Journal of plastic surgery and hand surgery
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J Plast Surg Hand Surg · Sep 2013
Results of intra-wound continuous negative pressure irrigation treatment for mediastinitis.
Intra-wound continuous negative pressure irrigation treatment (IW-CONPIT) was administered to cases of mediastinitis as the therapy of choice, with satisfactory results being obtained in terms of improved survival rates and quick healing of wounds. Accordingly, these treatment results and efficacy were evaluated. After debridement, a sponge was trimmed to conform to the shape of the wound and then it was attached to the surface of the wound. ⋯ After performing this treatment for 2-3 weeks, and when wound granulation improved, either skin grafts or the transplantation of muscle flaps was performed as necessary to achieve wound healing. A combination of the continuous negative pressure method and the continuous irrigation method resulted in improved healing rates and lower mortality rates for mediastinitis. It also significantly reduced the number of dressings, as well as the degree of labour and medical materials required; therefore, a reduced hospital stay and shorter treatment period was thus achieved using this treatment method.
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J Plast Surg Hand Surg · Sep 2013
Comparative StudyValidity of exploration for suitable vessels for replantation in the distal fingertip amputation in early childhood: replantation or composite graft.
Composite grafting, grafting without microvascular anastomoses, has been widely performed for distal fingertip amputation in children with variable results, whereas successful replantation of these amputations using microsurgical technique has been reported. However, most of these reports included a wide age-range and a mix of different amputation levels. This study reviewed our cases of paediatric digital amputation, in order to verify the value of distal fingertip replantation over composite grafting, especially in early childhood. ⋯ The only one proximal-type amputation was failed in replantation. For the middle-type zone I amputation in early childhood, replantation has a high success rate if suitable vessels can be found. Therefore, exploration is recommended for amputations at this level with a view to replantation, irrespective of the mechanism of injury.
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J Plast Surg Hand Surg · Jun 2013
Comparative StudySurgical treatment of spontaneous anterior interosseous nerve palsy: a comparison between minimal incision surgery and wide incision surgery.
Recent reports have suggested that fascicular constriction located proximal to the elbow may be the primary aetiology of spontaneous anterior interosseous nerve palsy (sAINP), and recommended interfascicular neurolysis ranging from the proximal forearm to distal upper arm (wide incision surgery: WIS) for its treatment. On the basis of these reports, it was hypothesised that, if the aetiology of sAINP was fascicular constriction, neurolysis limited proximal to the elbow (minimal incision surgery: MIS) should have similar results to those of WIS. Twenty-five surgically treated sAINP cases were retrospectively evaluated. ⋯ At the latest follow-up, 82% of the patients had British Medical Research Council grade of ≥4 in flexor-pollicis-longus, while 80% had grade of ≥4 in flexor-digitorum-profundus-of-the-index-finger. There were no significant differences between the results of either group. These result suggested that the aetiology of sAINP may not be external compression, but fascicular constriction, and MIS may be its favourable surgical treatment.
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J Plast Surg Hand Surg · Jun 2013
Case ReportsAtypical Spitz tumour with positive sentinel lymph node.
A 16-year-old young man presented with an atypical Spitz tumour of the left buttock with involvement of the left inguinal sentinel node. After inguinal lymphadenectomy, none among the further 21 left inguinal lymph nodes excised was positive. The patient has been free of disease for 39 months. ⋯ The real biologic potential of the disease could not often be evaluated by sentinel lymph node status. Although this procedure may have a role, possibly being therapeutic for those patients who have malignant lesions, it produces morbidity and outcomes that are sometimes difficult to interpret in this type of pigmented lesions. Thus, it should be reserved to selected patients.
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A schwannoma is a benign tumour of Schwann cells that presents as a palpable and painless mass on the volar aspect of the hand and wrist. A 44-year-old, right-handed woman, presented for a volar swelling of her right hand. On examination she had a non-pulsatile mass with no fluctuation at the radiopalmar aspect of the right hand, and a soft mass on the volar aspect of the right palm. ⋯ It is difficult to differentiate schwanommas from neurofibromas solely on the basis of an MRI. Neurofibroma grows intraneurally and infiltrates the nerve; it has the potential to require resection of all or part of the nerve, leaving a consequent functional deficit. Tumours of the hand are diagnostically challenging and median nerve shwannomas are rare.