[A free musculocutaneous flap and an intramedullary nail made the use of a prosthesis possible in a high traumatic femoral amputation]

The length of the stump and the quality of the soft tissue coverage are important for prosthesis fitting and mobility. In a high traumatic femoral amputation soft tissue reconstruction with a free musculocutaneous latissimus dorsi (LD) flap was performed to preserve bone length and provide proper tissue coverage. The extremely short stump was later on lengthened using a motorized intramedullary nail (Fitbone), and the achieved bone-lengthening was 14 cm. With the combined modalities of an LD-flap and Fitbone lengthening of the stump, the patient now has a useful limb function.

Danish experience with free flaps in war wounds

INTRODUCTION

To describe the lessons learned from treatment of war casualties at a public hospital in Denmark.

METHODS

A retrospective review of soldiers who underwent free flap reconstruction at Rigshospitalet, Denmark, between January 2006 and December 2010.

RESULTS

Nine patients were treated using free flaps. The age distribution was 21-34 years. Extremity fractures associated with considerable soft tissue loss were seen in all cases. The mean time from injury to reconstruction was 13.2 days. A total of 11 free flaps were used, the majority of which were latissimus dorsi flaps (seven out of 11). Flap-loss occurred in one patient, presumably due to leakage at the anastomotic site, which necessitated another free flap procedure. All patients received rehabilitation services following discharge from the inpatient unit, including prosthetic fitting. The mean follow-up time was 26 months.

CONCLUSIONS

This report is the first to detail the reconstructive procedures in soldiers treated at a public hospital in Denmark. The treatment of war casualties has not only been a challenge to the surgeons tasked with managing these devastating injuries, but also to Danish healthcare in general. The outcome of multidisciplinary treatment, combining the expertise of various specialties, is highly encouraging. The rate of complications was low, and the aesthetic appearance of the reconstructed limbs and the functional recovery were satisfactory. We therefore recommend the use of free flaps to reconstruct defects resulting from battlefield trauma.

FUNDING

none.

TRIAL REGISTRATION

not relevant.

Vein surgery with or without skin grafting versus conservative treatment for leg ulcers. A randomized prospective study

In order for us to evaluate the efficiency of perforator vein surgery and skin grafting in leg ulcer patients, 47 patients were randomized into 3 treatment groups (group A: surgery for incompetent perforators, group B: surgery for incompetent perforators and ulcer excision followed by grafting, group C: control group). All the patients were treated with a compression bandage. When cellulitis was observed, a systemic antibiotic was given; eczema was treated with a steroid ointment. Fourty patients were evaluated regularly during one year after entry. There were no differences between the 3 treatment groups considering base-line characteristics, median ulcer size at entry and after one year. According to a review of the initial phlebograms, the occurrence of post-thrombotic changes in the deep veins were recorded in the majority of the legs. Our results suggest that ligation of incompetent perforators and skin grafting, as used in the present study, may not offer an additional advantage for venous ulcer patients with insufficiency of the deep veins when compared to conservative treatment. However, the removal of insufficient superficial veins was not studied.

["Mouse" in Baker's cyst]

Calcified bodies may arise in a joint due to trauma, arthropathy resulting in joint destruction or synovial osteochondromatosis. These calcified loose bodies may pass into a popliteal cyst though posterior joint-bursal communications, or can arise in a popliteal cyst de novo on account of chondrometaplasia. A case history illustrates the differential diagnostic considerations. X-ray combined with ultrasound investigation will exclude soft tissue tumors and vascular lesions.

Treatment of excoriations with a transparent hydrocolloid dressing: a prospective study

A transparent hydrocolloid dressing (THCD) was compared with a traditional paraffin gauze dressing (PGD) in the treatment of excoriations with special focus on patient acceptability. A series of 12 emergency ward patients with 16 traumatic excoriations were included in the study. There were 9 women and 3 men. Average age was 26 years (range 12-66 years). Seven wounds were dressed with THCD and nine with PGD. Patients treated with THCD felt less pain than those treated with PGD. A significantly higher number of patients treated with PGD than THCD complained of wound or bandage sticking to their clothes (P = 0.0007). No infection was seen. We conclude that THCD is suitable for dressing acute excoriations. And the level of comfort is better than in traditional treatment with PGD.