Background This study aimed to determine if International Microsurgery Club (IMC) is an effective online resource for microsurgeons worldwide, in providing an avenue for timely group discussions and advice regarding complicated cases, and an avenue for collaboration and information sharing. Methods All posts on the IMC Facebook group from member 1 to 8,000 were analyzed according to inclusion criteria and categorized into three categories—case discussion, question, and information sharing. Posts were retrospectively analyzed for number of responses, time of responses, number of “likes,” number of treatment options, time of day, and demographics of authors and responders. Results A retrospective analysis of 531 cases showed an average response rate of 75.7% within 1 hour and as membership grew. The response rate stabilized averaging between 72.5 and 78% across all times of the day. An average of 11.8 microsurgeons was involved per case discussion, and 5.7 treatment options were provided per case. Conclusion IMC is shown to be an effective resource to allow microsurgeons to access timely advice from other microsurgeons without time and distance limitation, and to have interactive group discussions on complicated cases.
Background: This study introduced a novel technical approach to the ulnar nerve injuries. The ulnar nerve was divided into 4 distinct surgical zones, each mandating a unique management strategy. Methods: A prospective observational study was conducted to verify the hypothesized algorithm. The study included 110 patients diagnosed with ulnar nerve injury (Sunderland grade 5). We divided the patients into 4 groups depending on the site of injury. Each group of patients was managed in accordance with a particular strategy, exploiting nerve transfer techniques along with the updated knowledge of the internal topography of the ulnar nerve. The motor recovery of the small muscles of the hand was assessed after 2 years of follow-up, using the disabilities of the arm, shoulder, and hand score, and other parameters including key pinch strength, hand grip strength, and the motor power of the first dorsal interosseous muscle on the Medical Research Council scale. Results: The mean values of the disabilities of the arm, shoulder, and hand score, key pinch strength, and hand grip strength showed a statistically significant improvement across all patient groups (P < 0.05). Of those with zone (I) injury, postoperatively, 79.9% patients attained a first dorsal interosseous muscle power grade >3 on the Medical Research Council scale, while 93.9% of patients with zone (II) damage achieved the same result. Surprisingly, 84% of patients included in both zones (III) and (IV) also recovered to the same extent. Conclusions: This prospective observational study examined and successfully confirmed the validity of our proposed novel algorithm for the management of ulnar nerve injuries (Sunderland grade 5).
Background: Platelet-rich plasma has been extensively used in several clinical settings. However, there still a lack of conclusive evidence concerning the benefits of platelet-rich plasma in the field of wound healing. We aimed to evaluate the safety and the efficacy of autologous platelet-rich plasma in acute wound healing. Methods: This prospective study enrolled forty adult patients of both sexes and aged between 18 -50 years. All patients in need for split-thickness skin graft were included in our study. The donor sites were randomly divided into two equal halves: the platelet-rich plasma side, which was injected with recently activated platelet-rich plasma; and the control side, in which the conventional method of dressing was used. Measurement of the platelet count and transforming growth factor-B1 concentration in each platelet-rich plasma preparation and the whole blood was done for all patients. Clinical monitoring of the donor sites was done every 7 days for 3 weeks, regarding pain perception, epithelialization surface area and possible side effects of the platelet-rich plasma. Histopathological monitoring was done on the 7 th postoperative day. Results:The platelet count was increased about 3.5 folds and transforming growth factor-B1 was increased 2.4 folds in the platelet-rich plasma compared to the patients' blood. The platelet-rich plasma side had significantly lower pain scores at day 7 (4.8 ± 0.18 vs 5.9 ± 0.07) and day 14 (1.4 ± 0.11 vs 1.9 ± 0.09) postoperative (p = 0.002 and p = 0.004, respectively) and had significantly higher rate of epithelialization at day 7 (9.8 ± 0.35 cm 2 vs 7.5 ± 0.32 cm 2 ) and day 14 (38.4 ± 0.36 cm 2 vs 36.9 ± 0.42 cm 2 ) postoperative (p < 0.001 and p = 0.039, respectively), while at day 21 postoperative, there was no significant difference between both sides. There was no significant difference between both sides regarding the incidence of complications. The platelet-rich plasma side showed intact epithelium, differentiation of the cells in stratum spongiosum and stratum granulosum, neovascularization and earlier collagen deposition. Conclusion:The platelet-rich plasma is safe and effective adjuvant in the management of acute wounds. However, we recommend for larger clinical trials for standardized method for PRP preparation and better understanding of the efficacy of this blood product.
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