Deep burn of hand and forearm treated by abdominal wall flap. A case report.

AIM: Post-traumatic hand and forearm defects always represent a challenge for reconstructive surgeons, especially when multiple structures are involved, because of a high rate of amputation. MATERIAL OF STUDY: A 21 years old woman arrived to the E.R. with a complex crush-burn trauma of the upper limb caused by an accident with an industrial ironing machine, resulting in a ulnar bone fracture, ulnar artery laceration and a wide burn of the dorsum of the right forearm. RESULT: We achieved toTAL limb salvage with coverage of the "nobles" structures of the forearm. DISCUSSION AND CONCLUSIONS: Different reconstructive methods have been used over time to treat these defects focusing the attention on both functional and cosmetic aspects. The abdominal pedicle flap was one of the achiest reconstructive methods for hand and forearm defects. In an era in which microsurgery takes the lion's share, some basic procedure may be helpful, especially in certain cases. In this study the authors reported a case of a young woman with a complex trauma of the right arm resulting from an occupational accident.

Full restoration of spermatogenesis and male fertility after post-traumatic ectopic testis implant.

AIM: To restore testicular functional competence after traumatic avulsion of the scrotum, accompanied by penile decortication, by means of ad hoc surgery and post-surgical medical treatment. MATERIALS AND METHODS: A 26 years old patient underwent a on the job perineal trauma that resulted in loss of one testis while the other one was rescued together with the deferential duct. The spared testis was buried in a subcutaneous thigh pocket after creating a tunnel from the inguinal area. Because of post-traumatic ensued hypogonadism, the patient was treated with corticosteroids, phosphodiesterase 5 inhibitors and anti-oxidizing agents. RESULTS: Hypogonadism related clinical findings in terms of oligospermia, erectile dysfunction and alterations of the pituitary- testis axis, with low testosterone levels progressively improved along the post-traumatic months. Preservation of testis vascular supply associated with ad hoc medical therapy restored erectile dysfunction and spermatogenesis, and in the end at 6 months of the trauma the patients was able to regain fatherhood capability. DISCUSSION: The obtained results demonstrate that an appropriate testis burying in the subcutaneous thigh region, upon traumatic scrotum avulsion, followed by an ad hoc medical therapy may rescue male fertility. This is unlikely to happen in the clinical routine and previous published reports negate restoration of the testis function, that completely vanishes within 1 year of the intervention. CONCLUSION: Full restoration of testis and penile functions resulted in induction of spontaneous pregnancy in the patient's female partner may occur only if good reconstructive surgery is coupled with an efficient medical therapy.