Late arteriovenous fistula after finger replantation

The occurrence of arteriovenous fistula (AV) after finger replantation is a very rare complication. Since the first replantation performed in the Czech Republic in 1979, there has been one such case. A four-finger replantation was done for an injury on the right dominant hand on a 29-year-old patient. After 6 months, an arteriovenous fistula developed on the fourth finger. The other fingers were not affected. Following examination by digital subtraction angiography, selective ligature of the common digital artery for the fourth interdigital space was performed. Catheterization and embolization methods were not used. After detailed analysis of the factors which may have caused this complication, the following preventative and therapeutic approach is proposed. It is necessary to avoid tissue damage caused by cold. The advisable rate should be at least 1:1 between venous drainage of the finger in the area of the basic phalanx and the arterial supplementation. It would be better, however, to have the ratio at 2:1 or more. In case of the AV fistula formation before radical intervention, selective ligation of an artery causing vascular dilatation is advantageous.     

“Coagulum Suction”: A Simple Trick for the Reduction of Postoperative Hematoma Associated with Facelift

Background  

Facelift is currently one of the most requested procedures among consumers of aesthetic plastic surgery. Like any operation, it is accompanied by a variety of potential complications, with postoperative bleeding probably the most frequent. Hematomas can cause hyperpigmentation, contour changes due to subcutaneous scarring, prolongation of healing, and necrosis of the skin flap. The most common treatment is manual expression of the blood coagula. Needle aspiration sometimes cannot be used because of the viscosity of the coagula.     

History of upper extremity replantation in the Czech Republic and worldwide

Replantation surgery is a specialization in plastic surgery which, in comparison with other disciplines, has a relatively short history of only forty years. Replantation surgery developed due to experience with macrovascular anastomosis and to the evolution of the operative microscope, special micro-instruments and ultra delicate suturing material. Due to these advances, it is possible to implement anastomosis of blood vessels with a diameter smaller than 1-2 mm. Each of the three pillars of microvascular surgery has its own history. This work outlines their use and the contribution of each to the development of microsurgery. Finally, it compares the development of replantation surgery in the Czech Republic and worldwide within a specific time frame.     

Degloving injury--the use of a combination of free fasciocutaneous sensitive flap and pedicle flaps for reconstruction

The authors present a case report of reconstruction after a degloving injury to hand by a combination of microsurgery and standard pedicle flaps. Degloving injury high on the hand was solved by free sensitive fasciocutaneous flap transfer from the radial forearm (Chinese flap), which covered the defect in the palm, while finger defects were covered by pedicle flaps from the abdomen. Dorsum of the hand was treated with a mesh skin graft. The authors also describe techniques of treatment and the relevant results prior to the time of microsurgery and compare them to the possibilities offered by microsurgery today, and they include comprehensive illustrations.     

Psychometric properties of the World Health Organization Quality of Life instrument (WHOQoL-BREF) in alcoholic males: A pilot study

Objective: To evaluate criterion convergent and discriminant validity of the World Health Organization Instrument (WHOQoL-BREF) in evaluating quality of life and to verify its convergent validity with the Medical Outcomes study Short-forms (SF-36) and the Symptom Check List (SCL-90) instruments in male alcohol dependent patients who seek treatment at two Brazilian treatment centers. Methods: A cross-sectional study was performed, in which cases were divided in to two groups according to the severity of alcohol dependence, ascertained by the Short Form Alcohol Dependence Data scale (SADD). Results: The sample was comprised of 36 males, and 63.9% had severe dependence. Subjects with low/moderate dependence showed higher scores in all domains of the WHOQoL-BREF and in nearly all domains of the SF-36. Criterion validity and internal consistency in the WHOQoL-BREF were satisfactory. With regard to convergent validity between the WHOQoL-BREF and SF-36, most correlation coefficients were significant. Conclusions: The WHOQoL instrument proved to be satisfactory for evaluating quality of life in this sample.     

Primary surgical treatment of amputated fingers and indications for digital replantation

The amputation of a single finger, or its part, or more fingers results in functional and esthetic changes in the patient's life. Until 1965 when the first thumb ever was replanted, the treatment of amputated digits had been limited by technical facilities of the medical science. Since 1970s, the development of fine suture materials, microsurgical instruments and the operating microscope has made it possible that replantations have become routine procedures in hand surgery. Both surgical procedures and indication schemes have also evolved. The primary surgical treatment has been standardized to involve the wrapping of amputated parts in dressing material saturated with isotonic solution and cooling at 4 to 10 degrees C during transport. The first enthusiasm for replantation of everything that had been amputated was replaced, owing to long-term post-operative results, by a more selective approach. Even an absolute indication for digital replantation, such as amputation of a thumb, two or more fingers, amputation in the palm and all amputations in children, must be put aside when life-threatening injuries or serious diseases are present. The benefit of replantation should always outweigh the trauma of any operative procedure because this must not harm the patient.     

Possible donor nerves for axillary nerve reconstruction in dual neurotization for restoring shoulder abduction in brachial plexus injuries: a systematic review and meta-analysis

Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and suprascapular nerve is widely used and considered the best option. The most common donor nerve for the suprascapular nerve is the spinal accessory nerve. However, donor nerves for axillary nerve reconstructions vary and it is still unclear which donor nerve has the best outcome. The aim of this study was to perform a systematic review on reconstructions of suprascapular and axillary nerves and to perform a meta-analysis investigating the outcomes of different donor nerves on axillary nerve reconstructions. We conducted a systematic search of English literature from March 2001 to December 2020 following PRISMA guidelines. Two outcomes were assessed, abduction strength using the Medical Research Council (MRC) scale and range of motion (ROM). Twenty-two studies describing the use of donor nerves met the inclusion criteria for the systematic review. Donor nerves investigated included the radial nerve, intercostal nerves, medial pectoral nerve, ulnar nerve fascicle, median nerve fascicle and the lower subscapular nerve. Fifteen studies that investigated the radial and intercostal nerves met the inclusion criteria for a meta-analysis. We found no statistically significant difference between either of these nerves in the abduction strength according to MRC score (radial nerve 3.66?±?1.02 vs intercostal nerves 3.48?±?0.64, p?=?0.086). However, the difference in ROM was statistically significant (radial nerve 106.33?±?39.01 vs. intercostal nerve 80.42?±?24.9, p?<?0.001). Our findings support using a branch of the radial nerve for the triceps muscle as a donor for axillary nerve reconstruction when possible. Intercostal nerves can be used in cases of total brachial plexus injury or involvement of the C7 root or posterior fascicle. Other promising methods need to be studied more thoroughly in order to validate and compare their results with the more commonly used methods.

     

Use of deepithelialized flap in mammoplasties: simple method with excellent results

Background  

A deepithelialized flap is used in almost all surgical fields, particularly in plastic, reconstructive, and aesthetic surgery. This article describes several operating techniques using deepithelialized flaps that in specific cases can improve silicone breast implant coverage.