High-pressure delivery devices for paint and other substances can lead to severe injuries of the hand without immediate surgical debridement. We present a case of a high-pressure paint gun injury treated surgically with full resolution of function. A systematic review of the literature details outcomes of similar injuries.
Background
In microvascular free‐tissue harvest and transfer, the need for repositioning from lateral decubitus position and the inability to use a two‐team approach are major drawbacks of the subscapular system. We present our experience with the subscapular system for upper and lower extremity reconstruction using a two‐team approach without need for repositioning.
Methods
We conducted a retrospective chart review for all patients undergoing free flap transplant based on the subscapular system to the upper or lower extremity at our microsurgical facility from January 1, 2007 to December 31, 2011. Only cases not requiring intraoperative repositioning were included. Sixty‐four patients underwent the two‐team approach (37 upper extremity and 27 lower extremity transplants). Flap types included latissimus dorsi musculocutaneous, partial superior latissimus, dorsal thoracic fascia, serratus, scapular bone, and thoracodorsal artery perforator, either alone or as chimeric flaps. All patients were placed in the lateral decubitus position for the duration of the surgery.
Results
The ipsilateral subscapular system was used in 16% of cases for lower extremity defects, where the anterior tibial vessels served as recipient vessels. The contralateral subscapular system was used in all remaining cases for upper extremity or the vast majority for lower extremity (84%) defects, where either the superficial femoral, genicular, popliteal, sural, or posterior tibial vessels served as recipient vessels. With the exception of one partial flap loss secondary to infection, all flaps survived.
Conclusions
Proper lateral decubitus positioning allows for a two‐team approach without compromising safety or outcomes.
Background: T-plate fixation is a popular method for trapeziometacarpal arthrodesis in patients with osteoarthritis. Previous studies report an 8% to 18% rate of symptomatic nonunion and a 26% rate of radiographic nonunion. In this study, we present our surgical technique of trapeziometacarpal arthrodesis using the addition of an oblique interfragmentary screw to T-plate fixation on the rate of symptomatic and radiographic nonunion. Methods: A retrospective review of all trapeziometacarpal arthrodeses for osteoarthritis was completed by a single surgeon between 2010 and 2018. Preoperative demographics, pain, and Eaton classification were included. The technique was identical in all surgical cases, using a T-plate and oblique interfragmentary screw across the arthrodesis site from the metacarpal to the trapezium. Postoperative nonunion rate and time to clinical healing (absence of pain) and radiographic union were reviewed. Results: A total of 22 trapeziometacarpal arthrodeses were performed on 17 patients using the above technique. The average age was 53 years, 71% were women, and 53% involved the dominant hand. Mean preoperative Eaton classification was 2.74 (±0.73). Mean time to clinical healing was 34 days (±12 days), and mean time to radiographic union was 55 days (±23 days). Mean follow-up was 9 months, and no patients were found to have symptomatic or radiographic nonunion. Hardware removal was required bilaterally in 1 patient after complete healing. Conclusions: The addition of an oblique interfragmentary screw to T-plate fixation is a novel technique in trapeziometacarpal arthrodesis, resulting in no symptomatic or radiographic nonunion.
Since its development in 2005, incobotulinum toxin A (INCO) has become one of the most widely used neurotoxins worldwide for aesthetic and therapeutic indications. It was initially designed as a formulation free of complex proteins for reduced immunogenicity with an equal action and strength profile to the original and widespread onabotulinum toxin A (ONA). Multiple trials have demonstrated equivalent efficacy. Several studies have suggested a slight decrease in the time of visible treatment onset with INCO and a subsequent lack of difference in duration of effects when compared with ONA. Particularly appreciable with therapeutic doses, utilization of INCO led to significant cost savings over ONA or abobotulinum toxin A. Karschney et al. found that for the treatment of cervical dystonia and chronic migraine the cost to patients was reduced by 32.2% compared to ONA. Additionally, the ONA formulation allows for long-term storage at room temperature along with an increased stability time once reconstituted. Limitations of INCO include a similar side effect profile to other neurotoxin formulations, more likely at therapeutic dosing. Indications approved by the Federal Drug Administration in the United States and other regulatory agencies are currently more limited than those of ONA, though this may be in direct relation to the length of time on the market. INCO has overall been demonstrated to be a safe, efficacious alternative to other common neurotoxin formulations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.