Selective Fasciectomy in Dupuytren’s Contracture: An Experience of A Specialized Tertiary Hospital in Bangladesh

Background: Dupuytren’s disease is a benign yet disabling, irreversible, progressive fibroproliferative condition affecting the palm and fingers, leading to flection contracture of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.Objective: To evaluate results of selective fasciectomy to correct the deformity of MCP and PIP joints and observe the complications.Methods: This crosssectional study was done on 30 patients of Dupuytren’s contracture treated by selective fasciectomy, between January 2015 and December 2018, in Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Selective fasciectomy was done under brachial plexus block, tourniquet control and loupe magnification. Brunner zigzag incision was used. Indications for surgery was MCP flection contracture more than 30⁰ and any degree of PIP flection contracture. Postoperatively hand was immobilised in extension of MCP and PIP joints for 2 weeks and then active and passive movements were encouraged and intermittent splinting for 10 weeks (only at night in last 6 weeks).Results: Among 30 patients, 24 (80%) patients were male, 6 (20%) were female; mean age was 62 years (56-74 years). 12 (40%) cases were bilateral, ring and little fingers involvement were seen in most cases (92%). Mean MCP correction was 53⁰ and mean PIP correction was 34⁰ (p<0.001). There were 3 digital nerve injuries peroperatively which were repaired/reconstructed and protective sensation regained in repaired nerve area at 1 year and 3 (10%) marginal skin loss postoperatively which healed secondarily. Superficial wound infection developed in 3 (10%) patients which healed on dressing and antibiotics. Complex regional pain syndrome developed in 2 (6.66%) patients which were mild and resolved on conservative management. 3 (10%) patients developed scar sequilae which were mild and resolved on conservative treatment. Radial digital artery injury was observed in 1 (3.33%); however, no ischaemic insult was observed postoperatively. 2 (6.66%) patients developed recurrence of the disease who were more than 70 years old; however, they declined further intervention.Conclusion: Selective fasciectomy is an easy and effective procedure with less complication to correct the deformities and improve the gripstrength significantly in Dupuytren’s contracture patients.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 41-46

Traumatic wound difficult to heal: use of negative pressure therapy: case report

The skin is one of the largest organs of the anatomy. It is the barrier between the exterior and the first line of defense against aggression. A wound is a loss of continuity of the soft parts of the organism generating an interruption in the structure of the tissue, as a consequence of this loss of continuity, there is a loss of sterility existing inside and infection can occur. Another consequence of discontinuity are possible lesions in adjacent tissues or organs. Trauma results in complex wounds that are difficult to manage due to large skin loss or avulsion of large areas of tissue. Among the factors that can prevent proper healing can be systemic (malnutrition, chemotherapy, steroids) or local (infection, prosthetic material, bone exposure). Among the therapeutic options for complex wounds is negative pressure therapy which generates wound contraction, stabilization of the environment, reduction of edema, removal of exudate and micro-deformations of the surface, increase of angiogenesis, granulation tissue formation and decreased bacterial count. We described a clinical case of traumatic injury at the level of the right pelvic limb in a 70-years-old woman with diabetes and hypertension, in which surgical washing was performed, debridement and use of negative pressure therapy with adequate evolution in a second level public hospital.

Applications and Limitations of Suction Assisted Transverse Medial Thigh Lift

Aims and objectives: Skin laxity or excess can be a part of ageing process and weight loss. Skin laxity or excess is commonly experienced following weight loss around arms, thighs, face and neck, breast and abdomen. Various methods and techniques are described to address these excess skin issues. Liposuction assisted abdominoplasty has been described by Saldanha along with Colour Doppler studies of the superior and inferior epigastric arteries. Similarly DJ Hurwitz has described liposuction assisted brachioplasty. The process allows honeycombing of the subcutaneous tissue when suction lipectomy is performed using blunt tipped cannulas. Process allows creation of a safe plane superior to the deep fascial layer with preservation of the important nerves and vessels. Skin excess is removed without the need of sharp dissection or risks to the underlying structures. Postoperative bleeding and bruising is minimal and most of the instances the procedure is performed as a day case without drains. Patient postoperative analgesia requirements are minimal and allows patient to ambulate early with a quick recovery. Methods: Between 2009 and 2018, 153 suction assisted procedure were performed on various parts of the body. Of the 153 procedures 22 patients had thigh lifts as an outpatient. Results: There was no skin loss, DVT, PE or motor nerve damage. All patients retained sensation of the distal limbs.

A case report of a patient presented with skin ulcer after treatment of lenvatinib

A 60-year-old man diagnosed with unresectable hepatocellular carcinoma (HCC) presented to the hospital with pain in the perineal region. He had been taking lenvatinib every day for 2 months after he was diagnosed with HCC with metastases to the lymph node, small bowel mesentery, and retroperitoneal space. Enhanced abdominal computed tomography revealed mild elevation in intensity in the perineal subcutaneous tissue with subcutaneous emphysema. The patient was diagnosed with Common Terminology Criteria for Adverse Events grade 3, skin ulceration of stage IV with full-thickness skin loss and tissue necrosis in the muscular layer. The patient was taken off the medication with prescription of antibiotics, and after 3 weeks, the skin has fully recovered. This is the first report of an HCC patient who presented with a skin ulceration of stage IV after lenvatinib treatment. We recommend stopping the medication immediately and changing to alternative treatments with appropriate supportive care.

