We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC open fracture. All were treated with debridement, acute shortening and stabilisation of the fracture and vascular reconstruction. Further treatment involved restoration of tibial length by callus distraction through the distal or proximal metaphysis, which was commenced soon after the soft tissues had healed (n = 8) or delayed until union of the fracture (n = 5). All patients were male with a mean age of 28.4 years (17 to 44), and had sustained injury to the leg only. Chen grade II functional status was achieved in all patients. Although the number of patients treated with each strategy was limited, there was no obvious disadvantage in the early lengthening programme, which was completed more quickly.

ReferencesTERRA FIRMA FORME DISEASE Terra Firma Forme Disease (TFFD), first defined by Duncan and his collegues in 1987, is also known as Duncan's Dirty Disease. It is a rare type of keratinisation disorder with fully unidentified aetiology. While lesions look black dirt, thinly papillomatous and can not be removed by cleaning and rubbing with soap and water, they disappear totally after rubbing with 70% isopropyl or ethyl alcohol. Limited number of cases has been reported since it was diagnosed.The 14-year-old female patient visited our polyclinic with complaints of asymptomatic thinly papillomatous brown lesions on abdomen and back for 1 year. Medical and family history of the patient was examined and no significant pathology was detected. The patient stated that the problem still recurred despite rubbing with shampoo and soap. Dermotological examination revealed dirty, hyperkeratotic and hyperpigmented papules existed especially on the abdomen, back and shoulders. (Fig. 1) It was observed that the lesions disappeared totally after rubbing with 70% of alcohol. (Fig. 2) During histopathological examination, hyperkeratosis in the epidermis, increased pigmentation in the basal layer, oedema and mononuclear cell infiltration in papillary dermis were observed and no features were seen in periodic acid schiff coloration (Fig. 3).Lesions disappeared totally after rubbing with 70% of alcohol, and no emergence of new lesions were observed during the 8-month follow-up time.TFFD, defined by Duncan and colleagues, is a rare keratinisation disorder of unknown aetiology.1 Most of the cases reported in literature are about child and adolescent age groups (4 months minimum and as for age maximum 72) like our patient. No familial characteristic has been reported and no relationship with bathroom habits and hygiene have been observed. 2,3 The most frequent location of the disease is shoulder and back. However, some cases in which other body areas were affected have been reported. 2,4 Lesions are generally bilaterally symmetric and the most common comorbid conditions are atopic dermatitis and acne vulgaris. 5 The lesions disappearing entirely when wiped with 70% of isopropyl alcohol are Conflict of interest: None declared.

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Objective:The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries.Patients and Methods:13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis.Results:The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated.Conclusion:Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.