that we can overcome these problems with this new value. ΔQ contains multiple q-angles and gives information about all. Also it is a dynamic value for being oriented to position change. Therefore, ΔQ is an useful indicator for evaluating patellofemoral pain.

Percutaneous double-button fixation method for treatment of acute type III acromioclavicular joint dislocation.

OBJECTIVE: The aim of this study was to evaluate the functional and radiological results of patients treated with the percutaneous double-button technique for acute acromioclavicular (AC) joint dislocation. METHODS: A retrospective evaluation was performed of 13 patients surgically treated for acute Type III AC joint dislocation with the percutaneous double-button fixation method. The coracoclavicular (CC) distance of the affected side was compared with that of the healthy side on anterior-posterior radiographs obtained at the final follow-up. In the functional evaluation, Disabilities of the Arm, Shoulder and Hand (DASH), Constant, and visual analog scale (VAS) scores were used. RESULTS: The 13 patients in the study included 12 males and 1 female with a mean age of 43.4 years (range: 22-60 years). The mean follow-up period was 13.61 months (range: 9-24 months). The mean CC distance on the operated side was 9.23 mm (range: 8-15 mm), and when compared with the healthy side, no statistically significant difference was observed. Preoperative Constant scores of a mean of 30.3 (range: 18-42) increased to 84.4 (range: 70-90) at the final follow-up. Preoperative DASH scores had a mean of 14.1 (range: 11-28) and decreased to 0.4 (range: 0-3) at the final follow-up (p<0.001). Mean preoperative VAS score was 6.0 (range: 5-8), which decreased to 0.6 (range: 0-3) at the final follow-up (p<0.001). CONCLUSION: The percutaneous double-button fixation technique is a safe, practical, and effective fixation method that can be used as an alternative to arthroscopic and open methods for acute Type III AC joint dislocations.

Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis.

OBJECTIVE: Three methods of surgery used in the treatment of knee osteoarthritis (OA) are mobile bearing unicompartmental knee arthroplasty (Oxford UKA), opening wedge high tibial osteotomy (HTO), and dome-type HTO. This article aimed to retrospectively compare these three methods in terms of outcomes for health status, patient satisfaction, and function. METHODS: Between 2003 and 2010, 255 knees of 235 patients underwent operations for medial knee OA. Three types of surgery were performed. Group 1 consisted of 109 knees of 94 patients who underwent Oxford UKA. Group 2 was made up of 36 knees of 36 patients who underwent HTO using circular external fixation, and Group 3 comprised 57 knees of 52 patients on whom opening wedge type HTO using locking plate fixation was performed. SF-36 and HSS knee scores were used to compare the functional outcomes among groups. RESULTS: Statistically significant differences were found between the preoperative and postoperative measures in all 3 of the treatment groups for physical function, physical role, pain, general health, vitality, social function, emotional role, and mental health according to SF-36 and HSS scores. In the 2nd group, the average correction of the mechanical axis deviation (MAD) was 38 mm with 11.7º along the femorotibial axis and 6.2º along the medial proximal tibial angle (MPTA). In the 3rd group, the average correction in the MAD was 28 mm with 9.7º along the femorotibial axis and 5.6º along the MPTA. All 3 of the treatment alternatives were observed to be sufficient. Satisfactory postoperative results were achieved in the UKA group in terms of social function and mental health, and the patients were able to achieve early rehabilitation and return to their previous life activities. CONCLUSION: UKA is the ideal option for patients who wish for the earliest possible return to social and recreational activities.

Effect of Ankaferd blood stopper® on tendon healing: an experimental study in a rat model of Achilles tendon injury.