1322 Two Staged Skin Pedicle Reconstruction of Superior Helical Rim

Introduction Skin grafting onto the ear has its challenges, loss of the skin results in inadequate vascular bed for the graft leading to decreased uptake 1,2. As a result, advancement flaps or sacrifice of the underlying cartilage allows primary closure with compromised aesthetics. A two staged procedure however leads to acceptable scarring, can be performed under local anaesthetic, is quick and easy enabling transfer of skin to acutely exposed cartilage. The authors demonstrate a two staged reconstruction technique of the superior helix after traumatic degloving of the dermal tissues. Method Under local anaesthetic an incision in line with the most inferior extent of the skin loss is made. A subdermal plane is expanded superiorly, and the exposed auricular cartilage inserted, healing of the adjacent margins occurs and enables later skin transfer. The patient was discharged on oral antibiotics and returns at two weeks to have the pedicle divided in an outpatient setting. A further skin incision superior to the extent of the tip of the helix is performed. This skin flap is then thinned and folded to reconstruct the posterior aspect of the ear. The skin is sutured in place and the patient is sent home on oral antibiotics. A further reviewed in two weeks to check healing is advised and the patient was subsequently discharged. Conclusions In conclusion, this is demonstrated to be a useful technique to add to the Oral and Maxillofacial Surgeons armament for reconstruction of the superior helix when iatrogenic or traumatic loss of skin coverage occurs.

Advances in Skin Tissue Bioengineering and the Challenges of Clinical Translation

Skin tissue bioengineering is an emerging field that brings together interdisciplinary teams to promote successful translation to clinical care. Extensive deep tissue injuries, such as large burns and other major skin loss conditions, are medical indications where bioengineered skin substitutes (that restore both dermal and epidermal tissues) are being studied as alternatives. These may not only reduce mortality but also lessen morbidity to improve quality of life and functional outcome compared with the current standards of care. A common objective of dermal-epidermal therapies is to reduce the time required to accomplish stable closure of wounds with minimal scar in patients with insufficient donor sites for autologous split-thickness skin grafts. However, no commercially-available product has yet fully satisfied this objective. Tissue engineered skin may include cells, biopolymer scaffolds and drugs, and requires regulatory review to demonstrate safety and efficacy. They must be scalable for manufacturing and distribution. The advancement of technology and the introduction of bioreactors and bio-printing for skin tissue engineering may facilitate clinical products' availability. This mini-review elucidates the reasons for the few available commercial skin substitutes. In addition, it provides insights into the challenges faced by surgeons and scientists to develop new therapies and deliver the results of translational research to improve patient care.

Use of micro-grafts in a chronic infected open wound after limb amputation in a cat

In human medicine, skin grafting is an innovative surgical technique widely used in reconstructive surgery to repair skin loss. This case evaluated the effectiveness of a treatment with dermal micro-grafting obtained through the Rigenera^® technology in a chronic open wound resulting from a suture dehiscence of a limb amputation in a cat. Significant differences were observed between the aesthetic aspects of the injury using traditional treatments (cleaning and curettage) and the regenerative technology. The results showed that the healing periods were significantly reduced after the Rigenera^® treatment and that, moreover, a perfect skin status and a complete reduction in the wound area (100%) were achieved in one month. Given these results, Rigenera^® has proven to be a simple yet highly effective method in the treatment of inactivated chronic wounds.

Latissimus dorsi breast reconstruction

The latissimus dorsi flap provides a predictable, reliable, and safe breast reconstruction, and the original description and use of this flap was a defining moment in plastic surgery. It can replace skin loss, soften contours, produce a natural ptotic shape, provide vascularized protection of prosthetic devices, and even be fashioned as a complete reconstruction without implants. Partial breast defects can also be effectively reconstructed with this flap. It can be used in immediate, skin-sparing mastectomy reconstruction or equally in delayed reconstruction. While free tissue transfer, perforator flaps, and modern acellular dermal matrix techniques have been refined over the past decade, the latissimus dorsi flap has provided a safe alternative with the potential for excellent reconstructive results.

Anterolateral Thigh Skin and Fascia in Facial Skin Defects with Trismus: Two Problems, One Solution

A case series of five patients with skin loss in the lateral face with trismus that followed delayed presentation following trauma, necrotizing infection, and radiation fibrosis was treated with coronoidectomy and condylar excision to effect adequate mouth opening; the anterolateral thigh flap was used for cover and the fascia was used as an interposition graft to prevent recurrence. Two patients with more than 9 years of follow-up had an average of 40 mm interincisal opening.