Free hemi-hamate arthroplasty: A review of donor site outcomes

Introduction

The use of the dorsal hamate as a free osteochondral bone graft or vascularized bone flap has become the mainstay for large, comminuted middle phalanx volar lip fractures. To date, few studies have been conducted in the assessment of donor site morbidity for the hemi-hamate graft or flap, and none have discussed modes of repair or reconstruction of this donor site.

Methods

A retrospective analysis of 14 hemi-hamate arthroplasty (HHA) procedures, including 6 vascularized and 8 non-vascularized grafts, from two surgeons was performed. Four hamate defect reconstruction techniques were utilized: no formal reconstruction, autologous bone grafting, gel foam, or synthetic bone substitute. The dorsal capsule was repaired with either extensor retinaculum grafting or by direct closure. Wrist range of motion, pain scores, and radiographic alignment were assessed.

Results

At 6 months follow-up, all patients achieved full, pain-free wrist motion compared to the uninjured side, with visual analog scale pain scores of 0. Serial radiographs showed maintained carpal alignment without instability or subluxation. No differences based on the hamate defect reconstruction method or capsular repair technique was demonstrated.

Conclusion

Safe return to pain free, unrestricted wrist function is achievable after HHA, regardless of hamate donor site management. Adequate dorsal capsular repair appears critical to prevent instability. Further study is needed to compare techniques, but choice may be guided by surgeon preference in the absence of clear evidence.

Comparison of three different methods of dressing for partial thickness skin graft donor site

BACKGROUND

Split- thickness skin graft is one of the most common operations in plastic surgery. It is always painful and patient discomfort from donor site often is more significant than recipient site. There is not still a standard method for treatment of the donor site. The purpose of this study was to determine the best method of dressing the donor site among three different methods with respect to the rate of healing, pain, secretion, infection and cost.

METHODS

The study includes 60 patients that were randomly divided into three groups. Donor site and thickness of the graft was the same and were dressed with one of the methods including Method A: Paraffin fine mesh gauze, Method B: Nitrofurazone soaked fine mesh gauze and Method C: Dry fine mesh gauze. Each method included an intermediate layer of sterile plastic sheet witch was covered with 10 layers of dry gauze. Comparison with respect to the rate of healing, pain, secretion, infection and cost was done.

RESULTS

Thirty seven patients were men and 23 were women. The mean age of the patients was 27.2 years. There was a significant difference between three methods in average time of repair and superiority of dressing with Method B was noted. Pain severity was the least in Method B and difference between the methods was significant. Dressing with Method B had the least secretion and there was a statistically significant difference between three methods. There was no statistically significant difference in cost of the management.

CONCLUSION

This study showed that dressing the donor site with nitrofurazone ointment soaked gauze used as the first layer of dressing and intermediate layer of sterile plastic sheet which was covered with 10 layers of dry gauze was the best method of dressing and had the least complications.