No abstract

INTRODUCTION Kirschner wires (K-wires) are immensely versatile in fracture fixation in the paediatric population. Complications associated with the K-wiring procedure vary from minor to a life-threatening. The aim of this study was to analyse the outcome of fracture fixation using K-wires in all types of upper-extremity fractures in children in order to assess the incidence and type of complication critically.PATIENTS AND METHODS Between September 1999 and September 2001, we retrospectively reviewed a consecutive series of 105 fractures in 103 paediatric trauma cases (below 12 years) treated with K-wires in a university teaching hospital. The case notes and radiographs were reviewed by an independent single assessor. All paediatric, acute, upper-extremity, displaced and unstable fractures were included. All elective procedures using K-wires were excluded. RESULTS We observed an overall 32.3% complication rate associated with the K-wiring procedure affecting 34 pins (24 patients). Wound-related complications included over-granulation in 13 cases, pin tract infection in 6 cases and hypersensitive scar in 1 case. Neurapraxia was found in 3 patients and axonotmesis in 1 patient. Wire loosening at the time of removal in 14 cases and retrograde wire migration in 4 cases were observed. There were 2 cases of penetrating tendonitis and 1 case of osteomyelitis. There was a higher complication rate in terms of wire loosening and pin tract infection when the K-wires: (i) were left outside the skin compared with those placed under the skin; (ii) stayed longer in the patients; and (iii) did not traverse both cortices. There were more complications in complex operations performed by senior surgeons (P = 0.056). The duration of K-wire stay, associated co-morbidity and anatomical location were statistically insignificant.CONCLUSIONS Complications are part of operative procedures; an important point to consider is what causes them in order to take preventative measures. We recommend that the risks and complications should be explained to parents during the consenting process to allay their anxiety, irrespective of the fact that most complications are minor and of short duration.

No abstract

Since plastic surgery evolved as a specialty in the early part of this century, the integument of the anterior abdominal wall has been one of the premier sources of tissue for local and distant flap transfer. It enjoys a robust blood supply, scars are easily concealed, the anatomy is familiar to most surgeons, and there is an abundance of skin and subcutaneous tissue, especially in the parous woman. Perhaps the most coveted expanse of skin and fat is that area below the umbilicus because in most cases the donor defect can be closed by an abdominoplasty procedure, leaving only a suprapubic transverse scar.It is not surprising therefore that for decades attention has focused on the lower abdomen as a potential donor site for reconstruction of the breast following mastectomy. Initially flap transfers were performed as multistaged, tube pedicle procedures, but the pendulum of surgical preference has since swung towards one-stage operations. The first of these was a brief encounter by microsurgeons in which the lower abdominal integument was transferred to the breast as a free flap, designed to be based on the deep inferior epigastric (DIE) vesse1s.l Soon after, proponents of the pedicled musculocutaneous flap advocated a "burrowing" approach from above and Hartrampf, Scheflan, and Black2 introduced the lower transverse rectus abdominis musculocutaneous (TRAM) flap. More recently, the lower abdomen has been reappraised by microsurgeons. Hester et aL3 have transferred this skin paddle based on the superficial inferior epigastric (SIE) system, and Shaw4 has produced a large series of free flap reconstructions of the breast, returning once again to the DIE vessels to nourish the tissue.Unfortunately, none of these operations has proved to be a panacea for all occasions. Free flap operations provide tissue with a good blood supply, but then the surgeon is confronted with anastomotic problems: the SIE vessels are small and the pedicle is short. The DIE vessels are longer and Downloaded by: National University of Singapore. Copyrighted material.