OBJECTIVES: This in vivo study aims to investigate the effects of Ankaferd Blood Stopper® (ABS) which is a recently developed topical hemostatic agent on tendon healing using a rat Achilles tendon injury model. MATERIALS AND METHODS: Twelve male Wistar-Albino rats were used in the study. Right legs of the rats were assigned as the study group, and left legs were assigned as the control group. Under anesthesia, bilateral Achilles tendon injuries were created and repaired surgically. To the surgical sites, 1 mL of ABS for the right side and 1 mL of serum physiologic solution for the left side were applied. Animals were euthanized on the 21st postoperative day, and tendon samples were collected from the extremities. Histological analyses were performed according to the semiquantitative tendon scoring system (Bonar Scale). RESULTS: Total tendon healing scores were significantly poorer in the study group compared to the control group. Although there were no significant differences between the groups in terms of tenocyte morphology, degree of ground substance staining, and vascularity, the collagen morphology scores were significantly poorer in the study group. CONCLUSION: In our study, application of ABS had histologically negative effect on tendon healing in rats. However, further biomechanical and immune histochemical studies are required to support these results.

Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients.

BACKGROUND: There are a limited number of published studies describing reconstruction with an anterolateral thigh (ALT) flap following lower extremity injury in pediatric patients. The aim of this study was to present our experiences with the application of a free ALT flap not only in the reconstruction of soft tissue defects around the pediatric foot and ankle but also in patients with bone, tendon, and ligament injuries that require repair. MATERIALS AND METHODS: Reconstruction with a free ALT flap was performed in 11 pediatric patients (mean age, 8.9 years; range, 3-15 years) between November 2010 and February 2013. The modes of injury were as follows: six traffic accidents, three firearm accidents, one agricultural machinery accident, and one bicycle chain accident. A retrospective evaluation of the applied surgical procedures was performed: flap size, perforator type and number, placement area, site of anastomosis, closure of the donor site, complications, and flap survival. RESULTS: The mean size of the skin flap was 83.2 mm(2) (range, 48-117 mm(2)). Except for two patients, there were two perforators in the obtained flaps, which were 75% musculocutaneous and 25% septocutaneous. To strengthen the Achilles tendon in one patient, the ALT, together with the fascia lata, was raised as a composite flap. This flap was used as a "sensate flap" in three patients with defects in the heel area and as a "perforator flap" in seven patients. Anastomosis was performed in the anterior tibial artery in five patients and in the posterior tibial artery in six patients. Primary closure was performed for the donor site in all patients. Due to venous thrombus after 24 hours in one patient, reexploration was performed, and blood flow was regained with a vein graft. In the same patient, partial necrosis developed on the lateral edge of the flap; after debridement of the necrotic areas, closure was performed with a split thickness skin graft. After the ALT flap procedure, the primary flap survival rate was 90.9%. CONCLUSION: The free ALT flap could be a safe, reliable, and aesthetically appealing option for foot/ankle resurfacing in children after traumatic soft tissue loss. The ALT flap can cover a far greater area and provide the versatility needed to optimize soft-tissue coverage. CLINICAL QUESTION/LEVEL OF EVIDENCE: Level IV.

Reconstruction of dorsal hand and finger defects with reverse radial fasciocutaneous forearm flaps.

OBJECTIVES: To evaluate the midterm outcome and the degree of satisfaction of patients who underwent reconstruction of dorsal hand and finger defects with reverse flow radial fasciocutaneous forearm flaps and to test whether or not this is a reliable method which can be applied without the need for microsurgery. PATIENTS AND METHODS: Eleven patients were admitted with post-traumatic complex hand defects and treated by reconstruction with reverse flow radial fasciocutaneous forearm flaps from January 2010 to May 2013. The patient demographics, size of the hand and finger defects, and complications were recorded. The functional status of each of the patients was evaluated using the quick disabilities of the arm, shoulder and hand (DASH) scoring system, and patient satisfaction was assessed using Likert scores. RESULTS: The patients comprised nine males and two females with a mean age of 30.7 ± 9.7 years. The mean follow-up period was 18.4 ± 5.2 months. The average defect size was 41 ± 14.3 cm². None of the patients had circulation defects caused by the sacrifice of the radial artery. The mean quick DASH score was determined as 30.2 ± 15.3. The Likert patient satisfaction evaluation was good in one patient, and very good in ten patients. All flaps survived well with only two complications; superficial skin necrosis occurred at the suture site in one patient and venous insufficiency occurred in the other patient. Both complications recovered with secondary healing following wound debridement. CONCLUSIONS: The reverse-flow radial forearm flap is a reliable method in the management of dorsal defects of the hand and does not require micro-surgical techniques.