Narrow Results

Background: Groin flap has been considered the workhorse flap for hand reconstruction. However it has certain drawbacks when covering defects over elbow or proximal forearm. Pedicled oblique paraumbilical perforator (OPUP) based flaps provide a good alternative in such cases.

Methods: We performed OPUP flap in 11 cases of complex upper limb reconstructions over the past one year. We report our experience with this flap.

Results: All flaps survived. One patient had marginal necrosis of 1 cm in the proximal end after flap division. Three patients had donor site scar hypertrophy.

Conclusions: OPUP flap is superior to groin flap for larger defects or defects around the elbow. The major disadvantage is the donor site scar which is prone to hypertrophy.

Background: One of the methods of stabilizing the stump of the ulna following resection of the distal ulna is tenodesis of the extensor carpi ulnaris (ECU). Some studies have recommended stabilization, whereas others have not found it useful. Most of these studies have a mix of different pathologies and often do not have a control group. The aim of this study is to compare the outcomes of ECU tenodesis versus no tenodesis after resection of the distal ulna in patients with grade III giant cell tumor (GCT) of the distal ulna.

Methods: The retrospective study included 10 patients with Campanacci grade III GCT of the distal ulna treated by resection of the distal ulna between 2014 and 2019. Patients were stratified into two groups based on whether they underwent ECU tenodesis (n = 5) or no tenodesis (n = 5). The patients were assessed at 6 weeks, 6 months, and 12 months for complications and outcomes using the Mayo wrist score (MWS) and the revised musculoskeletal tumor society score (MSTS).

Results: The MWS and the MSTS were significantly better in the ECU tenodesis group at 6 weeks. At 6 months, MWS was similar in both groups, but MSTS continued to be significantly better in ECU tenodesis group. At 12 months, both groups reported similar MWS and MSTS. There were no recurrences in either groups. One patient in the ECU tenodesis group developed ECU tendonitis that resolved with conservative treatment.

Conclusions: The outcomes of ECU tenodesis were better in the short term (6 months), although both groups reported similar outcomes at 12 months.

Level of Evidence: Level III (Therapeutic)

Background: Current guidance for the management of septic arthritis is limited to large joints and, therefore, unspecific to the small joints of the hand, which may present differently, require different diagnostic approaches, and have different complications. The aim of this article was to review current treatment trends for the management of small joint septic arthritis (SJSA) of the hand and offer guidelines for its management.

Methods: A systematic review was carried out according to PRISMA guidelines and a survey distributed to Fellows of the British Society for Surgery of the Hand to establish expert opinion. The review and survey were combined to present a set of specific SJSA of the hand infection guidelines.

Results: All 20 included studies recommended physical drainage of infected joint fluid; subsequent lavage and early antibiotic therapy, with physiotherapist-guided joint mobilisation. Statistical analysis of the 77 responses to our survey revealed that (in order of preference) the diagnosis was made by history and examination, blood tests, joint aspiration and vital signs; and for interventions: joint elevation and intravenous antibiotics; then joint washout repeated within 48 hours, if necessary.

Conclusions: Small joint infection differs from large joint infection because it is difficult to obtain joint aspirate without damaging or opening the joint. We, therefore, recommend utilising exclusion blood tests, imaging and the clinical picture to establish the diagnosis and implement early treatment and rehabilitation.

Level of Evidence: Level III

Tissue engineered skin was the first out of the stable of tissues that could be made in the laboratory from biopsies of patients skin expanded and then delivered back to them. As patients have been benefiting from cultured skin cells since 1981,¹ at 25 years old this is far from being a new area. In this article the question of to what extent tissue engineered skin has finally come of age will be reviewed.

There are currently three clinical areas where it can benefit man — for the treatment of patients with extensive skin loss due to burns injuries, to accelerate or initiate healing in patients with chronic non-healing ulcers and for reconstructive surgery purposes (an area which is still in its infancy but can encompass the treatment of pigmentation defects and diseases such as vitiligo and scarring and hopefully blistering diseases). There are also many in vitro applications where having a physiologically relevant model of skin can teach us more about normal and pathological skin biology than working with monolayers of skin cells.

This chapter looks at why tissue engineered skin was initially developed for burns injuries and how it is now also used for chronic wounds and beginning to be used for reconstructive surgery. The challenges that remain are then considered followed by a summary of some of the in vitro applications for tissue engineered skin.